Measuring Alliance Toward Embodied Virtual Therapists in the Era of Automated Treatments With the Virtual Therapist Alliance Scale (VTAS): Development and Psychometric Evaluation.
alliance
automated treatment
avatar
embodiment
empathy
exposure therapy
presence
psychometric
usability
virtual coach
virtual reality
virtual therapist
Journal
Journal of medical Internet research
ISSN: 1438-8871
Titre abrégé: J Med Internet Res
Pays: Canada
ID NLM: 100959882
Informations de publication
Date de publication:
24 03 2020
24 03 2020
Historique:
received:
11
10
2019
accepted:
15
12
2019
revised:
09
12
2019
entrez:
25
3
2020
pubmed:
25
3
2020
medline:
7
10
2020
Statut:
epublish
Résumé
Automated virtual reality exposure therapies (VRETs) are self-help treatments conducted by oneself and supported by a virtual therapist embodied visually and/or with audio feedback. This simulates many of the nonspecific relational elements and common factors present in face-to-face therapy and may be a means of improving adherence to and efficacy of self-guided treatments. However, little is known about alliance toward the virtual therapist, despite alliance being an important predictor of treatment outcome. In this study, we aimed to evaluate the first alliance instrument developed for use with embodied virtual therapists in an automated treatment format-the Virtual Therapist Alliance Scale (VTAS)-by (1) assessing its psychometric properties, (2) verifying the dimensionality of the scale, and (3) determining the predictive ability of the scale with treatment outcome. A psychometric evaluation and exploratory factor analysis of the VTAS was conducted using data from two samples of spider-fearful patients treated with VRET and the help of an embodied, voice-based virtual therapist (n=70). Multiple regression models and bivariate correlations were used to assess the VTAS relationship with treatment outcome, according to self-reported fear and convergence with presence and user-friendliness process measures. The VTAS showed a sound two-factor solution composed of a primary factor covering task, goal, and copresence; adequate internal consistency; and good convergent validity, including moderate correlation (r=.310, P=.01) with outcomes over follow-up. These preliminary results suggest that alliance toward a virtual therapist is a significant predictor of treatment outcome, favors the importance of a task-goal over bond-factor, and should be explored in studies with larger sample sizes and in additional forms of embodiment.
Sections du résumé
BACKGROUND
Automated virtual reality exposure therapies (VRETs) are self-help treatments conducted by oneself and supported by a virtual therapist embodied visually and/or with audio feedback. This simulates many of the nonspecific relational elements and common factors present in face-to-face therapy and may be a means of improving adherence to and efficacy of self-guided treatments. However, little is known about alliance toward the virtual therapist, despite alliance being an important predictor of treatment outcome.
OBJECTIVE
In this study, we aimed to evaluate the first alliance instrument developed for use with embodied virtual therapists in an automated treatment format-the Virtual Therapist Alliance Scale (VTAS)-by (1) assessing its psychometric properties, (2) verifying the dimensionality of the scale, and (3) determining the predictive ability of the scale with treatment outcome.
METHODS
A psychometric evaluation and exploratory factor analysis of the VTAS was conducted using data from two samples of spider-fearful patients treated with VRET and the help of an embodied, voice-based virtual therapist (n=70). Multiple regression models and bivariate correlations were used to assess the VTAS relationship with treatment outcome, according to self-reported fear and convergence with presence and user-friendliness process measures.
RESULTS
The VTAS showed a sound two-factor solution composed of a primary factor covering task, goal, and copresence; adequate internal consistency; and good convergent validity, including moderate correlation (r=.310, P=.01) with outcomes over follow-up.
CONCLUSIONS
These preliminary results suggest that alliance toward a virtual therapist is a significant predictor of treatment outcome, favors the importance of a task-goal over bond-factor, and should be explored in studies with larger sample sizes and in additional forms of embodiment.
Identifiants
pubmed: 32207690
pii: v22i3e16660
doi: 10.2196/16660
pmc: PMC7139418
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e16660Informations de copyright
©Alexander Miloff, Per Carlbring, William Hamilton, Gerhard Andersson, Lena Reuterskiöld, Philip Lindner. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.03.2020.
