Rachel Yim Fong Leung

Background: Parents of autistic children frequently experience elevated stress levels, depressive symptoms, and reduced well-being. Positive psychology interventions (PPIs) can strengthen resilience, and chatbots offer a scalable channel through which such skills can be delivered. However, evidence on the evaluation of large language model–guided PPI-based chatbots for this population is limited. Objective: This study evaluated the feasibility and acceptability of a GPT-powered chatbot (“Allie”). This study was designed to deliver culturally adapted PPIs to parents of autistic children and to explore their preliminary effects on well-being, depression, stress, and health-related quality of life. Methods: We conducted a single-arm mixed-methods pilot study with 19 parents with autistic children. These parents engaged with Allie for 2 weeks to complete 8 structured PPI exercises. The primary outcomes were feasibility (completion, ease of use, and practicality) and acceptability (multidimensional user ratings). Secondary outcomes were the World Health Organization–Five Well-Being Index (WHO-5), Patient Health Questionnaire-9, Perceived Stress Scale-10, and Short Form-12 Health Survey (version 2) Physical and Mental Component Summary scores. Outcomes were analyzed using paired t tests or Wilcoxon signed-rank tests. Optional postintervention interviews were analyzed using reflexive thematic analysis. Results: A total of 17 (89.5%) participants completed all the exercises, which indicated a high degree of procedural feasibility. There were also high ratings for ease of use and practicality (means 4.47/5, SD 0.70, and 4.32/5, SD 0.67, respectively). Acceptability was favorable (overall satisfaction mean=5.68/7, SD 0.70; prompt response time=6.37/7, SD 0.68). The WHO-5 score improved significantly from 32.84 to 46.11 (t18=2.48, P=.02; Cohen d=0.52). Changes in the Patient Health Questionnaire-9 (z=−0.49, P=.63; r=0.11), Perceived Stress Scale-10 (t18=−0.82, P=.43; Cohen d=0.12), and Short Form-12 Health Survey (version 2) Physical Component Summary (t18=−0.94, P=.36; Cohen d=0.18) and Mental Component Summary (t18=−0.89, P=.39; Cohen d=0.17) scores were not significant. Qualitative feedback (14/19) described benefits aligned with PPI mechanisms such as greater self-reflection, a more positive orientation, perspective-taking, emotional support, and coping skills. However, participants also suggested refinements, such as more natural conversation (colloquial Cantonese), shorter or less repetitive outputs, user-chosen sequencing with reminders and progress tracking, multimodal features, and autism spectrum disorder–specific resources. Conclusions: This pilot study revealed the feasibility, acceptability, and preliminary improvement in well-being (WHO-5) of a PPI-based GPT-powered chatbot, Allie, among parents of autistic children. Although there was no significant short-term change in other outcomes, the findings provide insights into design priorities, including personalization, conversational naturalness, multimodal content, and autism spectrum disorder–specific guidance. Larger, controlled trials with longer exposures and more diverse samples are needed to establish efficacy and durability. Trial Registration: ClinicalTrials.gov NCT06438120; https://clinicaltrials.gov/study/NCT06438120

BACKGROUND Parents of autistic children frequently experience elevated stress levels, depressive symptoms, and reduced well-being. Positive psychology interventions (PPIs) can strengthen resilience, and chatbots offer a scalable channel through which such skills can be delivered. However, evidence on the evaluation of large language model–guided PPI-based chatbots for this population is limited. OBJECTIVE This study evaluated the feasibility and acceptability of a GPT-powered chatbot (“Allie”). This study was designed to deliver culturally adapted PPIs to parents of autistic children and to explore their preliminary effects on well-being, depression, stress, and health-related quality of life. METHODS We conducted a single-arm mixed-methods pilot study with 19 parents with autistic children. These parents engaged with Allie for 2 weeks to complete 8 structured PPI exercises. The primary outcomes were feasibility (completion, ease of use, and practicality) and acceptability (multidimensional user ratings). Secondary outcomes were the World Health Organization–Five Well-Being Index (WHO-5), Patient Health Questionnaire-9, Perceived Stress Scale-10, and Short Form-12 Health Survey (version 2) Physical and Mental Component Summary scores. Outcomes were analyzed using paired t tests or Wilcoxon signed-rank tests. Optional postintervention interviews were analyzed using reflexive thematic analysis. RESULTS A total of 17 (89.5%) participants completed all the exercises, which indicated a high degree of procedural feasibility. There were also high ratings for ease of use and practicality (means 4.47/5, SD 0.70, and 4.32/5, SD 0.67, respectively). Acceptability was favorable (overall satisfaction mean=5.68/7, SD 0.70; prompt response time=6.37/7, SD 0.68). The WHO-5 score improved significantly from 32.84 to 46.11 (t18=2.48, P=.02; Cohen d=0.52). Changes in the Patient Health Questionnaire-9 (z=−0.49, P=.63; r=0.11), Perceived Stress Scale-10 (t18=−0.82, P=.43; Cohen d=0.12), and Short Form-12 Health Survey (version 2) Physical Component Summary (t18=−0.94, P=.36; Cohen d=0.18) and Mental Component Summary (t18=−0.89, P=.39; Cohen d=0.17) scores were not significant. Qualitative feedback (14/19) described benefits aligned with PPI mechanisms such as greater self-reflection, a more positive orientation, perspective-taking, emotional support, and coping skills. However, participants also suggested refinements, such as more natural conversation (colloquial Cantonese), shorter or less repetitive outputs, user-chosen sequencing with reminders and progress tracking, multimodal features, and autism spectrum disorder–specific resources. CONCLUSIONS This pilot study revealed the feasibility, acceptability, and preliminary improvement in well-being (WHO-5) of a PPI-based GPT-powered chatbot, Allie, among parents of autistic children. Although there was no significant short-term change in other outcomes, the findings provide insights into design priorities, including personalization, conversational naturalness, multimodal content, and autism spectrum disorder–specific guidance. Larger, controlled trials with longer exposures and more diverse samples are needed to establish efficacy and durability. CLINICALTRIAL ClinicalTrials.gov NCT06438120; https://clinicaltrials.gov/study/NCT06438120

