Project Summary
Quality monitoring is essential in psychotherapy clinical trials and for supporting the use of evidence-based
interventions (EBI) in mental health service settings, but few are available, and these require costly and
laborious procedures. Without pragmatic, specific measures of quality, it is impossible to know whether key
quality components are being delivered, and to what effect. Natural Language Processing (NLP), a type of
artificial intelligence, has extraordinary potential to reduce burden by automating the process of quality coding.
Exposure therapy for anxiety is an ideal prototype for testing automated quality coding using NLP, given its
potential for public health impact and clear theory of mechanism to guide quality measurement. Building on
pilot work, this study will refine and test automated quality coding with audio data (N =1,286 patients and
11,213 sessions) from 6 existing clinical trials of exposure therapy for youth and adults, across both research
and community settings. To enhance project efficiency and future utility of findings, we will leverage strong
existing partnerships with 1) NIMH intramural researchers bringing expertise in the quantitative study of anxiety
and deep learning methods including NLP, 2) the international Exposure Therapy Consortium (ETC), whose
mission is to support centralized tools for researchers studying delivery and mechanisms of exposure therapy,
and 3) a diverse set of stakeholders including patients/families, providers, agency leaders, payers, policy
makers, and technology developers. Specific aims are designed to validate automated coding with NLP
against human coders, test predictive utility, and incorporate stakeholder feedback to facilitate near-term
usability of findings.