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Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
AnalysingDialogueforDiagnosisandPredic3oninMentalHealth
Ma8hewPurverQueenMaryUniversityofLondon
withChris3neHowes,RoseMcCabe,ClaireKelleher,NiallGunter,JulianHough
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
MentalHealth&Language• Communica3onisimportantinmentalhealth:
– Linguis3cindicatorsofcondi3ons– Communica3onduringtreatment:
• Communica3onqualityassociatedwithoutcomes• Conversa3onstructure(how)andcontent(what)
– CanNLPtechniqueshelpusanalyse&understandtherapy/condi3ons?
• PPATproject:– schizophrenia:face-to-faceoutpa3entconversa3on
• AOTDproject:– depression&anxiety:onlinetext-basedtherapy
• SLADEproject:– demen3a:face-to-faceclinicalconversa3on
• (Howes,McCabe,Purver2012-2014,2018toappear)
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Ques3ons• Doeslanguagecorrelatewithand/orpredictsymptoms&
outcomes?– Canweusethistohelpdiagnosisand/ortreatment?
• Whataretheinforma3vefeatures?– Topic?– Sen3ment/emo3onalcontent?– Conversa3onstructure?
• Canwedetectthemautoma3cally?– Accurately– Robustly– Usingexis3ngNLPtechniques/tools
• Howcanwedobe8er?
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
PPAT:Face-to-FaceDialogue• Transcriptsoftherapyforschizophrenia• Measuresofsymptomseverity
– posi0ve(delusions,hallucina3ons,beliefs)– nega0ve(withdrawal,bluntedaffect,alogia)
• Recordedrelatedoutcomes– ra3ngsofcommunica3onquality– futureadherencetotreatment(6monthslater):
• non-adherence:riskofrelapse3.73meshigher– sharedunderstandingknowntobearelatedfactor
• Manualannota3on&sta3s3calanalysis• McCabeetal(2013)
• Automa3cNLPprocessing&machinelearning• Howesetal(2012;2013)
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
UsingBruteForce• Classifyen3redialogues(pa3entturnsonly)withSVMs,ngrams
– Predictnon-adherencetotreatment6monthslater
• Similarforsymptoms,someoutcomese.g.HAS,PEQ• Humanpsychiatristgivensametask:
• Buthowwellwillthisgeneralise?Andwhatdoesitmean?
Features P(%) R(%) F(%)
Classofinterest 28.9 100.0 44.8
Baselinefeatures 27.0 51.9 35.5
Bestngramfeatures 70.3 70.3 70.3
Data P(%) R(%) F(%)
Texttranscripts 60.3 79.6 68.6
Transcripts+video 69.6 88.6 78.0
Images:wikipedia,coursera.com
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
UsingBruteForce• Classifyen3redialogues(pa3entturnsonly)withSVMs,ngrams
– Predictnon-adherencetotreatment6monthslater
• Similarforsymptoms,someoutcomese.g.HAS,PEQ• Humanpsychiatristgivensametask:
• Buthowwellwillthisgeneralise?Andwhatdoesitmean?
Features P(%) R(%) F(%)
Classofinterest 28.9 100.0 44.8
Baselinefeatures 27.0 51.9 35.5
Bestngramfeatures 70.3 70.3 70.3
Data P(%) R(%) F(%)
Texttranscripts 60.3 79.6 68.6
Transcripts+video 69.6 88.6 78.0
Images:wikipedia,coursera.com
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Manualtopicsegmenta3on
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
TopicModelling• LatentDirichletAlloca3on(Bleietal,2003)• UnsupervisedBayesianmodel:
– textsasmixturesof“topics”– topicsasdistribu3onsoverwords
• Nopriorknowledgeoftopics– numberoftopics– likelydistribu3onshapes– (automa3callyop3mised)
• Successfulapplica3oninawiderangeofdomains&tasks
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
LDAtopicmodelling• Infer20lexical“topics”:
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
LDAtopicmodelling• LDAtopicsgivenmanual“interpreta3ons”:– (someincludeposi3ve/nega3vesen3mentaspect)
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
ManualvsLDAtopiccorrela3on
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Outcomepredic3onusingtopics• Usetopicweightperdialogue,withgeneralDr/Pfactors,asfeatures:
Measure ManualAcc(%)
LDAAcc(%)
HASDr 75.8 75.0
HASP 59.0 53.7
PANSSposi3ve 61.1 58.8
PANSSnega3ve 62.1 56.1
PANSSgeneral 59.5 53.4
PEQcommunica3on 59.7 56.7
PEQcommbarriers 61.9 60.4
PEQemo3on 57.5 57.5
Adherence(balanced) 66.2 54.1
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Linguis3canalysis:Repair
