Virtual Therapists Help People Stay Adherent to Treatment

For clients with schizophrenia, maintaining their antipsychotic medication and clinical evaluations is sporadic and frequently results in non-compliance. “Factors contributing to non-adherence and partial adherence include medication side effects, severity of psychotic symptoms, impaired cognition, and inadequate understanding of the role of medication in preventing relapse,” said Kathryn Puskar, Ph.D. and Professor at the University of Pittsburgh School of Nursing. “Non-adherence to antipsychotic treatment is associated with lower global functioning, impaired insight, and greater number of inpatient days (44.8 days versus 20.6 days) compared with those who adhere to their antipsychotic treatment regimen.” New research has suggested that relational agents can improve client compliance. “Relational agents are typically deployed as software humanoid animated agents that can simulate face-to-face conversation with patients so that real-time dialogue, speech, gesture, gaze, and other verbal and nonverbal channels can be used to communicate therapeutic information,” said Puskar. These agents focus on caring and empathy and help clients stay on task with their medication and evaluations.

In a preliminary analysis of two participants from a study led by Puskar, relational agents have proven to be an effective mechanism for improving treatment adherence. Both subjects, a male and female, aged 54, used a laptop for 30 days to receive instructions from “Laura,” their relational agent. They were addressed by name and were engaged in conversation with Laura, and were encouraged to set their own medication schedule. At the end of the intervention, the male subject had increased his adherence from 21% to 46% and maintained that rate for several months. Additionally, the female participant increased her adherence rate to 100% at the end of the intervention and at each subsequent follow up. Puskar explained what the client reported about the intervention. “She said she had greater knowledge about her illness and the importance of taking her medication as prescribed and felt that Laura was ‘on her side.’” Puskar added, “The individual examples presented here, which were similar to the experiences of all study participants, indicate that use of modern technology by behavioral health nurses can be beneficial for patients.”

Puskar, Kathryn, Elizabeth A. Shlenk, Judith Callan, Timothy Bickmore, and Susan Sereika. “Relational Agents as an Adjunct in Schizophrenia Treatment.” Journal of Psychosocial Nursing & Mental Health Services 49.8 (2011): 22-29. Print.

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Claudia S

    Claudia S

    November 7th, 2011 at 5:17 PM

    Hey this is really great news! Especially for patients who need that kind of instant accountability this offers that to them.

  • Scott


    November 7th, 2011 at 11:36 PM

    When I’m ill it really makes me miss family and even a good friend who is by my side makes me feel so much better. Yes, I’m an adult but we all need support don’t we?

    And with the increasingly busy schedules that most of us have now it is not really practical to have someone by your side all the time and especially so for a long-term issue like this one.

    So using technology for the same sounds great. It gives a patient a sense of someone being their to look after them and the results confirm this.

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