Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.
JMIR Mhealth Uhealth. 2023 Jan 31;11:e40373. doi: 10.2196/40373.
Substance use disorder is one of the severe public health problems worldwide. Inequitable resources, discrimination, and physical distances limit patients' access to medical help. Automated conversational agents have the potential to provide in-home and remote therapy. However, automatic dialogue agents mostly use text and other methods to interact, which affects the interaction experience, treatment immersion, and clinical efficacy.
The aim of this paper is to describe the design and development of Echo-APP, a tablet-based app with the function of a virtual digital psychotherapist, and to conduct a pilot study to explore the feasibility and preliminary efficacy results of Echo-APP for patients with methamphetamine use disorder.
Echo-APP is an assessment and rehabilitation program developed for substance use disorder (SUD) by a team of clinicians, psychotherapists, and computer experts. The program is available for Android tablets. In terms of assessment, the focus is on the core characteristics of SUD, such as mood, impulsivity, treatment motivation, and craving level. In terms of treatment, Echo-APP provides 10 treatment units, involving awareness of addiction, motivation enhancement, emotion regulation, meditation, etc. A total of 47 patients with methamphetamine dependence were eventually enrolled in the pilot study to receive a single session of the Echo-APP-based motivational enhancement treatment. The outcomes were assessed before and after the patients' treatment, including treatment motivation, craving levels, self-perception on the importance of drug abstinence, and their confidence in stopping the drug use.
In the pilot study, scores on the Stages of Change Readiness and Treatment Eagerness Scale and the questionnaire on motivation for abstaining from drugs significantly increased after the Echo-APP-based treatment (P<.001, Cohen d=-0.60), while craving was reduced (P=.01, Cohen d=0.38). Patients' baseline Generalized Anxiety Disorder-7 assessment score (β=3.57; P<.001; 95% CI 0.80, 2.89) and Barratt Impulsiveness Scale (BIS)-motor impulsiveness score (β=-2.10; P=.04; 95% CI -0.94, -0.02) were predictive of changes in the patients' treatment motivation during treatment. Moreover, patients' baseline Generalized Anxiety Disorder-7 assessment score (β=-1.607; P=.03; 95% CI -3.08, -0.14), BIS-attentional impulsivity score (β=-2.43; P=.004; 95% CI -4.03, -0.83), and BIS-nonplanning impulsivity score (β=2.54; P=.002; 95% CI 0.98, 4.10) were predictive of changes in craving scores during treatment.
Echo-APP is a practical, accepted, and promising virtual digital psychotherapist program for patients with methamphetamine dependence. The preliminary findings lay a good foundation for further optimization of the program and the promotion of large-scale randomized controlled clinical studies for SUD.
物质使用障碍是全球严重的公共卫生问题之一。资源分配不均、歧视和物理距离限制了患者获得医疗帮助的机会。自动化对话代理具有提供家庭和远程治疗的潜力。然而，自动对话代理大多使用文本和其他方法进行交互，这会影响交互体验、治疗沉浸度和临床疗效。
本文旨在描述 Echo-APP 的设计和开发，Echo-APP 是一款基于平板电脑的应用程序，具有虚拟数字心理治疗师的功能，并进行一项试点研究，以探索 Echo-APP 对甲基苯丙胺使用障碍患者的可行性和初步疗效结果。
Echo-APP 是由一组临床医生、心理治疗师和计算机专家为物质使用障碍 (SUD) 开发的评估和康复计划。该计划适用于 Android 平板电脑。在评估方面，重点关注 SUD 的核心特征，如情绪、冲动、治疗动机和渴求水平。在治疗方面，Echo-APP 提供了 10 个治疗单元，涉及对成瘾的认识、动机增强、情绪调节、冥想等。共有 47 名甲基苯丙胺依赖患者最终入组了这项试点研究，以接受单次基于 Echo-APP 的动机增强治疗。在治疗前后评估了结果，包括治疗动机、渴求水平、对戒毒重要性的自我认知以及停止用药的信心。
在试点研究中，在接受基于 Echo-APP 的治疗后，改变阶段准备和治疗积极性量表以及戒除毒品动机问卷的得分显著增加 (P<.001，Cohen d=-0.60)，而渴求则降低 (P=.01，Cohen d=0.38)。患者基线广泛性焦虑症-7 评估得分 (β=3.57; P<.001; 95%CI 0.80, 2.89) 和巴瑞特冲动量表 (BIS)-运动冲动得分 (β=-2.10; P=.04; 95%CI -0.94, -0.02) 预测了治疗期间患者治疗动机的变化。此外，患者基线广泛性焦虑症-7 评估得分 (β=-1.607; P=.03; 95%CI -3.08, -0.14)、BIS 注意冲动得分 (β=-2.43; P=.004; 95%CI -4.03, -0.83) 和 BIS 非计划冲动得分 (β=2.54; P=.002; 95%CI 0.98, 4.10) 预测了治疗期间渴求得分的变化。
Echo-APP 是一种实用、可接受且有前途的甲基苯丙胺依赖患者虚拟数字心理治疗师程序。初步发现为进一步优化该程序和推广用于 SUD 的大规模随机对照临床试验奠定了良好的基础。
