[Other] Frontiers | Evaluating the Therapeutic Alliance With a Free-Text CBT Conversational Agent (Wysa): A Mixed-Methods Study

Abstract: The present study aims to examine whether users perceive a therapeutic alliance with an AI conversational agent (Wysa) and observe changes in the t‘herapeutic alliance over a brief time period. A sample of users who screened positively on the PHQ-4 for anxiety or depression symptoms (N = 1,205) of the digital mental health application (app) Wysa were administered the WAI-SR within 5 days of installing the app and gave a second assessment on the same measure after 3 days (N = 226). The anonymised transcripts of user’s conversations with Wysa were also examined through content analysis for unprompted elements of bonding between the user and Wysa (N = 950). Within 5 days of initial app use, the mean WAI-SR score was 3.64 (SD 0.81) and the mean bond subscale score was 3.98 (SD 0.94). Three days later, the mean WAI-SR score increased to 3.75 (SD 0.80) and the mean bond subscale score increased to 4.05 (SD 0.91). There was no significant difference in the alliance scores between Assessment 1 and Assessment 2.These mean bond subscale scores were found to be comparable to the scores obtained in recent literature on traditional, outpatient-individual CBT, internet CBT and group CBT. Content analysis of the transcripts of user conversations with the CA (Wysa) also revealed elements of bonding such as gratitude, self-disclosed impact, and personification. The user’s therapeutic alliance scores improved over time and were comparable to ratings from previous studies on alliance in human-delivered face-to-face psychotherapy with clinical populations. This study provides critical support for the utilization of digital mental health services, based on the evidence of the establishment of an alliance.

Lay summary (by Claude 2): The study looked at whether people develop a therapeutic relationship with Wysa, an AI chatbot for mental health. The researchers surveyed over 1,200 people who started using Wysa and screened positive for anxiety or depression. Within 5 days of first using Wysa, people rated their relationship with Wysa as moderately strong. After using Wysa for 3 more days, people rated their relationship with Wysa as slightly stronger. The study found that people’s ratings of their relationship with the AI chatbot were similar to ratings of relationships between patients and human therapists in previous research on in-person and online therapy. Analyzing conversations between users and Wysa also showed signs of bonding, like expressing gratitude, sharing impact, and talking to Wysa like a person. Overall, the study suggests that people can form a therapeutic alliance with an AI chatbot similar to alliances between patients and human therapists. This supports the use of AI chatbots as an option for digital mental health care.