Adapting the Number of Questions Based on Detected Psychological Distress for Cognitive Behavioral Therapy With an Embodied Conversational Agent: Comparative Study

BACKGROUND

The high prevalence of mental illness is a critical social problem. The limited availability of mental health services is a major factor that exacerbates this problem. One solution is to deliver cognitive behavioral therapy (CBT) using an embodied conversational agent (ECA). ECAs make it possible to provide health care without location or time constraints. One of the techniques used in CBT is Socratic questioning, which guides users to correct negative thoughts. The effectiveness of this approach depends on a therapist's skill to adapt to the user's mood or distress level. However, current ECAs do not possess this skill. Therefore, it is essential to implement this adaptation ability to the ECAs.

OBJECTIVE

This study aims to develop and evaluate a method that automatically adapts the number of Socratic questions based on the level of detected psychological distress during a CBT session with an ECA. We hypothesize that this adaptive approach to selecting the number of questions will lower psychological distress, reduce negative emotional states, and produce more substantial cognitive changes compared with a random number of questions.

METHODS

In this study, which envisions health care support in daily life, we recruited participants aged from 18 to 65 years for an experiment that involved 2 different conditions: an ECA that adapts a number of questions based on psychological distress detection or an ECA that only asked a random number of questions. The participants were assigned to 1 of the 2 conditions, experienced a single CBT session with an ECA, and completed questionnaires before and after the session.

RESULTS

The participants completed the experiment. There were slight differences in sex, age, and preexperimental psychological distress levels between the 2 conditions. The adapted number of questions condition showed significantly lower psychological distress than the random number of questions condition after the session. We also found a significant difference in the cognitive change when the number of questions was adapted based on the detected distress level, compared with when the number of questions was fewer than what was appropriate for the level of distress detected.

CONCLUSIONS

The results show that an ECA adapting the number of Socratic questions based on detected distress levels increases the effectiveness of CBT. Participants who received an adaptive number of questions experienced greater reductions in distress than those who received a random number of questions. In addition, the participants showed a greater amount of cognitive change when the number of questions matched the detected distress level. This suggests that adapting the question quantity based on distress level detection can improve the results of CBT delivered by an ECA. These results illustrate the advantages of ECAs, paving the way for mental health care that is more tailored and effective.

Linguistic Features of Clients and Counselors for Early Detection of Mental Health Issues in Online Text-based Counseling

Online counseling is essential for overcoming mobility restrictions, schedule limitations, and mental health stigma. However, government counseling offices are being inun-dated with consultations for which non-mental health supports are targeted. Therefore, we aim to create a classification model that classifies whether the clients have mental health issues or other issues. We expect to support counselors by presenting the classification results. We conducted the first automatic detection of clients who might be suffering from mental health issues and used almost 1000 actual counseling sessions for our machine learning framework. We achieved an F1-score of 0.646 by classifying dialogue sessions using features such as frequency-inverse, document frequency, document embedding of a large-scale language model, linguistic inquiry and word count, topic modeling, and statistics of dialogue sentences. In addition, we performed dimensionality reduction with principal component analysis. We also conducted evaluation experiments using dialogue sentences from the beginning to the middle of sessions as input and clarified the relationship between the number of messages in the dialogues and the transition in the classification performance. We also identified the words that contribute to detecting mental health issues for each client and counselor. Clinical relevance-This study makes it possible to detect the trends identified in a client's anxieties during counseling. Our findings are critical for designing systems that assist counselors.

Automatic Thoughts and Facial Expressions in Cognitive Restructuring With Virtual Agents

Cognitive restructuring is a well-established mental health technique for amending automatic thoughts, which are distorted and biased beliefs about a situation, into objective and balanced thoughts. Since virtual agents can be used anytime and anywhere, they are expected to perform cognitive restructuring without being influenced by medical infrastructure or patients' stigma toward mental illness. Unfortunately, since the quantitative analysis of human-agent interaction is still insufficient, the effect on the user's cognitive state remains unclear. We collected interaction data between virtual agents and users to observe the mood improvements associated with changes in automatic thoughts that occur in user cognition and addressed the following two points: (1) implementation of a virtual agent that helps a user identify and evaluate automatic thoughts; (2) identification of the relationship between a user's facial expressions and the extent of the mood improvement subjectively felt by users during the human-agent interaction. We focus on these points because cognitive restructuring by a human therapist starts by identifying automatic thoughts and seeking sufficient evidence to find balanced thoughts (evaluation of automatic thoughts). Therapists also use such non-verbal behaviors as facial expressions to detect changes in a user's mood, which is an important indicator for guidance. Based on the results of this analysis, we provide a technical guidance framework that fully automates the identification and evaluation of automatic thoughts to achieve a virtual agent that can interact with users by taking into account their verbal and non-verbal behaviors in face-to-face situations. This research supports the possibility of improving the effectiveness of mental health care in cognitive restructuring using virtual agents.

Inhibition of vascular endothelial growth factor in young adult mice causes low bone blood flow and bone strength with no effect on bone mass in trabecular regions

Objective

To determine the effect of an antibody to vascular endothelial growth factor (VEGF) on bone blood flow, bone strength, and bone mass in the young adult mouse.

Methods

Ten-week-old male BALB/cJ mice were body weight-randomized into either a rodent anti-VEGF monoclonal antibody (anti-VEGF, B20-4.1.1; 5 mg/kg 2×/wk.; n = 12) group or a vehicle (VEH; n = 12) group. After 42 days, mice were evaluated for bone blood flow at the distal femur by ¹⁸F-NaF-PET/CT and then necropsied. Samples from trabecular and cortical bone regions were evaluated for bone strength by mechanical testing, bone mass by peripheral quantitative computed tomography (pQCT), and micoarchitecture (MicroCT). Hydration of the whole femur was studied by proton nuclear magnetic resonance relaxometry (¹H NMR).

