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Chatbot May Curb Anxiety Among Young Adults With Cancer

October 15, 2019

By Marilynn Larkin

NEW YORK—The Vivibot chatbot may reduce anxiety among young people who have been treated for cancer, a small feasibility study suggests.

"Given that (Vivibot) is engaging and available any time for free, it is worthy of recommending as part of a strategy to support the mental health of young people after cancer treatment," Dr. Danielle Ramo of Hopelab in San Francisco told Reuters Health by email.

Vivibot ( was developed by a team that included mental health professionals as well as teens and young adults living with cancer. Content includes four weeks of positive psychology skills, daily emotion ratings, video, and other material produced by survivors, as well as periodic feedback check-ins.

For the study, presented at the Society for Prevention Research in May and currently in press in the Journal of Medical Internet Research mHealth and uHealth, Dr. Ramo and colleagues recruited young adults (median age, 25; 80% female) within five years of completing active cancer treatment using the Vivibot chatbot on Facebook messenger.

Participants were on average 2.7 years post-diagnosis and 1.6 years post-completion of active cancer treatment. They were randomized to either immediate access to Vivibot content (experimental group; 25 participants) or access to only daily emotion ratings, then access to full chatbot content after four weeks (control). All were assessed for psychosocial well-being via online surveys at baseline and weeks 2, 4, and 8.

The rate of follow-up survey completion was 73% at two weeks; 73% at four weeks; and 58% at eight weeks. Higher completion rates were seen in the control group, reaching statistical significance in week 8: 75% in the control group, 44% in the experimental group.

Experimental group members spent an average of 74 minutes across an average of 12 active sessions chatting with Vivibot and rated their experience as helpful (mean 2.0/3) and would recommend it to a friend (mean 6.9/10).

Open-ended feedback noted the nonjudgmental nature of the chatbot as a particular benefit.

After four weeks, the experimental group had an average reduction in anxiety of 2.58 standardized t-score units, while the control group had an increase in anxiety of 0.7 units.

Experimental group members experienced greater reductions in anxiety when they engaged in more sessions.

However, there were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion.

"As of October 3, Vivibot has been transferred to our partner Gryt,, and will be part of their digital community for people diagnosed with cancer," Dr. Ramo said. "Gryt will support Vivibot through its desktop and mobile platforms."

"As Gryt's platform generates more users of Vivibot, we will be able to determine whether engagement and user behavior differs by cultural factors," she added. "Unfortunately, our initial trial was too small to look at that, but it is certainly something that is worth exploring in the future."

Dr. Timothy Sannes, a clinical psychologist at Dana-Farber Cancer Institute in Boston, commented in an email to Reuters Health, "The chatbot described here sounds very exciting and was ranked as generally useful and acceptable to these young adult cancer survivors."

"The results are preliminary and additional work will need to be done to verify whether the slight reductions in outcomes such as anxiety...can be replicated in a larger study," he said. "Nevertheless, this is a novel platform that may potentially harness other websites through which young adults are already engaged."

"Not everyone will engage with this type of technology," he noted. "Despite the promise of technology increasing our 'reach' as providers of supportive care, engaging those most in need and with the greatest distress remains a challenge."

"There also may be advantages to engaging with clinicians in person, as the alliance between providers and patients is related to a number of important outcomes after supportive interventions, such as adherence and improvements in depression," he added. "Larger studies that harness novel technologies, such as Vivibot, with other evidence-based treatments will continue to inform how we can meet young adult survivors in need."

The study was supported by the nonprofit Hopelab Foundation, which also developed Vivibot in collaboration with study coauthor Dr. Judith Moscowitz at Northwestern University. Dr. Ramo and the other coauthors are employed by Hopelab Foundation.


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