Overview

We used an iterative, human-centered approach to designing our chatbot suite (Table 1). The initial chatbot scripts were developed in a 4-hour workshop with the aid of 6 novice designers, curated by a clinical psychologist, and tested for quality purposes by conducting simulations in which pairs of designers acted as users and chatbots. Each chatbot relied on a decision tree to facilitate conversations, usually resulting in the user providing a response to a series of open-ended (eg, What is the worst-case scenario for [a stressor]?), yes-no (eg, Has [the stressor] affected your sleep?), or numerical (eg, What is the severity of a scenario?) questions (Textbox 1). Stress management literature—particularly literature related to CBT techniques [26,41,42]—was used to derive conversations for stress relief. Using this approach, our novice design team created chatbots based on three techniques (ie, worst-case scenario, problem solving, and positive thinking). The total development time (ie, including design, curation, and quality assurance steps) was approximately 8 hours. We then evaluated the feasibility of our chatbot system against a control condition in a Wizard of Oz (WOZ) pilot study with 14 users (Multimedia Appendix 1). We observed that the participants in the condition with multiple chatbots tended to agree to a greater degree that the intervention helped to reduce their stress compared with those in the control condition with a single chatbot; however, follow-up interviews revealed that the participants still expected chatbots to act in human-like ways. The lessons learned from this pilot study were used to refine our chatbot scripts, and they also informed the development and implementation of our web-based system.

Prototype chatbot names, their techniques, and the studies in which they were used.

The script used by Doom Bot

Tell me more details about [problem]?

I’m sorry to hear that. What are you most afraid might happen as a result?

Alright, on a scale of 1 to 10, 1 being impossible, 10 being certain, how likely is this scenario?

Alright, in the case that this happens, what could you do to get back on track?

Cool, looks like you have a plan B. Just remember, though you cannot control everything, there is a way to get back on your feet.