Evidence of Human-Level Bonds Established With a Digital Conversational Agent: Cross-sectional, Retrospective Observational Study

We aimed to investigate whether users of a cognitive behavioral therapy (CBT)–based conversational agent would report therapeutic bond levels that are similar to those in literature about other CBT modalities, including face-to-face therapy, group CBT, and other digital interventions that do not use a conversational agent.

Although bonds are often presumed to be the exclusive domain of human therapeutic relationships, our findings challenge the notion that digital therapeutics are incapable of establishing a therapeutic bond with users. Future research might investigate the role of bonds as mediators of clinical outcomes, since boosting the engagement and efficacy of digital therapeutics could have major public health benefits.

Although the implicit assumption has been that the involvement of a human leads to improved outcomes in self-directed programs, human involvement limits these programs’ scalability and limits their accessibility for those who live in remote locations [4]. If digital interventions could replicate some of the factors that are generally believed to be uniquely human, such as therapeutic rapport, these interventions would have greater potential for improving mental health.

Intriguingly, the study’s qualitative data suggested that users seemed to relate to the CA in a manner that was analogous to therapeutic rapport, which may have mediated users’ outcomes. For example, study participants reported that they felt cared for by the CA (eg, “Woebot felt like a real person that showed concern”), despite the fact that the tool’s scripts reminded users that Woebot is not a real person (Figure 1). Unfortunately however, the study did not formally assess the existence of a working alliance. This is a crucial factor because a strong working alliance between therapists and clients is considered to be predictive of positive outcomes, essential for the delivery of health care,