The Feasibility and Usability of an Artificial Intelligence-Enabled Conversational Agent in Virtual Reality for Patients with Alcohol-Associated Cirrhosis: A Multi-Methods Study.

Background & Aims: Patients with alcohol-associated cirrhosis often lack access to effective interventions to prevent drinking. We assessed the feasibility and usability of an artificial intelligence (AI)-enabled conversational agent in virtual reality to deliver self-administered mental health support. Methods: Our multidisciplinary team combined spatial computing and AI to deliver an immersive form of cognitive behavioral therapy and motivational interviewing using established relapse prevention protocols. Participants engaged with the program privately for 30 min, followed by a semistructured interview. Usability was measured with the intervention usability scale (IUS). Thematic content analysis of interviews was conducted to extract themes and insights. Results: Of 20 participants, 50% reported active alcohol use. The median Model for End-Stage Liver Disease 3.0 score was 22. All participants used the full 30 min of psychotherapy; no severe adverse events were reported. The IUS score was acceptable (≥75) in 78% of participants. Thematic analysis distilled 509 first-level codes into nine overarching themes. The program quickly established rapport, providing positive reinforcement and actionable goals perceived as nonjudgmental. About 80% felt themselves open up to the avatar; 85% reported the experience as beneficial and noted belief in potential efficacy. Many endorsed the privacy, accessibility, and immersion of the program. While a minority preferred human therapists and noted shortcomings in the program, 90% expressed interest in further use. Conclusions: Combining spatial computing and AI is perceived to be a safe, acceptable, easy-to-use, nonjudgmental, and immersive form of self-administered psychotherapy among patients with alcohol-associated cirrhosis. Studies to examine the impact on cessation are needed.