Automated quality assessment of cognitive behavioral therapy sessions through highly contextualized language representations

PLoS One. 2021 Oct 22;16(10):e0258639. doi: 10.1371/journal.pone.0258639. eCollection 2021.

Abstract

During a psychotherapy session, the counselor typically adopts techniques which are codified along specific dimensions (e.g., 'displays warmth and confidence', or 'attempts to set up collaboration') to facilitate the evaluation of the session. Those constructs, traditionally scored by trained human raters, reflect the complex nature of psychotherapy and highly depend on the context of the interaction. Recent advances in deep contextualized language models offer an avenue for accurate in-domain linguistic representations which can lead to robust recognition and scoring of such psychotherapy-relevant behavioral constructs, and support quality assurance and supervision. In this work, we propose a BERT-based model for automatic behavioral scoring of a specific type of psychotherapy, called Cognitive Behavioral Therapy (CBT), where prior work is limited to frequency-based language features and/or short text excerpts which do not capture the unique elements involved in a spontaneous long conversational interaction. The model focuses on the classification of therapy sessions with respect to the overall score achieved on the widely-used Cognitive Therapy Rating Scale (CTRS), but is trained in a multi-task manner in order to achieve higher interpretability. BERT-based representations are further augmented with available therapy metadata, providing relevant non-linguistic context and leading to consistent performance improvements. We train and evaluate our models on a set of 1,118 real-world therapy sessions, recorded and automatically transcribed. Our best model achieves an F1 score equal to 72.61% on the binary classification task of low vs. high total CTRS.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Clinical Competence
  • Cognitive Behavioral Therapy / methods*
  • Data Interpretation, Statistical
  • Female
  • Humans
  • Male
  • Mental Disorders / therapy*
  • Models, Psychological
  • Natural Language Processing
  • Psychiatric Status Rating Scales