• Manuallinguis3canalysis– Significantroleofrepair– Pa3ent-ini3atedother-repair&self-repair
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Compareotherdialoguecontexts
• Therapy:moreself-repair,lessother-repair&ini3a3on
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Pa3ent-doctorcomparison
• Pa3ents:moreself-repair,lessother-repair&ini3a3on
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
But…• Experimentswithautoma3cother-repairdetec3ondidn’thelp:– Averysparseproblem(e.g.<1%ofturns)– Needsageneralmeasureofparallelism– Needsvocabulary-independence
• Sosparse,evenperfectperformancewouldn’thavehelpedpredic3on
• Wecandobe8ernow!– (seelater)
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Schizophrenia:Summary• Predic3ngfutureadherencetotreatment:– words&ngrams(phrases):70%– humans:70%(transcripts),80%(video)– topics:66%(manual),54%(auto)– i.e.wecandoit,butwedon’treallyunderstandhow…
• Topicmodellingprovidesusefulfeatures:– topicscorrelatewellwithhuman-annotatedtopics– topicspredictsymptomseverity– topicspredicttherapeu3crela3onshipra3ngs– topics&emo3on/stanceinterrelate
• Repaircorrelateswithadherence– butautoma3cdetec3onisdifficult– …andit’saverysparsephenomenon
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
OnlineText-basedTherapy• Text-basedtherapyfor
depression&anxiety– IESODigitalHealthLtd
• Cogni3veBehaviouralTherapy– 2,000sessions,500pa3ents,
mean5.65sessions/pa3ent• Anonymisa3onusingRASP
– (Briscoeetal,2006)– Non-trivial
• Outcomemeasure– Pa3entHealthQues3onnaire
(PHQ-9)– Currentseverity,progress
sincestart
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Topics• Themesincludefamily,sleep,symptoms,progress,process:0 3mesessionsorrytodaygreatsendnextnowoneworkthanksseethank
pleasehelpmakeableperhapslook
1 feellifethinkknowwaythingsnowlikewantmakeselffeelingspeoplechangemaybesomeonemuchneedothers
2 rightwellgreatsureappointmentfeelthankjustloltonightpleaseknowgetsorrysaybyemee3nglastthough
3 ea3ngeatfoodweightsickdrinkmealnowlunchcontrolgreatchocolateabsolutelydayhealthydinnerputusereally
4 3mehusbandmumfamilyfeelchildrennowdadwantseesaidfriendsalsokidshomelifegotschooldaughter
5 peoplesayangrysitua3onangersitua3onssaidwaysocialotherslikeonefriendstalksomeonepersonbehavioursayingknow
6 getgoknowlikeneedthingsgoingjustthinktrywantonesomething3megoodnowmakedaystart
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
TopicsvsSchizophreniaSleeppa8erns daysleepweek3mebedwork
moodnightgetthingsdayssleepday3mefeelbedbitthingshoursmorningsleepingnight
Family 3mehusbandmumfamilyfeelchildrennowdadwantseesaidfriendsalsokidshomelife
mummoneydadbrothershoppingdiedenjoytabletsbloodbaddaughtersister
Food/weight ea3ngeatfoodweightsickdrinkmealnowlunchcontrolgreatchocolateabsolutelydayhealthy
weightstoneeatmedica3ongainhospitaltwelveweighexercisecutgym
Nega3vefeelings feellifethinkknowwaythingsnowlikewantmakeselffeelings
feelmedica3onfeelingthoughts3memoodlowheadpastillness
Crises gethelpgpdepressionpainknowmedica3onhealththerapysorryappointmentlastfacemoment
rememberdoctorhospitalreasonpolicepeoplememoryringshakingheadachesdoor
Socialstress workjob3megoodstressworkinggetschoollifemoneywifeissues
thingsbackplaceyearsthoughtbitagohomeputdaycoming
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Topicvsseverity&progress0 Materials,self-help,procedures − 10 Unhelpfulthinking/habits
1 Feelings/effectsofrela3onshipsonsenseofself
+ + 11 Work/training/educa3onissues/goals
2 Posi3vereac3ons/encouragement 12 Agenda/goalsetng&review
3 Issuesaroundfood 13 Panica8ackdescrip3on/explana3on − −
4 Family/rela3onships&issueswith(mostlynega3ve)
+ 14 Otherhealthcareprofessionals,crises,risk,interven3ons
++
5 Responsestosocialsitua3ons 15 Sleep/dailyrou3ne +
6 Breakingthingsdownintosteps + 16 Posi3veprogress,improvements −− −
7 Worries/fears/anxie3es − 17 Feelings,specificoccasions/thoughts
8 Managingnega3vethoughts/mindfulness
18 Explaining/framingintermsofCBTmodel
+
9 Fears,checking,rituals,phobias − − 19 Techniquesfortakingcontrol − −
