Skip to main content
Log in

Verbal empathy and explanation to encourage behaviour change intention

  • Original Paper
  • Published:
Journal on Multimodal User Interfaces Aims and scope Submit manuscript

Abstract

Inspired by the role of therapist-patient relationship in fostering behaviour change, agent-human relationship has been an active research area. This trusted relationship could be a result of the agent’s behavioural cues or the content it delivers that shows its knowledge. However, the impact of the resulting relationship using the various strategies on behaviour change is understudied. In this paper, we investigate the role of two strategies (empathic and social dialogue and explanation) in building agent-user rapport and whether the level of behaviour change intentions are due to the use of empathy or to trusting the agent’s understanding and recommendations through explanation. Hence, we designed two versions of a virtual advisor, empathic and neutral, to reduce study stress among university students and measured students’ rapport levels and intentions to change their behaviour. Some recommended behaviours had explanations based on the user’s beliefs. Our results showed that the agent could build a trusting relationship with the user with the help of the explanation regardless of the level of rapport. The results further showed that nearly all of the recommendations provided by the agent highly significantly increased the intention of the user to change their behavior related to these recommendations. However, we also found that it is important for the agent to obtain and reason about the user’s intentions concerning the specific behaviour before recommending a certain behavior change.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bailenson JN, Yee N (2005) Digital chameleons: automatic assimilation of nonverbal gestures in immersive virtual environments. Psychol Sci 16(10):814–819

    Article  Google Scholar 

  2. Bickmore T, Gruber A, Picard R (2005) Establishing the computer-patient working alliance in automated health behavior change interventions. Patient Educ Couns 59(1):21–30

    Article  Google Scholar 

  3. Bickmore TW, Picard RW (2005) Establishing and maintaining long-term human-computer relationships. ACM Trans Comput-Human Interact 12(2):293–327

    Article  Google Scholar 

  4. Bickmore TW, Pfeifer LM, Paasche-Orlow MK (2009) Using computer agents to explain medical documents to patients with low health literacy. Patient Educ Couns 75(3):315–320

    Article  Google Scholar 

  5. Bordin ES (1979) The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy 16(3):252

    Article  Google Scholar 

  6. Broekens J, Harbers M, Hindriks K, Van Den Bosch K, Jonker C, Meyer JJ (2010) Do you get it? user-evaluated explainable bdi agents. In: German conference on multiagent system technologies, Springer, pp 28–39

  7. Bruffaerts R, Mortier P, Kiekens G, Auerbach RP, Cuijpers P, Demyttenaere K, Green JG, Nock MK, Kessler RC (2018) Mental health problems in college freshmen: prevalence and academic functioning. J Affect Disord 225:97–103

    Article  Google Scholar 

  8. Bylund CL, Makoul G (2005) Examining empathy in medical encounters: an observational study using the empathic communication coding system. Health Commun 18(2):123–140

    Article  Google Scholar 

  9. Carver CS, Connor-Smith J (2010) Personality and coping. Annu Rev Psychol 61:679–704

    Article  Google Scholar 

  10. Chacón-Cuberos R, Zurita-Ortega F, Olmedo-Moreno EM, Castro-Sánchez M (2019) Relationship between academic stress, physical activity and diet in university students of education. Behav Sci 9(6):59

    Article  Google Scholar 

  11. Conner M (2008) Initiation and maintenance of health behaviors. Appl Psychol 57(1):42–50

    Article  Google Scholar 

  12. DeVault D, Artstein R, Benn G, Dey T, Fast E, Gainer A, Georgila K, Gratch J, Hartholt A, Lhommet M, et al. (2014) Simsensei kiosk: a virtual human interviewer for healthcare decision support. In: Proceedings of the 2014 international conference on Autonomous agents and multi-agent systems, international foundation for autonomous agents and multiagent systems, pp 1061–1068

  13. Dias J, Mascarenhas S, Paiva A (2014) Fatima modular: towards an agent architecture with a generic appraisal framework. In: Emotion modeling, Springer, pp 44–56

  14. Feighny K, Arnold L, Monaco M, Munro S, Earl B (1998) In pursuit of empathy and its relationship to physician communication skills: multidimensional empathy training for medical students. Ann Behav Sci Med Educ 5:13–21

