Investigating the Integrated Digital Interventions Delivered by a Therapeutic Companion Agent for Young Adults with Symptoms of Depression: A Proof-of-Concept Study

Abstract: Background: Despite the clinical effectiveness of digital interventions for young adults with depression, low engagement and adherence remain persistent challenges. Building a strong digital therapeutic alliance has been proposed to address these barriers. This study highlights the need for a conversational therapeutic companion agent (TCA)-based intervention design. Objective: This study aimed to develop a Wizard-of-Oz TCA-centered prototype integrating social-support-based ecological momentary assessment (EMA), ecological momentary intervention (EMI), behavioral activation, and gamification. We evaluated the six-week proof-of-concept efficacy of this intervention among young adults with depressive symptoms. Methods: Korean young adults aged 20--39 years with mild-to-moderate depressive symptoms (PHQ-9) were recruited online. The intervention group ($n = 29$) received a six-week TCA-based digital intervention, while the control group ($n = 29$), recruited four weeks later, continued their usual routines. The TCA guided four daily behavioral-activation tasks, three mood assessments, meditation, daily summaries, and weekly mission feedback. Both groups were assessed at baseline and at weeks 2, 4, and 6 using the BDI-II, GAD-7, and Q-LES-Q-SF. Results: Of 58 participants, 57 completed the study (one dropout in the intervention group). At week 6, the intervention group showed significantly greater reductions in depressive symptoms and improvements in quality of life than controls. Adherence was 78\% for EMA, 51\% for EMI, and 65\% for daily routines. Conclusions: The TCA-based digital intervention improved depressive symptoms and quality of life with adherence levels comparable to previous digital health interventions. Future studies should refine the TCA design and conduct larger-scale evaluations.