The DOI matches its Crossref record; 50 of the 52 references it cites were found in a registry or an index.
Relational Agents in Clinical Psychiatry
Abstract
Relational agents are computational artifacts, such as animated, screen-based characters or social robots, that are designed to establish a sense of rapport, trust, and even therapeutic alliance with patients, using ideal therapeutic relationships between human counselors and patients as role models. We describe the development and evaluation of several such agents designed for health counseling and behavioral-change interventions, in which a therapeutic alliance is established with patients in order to enhance the efficacy of the intervention. We also discuss the promise of using such agents as adjuncts to clinical psychiatry, a range of possible applications, and some of the challenges and ethical issues in developing and fielding them in psychiatric interventions.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Third, relational agents (RAs), which can mimic human healthcare professionals' behavior, could be built based on affective computing.”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [66]
In the citing paper
“Bickmore and Gruber (66) further argued that RAs can build long-term relationships with clients when using certain design strategies, such as variability and self-disclosure.”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as Bickmore and Gruber (66)
In the citing paper
“Recent existing reviews have focused exclusively on a subset of embodied conversational agent interventions despite other modalities aiming to achieve the common goal of improved mental health.”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [7]
Citations
Cites
Motivational interviewing: preparing people for change.
Miller, W. R., & Rollnick, S. (2002) · Cited by 7,002
ELIZA—a computer program for the study of natural language communication between man and machine
Weizenbaum, J. (1966) · Communications of the ACM · doi:10.1145/365153.365168 · Cited by 4,452
Development and validation of the working alliance inventory
Horvath, A. O., & Greenberg, L. S. (1989) · Journal of Counseling Psychology · doi:10.1037//0022-0167.36.2.223 · Cited by 3,520
ELIZA — a computer program for the study of natural language communication between man and machine
Weizenbaum, J. (1983) · Communications of the ACM · doi:10.1145/357980.357991 · Cited by 2,807
Motivational Interviewing: Preparing People for Change, 2nd ed.
Miller, W., & Rollnick, S. (2003) · Journal For Healthcare Quality · doi:10.1097/01445442-200305000-00013 · Cited by 2,634
Embodied Conversational Agents
(2000) · The MIT Press eBooks · doi:10.7551/mitpress/2697.001.0001 · Cited by 1,829
Lacro, J. P., Dunn, L. B., Dolder, C. R., Leckband, S. G., & Jeste, D. V. (2002) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v63n1007 · Cited by 1,383
Interventions to Enhance Medication Adherence in Chronic Medical Conditions: A Systematic Review
Kripalani, S., Yao, X., & Haynes, R. B. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.6.540 · Cited by 810
BEAT: the Behavior Expression Animation Toolkit
Cassell, J., Vilhjálmsson, H. H., & Bickmore, T. (2001) · Proceedings of the 28th annual conference on Computer graphics and interactive techniques · doi:10.1145/383259.383315 · Cited by 739
Self-citationThis computer responds to user frustration:
Klein, J., Moon, Y., & Picard, R. W. (2002) · Interacting with Computers · doi:10.1016/s0953-5438(01)00053-4 · Cited by 560
Interventions to Improve Medication Adherence in Schizophrenia
Zygmunt, A., Olfson, M., Boyer, C. A., & Mechanic, D. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.10.1653 · Cited by 541
Brave, S., Nass, C., & Hutchinson, K. (2005) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2004.11.002 · Cited by 512
Establishing the computer-patient working alliance in automated health behavior change interventions
Bickmore, T., Gruber, A., & Picard, R. (2005) · Patient Education and Counseling · doi:10.1016/j.pec.2004.09.008 · Cited by 494
Self-citationCarroll, K. M., Ball, S. A., Martino, S., Nich, C., Babuscio, T. A., Nuro, K. F., Gordon, M. A., Portnoy, G. A., & Rounsaville, B. J. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07111835 · Cited by 405
PROUDFOOT, J., GOLDBERG, D., MANN, A., EVERITT, B., MARKS, I., & GRAY, J. A. (2003) · Psychological Medicine · doi:10.1017/s0033291702007225 · Cited by 389
McCrone, P., Knapp, M., Proudfoot, J., Ryden, C., Cavanagh, K., Shapiro, D. A., Ilson, S., Gray, J. A., Goldberg, D., Mann, A., et al. (2004) · British Journal of Psychiatry · doi:10.1192/bjp.185.1.55 · Cited by 371 · cited 1×
“33 Most of these interactive CCBT programs have not employed relational agents.”