Références
Psychotherapy (Chic). 2018 Dec;55(4):316-340
pubmed: 29792475
Technol Health Care. 2017 Dec 4;25(6):1081-1096
pubmed: 28800346
Front Hum Neurosci. 2014 Mar 04;8:112
pubmed: 24624073
Internet Interv. 2016 Oct 03;6:107-114
pubmed: 30135819
J Psychother Pract Res. 1996 Summer;5(3):260-71
pubmed: 22700294
J Behav Ther Exp Psychiatry. 1995 Mar;26(1):31-4
pubmed: 7642758
J Clin Psychol. 2018 Jun;74(6):839-848
pubmed: 29364509
JAMA Psychiatry. 2019 Jul 1;76(7):682-690
pubmed: 30892564
J Psychother Pract Res. 2001 Summer;10(3):173-8
pubmed: 11402080
Curr Psychiatry Rep. 2019 Jul 8;21(8):76
pubmed: 31286280
PLoS One. 2014 May 06;9(5):e96144
pubmed: 24801324
Internet Interv. 2018 Feb 05;11:41-46
pubmed: 30135758
J Consult Clin Psychol. 2013 Oct;81(5):751-60
pubmed: 23796315
Pers Soc Psychol Bull. 2003 Jul;29(7):819-33
pubmed: 15018671
Br J Psychiatry. 2017 Apr;210(4):276-283
pubmed: 27979818
Psychother Res. 2018 May;28(3):446-456
pubmed: 27494662
J Clin Psychol. 2020 Jun;76(6):973-986
pubmed: 31240727
J Med Internet Res. 2009 Apr 24;11(2):e13
pubmed: 19403466
Psychol Assess. 2019 Dec;31(12):1412-1427
pubmed: 30896212
Cogn Behav Ther. 2019 Jul;48(4):285-299
pubmed: 30372653
Cogn Behav Ther. 2017 Sep;46(5):404-420
pubmed: 28270059
Assessment. 2015 Oct;22(5):581-93
pubmed: 25271007
Behav Cogn Psychother. 2013 Jul;41(4):505-9
pubmed: 23410820
Am Psychol. 2003 Jan;58(1):78-9
pubmed: 12674822
J Anxiety Disord. 2019 Jan;61:27-36
pubmed: 30287083
Br J Clin Psychol. 2012 Nov;51(4):396-417
pubmed: 23078210
Lancet Psychiatry. 2018 Aug;5(8):625-632
pubmed: 30007519
J Consult Clin Psychol. 1993 Aug;61(4):561-73
pubmed: 8370852
World Psychiatry. 2019 Feb;18(1):20-28
pubmed: 30600624
J Med Internet Res. 2012 Nov 14;14(6):e152
pubmed: 23151820
Behav Res Ther. 2019 Jul;118:130-140
pubmed: 31075675
Front Behav Neurosci. 2019 Jan 29;12:293
pubmed: 30760986
Psychol Med. 2017 Oct;47(14):2393-2400
pubmed: 28325167
Psychother Res. 2017 Sep;27(5):511-524
pubmed: 26732852
Front Robot AI. 2018 Oct 15;5:114
pubmed: 33500993
Stud Health Technol Inform. 2011;163:503-9
pubmed: 21335847
J Med Internet Res. 2018 Apr 19;20(4):e90
pubmed: 29674307
Behav Cogn Psychother. 2015 Mar;43(2):167-81
pubmed: 24131567
J Med Internet Res. 2017 May 09;19(5):e151
pubmed: 28487267
Front Psychol. 2015 Oct 08;6:1531
pubmed: 26500589
Front Psychol. 2019 Feb 04;10:132
pubmed: 30778311
J Consult Clin Psychol. 2016 Aug;84(8):738-51
pubmed: 27213493
Depress Anxiety. 2010 Oct;27(10):933-44
pubmed: 20734361
Behav Res Ther. 2017 Jan;88:19-25
pubmed: 28110672
Psychother Res. 2018 Jul;28(4):499-516
pubmed: 28899230