Virtual Avatar Coaches: Improving Mental Health Treatment for College Students with Accessible Peer Support (2018-2019)


Every year, approximately 25% of American adults are living with a diagnosable mental illness. College students are a particularly high-risk group; 75% of adult-onset mental illnesses are present by age 25.  Students face a multitude of stressors during college, and these stressors can serve to exacerbate underlying predispositions to mental illness.

There are significant barriers to the delivery and effectiveness of mental health services for college students. Barriers to seeking services include feelings of personal shame, feelings of ambiguity about the need for treatment and skepticism about treatment effectiveness. The traditional manner of delivery of mental health services may present another obstacle. We expect that talking to someone in an office on a weekly basis will lead to generalization of new skills. Yet, people often need coaching and support in the precise moment that something challenging is unfolding. If that were possible, the potency of therapeutic interventions could greatly improve. However, there are also significant barriers to implementation of in-the-moment services including cost, therapist availability, ethical or legal issues and potential for therapist burnout. The use of trained teams of virtual peer health coaches (“avatars”) has the potential to address these barriers.

Project Description

This Bass Connections project will develop and pilot an innovative way to improve the mental health of college students, through the use of peer health coaches who will deliver support via virtual avatars.

The project will build off an existing application, Sidekicks™, utilizing this technology to connect college students struggling with mental health disorders to peer health coaches. Trained by licensed professionals, the peer coaches will be able to provide one-to-one online help to students who are unwilling or unable to seek professional treatment and to students who could benefit from extra services. Students will be able to download an iPhone-compatible application that will connect them to a peer health coach. The coach, acting through a virtual avatar to remain anonymous, can provide real-time, moment-to-moment support via the phone app.

The team will start by addressing the needs of students with eating disorders, modeling services for daily disorder management on coaching someone through a meal. Team members will evaluate existing peer coaching programs on college campuses, and augment existing programs with tools to target eating disorders.

Team members will develop a curriculum to train the peer health coaches in providing mental health coaching services, with augmentation of services specifically for students with eating disorders. A website will connect students to peer coaches and other relevant mental health resources. The team will collect data on app usage, website traffic and peer coach and student satisfaction that will inform further research and grant applications.

Anticipated Outcomes

Training curriculum for peer health coaches; feasibility study regarding Sidekicks™ for college students; publications


Summer 2018 – Spring 2019

  • Summer 2018: Review existing peer-health curricula; develop peer health training; conduct intensive peer health training in the final week of the summer prior to class initiation (for students already on campus this will occur live; if not it will recur by WebEx); design advertising campaign; identify legal and ethical issues and key stakeholders involved in decision-making; begin discussions and navigating legal and ethical barriers; submit IRB application
  • Fall 2018: Finalize peer health training; finalize legal and ethical barriers; mid-semester kickoff peer health coaching
  • Spring 2019: Collect data on program feasibility; revise and improve program based on satisfaction data; if possible, begin to analyze efficacy data

Team Outcomes To Date

Peer Avatars for Mental Health: A Peer to Peer Support Program (poster by Christina Boghosian, Kyra Citron, Brooke Keene, Bruny Kenou, Urmi Pandya, Ameya Sanyal, Taylor Shabani, Lindsey Trematerra, Esther Wang, Lulu Wein, Shan Zhong, Jonathan Cloughesy, Savannah Erwin, David Goldston, Guillermo Sapiro, Timothy Strauman, Sue Wasiolek, Nancy Zucker, presented at EHDx, Duke University, April 9, 2019 and at Bass Connections Showcase, Duke University, April 17, 2019; runner up, Bass Connections Poster Competition, Audience Award)

Virtual Avatar Coaches (talk by Bruny Kenou, EHDx, Duke University, April 9, 2019, winner, Best Talk)

This Team in the News

Meet the Members of the 2018-19 Student Advisory Council

Student using computer

Team Leaders

  • Guillermo Sapiro, Pratt School of Engineering-Electrical & Computer Engineering
  • Nancy Zucker, School of Medicine-Psychiatry and Behavioral Sciences

/graduate Team Members

  • Savannah Erwin, Psychology-PHD

/undergraduate Team Members

  • Christina Boghosian, Public Policy Studies (AB)
  • Kyra Citron, Gender Sexuality & Fem St(AB2), Psychology (AB)
  • Brooke Keene, Electrical & Computer Egr(BSE), Computer Science (BSE2)
  • Bruny Kenou, Neuroscience (BS)
  • Urmi Pandya, Psychology (BS)
  • Ameya Sanyal, Psychology (AB), Global Health (AB2)
  • Taylor Shabani
  • Lindsey Trematerra, Political Science (AB), Psychology (AB2)
  • Weiwei Wang, Interdepartmental Major
  • Shan Zhong, Mathematics (BS), Economics (BS2)

/yfaculty/staff Team Members

  • Franca Alphin, School of Medicine-Community and Family Medicine
  • Jonathan Bae, Duke Health Patient Safety and Clinical Quality
  • Richard Chung, School of Medicine-Pediatrics: Primary Care Pediatrics
  • Martha Foukal, School of Medicine-Psychiatry: Behavioral Medicine
  • David Goldston, School of Medicine-Psychiatry and Behavioral Sciences
  • Timothy Strauman, Arts & Sciences-Psychology and Neuroscience
  • Suzanne Wasiolek, Administrative Offices

/zcommunity Team Members

  • Orange County Rape Crisis Center
  • Project Heal
  • Ron Suskind, Sidekicks