A Chatbot to Improve Adherence to Internet-based Cognitive Behavioral Therapy Among Workers with Subthreshold Depression: A Randomized Controlled Trial

Abstract

Background Internet-based cognitive behavioral therapy (iCBT) is effective for subthreshold depression. However, iCBT has problems with adherence, especially when unaccompanied by human guidance. Knowledge on how to enhance adherence to iCBT without human involvement can contribute to improving the effectiveness of iCBT. Objective Examining the effect of an automated chatbot to improve the adherence rate of iCBT. Methods We developed a chatbot to increase adherence to an existing iCBT program, and a randomized controlled trial was conducted with two groups: one group using iCBT plus chatbot (iCBT plus chatbot group) and one group not using the chatbot (iCBT group). Participants were full-time employees with subthreshold depression working in Japan (n=149, Age Mean=41.4 (SD=11.1)). The primary endpoint was the completion rate of the iCBT program at eight weeks. Findings We analyzed data from 142 participants for the primary outcome. The completion rate of the iCBT + chatbot group was 34.8% (24/69, 95% CI 23.5‒46.0), that of the iCBT group was 19.2% (14/73, 95% CI 10.2‒28.2), and the risk ratio was 1.81 (95% CI 1.02‒3.21). Conclusions Combining iCBT with a chatbot increased participants’ iCBT completion rate. Clinical implications Encouraging messages from the chatbot could improve participation in an iCBT program. Further studies are needed to investigate whether chatbots can improve adherence to the program in the long term and to assess their impact on depression, anxiety, and well-being.