Cognitive Behavioral Therapy Clinical Trial
— AFFECTOfficial title:
Enhancing the Quality of CBT in Community Mental Health Through AI-generated Fidelity Feedback
This study is being conducted together by researchers at the University of Pennsylvania and Lyssn.io, Inc., ("Lyssn"), a technology start-up developing digital tools to support evidence-based psychotherapies (EBPs) for mental health disorders and addiction. This study will implement a technology to assess and enhance the quality of EBPs like Cognitive Behavioral Therapy (CBT) that includes a user interface geared to clinical, supervision, and administrative workflows and needs, and then assess this technology for effectiveness in comparison to usual care. There is a tremendous global burden of mental illness: Over 50 million American adults have a diagnosable mental health disorder, and major depression on its own is the leading cause of disability worldwide. In the face of this burden, clinical research has documented a variety of effective EBPs (e.g. CBT), and these psychotherapies are utilized on a massive scale. Systems have invested over $2 billion in training providers in specific EBPs. Once trained, however, therapists' adherence to the EBP, also called fidelity, is both crucial for effectiveness and difficult to assess. There is no scalable method to assess the fidelity and quality of EBPs in community practice settings. This is a foundational problem for healthcare systems. Advances in speech processing and machine learning make technology a promising solution to this problem. The use of technology - instead of humans - to evaluate EBPs means that objective, performance-based feedback can be provided quickly, efficiently, cost-effectively, and without human error. If successful, the present research will be among the first examples of a method for building, monitoring, and assessing the quality of therapy that can scale up to large, real-world healthcare settings. In this study, the investigators will implement an existing, fully-functional prototype (LyssnCBT) that includes a user interface geared to community mental health (CMH) clinical, supervision, and administrative workflows and needs, and then assess for effectiveness of psychotherapy supported by LyssnCBT in comparison to usual care. This study will implement LyssnCBT in 5 community mental health agencies, beginning with a single-arm pilot field trial to identify and address any specific barriers to implementing the tool in a community mental health context. The study team will then conduct a larger study in community mental health agencies comparing LyssnCBT to services as usual.
Status | Recruiting |
Enrollment | 1957 |
Est. completion date | June 30, 2025 |
Est. primary completion date | June 30, 2025 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: Therapists - Able to participate in therapy sessions conducted in English - Employed at a Philadelphia CMH treatment center that allows the recruitment and participation of therapists in research-related activities - Willing to allow their session recordings to be used for research purposes - Computer and internet access Supervisors - Oversee participating therapists - Computer and internet access Clients - Able to participate in therapy sessions conducted in English - Willing to allow the team to collect data and use their session recordings for research purposes Exclusion Criteria: - Unwilling to allow the research team to access their therapy session recordings |
Country | Name | City | State |
---|---|---|---|
United States | The Penn Collaborative for CBT and Implementation Science | Philadelphia | Pennsylvania |
Lead Sponsor | Collaborator |
---|---|
University of Pennsylvania | Lyssn.io, Inc., National Institute of Mental Health (NIMH) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in therapist CBT fidelity as assessed by CTRS scores | CBT Fidelity will be assessed by AI-generated Cognitive Therapy Rating Scale (CTRS) scores for every recorded therapy session, which will be recorded via the Lyssn platform during both SAU and LyssnCBT phases of the study. CBT sessions are scored on different session components (agenda, feedback, understanding, etc.) with the CTRS on a scale of 0-6, from "poor" to "excellent", where higher scores indicate a greater degree of CBT fidelity. CTRS deviation scores will be created.Mean CTRS scores during SAU will be estimated for each therapist and for each CTRS item. These means will be subtracted from each corresponding CTRS score during the LyssnCBT phase. | Phase 2; Immediately after every recorded therapy session | |
Primary | Acceptability of LyssnCBT tools (Acceptability of Intervention Measure; AIM) | A brief, 4-item measure of a mental health professional's perception of how acceptable an innovation would be for use in their context. Each statement about the acceptability of the innovation is rated on a 5-point ordinal scale ranging from "completely disagree" to "completely agree," where higher scores indicate higher levels of acceptability. This measure has demonstrated good test-retest reliability and sensitivity to change among community mental health providers. | After three months of engagement with the LyssnCBT tools | |
Primary | Appropriateness of LyssnCBT tools (Intervention Appropriateness Measure; IAM) | A brief, 4-item measure of a mental health professional's perception of how appropriate an innovation would be for use in their context. Each statement about the appropriateness of the innovation is rated on a 5-point ordinal scale ranging from "completely disagree" to "completely agree," where higher scores indicate higher levels of appropriateness. This measure has demonstrated good test-retest reliability and sensitivity to change among community mental health providers. | Phase 2; Three months after the site moves from SAU to LyssnCBT | |
Primary | Feasibility of LyssnCBT tools (Feasibility of Intervention Measure; FIM) | A brief, 4-item measure of a mental health professional's perception of how feasible an innovation would be for use in their context. Each statement about the feasibility of the innovation is rated on a 5-point ordinal scale ranging from "completely disagree" to "completely agree," where higher scores indicate higher levels of feasibility. This measure has demonstrated good test-retest reliability and sensitivity to change among community mental health providers. | Phase 2; Three months after the site moves from SAU to LyssnCBT | |
Primary | Usability of LyssnCBT tools (System Usability Scale; SUS) | A brief, 10-item questionnaire to evaluate an end-user's perceptions of an innovation's usability. Each statement is rated on a 5-point ordinal scale ranging from "strongly disagree" to "strongly agree," with every other question reverse-coded. Scores are converted to a common scale, added together and then multiplied by 2.5 to convert the original scores to a scale of 0-100. "Average" usability is defined as a total score >68 | Phase 2; Three months after the site moves from SAU to LyssnCBT | |
Primary | Change in client depression symptoms (Patient Health Questionnaire; PHQ-9) | The PHQ-9 (Patient Health Questionnaire) is a brief, widely used depression inventory assessing frequency of symptoms with 9 total items rated on a likert scale of 0-3. Higher scores indicate a greater frequency of symptoms of depression and presence of a clinically significant depressive disorder. This measure has demonstrated good test-retest reliability and can be completed within 2-3 minutes. This measure will be collected at every therapy session. | Immediately before weekly therapy sessions for the duration of treatment or through study completion, a maximum of 18 months | |
Primary | Change in client anxiety symptoms (General Anxiety Disorder; GAD-7) | The GAD-7 (General Anxiety Disorder) is a brief, widely used anxiety inventory assessing frequency of symptoms with 7 total items rated on a likert scale of 0-3. Higher scores indicate a greater frequency of symptoms of anxiety and presence of a clinically significant anxiety disorder. This measure has demonstrated good test-retest reliability and can be completed within 2-3 minutes. This measure will be collected at every therapy session. | Immediately before weekly therapy sessions for the duration of treatment or through study completion, a maximum of 18 months | |
Primary | Client drop-out/premature termination from therapeutic engagement | Dropout is collected via a brief monthly survey sent out to participating therapists which will ask, for each participating client, whether the client has been discharged and if that discharge was planned. | Immediately before weekly therapy sessions for the duration of treatment or through study completion, a maximum of 18 months |
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