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There is growing evidence that mobile text message exchanges between patients and therapists can augment traditional cognitive behavioral therapy. The automatic characterization of patient thinking patterns in this asynchronous text communication may guide treatment and assist in therapist training. In this work, we automatically identify distorted thinking in text-based patient-therapist exchanges, investigating the role of conversation history (context) in distortion prediction. We identify six unique types of cognitive distortions and utilize BERT-based architectures to represent text messages within the context of the conversation. We propose two approaches for leveraging dynamic conversation context in model training. By representing the text messages within the context of the broader patient-therapist conversation, the models better emulate the therapist&#39;s task of recognizing distorted thoughts. This multi-turn classification approach also leverages the clustering of distorted thinking in the conversation timeline. We demonstrate that including conversation context, including the proposed dynamic context methods, improves distortion prediction performance. The proposed architectures and conversation encoding approaches achieve performance comparable to inter-rater agreement. The presence of any distorted thinking is identified with relatively high performance at 0.73 F1, significantly outperforming the best context-agnostic models (0.68 F1).

NAACL 2022

Identifying Distorted Thinking in Patient-Therapist Text Message Exchanges by Leveraging Dynamic Multi-Turn Context

cognitive distortions

cognitive behavioral therapy

machine learning

natural language processing

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EMNLP 2024

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There is growing evidence that mobile text message exchanges between patients and therapists can augment traditional cognitive behavioral therapy. The automatic characterization of patient thinking patterns in this asynchronous text communication may guide treatment and assist in therapist training. In this work, we automatically identify distorted thinking in text-based patient-therapist exchanges, investigating the role of conversation history (context) in distortion prediction. We identify six unique types of cognitive distortions and utilize BERT-based architectures to represent text messages within the context of the conversation. We propose two approaches for leveraging dynamic conversation context in model training. By representing the text messages within the context of the broader patient-therapist conversation, the models better emulate the therapist's task of recognizing distorted thoughts. This multi-turn classification approach also leverages the clustering of distorted thinking in the conversation timeline. We demonstrate that including conversation context, including the proposed dynamic context methods, improves distortion prediction performance. The proposed architectures and conversation encoding approaches achieve performance comparable to inter-rater agreement. The presence of any distorted thinking is identified with relatively high performance at 0.73 F1, significantly outperforming the best context-agnostic models (0.68 F1).

workshop paper

## Welcome to NAACL 2022!
The Annual Meeting of the North American Chapter of the Association for Computational Linguistics (NAACL) is taking place July 10-15, 2022 as a hybrid event, in Seattle, WA and online. We are happy to welcome all of you to conference! 
 
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2022 Annual Conference of the North American Chapter of the Association for Computational Linguistics

This study examined differences in linguistic features produced by autistic and neurotypical (NT) children during brief picture descriptions, and assessed feature stability over time. Weekly speech samples from well-characterized partic- ipants were collected using a telephony system designed to improve access for geographically isolated and historically marginalized commu- nities. Results showed stable group differences in certain acoustic features, some of which may potentially serve as key outcome measures in future treatment studies. These results high- light the importance of eliciting semi-structured speech samples in a variety of contexts over time, and adds to a growing body of research showing that fine-grained naturalistic commu- nication features hold promise for intervention research.

Identifying stable speech-language markers of autism in children: Preliminary evidence from a longitudinal telephony-based study

Formulation is central to clinical practice. Formulation has a factor weighing, pattern recognition and explanatory hypothesis modelling focus. Formulation attempts to make sense of why a person presents in a certain state at a certain time and context, and how that state may be best managed to enhance mental health, safety and optimal change. Inherent to the clinical need for formulation is an appreciation of the complexities, uncertainty and limits of applying theoretical concepts and symptom, diagnostic and risk categories to human experience; or attaching meaning or weight to any particular factor in an individual’s history or mental state without considering the broader biopsychosocial and cultural context. With specific reference to suicide prevention, this paper considers the need and potential for the computational linguistics community to be both cognisant of and ethically contribute to the clinical formulation process.

The ethical role of computational linguistics in digital psychological formulation and suicide prevention

Natural language processing tools have been shown to be effective for detecting symptoms of schizophrenia in transcribed speech. We analyze and assess the contribution of the various syntactic and morphological categories towards successful machine classification of texts produced by subjects with schizophrenia and by others. Specifically, we fine-tune a language model for the classification task, and mask all words that are attributed with each category of interest. The speech samples were generated in a controlled way by interviewing inpatients who were officially diagnosed with schizophrenia, and a corresponding group of healthy controls. All participants are native Hebrew speakers. Our results show that nouns are the most significant category for classification performance.

Masking Morphosyntactic Categories to Evaluate Salience for Schizophrenia Diagnosis

There are many different forms of psychotherapy. Itemized inventories of psychotherapeutic interventions provide a mechanism for evaluating the quality of care received by clients and for conducting research on how psychotherapy helps. However, evaluations such as these are slow, expensive, and are rarely used outside of well-funded research studies. Natural language processing research has progressed to allow automating such tasks. Yet, NLP work in this area has been restricted to evaluating a single approach to treatment, when prior re- search indicates therapists used a wide variety of interventions with their clients, often in the same session. In this paper, we frame this scenario as a multi-label classification task, and develop a group of models aimed at predicting a wide variety of therapist talk-turn level orientations. Our models achieve F1 macro scores of 0.5, with the class F1 ranging from 0.36 to 0.67. We present analyses which offer insights into the capability of such models to capture psychotherapy approaches, and which may complement human judgment.

