Automated classification of exposure and encourage events in speech data from pediatric OCD treatment.

Objective: To develop and evaluate an automated classification system for labeling Exposure Process Coding System (EPCS) quality codes-specifically exposure and encourage events-during in-person exposure therapy sessions using automatic speech recognition (ASR) and natural language processing techniques. Materials and Methods: The system was trained and tested on 360 manually labeled pediatric Obsessive-Compulsive Disorder (OCD) therapy sessions from 3 clinical trials. Audio recordings were transcribed using ASR tools (OpenAI's Whisper and Google Speech-to-Text). Transcription accuracy was evaluated via word error rate (WER) on manual transcriptions of 2-minute audio segments compared against ASR-generated transcripts. The resulting text was analyzed with transformer-based models, including Bidirectional Encoder Representations from Transformers (BERT), Sentence-BERT, and Meta Llama 3. Models were trained to predict EPCS codes in 2 classification settings: sequence-level classification, where events are labeled in delimited text chunks, and token-level classification, where event boundaries are unknown. Classification was performed either with fine-tuned transformer-based models, or with logistic regression on embeddings produced by each model. Results: With respect to transcription accuracy, Whisper outperformed Google Speech-to-Text with a lower WER (0.31 vs 0.51). For sequence classification setting, Llama 3 models achieved high performance with area under the ROC curve (AUC) scores of 0.95 for exposures and 0.75 for encourage events, outperforming traditional methods and standard BERT models. In the token-level setting, fine-tuned BERT models performed best, achieving AUC scores of 0.85 for exposures and 0.75 for encourage events. Discussion and Conclusion: Current ASR and transformer-based models enable automated quality coding of in-person exposure therapy sessions. These findings demonstrate potential for real-time assessment in clinical practice and scalable research on effective therapy methods. Future work should focus on optimization, including improvements in ASR accuracy, expanding training datasets, and multimodal data integration.