Predicting Engagement With Conversational Agents in Mental Health Therapy by Examining the Role of Epistemic Trust, Personality, and Fear of Intimacy: Cross-Sectional Web-Based Survey Study

Epistemic trust and fear of intimacy emerged as pivotal factors influencing preferences for CA-based therapy, underscoring the role of interpersonal dynamics and emotional vulnerabilities. The findings suggest that individuals with avoidant attachment styles or maladaptive personality traits are more inclined toward AI-mediated interventions, driven by reduced fear of judgment and increased perceived safety. The relative homogeneity of the sample considered-particularly in terms of age, education level, and cultural exposure-limits the generalizability of these findings to broader or more diverse populations. Nonetheless, these insights highlight the need for ethical considerations and personalized approaches in deploying CA-based mental health tools to balance user reliance with human-centric therapeutic values.