Results

Distal femur blood flow was 43% lower in anti-VEGF mice than in VEH mice (p = 0.009). Ultimate load in the lumbar vertebral body was 25% lower in anti-VEGF than in VEH mice (p = 0.013). Bone mineral density (BMD) in the trabecular region of the proximal humeral metaphysis by pQCT, and bone volume fraction and volumetric BMD by MicroCT were the same in the two groups. Volume fraction of bound water (BW) of the whole femur was 14% lower in anti-VEGF than in VEH mice (p = 0.003). Finally, BW, but not cortical tissue mineral density, helped section modulus explain the variance in the ultimate moment experienced by the femur in three-point bending.

Conclusion

Anti-VEGF caused low bone blood flow and bone strength in trabecular bone regions without influencing BMD and microarchitecture. Low bone strength was also associated with low bone hydration. These data suggest that bone blood flow is a novel bone property that affects bone quality.

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An antibody to vascular endothelial growth factor (anti-VEGF) caused low bone blood flow in a trabecular bone rich region.

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Anti-VEGF did not affect trabecular bone region and bone hydration of the whole femur were also low, trabecular bone mass was not affected by anti-VEGF.

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Bone blood flow may be a bone property that affects bone quality through bone hydration.

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Anti-VEGF caused low trabecular bone strength in the vertebral body and low bone hydration of the whole femur.

Osteoarthritis year in review 2016: clinical

Both epidemiologic and clinical research continues to be performed in osteoarthritis (OA). While epidemiologic studies identify risk factors for incident and progressive disease, clinical studies explore the role of both non-pharmacologic and pharmacologic treatments, including oral and intra-articular therapies. We performed a systematic review of the literature using PubMed for the time period between April 1, 2015 to February 22, 2016. Selected publications in the areas of both epidemiology and treatment are reviewed in this article.

Ultra-High-Sensitive Image Pickup Tubes Using Avalanche Multiplication in a-Se

Extremely high-sensitive image pickup tubes with sensitivities 1000 times higher than those of conventional tubes are fabricated using the avalanche phenomenon in a-Se as photoconductive targets. The excess avalanche noise of a video signal is found to be much less than that expected, based on the carrier ionization rates. The frequency spectra of the noise currents of both the pickup tubes and sandwich-type photocells are examined. The results are compared with those of a simulation, and it is found that the excess noise can be reduced by the charge-storage operation of imaging devices.

High frequency of p53 abnormality in laryngeal cancers of heavy smokers and its relation to human papillomavirus infection

A series of 41 laryngeal squamous cell carcinomas was examined for p53 abnormalities and human papillomavirus (HPV) infection by an immunohistochemical and/or molecular approach. Immunohistochemically, p53 over-expression was observed in about 60% of the cancers, of which 12 were revealed to contain point mutations of p53 by a combination of the single-strand conformational polymorphism technique and direct sequencing. The p53 point mutations ranged from codons 157 to 278 and most of these mutations lay in two "hot spots" (codon 157 in four cancers and codon 248 in three cancers). The majority of p53 mutations, both transversions (seven cancers) and transitions (five cancers), occurred at the G nucleotide of the codons. An analysis of the clinical information indicated that p53 point mutation was frequently observed in heavy smokers with an average Brinkman index score of more than 1000. On the other hand, HPV DNA, type 16 or 18, was detected in a quarter of the laryngeal cancers. Of eleven HPV-positive cases, nine were immunohistochemically positive for p53, of which four contained a p53 point mutation. These results suggested no inverse relation between p53 mutation and HPV infection in laryngeal cancers. Our study indicates that p53 abnormalities are related to smoking history and the correlation might be better for smoking and chemical mutagenesis than for HPV.

Lack of synergistic association between human papillomavirus and ras gene point mutation in laryngeal carcinomas

The spectrum of human papillomavirus (HPV) subtypes in laryngeal carcinomas was investigated by combined polymerase chain reaction (PCR) and restriction fragment length polymorphism analysis. HPV DNA was detected in 11 (24%) of 45 cases, including HPV 16 in 9 cases and HPV 18 in 2 cases. Other HPV subtypes commonly found in the female genital organs were not detected. In addition, the point mutation of codons 12 and 13 in c-Ki-ras-2, c-Ha-ras-1, and N-ras genes was studied by the PCR-single-strand conformational polymorphism (SSCP) method. Of 45 cases tested, only 1 had a point mutation of c-Ki-ras-2 gene at codon 12. These results indicate that the incidence of ras gene point mutation is uncommon and that the synergistic effect of HPV infection and ras gene activation in laryngeal carcinogenesis is probably rare.

Two cases of nasopharyngeal branchial cyst

Two cases of nasopharyngeal cyst, in a two-year-old girl and a six-year-old boy, are described. The cysts were located in the right lateral wall of the nasopharynx in both cases. Histopathological examinations revealed that the cyst walls were lined with columnar epithelium. The positions of the cysts and pathological features indicated that they were of branchial origin, and they were assumed to originate in the second branchial pouch because of their anatomic location. They differed from previously reported cases in that they extended nearly to the base of the skull, occupying the parapharyngeal space. It was considered that they might have originated from the dorsal part of the second branchial pouch or the layer of endodermal cells cut off from the lower part of the eustachian tube.