Chaitali Sinha

Tata Institute of Social Sciences, Clinical Psychology, Alumna

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A psychologist working primarily with digital mental health, trauma and global mental health. Building clinical support at scale with Wysa.

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Evaluating the Therapeutic Alliance With a Free-Text CBT Conversational Agent (Wysa): A Mixed-Methods Study

Frontiers in Digital Health, 2022

The present study aims to examine whether users perceive a therapeutic alliance with an AI conver... more The present study aims to examine whether users perceive a therapeutic alliance with an AI conversational agent (Wysa) and observe changes in the t‘herapeutic alliance over a brief time period. A sample of users who screened positively on the PHQ-4 for anxiety or depression symptoms (N = 1,205) of the digital mental health application (app) Wysa were administered the WAI-SR within 5 days of installing the app and gave a second assessment on the same measure after 3 days (N = 226). The anonymised transcripts of user's conversations with Wysa were also examined through content analysis for unprompted elements of bonding between the user and Wysa (N = 950). Within 5 days of initial app use, the mean WAI-SR score was 3.64 (SD 0.81) and the mean bond subscale score was 3.98 (SD 0.94). Three days later, the mean WAI-SR score increased to 3.75 (SD 0.80) and the mean bond subscale score increased to 4.05 (SD 0.91). There was no significant difference in the alliance scores between Assessment 1 and Assessment 2.These mean bond subscale scores were found to be comparable to the scores obtained in recent literature on traditional, outpatient-individual CBT, internet CBT and group CBT. Content analysis of the transcripts of user conversations with the CA (Wysa) also revealed elements of bonding such as gratitude, self-disclosed impact, and personification. The user's therapeutic alliance scores improved over time and were comparable to ratings from previous studies on alliance in human-delivered face-to-face psychotherapy with clinical populations. This study provides critical support for the utilization of digital mental health services, based on the evidence of the establishment of an alliance.

Evaluating User Feedback for an Artificial Intelligence–Enabled, Cognitive Behavioral Therapy–Based Mental Health App (Wysa): Qualitative Thematic Analysis

by Tanya Malik and Chaitali Sinha

JMIR Human Factors, 2022

Background: Digital mental health apps are rapidly becoming a common source of accessible support... more Background:
Digital mental health apps are rapidly becoming a common source of accessible support across the world, but their effectiveness is often influenced by limited helpfulness and engagement.

Objective:
This study’s primary objective was to analyze feedback content to understand users’ experiences with engaging with a digital mental health app. As a secondary objective, an exploratory analysis captured the types of mental health app users.

Methods:
This study utilized a user-led approach to understanding factors for engagement and helpfulness in digital mental health by analyzing feedback (n=7929) reported on Google Play Store about Wysa, a mental health app (1-year period). The analysis of keywords in the user feedback categorized and evaluated the reported user experience into the core domains of acceptability, usability, usefulness, and integration. The study also captured key deficits and strengths of the app and explored salient characteristics of the types of users who benefit from accessible digital mental health support.

Results:
The analysis of user feedback found the app to be overwhelmingly positively reviewed (6700/7929, 84.50% 5-star rating). The themes of engaging exercises, interactive interface, and artificial intelligence (AI) conversational ability indicated the acceptability of the app, while the nonjudgmentality and ease of conversation highlighted its usability. The app’s usefulness was portrayed by themes such as improvement in mental health, convenient access, and cognitive restructuring exercises. Themes of privacy and confidentiality underscored users’ preference for the integrated aspects of the app. Further analysis revealed 4 predominant types of individuals who shared app feedback on the store.

Conclusions:
Users reported therapeutic elements of a comfortable, safe, and supportive environment through using the digital mental health app. Digital mental health apps may expand mental health access to those unable to access traditional forms of mental health support and treatments.

Delivery of a Mental Health Intervention for Chronic Pain Through an Artificial Intelligence–Enabled App (Wysa): Protocol for a Prospective Pilot Study

by Chaitali Sinha and Tanya Malik

JMIR Research Protocols, 2022

Background: Patients with chronic pain often experience coexisting, long-term and debilitating me... more Background:
Patients with chronic pain often experience coexisting, long-term and debilitating mental health comorbidities such as depression and anxiety. Artificial intelligence–supported cognitive behavioral therapy (AI-CBT) interventions could offer cost-effective, accessible, and potentially effective resources to address this problem. However, there is not enough research conducted about the efficacy of AI-CBT interventions for chronic pain.

Objective:
This prospective cohort study aims to examine the efficacy and use of an AI-CBT intervention for chronic pain (Wysa for Chronic Pain app, Wysa Inc) using a conversational agent (with no human intervention). To the best of our knowledge, this is the first such study for chronic pain using a fully-automated, free-text–based conversational agent.

Methods:
Participants with self-reported chronic pain (n=500) will be recruited online on a rolling basis from April 2022 through posts on US-based internet communities within this prospective cohort. Informed consent is received from participants within the app, and the Wysa for Chronic Pain intervention is delivered remotely for 8 weeks. Outcome measures including a numeric pain rating scale and Patient-Reported Outcomes Measurement Information System–Pain Interference, Generalized Anxiety Disorder–7, and Patient Health Questionnaire–9 questionnaires administered to test the effectiveness of the intervention on reducing levels of pain interference, depression, and anxiety. The therapeutic alliance created with the conversational agent will be assessed through the Working Alliance Inventory–Short Revised instrument. Retention and use statistics will be observed for adherence and engagement.

Results:
The study will open for recruitment in April 2022, and data collection is expected to be completed by August 2022. The results for the primary outcomes are expected to be published by late 2022.

Conclusions:
Mental health conversational agents driven by artificial intelligence could be effective in helping patients with chronic pain learn to self-manage their pain and common comorbidities like depression and anxiety. The Wysa for Chronic Pain app is one such digital intervention that can potentially serve as a solution to the problems of affordability and scalability associated with interventions that include a human therapist. This prospective study examines the efficacy of the app as a treatment solution for chronic pain. It aims to inform future practices and digital mental health interventions for individuals with chronic pain.

The Co-Construction of Marital Intimacy: Narratives from Garhwal

The present study explored the narratives of couples from villages in Garhwal. Through the use of... more The present study explored the narratives of couples from villages in Garhwal. Through the use of in-depth interviews, an attempt was made to examine the notions of intimacy as understood by them, the process of co-constructing this intimacy within their culture and marriage, and the factors that mediated this process. The interviews were conducted separately with each individual, and the dyad together to understand the separations and negotiations between their selves, the relationships and the social framework. The transcripts were analyzed using thematic analysis, and the social constructionist stance, following which salient findings were discussed under the broad categories that emerged. Intimacy was redefined for this context by the respondents, in terms of aspects that added to the individual‟s sense of stability and harmony. A lopsided picture of co-construction emerged; men almost single-handedly decided the course and nature of the couple‟s lives and realities. Women rarely had a voice, and had to negotiate with the implicit powers of persuasion and diplomacy to make room for themselves in the stories. The factors mediating these notions gave insights into the diffused understanding of religion and the dissonant alternatives offered by cinema and their rejection. The society and family were recognized as overwhelmingly powerful structures which were deeply internalized and affected the functioning of all spheres. The collapse of the private spheres into a singular social sphere, had occurred due to the lack of exits and options present in this culture; the privilege of exploration and choice was not present, providing implications for couples therapy and theoretical approaches.

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