JMIR Publications

ABSTRACT

Background:

Behavioral Activation (BA) is rooted in the behavioral theory of depression, which states that increased exposure to meaningful, rewarding activities is a critical factor in the treatment of depression. Assessing constructs relevant to BA currently requires the administration of standardized instruments, such as the Behavioral Activation for Depression Scale (BADS), which places a burden on patients and providers and has potential limitations. Previous work has shown that depressed and non-depressed individuals may use language differently and that automated tools can detect these differences. The increasing use of online chat-based mental health counseling presents an unparalleled resource for automated longitudinal linguistic analysis of patients with depression, with the potential to illuminate the role of reward exposure in recovery.

Objective:

This work investigates how linguistic indicators of planning and participation in enjoyable activities identified in online, text-based counseling sessions relate to depression symptomatology over time.

Methods:

Using distributional semantics methods applied to a large corpus of text-based online therapy sessions, we devised a set of novel BA-related categories for the Linguistic Inquiry and Word Count (LIWC) software package. We then analyzed the language used by 10,000 patients in online therapy chat logs for indicators of activation and other depression-related markers using LIWC.

Results:

Despite their conceptual and operational differences, both previously established LIWC markers of emotional tone and pronoun use and our novel linguistic indicators of activation are strongly associated with depression scores (PHQ-9) and longitudinal patient trajectories. Tone, pronoun and BA-related LIWC categories appear to be complementary, explaining more of the variance in the PHQ score together than they do independently.

Conclusions:

This study enables further work in automated diagnosis and assessment of depression, the refinement of BA psychotherapeutic strategies, and the development of predictive models for decision support.