Effectiveness and acceptability of conversational agents for sexual health promotion: a systematic review and meta-analysis.

Digital health interventions for sexual health promotion have evolved considerably alongside innovations in technology. Despite these efforts, studies have shown that they do not consistently result in the desired sexual health outcomes. This could be attributed to low levels of user engagement, which can hinder digital health intervention effectiveness, as users do not engage with the system enough to be exposed to the intervention components. It has been suggested that conversational agents (automated two-way communication systems e.g. Alexa) have the potential to overcome the limitations of prior systems and promote user engagement through the increased interactivity offered by bidirectional, natural language-based interactions. The present review, therefore, provides an overview of the effectiveness and user acceptability of conversational agents for sexual health promotion. A systematic search of seven databases provided 4534 records, and after screening, 31 articles were included in this review. A narrative synthesis of results was conducted for effectiveness and acceptability outcomes, with the former supplemented by a meta-analysis conducted on a subset of studies. Findings provide preliminary support for the effectiveness of conversational agents for promoting sexual health, particularly treatment adherence. These conversational agents were found to be easy to use and useful, and importantly, resulted in high levels of satisfaction, use and intentions to reuse, whereas user evaluations regarding the quality of information left room for improvement. The results can inform subsequent efforts to design and evaluate these interventions, and offer insight into additional user experience constructs identified outside of current technology acceptance models, which can be incorporated into future theoretical developments.

Detecting Emotions through Electrodermal Activity in Learning Contexts: A Systematic Review.

There is a strong increase in the use of devices that measure physiological arousal through electrodermal activity (EDA). Although there is a long tradition of studying emotions during learning, researchers have only recently started to use EDA to measure emotions in the context of education and learning. This systematic review aimed to provide insight into how EDA is currently used in these settings. The review aimed to investigate the methodological aspects of EDA measures in educational research and synthesize existing empirical evidence on the relation of physiological arousal, as measured by EDA, with learning outcomes and learning processes. The methodological results pointed to considerable variation in the usage of EDA in educational research and indicated that few implicit standards exist. Results regarding learning revealed inconsistent associations between physiological arousal and learning outcomes, which seem mainly due to underlying methodological differences. Furthermore, EDA frequently fluctuated during different stages of the learning process. Compared to this unimodal approach, multimodal designs provide the potential to better understand these fluctuations at critical moments. Overall, this review signals a clear need for explicit guidelines and standards for EDA processing in educational research in order to build a more profound understanding of the role of physiological arousal during learning.

Multimodal measurements enhance insights into emotional responses to immediate feedback.

Adaptive learning technologies often provide students with immediate feedback on task performance. This feedback can elicit various emotional responses, which, in turn, influence learning. Most recent studies capture these emotions by single data streams, contradicting the multi-componential nature of emotion. Therefore, this study investigated 32 university students solving mathematical problems using an adaptive learning technology. Students received immediate feedback on every step in the solution process, after which their physiological, experiential and behavioral responses to this feedback were recorded. Physiological arousal was measured by electrodermal activity, valence was measured by self-reports (experiential), and emotion types were measured by observations of facial expressions (behavioral). Results showed more peaks in electrodermal activity after feedback than was expected based on chance. These responses were comparable in strength after feedback on failure and success. Students' experiential responses conveyed mostly positive valence after feedback on success and mostly negative valence after feedback on failure. Behavioral observations showed more negative than positive emotion types after feedback on failure and more positive than negative emotion types after feedback on success. These results show that physiological arousal is a valuable objective indicator of emotional responses after immediate feedback but should be accompanied by other data streams in order to understand students' emotional responses. Both valence and emotion types can be used for this purpose. These outcomes pave the way for designing adaptive learning technologies that take students' emotions into account.

Voice-Enabled Intelligent Virtual Agents for People With Amnesia: Systematic Review.

