Linguistic Synchrony Predicts the Immediate and Lasting Impact of Text-Based Emotional Support.

Emotional support is critical to well-being, but the factors that determine whether support attempts succeed or fail are incompletely understood. Using data from more than 1 million support interactions enacted within an online environment, we showed that emotional-support attempts are more effective when there is synchrony in the behavior of support providers and recipients reflective of shared psychological understanding. Benefits of synchrony in language used and semantic content conveyed were apparent in immediate measures of support impact (recipient ratings of support effectiveness and expressions of gratitude), as well as delayed measures of lasting change in the emotional impact of stressful life situations (recipient ratings of emotional recovery made at a 1-hr delay). These findings identify linguistic synchrony as a process underlying successful emotional support and provide direction for future work investigating support processes enacted via linguistic behaviors.

Towards an Artificially Empathic Conversational Agent for Mental Health Applications: System Design and User Perceptions.

BACKGROUND: Conversational agents cannot yet express empathy in nuanced ways that account for the unique circumstances of the user. Agents that possess this faculty could be used to enhance digital mental health interventions. OBJECTIVE: We sought to design a conversational agent that could express empathic support in ways that might approach, or even match, human capabilities. Another aim was to assess how users might appraise such a system. METHODS: Our system used a corpus-based approach to simulate expressed empathy. Responses from an existing pool of online peer support data were repurposed by the agent and presented to the user. Information retrieval techniques and word embeddings were used to select historical responses that best matched a user's concerns. We collected ratings from 37,169 users to evaluate the system. Additionally, we conducted a controlled experiment (N=1284) to test whether the alleged source of a response (human or machine) might change user perceptions. RESULTS: The majority of responses created by the agent (2986/3770, 79.20%) were deemed acceptable by users. However, users significantly preferred the efforts of their peers (P<.001). This effect was maintained in a controlled study (P=.02), even when the only difference in responses was whether they were framed as coming from a human or a machine. CONCLUSIONS: Our system illustrates a novel way for machines to construct nuanced and personalized empathic utterances. However, the design had significant limitations and further research is needed to make this approach viable. Our controlled study suggests that even in ideal conditions, nonhuman agents may struggle to express empathy as well as humans. The ethical implications of empathic agents, as well as their potential iatrogenic effects, are also discussed.

Efficacy of a Web-based, crowdsourced peer-to-peer cognitive reappraisal platform for depression: randomized controlled trial.

BACKGROUND: Self-guided, Web-based interventions for depression show promising results but suffer from high attrition and low user engagement. Online peer support networks can be highly engaging, but they show mixed results and lack evidence-based content. OBJECTIVE: Our aim was to introduce and evaluate a novel Web-based, peer-to-peer cognitive reappraisal platform designed to promote evidence-based techniques, with the hypotheses that (1) repeated use of the platform increases reappraisal and reduces depression and (2) that the social, crowdsourced interactions enhance engagement. METHODS: Participants aged 18-35 were recruited online and were randomly assigned to the treatment group, "Panoply" (n=84), or an active control group, online expressive writing (n=82). Both are fully automated Web-based platforms. Participants were asked to use their assigned platform for a minimum of 25 minutes per week for 3 weeks. Both platforms involved posting descriptions of stressful thoughts and situations. Participants on the Panoply platform additionally received crowdsourced reappraisal support immediately after submitting a post (median response time=9 minutes). Panoply participants could also practice reappraising stressful situations submitted by other users. Online questionnaires administered at baseline and 3 weeks assessed depression symptoms, reappraisal, and perseverative thinking. Engagement was assessed through self-report measures, session data, and activity levels. RESULTS: The Panoply platform produced significant improvements from pre to post for depression (P=.001), reappraisal (P<.001), and perseverative thinking (P<.001). The expressive writing platform yielded significant pre to post improvements for depression (P=.02) and perseverative thinking (P<.001), but not reappraisal (P=.45). The two groups did not diverge significantly at post-test on measures of depression or perseverative thinking, though Panoply users had significantly higher reappraisal scores (P=.02) than expressive writing. We also found significant group by treatment interactions. Individuals with elevated depression symptoms showed greater comparative benefit from Panoply for depression (P=.02) and perseverative thinking (P=.008). Individuals with baseline reappraisal deficits showed greater comparative benefit from Panoply for depression (P=.002) and perseverative thinking (P=.002). Changes in reappraisal mediated the effects of Panoply, but not the expressive writing platform, for both outcomes of depression (ab=-1.04, SE 0.58, 95% CI -2.67 to -.12) and perseverative thinking (ab=-1.02, SE 0.61, 95% CI -2.88 to -.20). Dropout rates were similar for the two platforms; however, Panoply yielded significantly more usage activity (P<.001) and significantly greater user experience scores (P<.001). CONCLUSIONS: Panoply engaged its users and was especially helpful for depressed individuals and for those who might ordinarily underutilize reappraisal techniques. Further investigation is needed to examine the long-term effects of such a platform and whether the benefits generalize to a more diverse population of users. TRIAL REGISTRATION: ClinicalTrials.gov NCT02302248; https://clinicaltrials.gov/ct2/show/NCT02302248 (Archived by WebCite at http://www.webcitation.org/6Wtkj6CXU).

