SimCoach Evaluation: A Virtual Human Intervention to Encourage Service-Member Help-Seeking for Posttraumatic Stress Disorder and Depression.

This article describes RAND Corporation researchers' assessment of SimCoach, a computer program featuring a virtual human that speaks and gestures in a video game-like interface, designed to encourage service members, especially those with signs or symptoms of posttraumatic stress disorder (PTSD) or depression, to seek help to improve their psychological health. The assessment included a formative component assessing SimCoach's design, development, and implementation approaches and a summative component assessing outcomes among participants in a user experience survey and a randomized controlled trial (RCT). Results of the formative evaluation identified both strengths and opportunities for improvement. For example, although SimCoach development processes were well-aligned with best practices for software engineering, SimCoach content development and evaluation processes could have been more tightly coupled to best practices in psychological health. The summative evaluation RCT did not show any SimCoach-related benefit in intent to seek help compared with that of control users not exposed to any intervention. However, secondary outcomes indicated that SimCoach users had satisfying experiences without distress. If SimCoach development is continued, greater attention to clinical processes and outcomes is needed so that the program can have its intended impact on help-seeking for PTSD and depression.

[1]  Ryen W. White,et al.  Understanding web browsing behaviors through Weibull analysis of dwell time , 2010, SIGIR.

[2]  K. van Rosmalen-Nooijens,et al.  “Young people, adult worries”: RCT of an internet-based self-support method “Feel the ViBe” for children, adolescents and young adults exposed to family violence, a study protocol , 2013, BMC Public Health.

[3]  M. Bruce.  Suicide risk and prevention in veteran populations , 2010, Annals of the New York Academy of Sciences.

[4]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[5]  Patrick Kenny,et al.  SimCoach: an intelligent virtual human system for providing healthcare information and support , 2011 .

[6]  David DeVault,et al.  Towards Natural Language Understanding of Partial Speech Recognition Results in Dialogue Systems , 2009, HLT-NAACL.

[7]  H. Bayır,et al.  Bench-to-bedside review: Mitochondrial injury, oxidative stress and apoptosis – there is nothing more practical than a good theory , 2008, Critical Care.

[8]  Stephanie L. Shimada,et al.  Veteran internet use and engagement with health information online. , 2013, Military medicine.

[9]  Charles W Hoge,et al.  Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. , 2006, JAMA.

[10]  Thomas W. Britt,et al.  Stigma, Negative Attitudes About Treatment, and Utilization of Mental Health Care Among Soldiers , 2011 .

[11]  Abdul Ghaaliq Lalkhen,et al.  Clinical tests: sensitivity and specificity , 2008 .

[12]  Murray B Stein,et al.  An abbreviated PTSD checklist for use as a screening instrument in primary care. , 2005, Behaviour research and therapy.

[13]  R. Kravitz,et al.  Suicide Inquiry in Primary Care: Creating Context, Inquiring, and Following Up , 2010, The Annals of Family Medicine.

[14]  R. Ruff,et al.  Mild traumatic brain injury in U.S. soldiers returning from Iraq. , 2008, The New England journal of medicine.

[15]  Dawne Vogt,et al.  Mental health-related beliefs as a barrier to service use for military personnel and veterans: a review. , 2011, Psychiatric services.

[16]  J. Prochaska,et al.  Transtheoretical therapy: Toward a more integrative model of change. , 1982 .

[17]  Heidi Zinzow,et al.  Internet-based interventions for traumatic stress-related mental health problems: a review and suggestion for future research. , 2009, Clinical psychology review.

[18]  Lynda A. King,et al.  PTSD symptom increases in Iraq-deployed soldiers: comparison with nondeployed soldiers and associations with baseline symptoms, deployment experiences, and postdeployment stress. , 2010, Journal of traumatic stress.

[19]  Amy Belasco.  The Cost of Iraq, Afghanistan, and Other Global War on Terror Operations Since 9/11 , 2011 .

[20]  C. Sherbourne,et al.  Abbreviated PTSD Checklist (PCL) as a guide to clinical response. , 2012, General hospital psychiatry.

[21]  F. Rotgers.  Motivational Interviewing: Preparing People to Change Addictive Behavior , 1993 .

[22]  Eric Chance,et al.  Embodied Conversational Agent Avatars in Virtual Worlds: Making Today's Immersive Environments More Responsive to Participants , 2012, Believable Bots.

[23]  Francis Hamilton,et al.  An assessment of beliefs about mental health care among veterans who served in Iraq. , 2007, Psychiatric services.

[24]  Stacy Marsella,et al.  Nonverbal Behavior Generator for Embodied Conversational Agents , 2006, IVA.

[25]  J. Daley,et al.  Barriers to veterans health administration care in a nationally representative sample of women veterans , 2006, Journal of General Internal Medicine.

[26]  D. Wingard,et al.  Prior Assault and Posttraumatic Stress Disorder After Combat Deployment , 2008, Epidemiology.

[27]  Bruce Neal,et al.  Rethinking the Dose-Response Relationship Between Usage and Outcome in an Online Intervention for Depression: Randomized Controlled Trial , 2013, Journal of medical Internet research.

[28]  David DeVault,et al.  A Mixed-Initiative Conversational Dialogue System for Healthcare , 2012, SIGDIAL Conference.

[29]  B. Shiner,et al.  Treatment-seeking barriers for veterans of the Iraq and Afghanistan conflicts who screen positive for PTSD. , 2013, Psychiatric services.

[30]  P. Cuijpers,et al.  Internet-based treatment of major depression for patients on a waiting list for inpatient psychotherapy: protocol for a multi-centre randomised controlled trial , 2013, BMC Psychiatry.

[31]  Charles Marmar,et al.  Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. , 2007, Archives of internal medicine.

[32]  J. Annon.  The PLISSIT Model: A Proposed Conceptual Scheme for the Behavioral Treatment of Sexual Problems , 1976 .

[33]  H. Christensen,et al.  A systematic review of help-seeking interventions for depression, anxiety and general psychological distress , 2012, BMC Psychiatry.

[34]  H. Chad Lane,et al.  Virtual Humans for Learning , 2013, AI Mag..

[35]  P. Sandercock,et al.  Framework for design and evaluation of complex interventions to improve health , 2000, BMJ : British Medical Journal.

[36]  S. Marsella,et al.  Interactive Pedagogical Drama for Health Interventions , 2003 .

[37]  JoAnn Difede,et al.  Virtual Reality Applications to Address the Wounds of War , 2013 .

[38]  Nina M. Serafino,et al.  Peacekeeping And Related Stability Operations , 2005 .

[39]  Anthony L. Cox,et al.  Perceived Stigma and Barriers to Care for Psychological Treatment: Implications for Reactions to Stressors in Different Contexts , 2008 .

[40]  J. Green,et al.  The role of theory in evidence-based health promotion practice. , 2000, Health education research.

[41]  C. Hoge,et al.  Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. , 2004, U.S. Army Medical Department journal.

[42]  Stacy Marsella,et al.  SmartBody: behavior realization for embodied conversational agents , 2008, AAMAS.

[43]  Daniel B. Horn,et al.  Are Soldiers Gamers? Videogame Usage among Soldiers and Implications for the Effective Use of Serious Videogames for Military Training , 2010 .

[44]  Edward F Bruner.  Military Forces: What is the Appropriate Size for the United States? , 2005 .