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Sen3ment/Emo3onDetec3on• Detectposi3ve&nega3vesen3ment
– seee.g.(DeVaultetal,2013)• Detectanger
– challenge&emo3onelicita3oninCBTprocess• Comparedexis3ngtools
– Manuallyannotated85u8erancesin1session• posi0ve/nega0ve/neutral(inter-annotatoragreementκ=0.66)
• Dic3onary-basedLIWC– sen3ment34-45%;angerrecall=0
• Data-based(RNNs)Stanford,trainedonnewstext(85%)– sen3ment51-54%(noanger)
• Data-based(SVMs),trainedonTwi8ertext– sen3ment63-80%
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Sen3ment/Emo3onvsPHQ
• Moreposi3vesen3mentèbe8erPHQ,progress• Morevariablesen3mentèworseprogress• More/morevariableangerèworsePHQ
Severity(PHQ) Progress(ΔPHQ)
Sen3mentmean −− −
Sen3mentstddev +
Angermean/max +
Angerstddev +
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Predic3ngfinaloutcomes• Changesinlevelshelppredic3ngfinalin/out-of-caseness:– usingfeaturesfromini3aland/orfinalsessions:
• Featureschosenareinforma3ve:– Levelsofsen3ment&anger,progress&crisis/risktopics
• Deltasbetweensessions– PHQscoresatassessmentandini3altreatmentsessions
FinalIn-caseness
Baselinepropor0on 26.8%
First+lastsessionfeatures,incldeltas 0.71(0.48)
IncludingearlyPHQscores 0.76(0.51)
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Predic3ngdropout• Canwepredictdropout&non-engagement?
– 148of500didnotenterorstayintreatment
• >70%accuracyusingini3alsessionfeatures
– Butonlybyincludingfine-grainedwordfeatures
Dropout
Baselinepropor0on 29.6%
Assessmentsessionfeatures 0.65(0.26)
Treatmentsessionfeatures 0.70(0.59)
Bothsessions 0.73(0.64)
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Predic3ngtherapyquality• Canwedis3nguish“good”from“bad”therapists?
– Top25%vsbo8om25%basedonnumberofpa3entsrecovered
• Goodaccuracyusingini3al&finalsessionfeatures
– Butmostlybyincludingfine-grainedwordfeatures
Dropout
Baselinepropor0on 50%
Onlyhigh-levelfeatures 0.67(0.63)
Incudinglexicalfeatures 0.78(0.74)
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Depression/Anxiety:Summary• Topicmodellingprovidesusefulfeatures:
– correlatewellwithhuman-annotatedtopicsandpreviousstudy– topicscorrelatewithsymptomseverityandprogress
• Emo3ondetec3onprovidesusefulfeatures:– levelsandvariabilitypredictsymptomsandprogress– needscarechoosing&trainingtools
• Predic3ngusefuloutcomemeasures:– recovery:71%,76%withPHQinforma3on
• emo3onlevels&variability;talkaboutprogress&dealingwithcrises• (arewestar3ngtounderstandwhat’sgoingon?)
– dropout:73%– therapistquality:78%
• detailsofcontent&structure:wes3lldon’tunderstandthese…
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
SLADE:Demen3aDiagnosis• U.Exeterdataset
– 148diagnosisconversa3onswithdoctor(&carer)• 70posi3vediagnosisofdemen3a• 78nega3vediagnosis(MildCogni3veImpairmentinsomecases)
– AyerreferralfromGP,memorytests/scans– Givendiagnosis,advice
• Rela3velyearlystage– Canweaiddiagnosis?
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Demen3a&Language• Vocabularyreduc3on(e.g.Hirst&Feng,2012)
– Authorsoverlong3mescales• Contentreduc3on(e.g.Orimayeetal2014)
– Fewerpredicates,feweru8erances,shortersentences– Demen3aBank:74%
• Speechfeatures(Jarroldetal,2014)– Includinglexicalclassfeaturese.g.pronoun/noun/verbfrequencies– Smallset,healthycontrols:80-90%
• Combinedfeatures(Fraseretal,2016)– Impairment:seman3c,syntac3c,informa3on,acous3c– Demen3aBank:c.80%
• Butwehaveshort3mescales,diagnosis-dependentcontent…– Adviceondriving,legalrequirements,futureplanning– Andmanyotherfeaturese.g.length– Needcontent-independentfeatures
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Conversa3on-basedstudies• ManyCA-likestudies(Watsonetal1999…Jonesetal2015)
• Indica3vedialogue-structuralfeatures:– “Lackoffluency”
• Self-repair• Lackoftopiccoherence
– Other-repair• Types,appropriateness,answeringbehaviour,lackofcorrec3ons
– Ques3on-answering• Avoidancestrategies,contentlessness
– Pausingbehaviour• Intra-andinter-u8erance
– Backchannelbehaviour• Morecontentlessu8erancesvsloweruseofcon3nuants?