Clinical science and practice in the age of large language models and generative artificial intelligence.

In this article, Schueller and Morris discuss the recent advances made from large language models (LLMs) and generative artificial intelligence (AI). These advances include supporting humans to provide better interventions, understanding processes in clinical interventions, and providing ethical considerations for the use of generative AI in clinical research and practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating change in body image concerns following a single session digital intervention.

Many young individuals at risk for eating disorders spend time on social media and frequently search for information related to their body image concerns. In a large randomized study, we demonstrated that a guided chat-based intervention could reduce weight and shape concerns and eating disorder pathology. The goal of the current study was to determine if a modified single session mini-course, derived from the aforementioned chat-based intervention, could reduce body image concerns among individuals using eating disorder related search terms on a social media platform. Over a two-month period of prompting individuals, 525 people followed the link to the web-based application where the intervention was hosted and subsequently completed the mini-course. This resulted in a significant improvement on the one-time body image satisfaction question pre-to post intervention (p < .001) with a moderate effect size (Cohen's d = 0.54). Additionally, individuals completing the program showed significant improvement on motivation to change their body image (p < .001) with a small effect size (Cohen's d = 0.28). Additionally, users reported that the program was enjoyable and easy to use. These results suggest that a single session micro-intervention, offered to individuals on social media, can help improve body image.

Single-Session Interventions Embedded Within Tumblr: Acceptability, Feasibility, and Utility Study.

BACKGROUND: Existing mental health treatments are insufficient for addressing mental health needs at scale, particularly for teenagers, who now seek mental health information and support on the web. Single-session interventions (SSIs) may be particularly well suited for dissemination as embedded web-based support options that are easily accessible on popular social platforms. OBJECTIVE: We aimed to evaluate the acceptability and effectiveness of three SSIs, each with a duration of 5 to 8 minutes (Project Action Brings Change, Project Stop Adolescent Violence Everywhere, and REFRAME)-embedded as Koko minicourses on Tumblr-to improve three key mental health outcomes: hopelessness, self-hate, and the desire to stop self-harm behavior. METHODS: We used quantitative data (ie, star ratings and SSI completion rates) to evaluate acceptability and short-term utility of all 3 SSIs. Paired 2-tailed t tests were used to assess changes in hopelessness, self-hate, and the desire to stop future self-harm from before to after the SSI. Where demographic information was available, the analyses were restricted to teenagers (13-19 years). Examples of positive and negative qualitative user feedback (ie, written text responses) were provided for each program. RESULTS: The SSIs were completed 6179 times between March 2021 and February 2022. All 3 SSIs generated high star ratings (>4 out of 5 stars), with high completion rates (approximately 25%-57%) relative to real-world completion rates among other digital self-help interventions. Paired 2-tailed t tests detected significant pre-post reductions in hopelessness for those who completed Project Action Brings Change (P<.001, Cohen dz=-0.81, 95% CI -0.85 to -0.77) and REFRAME (P<.001, Cohen dz=-0.88, 95% CI -0.96 to -0.80). Self-hate significantly decreased (P<.001, Cohen dz=-0.67, 95% CI -0.74 to -0.60), and the desire to stop self-harm significantly increased (P<.001, Cohen dz=0.40, 95% CI 0.33 to 0.47]) from before to after the completion of Project Stop Adolescent Violence Everywhere. The results remained consistent across sensitivity analyses and after correcting for multiple tests. Examples of positive and negative qualitative user feedback point toward future directions for SSI research. CONCLUSIONS: Very brief SSIs, when embedded within popular social platforms, are one promising and acceptable method for providing free, scalable, and potentially helpful mental health support on the web. Considering the unique barriers to mental health treatment access that many teenagers face, this approach may be especially useful for teenagers without access to other mental health supports.

Social Interactivity in Live Video Experiences Reduces Loneliness.

