Relational Agents in Mental Health

  • Hannah Gaffney

Student thesis: Doctor of Clinical Psychology


Demand for psychological treatment still far outstrips supply. Digital options for intervention are evolving rapidly. Software programs called relational agents use artificial intelligence to emulate conversation through text or speech. Relational agent interventions have been developed to treat a range of mental health problems, however, there is little consensus on whether this type of intervention is acceptable to clients or efficacious. Paper one systematically reviewed the literature on relational agent interventions in the treatment of mental health problems. The thirteen included studies were diverse in design and aimed to treat a broad range of mental health problems using an eclectic variety of therapeutic orientations and formats. Their potential to provide acceptable and efficacious mental health support without human therapist input appears promising. However, more robust study designs, comparison with existing or alternative intervention formats and clarity over their mechanisms of action is required to demonstrate and maximise efficacy and efficiency. It remains mostly unclear how psychological interventions achieve their effects and what it is about therapy that clients find helpful. A relational agent intervention called Manage Your Life Online (MYLO) emulates a transdiagnostic cognitive therapy called the Method of Levels (MOL). MOL arises from a theoretical approach called Perceptual Control Theory (PCT). The primary aim of Paper two was to explore participant experiences of the process of intervention with MYLO from a theory driven, PCT perspective. A multi-method approach was used to elucidate what people find helpful or hindering during intervention with MYLO. Fifteen participants with a variety of mental health related problems appeared to find MYLO acceptable. Consistent with core processes of psychological change according to PCT, questions which enabled free expression, increased awareness and novel insights were associated with helpfulness. In contrast, questions eliciting intense emotions, which were confusing or inappropriate or repetitive were unhelpful and associated with disengagement or loss of faith in the MYLO intervention. Findings provide insight into how to optimise the acceptability and efficiency of MYLO and support the transdiagnostic processes outlined in PCT. Critical appraisal of the processes and rationale for Papers one and two is conducted in Paper three alongside broader reflections on the contributions of both papers to the evidence base, implications for clinical practice and future research directions.
Date of Award31 Dec 2019
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorSara Tai (Supervisor) & Warren Mansell (Supervisor)

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