– Laughter
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Tes3ngInterac3onalFeatures• Addinterac3vityfeaturestoFraseretal(2016)model:
– Self-repairindices:• Pauses,filledpauses,incompletewords,repe33on,editterms• Similarityofpost-fillerterms
– Other-repairindices:• Ques3onforms,inter-turnpauses• Backchannels,answerlength
– Generalindices:• Laughter• “Don’tknow”answers• Par3cipantturn&ques3onfrequency/ra3os
• Top3mostpredic3vefeaturesareinterac3onal(Kelleheretal,inprep)• Performanceimprovement:
– Benchmarkreplica3on:F=73.8%– Addinginterac3vefeatures:F=79.4%
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Doingbe8er:Other-Repair• (HowesetalSIGDIAL2012;Purveretal,2018toappear)
• Discrimina3veclassifica3on– Weightedclassifierstocombatsparsity– Per-turnincrementality– Assumeadjacentantecedent-repairpairs
• 85%ofcases(Purveretal,2003)
• Definefeaturesmanually,extractautoma3cally– Linguis3cally/observa3onallyinformed:
• Wh-ques3onwords,closedclassrepairwords• Backchannelbehaviour,fillers,pauses,overlaps• Lexicalparallelism,syntac3c(POS)parallelism• Seman3cparallelism(Mikolovetal2013;Turianetal2010)
– Bruteforce“ceiling”:allunigrams
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Other-repairresults• Resultsonrealunbalanceddata:
• Worseonsomedatasetse.g.MapTaskF-score38-50(PRC0.55)
Target Features P(%) R(%) F(%) PRC
PCC (baseline) 1 100 3 0.01
PCC Allhigh-level 44 43 44 0.40
PCC Allfeatures 46 47 46 0.48
BNC (baseline) 4 100 8 0.04
BNC Allhigh-level 55 55 55 0.52
BNC Allfeatures 57 62 60 0.61
SWBD (baseline) 0.2 100 1 0.00
SWBD Allhigh-level 54 52 53 0.50
SWBD Allfeatures 52 60 56 0.58
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Doingbe8er:Self-repair• (Hough&Purver,EMNLP2014;Purveretal,2018toappear)• “Disfluencydetec3on”forspeechrecogni3on
AflighttoBoston–uh,Imean,toDenverè AflighttoDenver
• Per-wordincrementaloutput,maintainingseman3ccontext:Theinterviewwas–itwasalrightIwentswimmingwithSusan–orrather,surfing
• Domain-general,informa3on-theore3cfeatures:– Similari3esbetweenprobabilitydistribu3ons– Changesinprobability&entropygivenrepairhypotheses– Combinedinrandomforestclassifiers
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Self-repairresults• Designed&trainedonSwitchboardcorpus:
– State-of-the-artaccuracyF=0.85(P0.93>>R0.79)– Per-u8erancecorrela3on0.96– Fasterincrementality
• Transfertomentalhealthdomain(PPAT):– F=0.62(P0.66>R0.59)– Per-u8erancecorrela3on0.81– Per-dialoguecorrela3on0.94
• Othercorporalessimpressive(BNC,Colman&Healey2011):– F=0.42(P0.40<R0.44)– Per-u8erancecorrela3on0.58(p<0.001)
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
Summary• Wecanpredictusefuloutcomemeasures
– (diagnosis,severity,adherence)– butwe’dreallylikeaninterpretablemodel
• Topic&emo3ondetec3onisausefulstep– needscarechoosing&trainingtools– goodforpredic3ngsymptomsandprogress– notgoodforotheroutcomes(therapyquality,adherence…)
• Interac3onmodellingisanotherusefulstep– par3cularlytheroleofrepair(self-andother-)– approxima3onshelpdemen3adiagnosis– generalmodelsarenowinastatetobeapplied!
Cognitive Science Research Grouphttp://cogsci.eecs.qmul.ac.uk
AcknowledgementsTheCMSIprojectwassupportedbyCrea3veWorksLondon,aKnowledgeExchangeHubfortheCrea3veEconomyfundedbythe
ArtsandHumani3esResearchCouncil;andcompletedincollabora3onwithCha8erboxLabsLtd&theBarbican
ThePPAT&AOTDprojectsweresupportedbyQueenMaryUniversityofLondon’sEPSRC-fundedPump-PrimingandInnova3onFunds,andPsychologyOnlineLtd;andcompletedincollabora3onwithPsychologyOnlineLtdandiLexIRLtd.
TheprojectConCreTeacknowledgesthefinancialsupportoftheFutureandEmergingTechnologies(FET)programmewithinthe
SeventhFrameworkProgrammeforResearchoftheEuropeanCom-mission,underFETgrantnumber611733§