Background: Older adults may experience chronic pain as they age, which can affect their physical and psychological well-being. Virtual reality (VR) is emerging as a novel and nonpharmacological intervention that offers pain relief and mood enhancement through immersive experiences. However, the feasibility and effectiveness of using nonlocalized and commercial VR applications for chronic pain relief and mood enhancement among community-dwelling older adults remain underexplored. Objective: The main objectives of this study were to (1) evaluate the feasibility of using commercial-off-the-shelf VR applications for managing chronic pain among older adults, (2) assess the efficacy of VR in alleviating chronic pain, and (3) examine its impact on the well-being of older adults in a community setting. Methods: The study was a single-arm mixed methods pilot study. It was divided into two stages, including preparation and implementation. A total of 13 older adults (8 with chronic pain and 5 without) were recruited to participate in a 3-week VR intervention. Participants engaged in VR sessions that followed a step-by-step adaptation process. Each session included 360-degree relaxation videos and VR-based boxing exercises via Les Mills BODYCOMBAT, lasting 15 minutes. Pain intensity, pain self-efficacy, well-being, and mood were measured pre- and post-intervention using the Numeric Pain Rating Scale (NPRS), a pain self-efficacy question, the World Health Organization–Five Well-Being Index (WHO-5), and the Mood Assessment Scale (Mood). VR feasibility was evaluated based on completion rates, adverse outcomes, and qualitative feedback from semistructured interviews. Results: Of the 13 participants recruited, 11 completed the intervention (84.6% completion rate). The mean age was 79.2 (SD 9.2) years. The study found a statistically significant 16.32% improvement in the mean mood score, with a mean increase of 2.64 (SD 1.45) points and a large effect size (P<.001; Cohen d=1.82). The median pain self-efficacy score decreased from 3.0 (IQR 1.5-3.0) to 1.0 (IQR 1.0-2.0) (z=−2.236; P=.03). However, no significant changes were observed in pain intensity or overall well-being. The study demonstrated the high feasibility of commercial-off-the-shelf VR technology for older adults. Minor adverse effects were reported, including back pain and headset discomfort. In addition, 90.9% of participants enjoyed the VR experience, and all were willing to join future sessions. Conclusions: The pilot study demonstrated that commercial-off-the-shelf VR applications can effectively enhance mood and pain self-efficacy. Additional procedures, such as prebriefing, real-time interpretation, and a gradual adaptation process, were essential to overcoming barriers such as language, cultural nuances, and the digital literacy of older adults. Despite the lack of significant changes in pain intensity or overall well-being, the psychological benefits suggest that VR could be a valuable adjunct tool in chronic pain management. Future research should focus on larger sample sizes, longer intervention durations, randomized controlled trials, and the development of localized commercial VR applications to further explore their efficacy.

BACKGROUND Older adults may experience chronic pain as they age, which can affect their physical and psychological well-being. Virtual reality (VR) becomes a novel and non-pharmacological intervention that offers pain relief and mood enhancement through immersive experiences. However, the feasibility and effectiveness of using non-localized and commercial VR applications for chronic pain relief and mood enhancement among community older adults remain underexplored. OBJECTIVE The main objectives of this study were to: (1) evaluate the feasibility of using commercial-off-the-shelf VR applications for managing chronic pain among older adults; (2) assess the efficacy of VR in alleviating chronic pain; and (3) examine its impact on the well-being of older adults in a community setting. METHODS The study was a single-armed mixed-methods pilot study. It was divided into two stages, including preparation and implementation. A total of 13 older adults (8 with chronic pain and 5 without) were recruited to participate in a 3-week VR intervention. Participants engaged in VR sessions followed a step-by-step adaptation process. Each session included 360-degree relaxation videos and interactive boxing exercises via Les Mills BodyCombat, lasting 15 minutes. Pain intensity, pain self-efficacy, well-being, and mood were measured pre- and post-intervention using the Numeric Pain Rating Scale (NPRS), a pain self-efficacy questionnaire, the World Health Organization-Five Well-Being Index (WHO-5), and the Mood Assessment Scale. VR feasibility was evaluated based on completion rates, adverse outcomes, and qualitative feedback from semi-structured interviews. RESULTS Of the 13 participants recruited, 11 completed the intervention (84.6% completion rate). The mean age was 79.2 years (SD 9.2). The study found a significant 16.32% improvement in the mean mood score, with a large effect size (p < .001, Cohen's d = 1.82). The pain self-efficacy median score decreased significantly by 2.0 (Z = -2.236, p = .025). However, we observed no significant changes in pain intensity or overall well-being. The study demonstrated the high feasibility of commercial-off-the-shelf VR technology for older adults. Minor adverse effects were reported, including back pain and headset discomfort. Additionally, 90.9% of participants enjoyed the VR experience, and all were willing to join future sessions. CONCLUSIONS The pilot study demonstrated that commercial-off-the-shelf VR applications could effectively enhance mood and pain self-efficacy. Additional procedures, such as pre-briefing, real-time interpretation, and a gradual adaptation process, were essential to overcoming barriers like language, cultural nuances, and the digital literacy of older adults. Despite the lack of significant changes in pain intensity or overall well-being, the psychological benefits suggest that VR could be a valuable adjunct tool in chronic pain management. Future research should focus on larger sample sizes, longer intervention duration, randomized controlled trials, and the development of localized commercial VR to further explore its efficacy.