    Google Scholar 

  15. Gilbert SP, Weaver CC (2010) Sleep quality and academic performance in university students: a wake-up call for college psychologists. J College Stud Psychother 24(4):295–306

    Article  Google Scholar 

  16. Glass A, McGuinness DL, Wolverton M (2008) Toward establishing trust in adaptive agents. In: Proceedings of the 13th international conference on Intelligent user interfaces, ACM, pp 227–236

  17. Gratch J, Okhmatovskaia A, Lamothe F, Marsella S, Morales M, van der Werf RJ, Morency LP (2006) Virtual rapport. In: International workshop on intelligent virtual agents, Springer, pp 14–27

  18. Gratch J, Wang N, Gerten J, Fast E, Duffy R (2007) Creating rapport with virtual agents. In: International workshop on intelligent virtual agents, Springer, pp 125–138

  19. Guerini M, Stock O, Zancanaro M, O’Keefe DJ, Mazzotta I, de Rosis F, Poggi I, Lim MY, Aylett R (2011) Approaches to verbal persuasion in intelligent user interfaces. In: Emotion-oriented systems, Springer, pp 559–584

  20. Hamari J, Koivisto J, Pakkanen T (2014) Do persuasive technologies persuade?-a review of empirical studies. In: International conference on persuasive technology, Springer, pp 118–136

  21. Harman K, MacRae M, Vallis M, Bassett R (2014) Working with people to make changes: a behavioural change approach used in chronic low back pain rehabilitation. Physiother Can 66(1):82–90

    Article  Google Scholar 

  22. Hoffman RR, Klein G, Mueller ST (2018) Explaining explanation for “explainable ai”. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, SAGE Publications Sage CA: Los Angeles, CA vol 62, pp 197–201

  23. Hojat M (2007) Empathy in patient care: antecedents, development, measurement, and outcomes. Springer Science & Business Media

  24. Huang L, Morency LP, Gratch J (2011) Virtual rapport 2.0. In: International workshop on intelligent virtual agents, Springer, pp 68–79

  25. Hunt J, Eisenberg D (2010) Mental health problems and help-seeking behavior among college students. J Adolesc Health 46(1):3–10

    Article  Google Scholar 

  26. Kaptein F, Broekens J, Hindriks K, Neerincx M (2017) Personalised self-explanation by robots: The role of goals versus beliefs in robot-action explanation for children and adults. In: 2017 26th IEEE International symposium on robot and human interactive communication (RO-MAN), IEEE, pp 676–682

  27. Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer publishing company

  28. Lipson SK, Eisenberg D (2018) Mental health and academic attitudes and expectations in university populations: results from the healthy minds study. J Mental Health 27(3):205–213

    Article  Google Scholar 

  29. Lisetti C, Amini R, Yasavur U, Rishe N (2013) I can help you change! an empathic virtual agent delivers behavior change health interventions. ACM Trans Manage Inf Syst 4(4):19:1–19:28, https://doi.org/10.1145/2544103, http://doi.acm.org/10.1145/2544103

  30. Lucas GM, Gratch J, King A, Morency LP (2014) It’s only a computer: virtual humans increase willingness to disclose. Comput Hum Behav 37:94–100

    Article  Google Scholar 

  31. Lyons JB, Clark MA, Wagner AR, Schuelke MJ (2017) Certifiable trust in autonomous systems: Making the intractable tangible. AI Magazine 38(3):37–49

    Article  Google Scholar 

  32. Malle BF (1999) How people explain behavior: a new theoretical framework. Personal Soc Psychol Rev 3(1):23–48

    Article  Google Scholar 

  33. Matterne U, Diepgen TL, Weisshaar E (2011) A longitudinal application of three health behaviour models in the context of skin protection behaviour in individuals with occupational skin disease. Psychol Health 26(9):1188–1207

    Article  Google Scholar 

  34. Mercado JE, Rupp MA, Chen JY, Barnes MJ, Barber D, Procci K (2016) Intelligent agent transparency in human-agent teaming for multi-uxv management. Hum Factors 58(3):401–415

