The study, which was the first to test an AI voice-based virtual coach for behavioral therapy, found changes in patients’ brain activity along with improved depression and anxiety symptoms after using Lumen, an AI voice assistant that delivered a form of psychotherapy.
The UIC team says the results, which are published in the journal Translational Psychiatry, offer encouraging evidence that virtual therapy can play a role in filling the gaps in mental health care, where waitlists and disparities in access are often hurdles that patients, particularly from vulnerable communities, must overcome to receive treatment.
"We've had an incredible explosion of need, especially in the wake of COVID, with soaring rates of anxiety and depression and not enough practitioners," said Dr. Olusola A. Ajilore, UIC professor of psychiatry and co-first author of the paper. "This kind of technology may serve as a bridge. It’s not meant to be a replacement for traditional therapy, but it may be an important stop-gap before somebody can seek treatment."
Lumen, which operates as a skill in the Amazon Alexa application, was developed by Ajilore and study senior author Dr. Jun Ma, the Beth and George Vitoux Professor of Medicine at UIC, along with collaborators at Washington University in St. Louis and Pennsylvania State University, with the support of a $2 million grant from the National Institute of Mental Health.
The UIC researchers recruited over 60 patients for the clinical study exploring the application’s effect on mild-to-moderate depression and anxiety symptoms, and activity in brain areas previously shown to be associated with the benefits of problem-solving therapy.
Two-thirds of the patients used Lumen on a study-provided iPad for eight problem-solving therapy sessions, with the rest serving as a "waitlist" control receiving no intervention.
After the intervention, study participants using the Lumen app showed decreased scores for depression, anxiety and psychological distress compared with the control group. The Lumen group also showed improvements in problem-solving skills that correlated with increased activity in the dorsolateral prefrontal cortex, a brain area associated with cognitive control. Promising results for women and underrepresented populations also were found.
"It's about changing the way people think about problems and how to address them, and not being emotionally overwhelmed," Ma said. "It's a pragmatic and patient-driven behavior therapy that's well established, which makes it a good fit for delivery using voice-based technology."
A larger trial comparing the use of Lumen with both a control group on a waitlist, and patients receiving human-coached problem-solving therapy is currently being conducted by the researcher. They stress that the virtual coach doesn’t need to perform better than a human therapist to fill a desperate need in the mental health system.
"The way we should think about digital mental health service is not for these apps to replace humans, but rather to recognize what a gap we have between supply and demand, and then find novel, effective and safe ways to deliver treatments to individuals who otherwise do not have access, to fill that gap," Ma said.
Kannampallil T, Ajilore OA, Lv N, Smyth JM, Wittels NE, Ronneberg CR, Kumar V, Xiao L, Dosala S, Barve A, Zhang A, Tan KC, Cao KK, Patel CR, Gerber BS, Johnson JA, Kringle EA, Ma J.
Effects of a virtual voice-based coach delivering problem-solving treatment on emotional distress and brain function: a pilot RCT in depression and anxiety.
Transl Psychiatry. 2023 May 12;13(1):166. doi: 10.1038/s41398-023-02462-x