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Enhancing Digital Mental Health Interventions Through Human-Guided Use of a Personalized Video-Based Mobile Application

  • 조용혁 (아주대학교 일반대학원)

초록/요약

This dissertation reviews the developmental trajectory and limitations of digital mental health interventions and, in continuation of this perspective, presents the development process and structural foundations of MARO—a mobile platform that integrates personalized video content, emotional self- awareness training, and gamification features, built on real-world user data. It further evaluates, across diverse user groups, the platform’s therapeutic effects and underlying mechanisms. The central aim of this research is to elucidate how the effectiveness of digital mental health interventions is shaped and amplified by human guidance. To this end, a three-tier intervention model—Level I (App-only), Level II (App + Minimal Coaching), and Level III (App + Structured Group-Based Guidance)—was applied in various settings including the general population, individuals with Serious Mental Illness (SMI), workers, and students. A unifying finding across the studies is the presence of a therapeutic gradient, whereby the impact of digital interventions strengthens as human and social elements are added. Level I (Study A) demonstrated reductions in depression, anxiety, and stress, though the durability of these effects depended heavily on user adherence. Level II (Study B) revealed that even minimal early coaching produced substantial symptom improvement, highlighting the feasibility of hybrid intervention models in low-resource environments. Level III (Studies C and D) showed that, within socially rich contexts such as schools and workplaces, digital intervention effects were further amplified, producing improvements in emotional functioning, increases in empathy, and enhanced group cohesion. These findings support well-established therapeutic group mechanisms such as self-disclosure, normalization, and vicarious learning. The primary contribution of this dissertation is the empirical validation of the Level I–II–III model as a mechanism-based framework explaining how digital interventions generate therapeutic effects in real-world settings. These results suggest that next-generation digital therapeutics (DTx) and AI coaching systems must incorporate the core mechanisms identified in this research—engagement monitoring, early motivational scaffolding, and the facilitation of healthy social dynamics. Furthermore, the implementation of such systems will require careful alignment with emerging ethical and regulatory standards.

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초록/요약

본 학위논문은 디지털 정신건강 중재(digital mental health intervention)실제 사용자 데이터(real-world data)를 기반으로, 개인맞춤형 영상, 정서 인식(emotional self-awareness), 게이미피케이션 기능을 통합한 모바일 플랫폼인 MARO의 개발 과정과 구조적 기반을 제시하고, 이를 다양한 사용자 집단에 적용하여 치료 효과와 작동 기제를 체계적으로 평가하였다. 본 연구의 핵심 목적은 디지털 정신건강 중재의 효과가 인간적 안내(human guidance)를 통해 어떠한 방식으로 형성되고 증폭되는지를 규명하는 데 있으며, 이를 위해 Level I(App 단독), Level II(App + 최소 코칭), Level III(App + 구조화된 집단 기반 안내)로 구성된 3단계 중재 모델을 일반 인구, 중증정신질환자(SMI), 근로자, 학생 등 다양한 환경에 적용하였다. 연구 전반에서 일관되게 확인된 발견은 디지털 중재의 효과가 인간적·사회적 요소가 더해질수록 강화되는 ‘치료 기울기(therapeutic gradient)’를 보인다는 점이다. Level I(Study A)은 우울/불안/스트레스 증상 감소 효과를 확인하였으나, 그 지속 여부는 사용자 순응도(adherence)에 크게 의존하였다. Level II(Study B)는 초기 단계의 최소한의 코칭만으로도 증상 개선 효과가 크다는 결과를 확인하여, 저자원 환경에서도 실현 가능한 하이브리드 모델의 가능성을 제시하였다. Level III(Studies C와 D)은 학교 및 직장과 같은 뚜렷한 사회적 맥락에서 디지털 중재의 효과가 더욱 증폭되며, 정서 개선, 공감 능력 향상, 집단 응집력 증진 등 개인 및 집단 수준의 변화를 확인하였다. 이러한 결과는 자기노출(self-disclosure), 정상화(normalization), 대리학습(vicarious learning) 등 집단 역동이 가지는 치료적 기제를 뒷받침한다. 본 논문은 Level I–II–III 모델을 통해 디지털 중재의 치료 효과가 어떠한 작동 원리를 통해 다양한 환경에서 발현되고 증폭될 수 있는지를 실증적으로 제시하였다. 이는 향후 디지털 치료제(DTx)와 AI 코칭 시스템의 개발에서, 지속적 참여 모니터링, 동기부여, 그리고 집단 역동의 강화와 같은 핵심 요소를 통합해야 함을 보여준다. 더불어, 이러한 시스템이 현실에서 구현되기 위해서는 새로운 윤리적/규제적 기준을 충족하는 과정이 필수적임을 제안한다.

