Mindfulness Focused Stress Management Chatbot (MISHA) for Students: Pilot Randomized Controlled Trial (Preprint)
Journal
JMIR Preprints
Type
journal article
Date Issued
2023
Author(s)
Abstract
BACKGROUND
Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents (CAs) in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for stressed students remains limited.
OBJECTIVE
This study aimed to develop a CA-delivered stress-management coaching intervention for students called MISHA, and to evaluate the effectiveness, engagement, and acceptance.
METHODS
In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited online. By a 1.1 randomization, participants (N=140) were allocated to the intervention or wait-list control group. Treatment effectiveness on changes on primary outcome perceived stress, and secondary outcomes depression, anxiety, psychosomatic symptoms, and active coping, were evaluated using analyses of variance (ANOVA) and general estimating equations (GEE).
RESULTS
The per protocol (PP) analysis revealed evidence for improvement of stress, depression, and somatic symptoms with effects ranging from medium to medium-large (d=0.54 to d=0.67), while anxiety, and active coping did not change significantly (d=0.37; d=0.39). In the intention to treat (ITT) analysis, we found evidence for reduced stress (β=–0.13, 95% CI –0.20 to –0.05, P<.001), depressive symptoms (β=–0.23, 95% CI –0.38 to –0.08, P=.003), and psychosomatic symptoms (β=–0.16, 95% CI = –0.27 to –0.06, P=.003), while anxiety, and active comping did change. Overall, 60% of participants in the intervention group completed the coaching by completing the outro. The particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated lowest, the target group fitting was perceived high.
CONCLUSIONS
Findings indicate that MISHA is feasible, acceptable and effective in reducing perceived stress among students in Switzerland. Future research is needed for different populations, for example in students with high stress levels or compared to active controls.
CLINICALTRIAL
German Clinical Trials Register DRKS 00030004; Swiss Ethics BASEC-Nr. Req-2020-01038
Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents (CAs) in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for stressed students remains limited.
OBJECTIVE
This study aimed to develop a CA-delivered stress-management coaching intervention for students called MISHA, and to evaluate the effectiveness, engagement, and acceptance.
METHODS
In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited online. By a 1.1 randomization, participants (N=140) were allocated to the intervention or wait-list control group. Treatment effectiveness on changes on primary outcome perceived stress, and secondary outcomes depression, anxiety, psychosomatic symptoms, and active coping, were evaluated using analyses of variance (ANOVA) and general estimating equations (GEE).
RESULTS
The per protocol (PP) analysis revealed evidence for improvement of stress, depression, and somatic symptoms with effects ranging from medium to medium-large (d=0.54 to d=0.67), while anxiety, and active coping did not change significantly (d=0.37; d=0.39). In the intention to treat (ITT) analysis, we found evidence for reduced stress (β=–0.13, 95% CI –0.20 to –0.05, P<.001), depressive symptoms (β=–0.23, 95% CI –0.38 to –0.08, P=.003), and psychosomatic symptoms (β=–0.16, 95% CI = –0.27 to –0.06, P=.003), while anxiety, and active comping did change. Overall, 60% of participants in the intervention group completed the coaching by completing the outro. The particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated lowest, the target group fitting was perceived high.
CONCLUSIONS
Findings indicate that MISHA is feasible, acceptable and effective in reducing perceived stress among students in Switzerland. Future research is needed for different populations, for example in students with high stress levels or compared to active controls.
CLINICALTRIAL
German Clinical Trials Register DRKS 00030004; Swiss Ethics BASEC-Nr. Req-2020-01038
Division(s)