Toward Large Language Models as a Therapeutic Tool: Comparing Prompting Techniques to Improve GPT-Delivered Problem-Solving Therapy

While Large Language Models (LLMs) are being quickly adapted to many domains, including healthcare, their strengths and pitfalls remain under-explored. In our study, we examine the effects of prompt engineering to guide Large Language Models (LLMs) in delivering parts of a Problem-Solving Therapy (PST) session via text, particularly during the symptom identification and assessment phase for personalized goal setting. We present evaluation results of the models' performances by automatic metrics and experienced medical professionals. We demonstrate that the models' capability to deliver protocolized therapy can be improved with the proper use of prompt engineering methods, albeit with limitations. To our knowledge, this study is among the first to assess the effects of various prompting techniques in enhancing a generalist model's ability to deliver psychotherapy, focusing on overall quality, consistency, and empathy. Exploring LLMs' potential in delivering psychotherapy holds promise with the current shortage of mental health professionals amid significant needs, enhancing the potential utility of AI-based and AI-enhanced care services.

Reexamining Racial Disparities in Automatic Speech Recognition Performance: The Role of Confounding by Provenance

Automatic speech recognition (ASR) models trained on large amounts of audio data are now widely used to convert speech to written text in a variety of applications from video captioning to automated assistants used in healthcare and other domains. As such, it is important that ASR models and their use is fair and equitable. Prior work examining the performance of commercial ASR systems on the Corpus of Regional African American Language (CORAAL) demonstrated significantly worse ASR performance on African American English (AAE). The current study seeks to understand the factors underlying this disparity by examining the performance of the current state-of-the-art neural network based ASR system (Whisper, OpenAI) on the CORAAL dataset. Two key findings have been identified as a result of the current study. The first confirms prior findings of significant dialectal variation even across neighboring communities, and worse ASR performance on AAE that can be improved to some extent with fine-tuning of ASR models. The second is a novel finding not discussed in prior work on CORAAL: differences in audio recording practices within the dataset have a significant impact on ASR accuracy resulting in a ``confounding by provenance'' effect in which both language use and recording quality differ by study location. These findings highlight the need for further systematic investigation to disentangle the effects of recording quality and inherent linguistic diversity when examining the fairness and bias present in neural ASR models, as any bias in ASR accuracy may have negative downstream effects on disparities in various domains of life in which ASR technology is used.

Too Big to Fail: Larger Language Models are Disproportionately Resilient to Induction of Dementia-Related Linguistic Anomalies

As artificial neural networks grow in complexity, understanding their inner workings becomes increasingly challenging, which is particularly important in healthcare applications. The intrinsic evaluation metrics of autoregressive neural language models (NLMs), perplexity (PPL), can reflect how "surprised" an NLM model is at novel input. PPL has been widely used to understand the behavior of NLMs. Previous findings show that changes in PPL when masking attention layers in pre-trained transformer-based NLMs reflect linguistic anomalies associated with Alzheimer's disease dementia. Building upon this, we explore a novel bidirectional attention head ablation method that exhibits properties attributed to the concepts of cognitive and brain reserve in human brain studies, which postulate that people with more neurons in the brain and more efficient processing are more resilient to neurodegeneration. Our results show that larger GPT-2 models require a disproportionately larger share of attention heads to be masked/ablated to display degradation of similar magnitude to masking in smaller models. These results suggest that the attention mechanism in transformer models may present an analogue to the notions of cognitive and brain reserve and could potentially be used to model certain aspects of the progression of neurodegenerative disorders and aging.

Useful Blunders: Can Automated Speech Recognition Errors Improve Downstream Dementia Classification?

\textbf{Objectives}: We aimed to investigate how errors from automatic speech recognition (ASR) systems affect dementia classification accuracy, specifically in the ``Cookie Theft'' picture description task. We aimed to assess whether imperfect ASR-generated transcripts could provide valuable information for distinguishing between language samples from cognitively healthy individuals and those with Alzheimer's disease (AD). \textbf{Methods}: We conducted experiments using various ASR models, refining their transcripts with post-editing techniques. Both these imperfect ASR transcripts and manually transcribed ones were used as inputs for the downstream dementia classification. We conducted comprehensive error analysis to compare model performance and assess ASR-generated transcript effectiveness in dementia classification. \textbf{Results}: Imperfect ASR-generated transcripts surprisingly outperformed manual transcription for distinguishing between individuals with AD and those without in the ``Cookie Theft'' task. These ASR-based models surpassed the previous state-of-the-art approach, indicating that ASR errors may contain valuable cues related to dementia. The synergy between ASR and classification models improved overall accuracy in dementia classification. \textbf{Conclusion}: Imperfect ASR transcripts effectively capture linguistic anomalies linked to dementia, improving accuracy in classification tasks. This synergy between ASR and classification models underscores ASR's potential as a valuable tool in assessing cognitive impairment and related clinical applications.