    Article  Google Scholar 

  35. Moulin B, Irandoust H, Bélanger M, Desbordes G (2002) Explanation and argumentation capabilities: towards the creation of more persuasive agents. Artif Intell Rev 17(3):169–222

    Article  Google Scholar 

  36. Ortony A, Clore GL, Collins A (1988) The cognitive structure of emotions. Cambridge Uni

  37. Paiva A, Leite I, Boukricha H, Wachsmuth I (2017) Empathy in virtual agents and robots: a survey. ACM Trans Interact Intell Syst 7(3):1–40

    Article  Google Scholar 

  38. Pettit ML, DeBarr KA (2011) Perceived stress, energy drink consumption, and academic performance among college students. J Am Coll Health 59(5):335–341

    Article  Google Scholar 

  39. Pieters W (2011) Explanation and trust: what to tell the user in security and ai? Ethics Inf Technol 13(1):53–64

    Article  Google Scholar 

  40. Preston SD, De Waal FB (2002) Empathy: its ultimate and proximate bases. Behav Brain Sci 25(1):1–20

    Article  Google Scholar 

  41. Von der Puetten AM, Krämer NC, Gratch J, Kang SH (2010) “it doesn’t matter what you are!” explaining social effects of agents and avatars. Comput Human Behav

  42. Ranjbartabar H, Richards D, Bilgin A, Kutay C (2019) First impressions count! the role of the human’s emotional state on rapport established with an empathic versus neutral virtual therapist. IEEE Trans Affect Comput

  43. Schulman D, Bickmore T (2009) Persuading users through counseling dialogue with a conversational agent. In: Proceedings of the 4th international conference on persuasive technology, ACM, p 25

  44. Shapiro F (2017) Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications

  45. Tanner BA (2012) Validity of global physical and emotional suds. Appl Psychophysiol Biofeedback 37(1):31–34

    Article  Google Scholar 

  46. Tintarev N, Masthoff J (2011) Designing and evaluating explanations for recommender systems. In: Recommender systems handbook, Springer, pp 479–510

  47. Walton D (2007) Dialogical models of explanation. ExaCt 2007:1–9

  48. Westmaas JL, Gil-Rivas V, Silver RC (2011) Designing and conducting interventions to enhance physical and mental health. The Oxford handbook of health psychology p 73

  49. Wilson EV (2003) Perceived effectiveness of interpersonal persuasion strategies in computer-mediated communication. Comput Hum Behav 19(5):537–552

    Article  Google Scholar 

  50. Xiao H, Carney DM, Youn SJ, Janis RA, Castonguay LG, Hayes JA, Locke BD (2017) Are we in crisis? national mental health and treatment trends in college counseling centers. Psychol Serv 14(4):407

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amal Abdulrahman.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

A Appendix

Rapport Questionnaire

  1. 1.

    I liked the character.

  2. 2.

    The character was weird.

  3. 3.

    I think the character and I established rapport.

  4. 4.

    I felt I had a connection with the character.

  5. 5.

    I think the character and I understood each other.

  6. 6.

    I would like to have someone like the character help me.

  7. 7.

    I would recommend the character to a friend.

  8. 8.

    I felt uncomfortable during the session.

  9. 9.

    I felt embarrassed during the session.

  10. 10.

    I had difficulty understanding the character.

  11. 11.

    I don’t like the way the character looks.

  12. 12.

    It would be difficult to virtually meet and talk with the character.

  13. 13.

    Communicating with the character felt natural.

  14. 14.

    This character was warm and caring.

  15. 15.

    Interacting with the character was believable.

  16. 16.

    The character was not empathic towards me.

  17. 17.

    I felt that the character was interested in what s/he was doing.

  18. 18.

    The character would be a poor problem solver.

  19. 19.

    I couldn’t get anything accomplished with the character.

  20. 20.

    I would be able to engage with the character.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdulrahman, A., Richards, D., Ranjbartabar, H. et al. Verbal empathy and explanation to encourage behaviour change intention. J Multimodal User Interfaces 15, 189–199 (2021). https://doi.org/10.1007/s12193-020-00359-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12193-020-00359-3

Keywords

Navigation