Beatty C, Malik T, Meheli S, and Sinha C (2022). Evaluating the Therapeutic Alliance With a Free-Text CBT Conversational Agent (Wysa): A Mixed-Methods Study. Front Digit Health 4:847991. doi: 10.3389/fdgth.2022.847991
The goal of this study was to explore therapeutic alliance (I.e., the emotional bond and collaboration between a patient and therapist on the tasks and goals of treatment) using an artificial intelligence (AI) conversational agent (Wysa). Wysa is a mental health app that provides a virtual space for anonymous user-led conversations with AI-guided listening and support based in a cognitive behavioral framework. New users of Wysa, a freely accessible app, were invited to join the study through a notification and screening assessment within the app. Participants who screened positive for anxiety or depression symptoms (N=1205) completed therapeutic alliance assessments within 5 days of installing the app and 3 days after the first assessment. Therapeutic alliance was measured using the validated Working Alliance Inventory-Short Revised (WAI-SR); a score of at least 3.45 is considered high alliance. Researchers also analyzed the transcripts of users’ conversations with Wysa for qualitative elements related to therapeutic alliance. During initial app use, the mean score of therapeutic alliance was 3.64 (SD=0.81) and mean score of bonding was 3.98 (SD=0.94). After 3 days, the mean scores for alliance and bonding increased to 3.75 (SD=0.80) and 4.05 (SD=0.91) respectively, but these changes were not statistically significant. Findings from the content analysis of Wysa conversation transcripts identified elements of bonding, including gratitude, self-disclosure, and personification. This study provides evidence of the establishment of therapeutic alliance with a conversational agent with scores comparable to prior studies with face-face, human-based therapy. Little change in therapeutic alliance was observed over time.