New research from Cedars-Sinai Medical Center in Los Angeles describes the use of AI driven avatars programmed for motivational interviewing and cognitive behavioral therapy can be accepted by patients and considered helpful in counseling sessions.
Patients reported that after 30 minute sessions using virtual reality goggles, 85% of participants said they found the experience to be helpful, and 90% expressed interest in doing it again.
The patients were individuals who were awaiting liver transplants for cirrhosis and according to Dr. Brennan Spiegel, director of health services research at Cedars-Sinai, ‘alcohol addiction remains a high-risk factor.’ “We see VR as a way to augment traditional interventions, which often fall short due to a shortage of mental health professionals, societal stigmatizing of alcoholism and other factors.”
In the US, over 29 million individuals were identified with alcohol use disorder (AUD) in 2019 and is projected to increase further by 2030. Despite this, treatment access is low, with only 7.6% of affected individuals receiving AUD-related treatment in 2021. Furthermore, only 16% of individuals receiving AUD-directed therapy achieved abstinence. Relapse prevention treatment remains a challenge, with more than 60% relapsing within the first year of treatment
Treatment modalities for AUD encompass both pharmacotherapy and psychotherapeutic approaches, with increasing emphasis on combination therapy. Psychotherapeutic approaches, such as motivational interviewing (MI) and cognitive behavioral therapy (CBT), are widely disseminated evidence-based interventions for AUD and recommended by professional societies as they serve to address harmful drinking patterns. Unfortunately, treatment access is limited and aggravated by a scarcity of mental health professionals, pervasive societal stigma, financial, attitudinal, and geographic barriers.
New Technology Solutions
Technological solutions, such as telemedicine and mobile applications, have begun to address barriers to access. Including advancements in virtual reality (VR) is emerging as a valuable supplementary tool for AUD assessment and treatment. Current, traditional cognitive behavior therapy (CBT) and VR-assisted CBT have involved preprogrammed or scripted methods. Recently, advancements in artificial intelligence (AI) have introduced large language models (LLMs) capable of generating more dynamic and responsive interactions. LLMs have shown a remarkable ability to facilitate personalized treatment plans and enhance patient engagement in the fields of medicine. The applications of VR with integrative, interview-based therapies enabled through LLMs have been unexplored.
Results
The new study introduces a novel program that combines spatial computing with AI to deliver self-administered mental health support for patients with AUD. In earlier research, the researchers found this program to be feasible, safe, and acceptable for patients experiencing mild-to-moderate depression or anxiety. Building on this foundation, the study aimed to adapt the program to integrate motivational interviewing (MI) techniques, as well as to assess its feasibility, safety, and efficacy in delivering combined CBT and MI in VR to address persisting gaps in psychotherapeutic care delivery for patients with alcohol-associated cirrhosis.
Building upon the insights drawn from the thematic content analysis with 20 socioeconomically diverse participants, our study evaluated a program combining spatial computing and AI to deliver self-administered, immersive mental health support targeting alcohol craving reduction. The participants offered mostly positive feedback on their interaction with the virtual AI therapist.
Patient Assessment
Patients highlighted the program’s usability and acceptability, its personalized engagement, as well as the empathetic, private, and nonjudgmental therapeutic alliance it fostered. Participants described the AI avatar as realistic and engaging in its communication style, which many reported to be comparable with a human therapist. Most participants expressed a willingness to recommend this form of self-administered psychotherapy to others. These findings are notable given that three-quarters of participants reported minimal prior experience with VR.
Source:
Yeo YH, Clark A, Mehra M, Danovitch I, Osilla K, Yang JD, Kuo A, Kim H-S, Vipani A, Wang Y, Ayoub W, Trivedi H, Samaan, Wu T, Shah, Liran O, and Spiegel B. (2024) The feasibility and usability of an artificial intelligence-enabled conversational agent in virtual reality for patients with alcohol-associated cirrhosis: A multi-methods study, Journal of Medical Extended Reality 1:1, 257–270, DOI: 10.1089/jmxr.2024.0033.