Background: Loneliness, especially when chronic, can substantially reduce one's quality of life. However, positive social experiences might help to break cycles of loneliness by promoting more prosocial cognitions and behaviors. Internet-mediated live video communication platforms (eg Zoom and Twitch) may offer an engaging and accessible medium to deliver such social experiences to people at scale. Despite these platforms' widespread use, there is a lack of research into how their socially interactive elements affect users' feelings of loneliness and connection. Objective: We aimed to experimentally evaluate whether socially interactivity in live video experience improves loneliness-related outcomes. Materials and Methods: We recruited participants from an online survey recruitment platform and assigned half to participate in a socially interactive live video experience with 6-12 strangers and the other half to a non-interactive control experience that was designed to be identical in every way but not socially interactive. Participants completed several baseline self-report measures of psychosocial wellbeing, participated in the hour-long video experience (an entertaining astronomy lesson), and then completed some baseline measures again. Four weeks later, we followed up with participants to evaluate their change in trait loneliness since baseline. We Pre-registered our hypotheses and analysis plan and provide our data, analysis code, and study materials online. Results: Two hundred and forty-nine participants completed the initial study and met inclusion criteria, 199 of whom also completed the 4-week follow-up. Consistent with our predictions, we found that directly after the more socially interactive experience, participants' feelings of connectedness increased more (p < 0.001), positive affect increased more (p = 0.002), feelings of loneliness decreased more (p < 0.001), social threat decreased more (p = 0.006), and negative affect decreased more (p = 0.003) than they did after the less interactive experience. However, change in trait loneliness between baseline and 4 weeks later did not differ between conditions (p = 0.953). Conclusions: Including socially interactive components in live video experiences can improve loneliness-related psychosocial outcomes for a short time. Future work should explore leveraging these benefits toward longer-term prosociality. Future work can also identify if the effects we observed generalize across different populations and kinds of online experiences.

Randomized controlled trial of an online machine learning-driven risk assessment and intervention platform for increasing the use of crisis services.

OBJECTIVE: Mental illness is a leading cause of disease burden; however, many barriers prevent people from seeking mental health services. Technological innovations may improve our ability to reach underserved populations by overcoming many existing barriers. We evaluated a brief, automated risk assessment and intervention platform designed to increase the use of crisis resources provided to those online and in crisis. METHOD: Participants, users of the digital mental health app Koko, were randomly assigned to treatment or control conditions upon accessing the app and were included in the study after their posts were identified by machine learning classifiers as signaling a current mental health crisis. Participants in the treatment condition received a brief Barrier Reduction Intervention (BRI) designed to increase the use of crisis service referrals provided on the app. Participants were followed up several hours later to assess the use of crisis services. RESULTS: Only about one quarter of participants in a crisis (21.8%) reported being "very likely" to use clinical referrals provided to them, with the most commonly endorsed barriers being they "just want to chat" or their "thoughts are too intense." Among participants providing follow-up data (41.3%), receipt of the BRI was associated with a 23% increase in the use of crisis services. CONCLUSION: These findings suggest that a brief, automated BRI can be efficacious on digital platforms, even among individuals experiencing acute psychological distress. The potential to increase help seeking and service utilization with such procedures holds promise for those in need of psychiatric services. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT03633825. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Helping Others Regulate Emotion Predicts Increased Regulation of One's Own Emotions and Decreased Symptoms of Depression.

Although much research considers how individuals manage their own emotions, less is known about the emotional benefits of regulating the emotions of others. We examined this topic in a 3-week study of an online platform providing training and practice in the social regulation of emotion. We found that participants who engaged more by helping others (vs. sharing and receiving support for their own problems) showed greater decreases in depression, mediated by increased use of reappraisal in daily life. Moreover, social regulation messages with more other-focused language (i.e., second-person pronouns) were (a) more likely to elicit expressions of gratitude from recipients and (b) predictive of increased use of reappraisal over time for message composers, suggesting perspective-taking enhances the benefits of practicing social regulation. These findings unpack potential mechanisms of socially oriented training in emotion regulation and suggest that by helping others regulate, we may enhance our own regulatory skills and emotional well-being.

Neural processes underlying self- and other-related lies: an individual difference approach using fMRI.

Two hypotheses were tested using a novel individual differences approach, which identifies rate-limiting brain regions, that is, brain regions in which variations in neural activity predict variations in behavioral performance. The first hypothesis is that the rate-limiting regions that support the production of lies about oneself (self-related) are partially distinct from those underlying the production of lies about other individuals (other-related). The second hypothesis is that a cingulate-insular-prefrontal network found to be rate-limiting for interference tasks is involved in both types of lies. The results confirmed both hypotheses and supported the utility of this individual differences approach in the study of deception in particular, as well in the study of complex cognitive phenomena more generally.