Stress Management with a Virtual Health Coach

This study will take place entirely online. The questionnaires will be administered using Qualtrics software. The virtual health coach is programmed and designed using software provided by Soul Machines, and participants will access the consultation on a website supported by Soul Machines. Participants will be informed that the present study will explore the usefulness of a virtual health coach for helping people with stress management. Yet, the true primary objective is to investigate whether a stress management plan negotiated with a virtual health coach will positively influence their adherence to recommendations. In addition, participants will not be informed of the different conditions or their allocated group. This method ensures that participants do not adhere to their stress management plan differently because they know this factor is being assessed. A negotiated plan refers to a treatment regimen that is collaboratively developed by both the patient and their physician. Participants in the intervention condition will respond to a consultation script that follows the framework outlined by Gask & Underwood (2002). The virtual health coach first ascertains the participant’s expectations about their treatment by asking how much they know about stress management. The virtual health coach then suggests two stress management techniques for the participant: physical and relaxation exercises. For both approaches, the virtual health coach elicits the participant’s preferences by asking about the type of outcome they would hope to gain from these techniques. The virtual health coach will make recommendations seemingly based on these preferences. Finally, the virtual health coach will check with the participant to ensure they are clear about their treatment plan and advise on contingency management (e.g. “If you miss a day, just do it the next day”). These consultations will be individually delivered, once only. These consultations will be administered entirely online. They should take no longer than 10 minutes. Regardless of participants’ preferences, the virtual health coach will always recommend the same stress management plan: 15 minutes of mindful walking five times a week and 10 minutes of progressive muscle relaxation exercises once a day. Participants are recommended to engage in this stress management plan over 4 weeks. In fact, all participants will receive the same stress management plan, but it will be presented differently in each condition. The reason all participants are given the same recommendations is that any variation would create confounding factors (e.g. participants may be more willing to adhere to one exercise than another) that would affect the outcomes of the study. The virtual health coach will give the intervention group a plan that displays a range of exercises with their recommendations circled, to reinforce the perception that these recommendations are specific to the participant. In comparison, the control group will receive a copy of their treatment plan that only displays their recommended exercises. This approach is based on a study conducted by Bashyam et al. in which similar placebo-tailored treatment plans improved patient satisfaction, perception of personalisation and willingness to adhere (2020). This study's stress management plan has been specifically developed using the following evidence. As part of their stress management plan, participants will be recommended to engage in mindful walking for 15 minutes, 5 times a week. This exercise involves walking in nature while deeply experiencing one’s surroundings and being physically present rather than focusing on a destination (Kabat-Zinn, 2017). In their systematic review, Kondo et al. assert that studies using self-report measures and stress biomarkers provide convincing evidence that time spent in outdoor environments reduces the experience of stress (2018). In particular, most studies that asked participants to walk through a forest or a park for 15-30 minutes demonstrated notable reductions in stress measures. Physical exercise is also a known moderator of stress (Flueckiger et al., 2016). The present study combines this practice with Kabat-Zinn’s walking meditation resources (2017). Kabat-Zinn leads an extensive body of literature regarding mindfulness and developed the evidence-based mindfulness-based stress reduction (MBSR) program. Participants will walk outside while listening to an audio track that guides them through mindfulness techniques. Participants will also be recommended to engage in progressive muscle relaxation (PMR) exercises for 10 minutes, once a day. PMR involves tensing and relaxing the muscle groups, one at a time. This relaxation technique helps people manage the physical effects of stress and in doing so, relax their minds. There is substantial evidence supporting the efficacy of progressive muscle relaxation as a technique for reducing stress, with meta-analyses showing greater effect sizes for PMR than other techniques (Manzoni et al., 2008). Participants will also receive advice regarding healthy eating and sleeping to provide participants with a fully evidence-based stress management plan. The virtual health coach will provide resources, including short audio tracks and written guides, to support participants in the recommended mindful walking and progressive muscle relaxation exercises. These resources are provided on a website where all participants must create an account to access them. Whether participants create an account and the number of times they click on the resources will provide the researchers with an objective measure of their adherence to the stress management plan. Participants will be debriefed at 4-weeks post-consultation after completing follow-up questionnaires.