Psychotherapy is Not One Thing: Simultaneous Modeling of Different Therapeutic Approaches

Evidence has demonstrated the presence of similarities in language use across people with various mental health conditions. In this work, we investigate these relationships both as described in literature and as a data analysis problem. We also introduce a novel transfer learning-based approach that learns from linguistic feature spaces of previous conditions and predicts unknown ones. Our model achieves strong performance, with F\textsubscript{1} scores of 0.75, 0.80, and 0.76 at detecting depression, stress, and suicidal ideation in a first-of-its-kind transfer task and offering promising evidence that language models can harness learned patterns from known mental health conditions to aid in their prediction of others that may lie latent.

Are You Really Okay? A Transfer Learning-based Approach for Identification of Underlying Mental Illnesses

Models of mental health based on natural lan- guage processing can uncover latent signals of mental health from language. Models that in- dicate whether an individual is depressed, or has other mental health conditions, can aid in diagnosis and treatment. A critical aspect of integration of these models into the clinical setting relies on explaining their behavior to domain experts. In the case of mental health diagnosis, clinicians already rely on an assess- ment framework to make these decisions; that framework can help a model generate meaning- ful explanations.
In this work we propose to use PHQ-9 cate- gories as an auxiliary task to explaining a social media based model of depression. We develop a multi-task learning framework that predicts both depression and PHQ-9 categories as aux- iliary tasks. We compare the quality of expla- nations generated based on the depression task only, versus those that use the predicted PHQ-9 categories. We find that by relying on clinically meaningful auxiliary tasks, we produce more meaningful explanations.

Explaining Models of Mental Health via Clinically Grounded Auxiliary Tasks

Conversational Agents (CAs) powered with deep language models (DLMs) have shown tremendous promise in the domain of mental health. Prominently, the CAs have been used to provide informational or therapeutic services to patients. However, the utility of CAs to assist in mental health triaging has not been explored in the existing work as it requires a controlled generation of follow-up questions (FQs), which are often initiated and guided by the mental health professionals (MHPs) in clinical settings. In the context of depression, our experiments show that DLMs coupled with process knowledge in a mental health questionnaire generate 12.54% and 9.37% better FQs based on similarity and longest common subsequence matches to questions in the PHQ-9 dataset respectively, when compared with DLMs without process knowledge support. Despite coupling with process knowledge, we find that DLMs are still prone to hallucination, i.e., generating redundant, irrelevant, and unsafe FQs. We demonstrate the challenge of using existing datasets to train a DLM for generating FQs that adhere to clinical process knowledge. To address this limitation, we prepared an extended PHQ-9 based dataset, PRIMATE, in collaboration with MHPs. PRIMATE contains annotations regarding whether a particular question in the PHQ-9 dataset has already been answered in the user's initial description of the mental health condition. We used PRIMATE to train a DLM in a supervised setting to identify which of the PHQ-9 questions can be answered directly from the user's post and which ones would require more information from the user. Using performance analysis based on MCC scores, we show that PRIMATE is appropriate for identifying questions in PHQ-9 that could guide generative DLMs towards controlled FQ generation suitable for aiding triaging. Dataset created as a part of this research: github.com/primate-mh/Primate2022

Learning to Automate Follow-up Question Generation using Process
Knowledge for Depression Triage on Reddit Posts

We study the phenomenon of linguistic synchrony between clients and therapists in a psychotherapy process. Linguistic Synchrony (LS) can be viewed as any observed interdependence or association between more than one person’s linguistic behavior. Accordingly, we establish LS as a methodological task. We suggest a LS function that applies a linguistic similarity measure based on the Jensen-Shannon distance across the observed part-of-speech tag distributions (JSDuPos) of the speakers in different
time frames. We perform a study over a unique corpus of 872 transcribed sessions, covering 68 clients and 59 therapists. After establishing the presence of client-therapist LS, we verify its association with therapeutic alliance and treatment outcome (measured using WAI and ORS), and additionally analyse the behavior of
JSDuPos throughout treatment. 

Results indicate that (1) higher linguistic similarity at the session level associates with higher therapeutic alliance as reported by the client and therapist at the end of the session, (2) higher linguistic similarity at the session level associates with higher level of treatment outcome as reported by the client at the beginnings of the next sessions, (3) there is a significant linear increase in linguistic similarity throughout
treatment, (4) surprisingly, higher LS associates with lower treatment outcome. Finally, we demonstrate how the LS function can be used to interpret and explore the mechanism for synchrony.

Measuring Linguistic Synchrony in Psychotherapy

This paper describes the participation of the groups NLP@UNED and IXA@EHU on the CLPsych 2022 shared task.
For task A, which tries to capture changes in mood over time, we have applied an Approximate Nearest Neighbour (ANN) extraction technique with the aim of relabelling the user messages according to their proximity, based on the representation of these messages in a vector space. Regarding the subtask B, we have used the output of the subtask A to train a Recurrent Neural Network (RNN) to predict the risk of suicide at the user level.
The results obtained are very competitive considering that our team was one of the few that made use of the organisers' proposed virtual environment and also made use of the Task A output to predict the Task B results.

Approximate Nearest Neighbour Extraction Techniques and Neural Networks \\for Suicide Risk Prediction in the CLPsych 2022 Shared Task

This paper presents transformer-based models created for the CLPsych 2022 shared task. Using posts from Reddit users over a period of time, we aim to predict changes in mood from post to post. We test models that preserve timeline information through explicit ordering of posts as well as those that do not order posts but preserve features on the length of time between a user’s posts. We find that a model with temporal information may provide slight benefits over the same model without such information, although a RoBERTa transformer model provides
enough information to make similar predictions without custom-encoded time information.

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Next from NAACL 2022

Identifying stable speech-language markers of autism in children: Preliminary evidence from a longitudinal telephony-based study

Similar lecture

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