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목차

I. INTRODUCTION 1
1. Digital Therapeutics in Mental Health Care 1
1.1 Paradigm Shift in Mental Health Care: From Offline to Digital, and From Expert-Centered to Self-Help 1
1.2 Evolution of Digital Therapeutics: From First to Third Generation 2
1.3 The Dual Challenges in Digital Mental Health: Evidence and Adherence 5
1.4 Why Human-Guidance Matters in Digital Interventions 6
2. MARO: Digital Mental Health Intervention Applications 7
2.1 Why We Built MARO: Real-World Challenges and Needs-Driven Development 7
2.2 The emerging of Video-Based Personalized Intervention 12
2.3 MARO Architecture: Integrated Modules and Gamification for Sustained Engagement 13
3. Level I–II–III Non-Hierarchical Model and applying Across Diverse Populations 21
3.1 Establishing Baseline: Real-World Effectiveness and Engagement Dynamics (Level I) 22
3.2 Optimizing Care for High-Needs Cohorts: Minimal Human Coaching for Serious Mental Illness (Level II) 23
3.3 Harnessing Social Amplification: Group-Guided Interventions in Educational Settings (Level III) 25
4. Aims of the thesis 28
II. STUDY A: Level I - App-Only Self-Help Model (High-Adherence Real-World Study) 31
1. Materials and methods 31
1.1 Study Design and Data Collection 31
1.2 Participants 32
1.3 Measures 32
1.4 Statistical Analysis 33
2. Results 34
2.1 Participant Characteristics 34
2.2 Longitudinal Changes in Depression, Anxiety, and Stress 36
2.3 Summary 41
III. STUDY B: Level II - App + Minimal Coaching for Community-Dwelling Individuals with SMI 43
1. Materials and methods 43
1.1 Study Design 43
1.2 Participants 45
1.3 Intervention Conditions 47
1.4 Outcome Measures 47
1.5 Statistical Analysis 48
2. Results 49
2.1 Participant Characteristics 49
2.2 Clinical Outcomes 51
2.3 Within-Group Changes 53
2.4 Between-Group Differences 55
2.5 Symptom Trajectories 57
2.6 Summary 59
IV. STUDY C: Level III (Group-Guided Digital Mental Health Intervention in School Settings) 62
1. Materials and methods 62
1.1 Setting and Study Design 62
1.2 Participants 63
1.3 Intervention Characteristics 67
1.4 Outcome Measures 71
1.5 Statistical Analysis 71
2. Results 73
2.1 Effects of the MARO Application on Depression, Anxiety, and Perceived Stress 73
2.2 Visualization of intervention Effects 75
2.3 Summary 77
V. STUDY D: Level III - Group-Guided Digital Intervention in School Setting 79
1. Materials and methods 79
1.1 Study setting and Context 79
1.2 Participants 80
1.3 Intervention Structure 82
1.4 Outcome Measures 84
1.5 Statistical Analysis 85
2. Results 85
2.1 Pre-Post Changes in Mental Health Outcomes 85
2.2 Multiple Regression Analyses 88
2.3 Summary 92
VI. DISCUSSION 94
1. Overall Significance and Theoretical Contributions of the Study 94
2. Study A and Level I: Potential and Structural Limitations of Self-Help Digital Interventions 98
2.1 Level I demonstrates substantial effects when adherence is maintained 98
2.2 Engagement is the central mechanism driving Level I effects 99
2.3 Summary of Level I findings 100
3. Study B and Level II: Synergy Between Digital Interventions and Minimal Coaching 100
3.1 Even minimal coaching substantially amplifies Level I effects 101
3.2 The timing of coaching critically shapes treatment trajectories 102
3.3 Summary of Study B 103
4. Study C and Study D: Therapeutic Mechanisms of Social Amplification in Level III 104
4.1 Study C – Workplace Context (Level III): Extending Therapeutic Impact to Organizational Culture 104
4.2 Study D – School Context (Level III): Developmentally Tailored Amplification of Effects 105
4.3 Shared Mechanisms of Level III: Social Mechanisms of Change 106
5. Integrated Summary of Core Principles Across Level I-II-III 107
5.1 Level I: Technological efficacy exists, but sustaining engagement remains the primary challenge 108
5.2 Level II: Minimal human support substantially enhances the effectiveness of digital interventions 108
5.3 Level III: Digital effects are amplified through social structures 109
6. Limitations 110
7. Further Research: Toward Next-Generation AI Coaching-Technological, Clinical, Regulatory, and Ethical Imperatives 113
VII. CONCLUSION 118
REFERENCES 120
APPENDIX 131
국문요약 138

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