BackgroundToward an ethics of persuasive technology
Berdichevsky, D., & Neuenschwander, E. (1999) · Communications of the ACM · doi:10.1145/301353.301410 · Cited by 365
'It's just like you talk to a friend': relational agents for older adults
Bickmore, T. W., Caruso, L., Clough-Gorr, K., & Heeren, T. (2005) · Interacting with Computers · doi:10.1016/j.intcom.2005.09.002 · Cited by 341 · cited 1×
“A modified version of the FitTrack system was evaluated with 21 geriatrics patients in order to determine how approachable and effective the system was for individuals with low computer literacy.(25) The randomized trial compared older adults who interacted with the agent daily in their homes for two months with a sta…”
MethodSelf-citationEnsemble methods for spoken emotion recognition in call-centres
Morrison, D., Wang, R., & De Silva, L. C. (2007) · Speech Communication · doi:10.1016/j.specom.2006.11.004 · Cited by 320
Clinician-Assisted Internet-Based Treatment is Effective for Panic: A Randomized Controlled Trial
Wims, E., Titov, N., Andrews, G., & Choi, I. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048671003614171 · Cited by 290
Taking the time to care: empowering low health literacy hospital patients with virtual nurse agents
Bickmore, T. W., Pfeifer, L. M., & Jack, B. W. (2009) · Proceedings of the SIGCHI Conference on Human Factors in Computing Systems · doi:10.1145/1518701.1518891 · Cited by 289
Self-citationA Second Life for eHealth: Prospects for the Use of 3-D Virtual Worlds in Clinical Psychology
Gorini, A., Gaggioli, A., Vigna, C., & Riva, G. (2008) · Journal of Medical Internet Research · doi:10.2196/jmir.1029 · Cited by 270
Health dialog systems for patients and consumers
Bickmore, T., & Giorgino, T. (2006) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2005.12.004 · Cited by 242
Self-citationInterventions to Improve Antipsychotic Medication Adherence: Review of Recent Literature
Dolder, C. R., Lacro, J. P., Leckband, S. G., & Jeste, D. V. (2003) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000085413.08426.41 · Cited by 236
Clinician-Assisted Internet-Based Treatment is Effective for Depression: Randomized Controlled Trial
Perini, S., Titov, N., & Andrews, G. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670902873722 · Cited by 231
Newman, M. G., Kenardy, J. A., Herman, S., & Taylor, C. B. (1997) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.65.1.178 · Cited by 213
Newman, M. G., Kenardy, J., Herman, S., & Taylor, C. B. (1997) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.65.1.178 · Cited by 172
Ethical challenges of telemedicine and telehealth
KAPLAN, B., & LITEWKA, S. (2008) · Cambridge Quarterly of Healthcare Ethics · doi:10.1017/s0963180108080535 · Cited by 167
Kenardy, J. A., Dow, M. G. T., Johnston, D. W., Newman, M. G., Thomson, A., & Taylor, C. B. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.6.1068 · Cited by 157
The coming age of telecommunications in psychological research and practice.
Jerome, L. W., DeLeon, P. H., James, L. C., Folen, R. A., Earles, J. E., & Gedney, J. J. (2000) · American Psychologist · doi:10.1037/0003-066x.55.4.407 · Cited by 148
Using computer agents to explain medical documents to patients with low health literacy
Bickmore, T., Vardoulakis, L., & Paasche‐Orlow, M. K. (2009) · Patient Education and Counseling · doi:10.1016/j.pec.2009.02.007 · Cited by 137
Self-citationFully automatic upper facial action recognition
Kapoor, A., Qi, Y., & Picard, R. W. (2004) · IEEE International SOI Conference (SOI) · doi:10.1109/amfg.2003.1240843 · Cited by 135
Status of computerized cognitive behavioural therapy for adults
Titov, N. (2007) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670601109873 · Cited by 120 · cited 1×
“These patients include those with physical obstacles like illness or remoteness, and those with mental obstacles like agoraphobia and the perception that seeking mental health care is stigmatizing.(30)”
BackgroundHelping Patients Follow Prescribed Treatment: Clinical Applications
Haynes, R. B., McDonald, H. P., & Garg, A. X. (2002) · JAMA · doi:10.1001/jama.288.22.2880 · Cited by 98
Engagement vs. Deceit: Virtual Humans with Human Autobiographies
Bickmore, T., Schulman, D. J., & Yin, L. (2009) · Lecture notes in computer science · doi:10.1007/978-3-642-04380-2_4 · Cited by 85
Self-citationKaplan, B., Farzanfar, R., & Friedman, R. H. (2003) · International Journal of Medical Informatics · doi:10.1016/s1386-5056(03)00072-8 · Cited by 83
Practical approaches to comforting users with relational agents
Bickmore, T., & Schulman, D. J. (2007) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/1240866.1240996 · Cited by 75
Self-citationDesigning for long-term human-robot interaction and application to weight loss
