Opening the Black Box of Family-Based Treatments: an artificial intelligence Framework to Examine therapeutic alliance and therapist Empathy

The evidence-based treatment (EBT) movement has primarily focused on core intervention content or treatment fidelity and has largely ignored practitioner skills to manage interpersonal process issues that emerge during treatment, especially with difficult-to-treat adolescents (delinquent, substance-using, medical non-adherence) and those of color. A chief complaint of real world practitioners about manualized treatments is the lack of correspondence between following a manual and managing microsocial interpersonal processes (e.g. negative affect) that arise in treating real world clients. Although family-based EBTs share core similarities (e.g. focus on family interactions, emphasis on practitioner engagement, family involvement), most of these treatments do not have an evidence base regarding common implementation and treatment process problems that practitioners experience in delivering particular models, especially in mid-treatment when demands on families to change their behavior is greatest in treatment - a lack that characterizes the field as a whole. Failure to effectively address common interpersonal processes with difficult-to-treat families likely undermines treatment fidelity and sustained use of EBTs, treatment outcome, and contributes to treatment dropout and treatment nonadherence. Recent advancements in wearables, sensing technologies, multivariate time-series analyses, and machine learning allow scientists to make significant advancements in the study of psychotherapy processes by looking under the skin of the provider-client interpersonal interactions that define therapeutic alliance, empathy, and empathic accuracy, along with the predictive validity of these therapy processes (therapeutic alliance, therapist empathy) to treatment outcome. Moreover, assessment of these processes can be extended to develop procedures for training providers to manage difficult interpersonal processes while maintaining a physiological profile that is consistent with astute skills in psychotherapeutic processes. This paper argues for opening the black box of therapy to advance the science of evidence-based psychotherapy by examining the clinical interior of evidence-based treatments to develop the next generation of audit- and feedback- (i.e., systemic review of professional performance) supervision systems

Multimodal Emotion Recognition among Couples from Lab Settings to Daily Life using Smartwatches

Couples generally manage chronic diseases together and the management takes an emotional toll on both patients and their romantic partners. Consequently, recognizing the emotions of each partner in daily life could provide an insight into their emotional well-being in chronic disease management. The emotions of partners are currently inferred in the lab and daily life using self-reports which are not practical for continuous emotion assessment or observer reports which are manual, time-intensive, and costly. Currently, there exists no comprehensive overview of works on emotion recognition among couples. Furthermore, approaches for emotion recognition among couples have (1) focused on English-speaking couples in the U.S., (2) used data collected from the lab, and (3) performed recognition using observer ratings rather than partner's self-reported / subjective emotions. In this body of work contained in this thesis (8 papers - 5 published and 3 currently under review in various journals), we fill the current literature gap on couples' emotion recognition, develop emotion recognition systems using 161 hours of data from a total of 1,051 individuals, and make contributions towards taking couples' emotion recognition from the lab which is the status quo, to daily life. This thesis contributes toward building automated emotion recognition systems that would eventually enable partners to monitor their emotions in daily life and enable the delivery of interventions to improve their emotional well-being.Comment: PhD Thesis, 2022 - ETH Zuric