The feasibility and acceptability of automated feedback and deliberate practice in psychological therapies for anxiety and depression
Authors
Sam Malins, Grazziela Figueredo, David Saxon, Kate Horton, Jeremie Clos, Thomas Trimble, Kavan Fatehi, David Waldram, Fred Higton, Gillian E Hardy, Michael Barkham, Jonathan Couldridge and Nima Moghaddam
Abstract
Deliberate practice (DP) for psychological therapists involves using objective, corrective feedback to identify and improve individualised skill deficits, alongside iterative practice opportunities. Automated, prognostic feedback on session contents could enhance personalisation of DP across therapy professions and modalities. This study assessed the feasibility, acceptability and initial clinical utility of a 10-week therapist intervention integrating automated feedback on predicted prognosis with DP of individualised therapeutic skill deficits.
Participants were 97 therapy clients seen by nine therapists in the 10 weeks preceding intervention and 79 clients seen by the same therapists during the 10-week intervention period. Participating therapists, representing diverse professional backgrounds, invited their clients to consent to have sessions recorded and automatically assessed for predicted prognosis. Prognostic feedback was integrated into DP training and practice, comprising a total of 32 h intervention. Assessments of intervention feasibility, acceptability, credibility, outcome expectancy and therapists’ therapeutic skills were taken alongside qualitative interviews at baseline, 5- and 10-week follow-up. Reliable improvement in depression and anxiety was compared between clients receiving therapy in the pre-intervention and intervention periods.
Findings indicated significant pre-post improvements in intervention acceptability (dRM = 2.25, p = .008), credibility (dRM = 1.11, p = .039) and therapist skills (total score: dRM = 2.57, p = .008), with non-significant improvement in feasibility (dRM = 0.67, p = .268) and clinical outcomes, including a 3% increase in the proportion of clients reporting reliable improvement for depression (58–61%) and a 10% increase for anxiety (65–75%). However, client uptake of automated feedback was low due to concerns about artificial intelligence and related trust in the system.
Automated feedback and DP become more acceptable to therapists through engagement, with potential to improve therapeutic skills and effectiveness. However, addressing client concerns about how technology is used for automated feedback is essential to enhance participation.