Maintained effectiveness of a smartphone-based chatbot coach (BalanceUP) for mental well-being in headache sufferers: preliminary findings from a single-arm 6-month follow-up study.

BACKGROUND

Behavioral interventions delivered by smartphones have been proven effective in improving physical and mental well-being in clinical and non-clinical samples. However, it remains unclear whether improvements are sustained after intervention completion. This single-arm study evaluated the sustained effectiveness of BalanceUP, a smartphone-based coaching intervention delivered by a conversational agent (CA), for people suffering from frequent headaches.

METHODS

Following a randomized controlled trial, where an intervention group was compared with a waitlist control group, this within-group comparison examined follow-up results of all participants who participated in the coaching program. Measurements were taken pre-, post-, and 6 months after intervention start. Changes in the primary outcome mental well-being [Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)] and secondary outcomes (psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presentism, absenteeism, pain coping) were analyzed using repeated measure analysis of variance (ANOVA) and Cohen's d. Additionally, baseline predictors of improvement were explored.

RESULTS

Of 179 headache sufferers who started coaching [mean age 39.2 years, standard deviation (SD) 11.8 years; 157/179, 87.7% women], 117 (65.4%) completed the intervention and 67 (36.3%) provided 6-month follow-up data. Improvements in mental well-being were maintained at follow-up with a medium effect size (Cohen d=-0.54). Secondary outcomes also showed sustained improvements with effects ranging from small to medium (d=-0.24 to 0.70), including depression, anxiety, somatic symptoms, perceived stress, headache management self-efficacy, application of behavior change techniques, absenteeism/presentism, as well as pain coping skills. Higher baseline stress and presenteeism were associated with greater improvements in well-being.

CONCLUSIONS

These preliminary findings suggest the potential for CA-delivered coaching to support improvements in mental well-being and psychological functioning over time. However, the uncontrolled study design, attrition at follow-up, and other methodological limitations require cautious interpretation of the findings. More methodologically robust controlled studies are essential to establish the sustained effectiveness of digital behavioral interventions before drawing definitive conclusions.