BACKGROUND: Older adults often have increasing memory problems (amnesia), and approximately 50 million people worldwide have dementia. This syndrome gradually affects a patient over a period of 10-20 years. Intelligent virtual agents may support people with amnesia. OBJECTIVE: This study aims to identify state-of-the-art experimental studies with virtual agents on a screen capable of verbal dialogues with a target group of older adults with amnesia. METHODS: We conducted a systematic search of PubMed, SCOPUS, Microsoft Academic, Google Scholar, Web of Science, and CrossRef on virtual agent and amnesia on papers that describe such experiments. Search criteria were (Virtual Agent OR Virtual Assistant OR Virtual Human OR Conversational Agent OR Virtual Coach OR Chatbot) AND (Amnesia OR Dementia OR Alzheimer OR Mild Cognitive Impairment). Risk of bias was evaluated using the QualSyst tool (University of Alberta), which scores 14 study quality items. Eligible studies are reported in a table including country, study design type, target sample size, controls, study aims, experiment population, intervention details, results, and an image of the agent. RESULTS: A total of 8 studies was included in this meta-analysis. The average number of participants in the studies was 20 (SD 12). The verbal interactions were generally short. The usability was generally reported to be positive. The human utterance was seen in 7 (88%) out of 8 studies based on short words or phrases that were predefined in the agent's speech recognition algorithm. The average study quality score was 0.69 (SD 0.08) on a scale of 0 to 1. CONCLUSIONS: The number of experimental studies on talking about virtual agents that support people with memory problems is still small. The details on the verbal interaction are limited, which makes it difficult to assess the quality of the interaction and the possible effects of confounding parameters. In addition, the derivation of the aggregated data was difficult. Further research with extended and prolonged dialogues is required.

Do We Take a Robot's Needs into Account? The Effect of Humanization on Prosocial Considerations Toward Other Human Beings and Robots.

Robots are becoming an integral part of society, yet the extent to which we are prosocial toward these nonliving objects is unclear. While previous research shows that we tend to take care of robots in high-risk, high-consequence situations, this has not been investigated in more day-to-day, low-consequence situations. Thus, we utilized an experimental paradigm (the Social Mindfulness "SoMi" paradigm) that involved a trade-off between participants' own interests and their willingness to take their task partner's needs into account. In two experiments, we investigated whether participants would take the needs of a robotic task partner into account to the same extent as when the task partner was a human (Study I), and whether this was modulated by participant's anthropomorphic attributions to said robot (Study II). In Study I, participants were presented with a social decision-making task, which they performed once by themselves (solo context) and once with a task partner (either a human or a robot). Subsequently, in Study II, participants performed the same task, but this time with both a human and a robotic task partner. The task partners were introduced via neutral or anthropomorphic priming stories. Results indicate that the effect of humanizing a task partner indeed increases our tendency to take someone else's needs into account in a social decision-making task. However, this effect was only found for a human task partner, not for a robot. Thus, while anthropomorphizing a robot may lead us to save it when it is about to perish, it does not make us more socially considerate of it in day-to-day situations.

Improving adherence to an online intervention for low mood with a virtual coach: study protocol of a pilot randomized controlled trial.

BACKGROUND: Internet-based cognitive-behavioral therapy (iCBT) is more effective when it is guided by human support than when it is unguided. This may be attributable to higher adherence rates that result from a positive effect of the accompanying support on motivation and on engagement with the intervention. This protocol presents the design of a pilot randomized controlled trial that aims to start bridging the gap between guided and unguided interventions. It will test an intervention that includes automated support delivered by an embodied conversational agent (ECA) in the form of a virtual coach. METHODS/DESIGN: The study will employ a pilot two-armed randomized controlled trial design. The primary outcomes of the trial will be (1) the effectiveness of iCBT, as supported by a virtual coach, in terms of improved intervention adherence in comparison with unguided iCBT, and (2) the feasibility of a future, larger-scale trial in terms of recruitment, acceptability, and sample size calculation. Secondary aims will be to assess the virtual coach's effect on motivation, users' perceptions of the virtual coach, and general feasibility of the intervention as supported by a virtual coach. We will recruit N = 70 participants from the general population who wish to learn how they can improve their mood by using Moodbuster Lite, a 4-week cognitive-behavioral therapy course. Candidates with symptoms of moderate to severe depression will be excluded from study participation. Included participants will be randomized in a 1:1 ratio to either (1) Moodbuster Lite with automated support delivered by a virtual coach or (2) Moodbuster Lite without automated support. Assessments will be taken at baseline and post-study 4 weeks later. DISCUSSION: The study will assess the preliminary effectiveness of a virtual coach in improving adherence and will determine the feasibility of a larger-scale RCT. It could represent a significant step in bridging the gap between guided and unguided iCBT interventions. TRIAL REGISTRATION: Netherlands Trial Register (NTR) NL8110 . Registered on 23 October 2019.