Breazeal, C., & Kidd, C. D. (2008) · DSpace@MIT (Massachusetts Institute of Technology) · Cited by 61
Looking for the bright side of user interface agents
Shneiderman, B. (1995) · interactions · doi:10.1145/208143.208150 · Cited by 61
This Computer Responds to User Frustration Theory, Design, Results, and Implications
Klein, J., Moon, Y., & Picard, R. W. (2002) · Cited by 61
Embedded Empathy in Continuous, Interactive Health Assessment
Liu, K. K., & Picard, R. W. (2005) · Cited by 55
Context awareness in a handheld exercise agent
Bickmore, T., Mauer, D., & Brown, T. (2008) · Pervasive and Mobile Computing · doi:10.1016/j.pmcj.2008.05.004 · Cited by 52
Self-citationExperimenting with the Gaze of a Conversational Agent
Heylen, D., van Es, I., Nijholt, A., & van Dijk, E. M. A. G. (2002) · University of Twente Research Information · Cited by 47
Modalities for building relationships with handheld computer agents
Bickmore, T., & Mauer, D. (2006) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/1125451.1125567 · Cited by 31
Self-citationA virtual laboratory for studying long-term relationships between humans and virtual agents
Bickmore, T., & Schulman, D. J. (2009) · Adaptive Agents and Multi-Agents Systems · doi:10.65109/xdra5701 · Cited by 30
Self-citationA computer program using cognitive therapy to treat depressed patients
Colby, K. M. (1995) · Psychiatric Services · doi:10.1176/ps.46.12.1223 · Cited by 30
Patient-Computer Dialogue: A Review,
Slack, W. V. (2000) · Yearbook of Medical Informatics · doi:10.1055/s-0038-1637944 · Cited by 20
Towards Plan-based Health Behavior Change Counseling Systems.
Bickmore, T., & Sidner, C. L. (2006) · National Conference on Artificial Intelligence · Cited by 14
Self-citationNegotiating task interruptions with virtual agents for health behavior change
Bickmore, T., Mauer, D., Crespo, F., & Brown, T. G. (2008) · Adaptive Agents and Multi-Agents Systems · doi:10.5555/1402821.1402841 · Cited by 13
Self-citationEthical Theories for Promoting Health Through Behavioral Change
O’Connell, J. K., & Price, J. H. (1983) · Journal of School Health · doi:10.1111/j.1746-1561.1983.tb03170.x · Cited by 12
Research works printed but not linked: 1
- Picard, 2002, Monitoring stress and heart health with a phone and wearable computer., Motorola Offspring J, 1, 14
Cited by
Sorted by citations
Chatbots and Conversational Agents in Mental Health: A Review of the Psychiatric Landscape
Vaidyam, A. N., Wisniewski, H., Halamka, J. D., Kashavan, M. S., & Torous, J. B. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719828977 · Cited by 1,048
A Taxonomy of Social Cues for Conversational Agents
Feine, J., Gnewuch, U., Morana, S., & Maedche, A. (2019) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2019.07.009 · Cited by 586
Embodied conversational agents in clinical psychology: a scoping review
Provoost, S., Lau, H. M., Ruwaard, J., & Riper, H. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6553 · Cited by 433
Natural language processing in mental health applications using non-clinical texts
Calvo, R. A., Milne, D., Hussain, M. S., & Christensen, H. M. (2017) · Natural Language Engineering · doi:10.1017/s1351324916000383 · Cited by 405
“Maintaining engagement with any behavior change tool is challenging, even more so with agents that are expected to be used for a semester, a year or a whole life (Bickmore and Gruber 2010; Bickmore, Schulman and Yin 2010).”
BackgroundInfluentialConversational agents in the treatment of mental health problems: mixed-method systematic review
Gaffney, H., Mansell, W., & Tai, S. (2019) · JMIR Mental Health · doi:10.2196/14166 · Cited by 275
“Evidence has begun to accumulate around the potential benefits of conversational agents in diverse fields [5] within health and medical care [6] and specifically in mental health [7-11].”
Metadata
- Authors
- Bickmore, T., & Gruber, A.
- Affiliations
- Northeastern University (US)
- Corresponding author
- Bickmore, Timothy
- ORCID
- Bickmore, Timothy
- Venue
- Harvard Review of Psychiatry
- Published
- 2010-03
- Volume
- 18
- Issue
- 2
- Pages
- 119-130
- ISSN
- 1067-3229 (ISSN-L)
- OpenAlex
- W2149556084
- Cited by
- 112
- References
- 52
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 10 · 2023: 7 · 2022: 10 · 2021: 8 · 2020: 8 · 2019: 17 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 5 · 2014: 7 · 2013: 3 · 2012: 6
- FWCI
- 5.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Harvard Review of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- relational agents, social robots, therapeutic relationship, health counseling, behaviour change interventions, clinical psychiatry, rapport building, trust, ethical considerations
- MeSH terms
- Counseling, Humans, Psychiatry, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review