Bridging the Skills Gap: Evaluating an AI-Assisted Provider Platform to Support Care Providers with Empathetic Delivery of Protocolized Therapy

Despite the high prevalence and burden of mental health conditions, there is a global shortage of mental health providers. Artificial Intelligence (AI) methods have been proposed as a way to address this shortage, by supporting providers with less extensive training as they deliver care. To this end, we developed the AI-Assisted Provider Platform (A2P2), a text-based virtual therapy interface that includes a response suggestion feature, which supports providers in delivering protocolized therapies empathetically. We studied providers with and without expertise in mental health treatment delivering a therapy session using the platform with (intervention) and without (control) AI-assistance features. Upon evaluation, the AI-assisted system significantly decreased response times by 29.34% (p=0.002), tripled empathic response accuracy (p=0.0001), and increased goal recommendation accuracy by 66.67% (p=0.001) across both user groups compared to the control. Both groups rated the system as having excellent usability.

Enhancing Robustness of Foundation Model Representations under Provenance-related Distribution Shifts

Foundation models are a current focus of attention in both industry and academia. While they have shown their capabilities in a variety of tasks, in-depth research is required to determine their robustness to distribution shift when used as a basis for supervised machine learning. This is especially important in the context of clinical data, with particular limitations related to data accessibility, lack of pretraining materials, and limited availability of high-quality annotations. In this work, we examine the stability of models based on representations from foundation models under distribution shift. We focus on confounding by provenance, a form of distribution shift that emerges in the context of multi-institutional datasets when there are differences in source-specific language use and class distributions. Using a sampling strategy that synthetically induces varying degrees of distribution shift, we evaluate the extent to which representations from foundation models result in predictions that are inherently robust to confounding by provenance. Additionally, we examine the effectiveness of a straightforward confounding adjustment method inspired by Pearl's conception of backdoor adjustment. Results indicate that while foundation models do show some out-of-the-box robustness to confounding-by-provenance related distribution shifts, this can be considerably improved through adjustment. These findings suggest a need for deliberate adjustment of predictive models using representations from foundation models in the context of source-specific distributional differences.

Personalized Jargon Identification for Enhanced Interdisciplinary Communication

Scientific jargon can impede researchers when they read materials from other domains. Current methods of jargon identification mainly use corpus-level familiarity indicators (e.g., Simple Wikipedia represents plain language). However, researchers' familiarity of a term can vary greatly based on their own background. We collect a dataset of over 10K term familiarity annotations from 11 computer science researchers for terms drawn from 100 paper abstracts. Analysis of this data reveals that jargon familiarity and information needs vary widely across annotators, even within the same sub-domain (e.g., NLP). We investigate features representing individual, sub-domain, and domain knowledge to predict individual jargon familiarity. We compare supervised and prompt-based approaches, finding that prompt-based methods including personal publications yields the highest accuracy, though zero-shot prompting provides a strong baseline. This research offers insight into features and methods to integrate personal data into scientific jargon identification.

Deep Representations of First-person Pronouns for Prediction of Depression Symptom Severity

Prior work has shown that analyzing the use of first-person singular pronouns can provide insight into individuals' mental status, especially depression symptom severity. These findings were generated by counting frequencies of first-person singular pronouns in text data. However, counting doesn't capture how these pronouns are used. Recent advances in neural language modeling have leveraged methods generating contextual embeddings. In this study, we sought to utilize the embeddings of first-person pronouns obtained from contextualized language representation models to capture ways these pronouns are used, to analyze mental status. De-identified text messages sent during online psychotherapy with weekly assessment of depression severity were used for evaluation. Results indicate the advantage of contextualized first-person pronoun embeddings over standard classification token embeddings and frequency-based pronoun analysis results in predicting depression symptom severity. This suggests contextual representations of first-person pronouns can enhance the predictive utility of language used by people with depression symptoms.

Backdoor Adjustment of Confounding by Provenance for Robust Text Classification of Multi-institutional Clinical Notes

Natural Language Processing (NLP) methods have been broadly applied to clinical tasks. Machine learning and deep learning approaches have been used to improve the performance of clinical NLP. However, these approaches require sufficiently large datasets for training, and trained models have been shown to transfer poorly across sites. These issues have led to the promotion of data collection and integration across different institutions for accurate and portable models. However, this can introduce a form of bias called confounding by provenance. When source-specific data distributions differ at deployment, this may harm model performance. To address this issue, we evaluate the utility of backdoor adjustment for text classification in a multi-site dataset of clinical notes annotated for mentions of substance abuse. Using an evaluation framework devised to measure robustness to distributional shifts, we assess the utility of backdoor adjustment. Our results indicate that backdoor adjustment can effectively mitigate for confounding shift.

APPLS: A Meta-evaluation Testbed for Plain Language Summarization

While there has been significant development of models for Plain Language Summarization (PLS), evaluation remains a challenge. This is in part because PLS involves multiple, interrelated language transformations (e.g., adding background explanations, removing specialized terminology). No metrics are explicitly engineered for PLS, and the suitability of other text generation evaluation metrics remains unclear. To address these concerns, our study presents a granular meta-evaluation testbed, APPLS, designed to evaluate existing metrics for PLS. Drawing on insights from previous research, we define controlled perturbations for our testbed along four criteria that a metric of plain language should capture: informativeness, simplification, coherence, and faithfulness. Our analysis of metrics using this testbed reveals that current metrics fail to capture simplification, signaling a crucial gap. In response, we introduce POMME, a novel metric designed to assess text simplification in PLS. We demonstrate its correlation with simplification perturbations and validate across a variety of datasets. Our research contributes the first meta-evaluation testbed for PLS and a comprehensive evaluation of existing metrics, offering insights with relevance to other text generation tasks.