Validating Automated Sentiment Analysis of Online Cognitive Behavioral Therapy Patient Texts: An Exploratory Study.

INTRODUCTION: Sentiment analysis may be a useful technique to derive a user's emotional state from free text input, allowing for more empathic automated feedback in online cognitive behavioral therapy (iCBT) interventions for psychological disorders such as depression. As guided iCBT is considered more effective than unguided iCBT, such automated feedback may help close the gap between the two. The accuracy of automated sentiment analysis is domain dependent, and it is unclear how well the technology is applicable to iCBT. This paper presents an empirical study in which automated sentiment analysis by an algorithm for the Dutch language is validated against human judgment. METHODS: A total of 493 iCBT user texts were evaluated on overall sentiment and the presence of five specific emotions by an algorithm, and by 52 psychology students who evaluated 75 randomly selected texts each, providing about eight human evaluations per text. Inter-rater agreement (IRR) between algorithm and humans, and humans among each other, was analyzed by calculating the intra-class correlation under a numerical interpretation of the data, and Cohen's kappa, and Krippendorff's alpha under a categorical interpretation. RESULTS: All analyses indicated moderate agreement between the algorithm and average human judgment with respect to evaluating overall sentiment, and low agreement for the specific emotions. Somewhat surprisingly, the same was the case for the IRR among human judges, which means that the algorithm performed about as well as a randomly selected human judge. Thus, considering average human judgment as a benchmark for the applicability of automated sentiment analysis, the technique can be considered for practical application. DISCUSSION/CONCLUSION: The low human-human agreement on the presence of emotions may be due to the nature of the texts, it may simply be difficult for humans to agree on the presence of the selected emotions, or perhaps trained therapists would have reached more consensus. Future research may focus on validating the algorithm against a more solid benchmark, on applying the algorithm in an application in which empathic feedback is provided, for example, by an embodied conversational agent, or on improving the algorithm for the iCBT domain with a bottom-up machine learning approach.

Formalization of Damasio's theory of emotion, feeling and core consciousness.

This paper contributes an analysis and formalization of Damasio's theory on core consciousness. Three important concepts in this theory are 'emotion', 'feeling' and 'feeling a feeling' (or core consciousness). In particular, a simulation model is described of the dynamics of basic mechanisms leading via emotion and feeling to core consciousness, and dynamic properties are formally specified that hold for these dynamics at a more global level. These properties have been automatically checked for the simulation model. Moreover, a formal analysis is made of relevant notions of representation used by Damasio. As part of this analysis, specifications of representation relations have been verified and confirmed against the simulation model.

Formalization and analysis of reasoning by assumption.

This article introduces a novel approach for the analysis of the dynamics of reasoning processes and explores its applicability for the reasoning pattern called reasoning by assumption. More specifically, for a case study in the domain of a Master Mind game, it is shown how empirical human reasoning traces can be formalized and automatically analyzed against dynamic properties they fulfill. To this end, for the pattern of reasoning by assumption a variety of dynamic properties have been specified, some of which are considered characteristic for the reasoning pattern, whereas some other properties can be used to discriminate among different approaches to the reasoning. These properties have been automatically checked for the traces acquired in experiments undertaken. The approach turned out to be beneficial from two perspectives. First, checking characteristic properties contributes to the empirical validation of a theory on reasoning by assumption. Second, checking discriminating properties allows the analyst to identify different classes of human reasoners.

Towards virtual training of emotion regulation.

For professionals in military and law enforcement domains, learning to regulate one's emotions under threatening circumstances is crucial. The STRESS project envisions a virtual reality-based system to enable such professionals to train their emotion regulation skills. To explore the possibilities for such a system, this article describes an experiment performed to investigate the impact of virtual training on participants' experienced emotional responses in threatening situations. A set of 15 participants were asked to rate the subjective emotional intensity of a set of affective pictures at two different time points, separated by 6 h. The participants were divided into three groups: the first group performed a session of virtual training in between, in which they received a choice-reaction task; the second group performed a session of virtual training, in which they had to apply reappraisal strategies; and a control group, that did not have any training session. The results indicate that the reappraisal-based training caused the participants in that group to give significantly lower ratings for the emotional intensity of the negative pictures, whereas the content-based training resulted in significantly higher ratings compared to the group without training. Moreover, a second experiment, performed with the same participants 6 months later, indicated that these effects are fairly persistent over time, and that they transfer to different pictures with similar characteristics.