September 26, 2023

Analysis Spotlight

Eating disorders are serious and often fatal illnesses associated with severe disturbances in people’s eating behaviors, thoughts, and emotions. Research has found that delaying treatment results in poorer outcomes for people with eating disorders. Despite this, less than 20% of people with such disorders ever receive treatment. Tools that encourage and assist people with eating disorders to engage with mental health services are critical to helping them get the care they need.

In a new NIMH-funded study, Ellen Fitzsimmons-Craft, Ph.D., an affiliate professor of psychiatry at Washington College Faculty of Medication, and colleagues developed a chatbot to encourage folks with consuming problems to attach with care. Chatbots are pc applications designed to simulate human dialog. Analysis suggests that folks reply to chatbots in the identical manner they reply to people and that chatbots may be an efficient solution to attain a variety of people that want help.

On this examine, the researchers designed a chatbot named “Alex.” This examine is the primary in a deliberate three-part sequence, which features a preparation section, an optimization section, and an analysis section. On this “preparation” section, researchers developed Alex to incorporate 4 theoretically knowledgeable parts:

  • Psychoeducation: This element helped refute stereotypes about consuming problems, emphasised the seriousness of this psychological dysfunction, and supplied info particular to the consuming dysfunction the person indicated they had been experiencing.
  • Motivational interviewing: This element highlighted variations between customers’ well being objectives and their present conduct by encouraging them to guage how vital it was to deal with their consuming dysfunction behaviors and their confidence in making modifications.
  • Customized suggestions: This element supplied customized suggestions for in search of remedy.
  • Repeated check-ins: This element included as much as three check-ins within the weeks after interplay with the chatbot, which reminded customers of obtainable sources for remedy and promoted reflection on overcoming limitations to care.

The psychoeducation, motivational interviewing, and customized advice parts had been designed to take a complete of quarter-hour to finish. The repeated check-ins every took about 3 minutes to finish.

Testing the Alex prototype

The researchers held two in-person testing classes to get suggestions on a prototype model of Alex. After incorporating person suggestions, the researchers examined the chatbot once more in two remote-testing classes. Members within the testing classes had been individuals who had screened constructive for an consuming dysfunction however weren’t at present in remedy. After partaking with the chatbot, individuals rated the chatbot on usability, usefulness, ease of use, ease of studying, and satisfaction. The researchers additionally interviewed individuals to be taught extra about their experiences.

Within the first two testing classes, individuals rated the chatbot with a mean of 83.0 and 77.0 out of a potential rating of 100 on usability, indicating they’d an above-average person expertise with Alex. The individuals appreciated how human-like the chatbot was, with some noting that figuring out they had been chatting with a chatbot allowed them to open up greater than they may have in the event that they had been talking with somebody face-to-face.

Members typically supplied constructive suggestions, whereas additionally suggesting methods to enhance Alex’s parts. For instance, within the Motivational interview element, individuals indicated that they appreciated how the chatbot helped them take into consideration their potential to enact change, however they discovered finishing a number of quantitative scales associated to this reflection complicated. As one other instance, individuals appreciated the pressure-free nature of the customized suggestions for remedy that they obtained; nevertheless, they wished the flexibility to pick an choice that allowed them to obtain info on a number of kinds of care.

The researchers up to date Alex in response to this suggestions. As an illustration, they altered the movement of the chatbot-user dialog, improved the reflective scales, and provided customers with sources for numerous kinds of care, together with particular person remedy in individual or by way of telehealth and on-line self-help sources.

Testing Alex “2.0”

After incorporating the person suggestions, the researchers examined Alex once more in two distant testing classes. Usability rankings within the distant testing classes, which were75.0 and 85.8, confirmed a slight total enhance over rankings from the 2 in-person testing classes. Solely a modest enhance was anticipated because of the excessive rankings within the preliminary testing classes.

Members within the distant testing classes additionally obtained check-ins within the 2 weeks following interplay with the chatbot. These check-ins reminded individuals of the accessible remedy sources and inspired them to hunt help-. Members typically discovered that the reminders strengthened help-seeking behaviors however thought that it might be useful to have the ability to schedule these check-ins. This perception supplied vital suggestions for future chatbot iterations.

General, individuals had been open to the chatbot and in a position to efficiently use it, suggesting its potential as a extremely scalable instrument to enhance motivation and help-seeking behaviors amongst people with consuming problems. The researchers be aware that future research ought to be carried out to find out how efficient the chatbot is at bettering help-seeking behaviors instantly and long run. It’ll even be very important to grasp which particular features of chatbot interplay assist inspire help-seeking behaviors. Sooner or later, the chatbot may very well be tailored and examined for encouraging providers use amongst individuals who display screen constructive for different psychological problems.


Shah, J., DePietro, B., D’Adamo, L., Firebaugh, M. L., Laing, O., Fowler, L. A., Smolar, L., Sadeh-Sharvit, S., Taylor, C. B., Wilfley, D. E., & Fitzsimmons-Craft, E. E. (2022). Growth and value testing of a chatbot to advertise psychological well being providers use amongst people with consuming problems following screening. The Worldwide Journal of Consuming Problems, 55(9), 1229–1244.


MH115128, MH120341