Adherence Forecasting for Guided Internet-Delivered Cognitive Behavioral Therapy: A Minimally Data-Sensitive Approach

• Published in: IEEE journal of biomedical and health informatics Vol. 27; no. 6; pp. 2771 - 2781
• Main Authors: Cote-Allard, Ulysse, Pham, Minh H., Schultz, Alexandra K., Nordgreen, Tine, Torresen, Jim
• Format: Journal Article
• Language: English
• Published: United States IEEE 01.06.2023; The Institute of Electrical and Electronics Engineers, Inc. (IEEE)
• Subjects: Access control; adherence forecasting; Anxiety disorders; Behavior modification; Behavioral sciences; Cognitive ability; Cognitive Behavioral Therapy; Cognitive therapy; Deep learning; Depression; e-health; Forecasting; General Data Protection Regulation; Health care; Health Personnel; Humans; Interaction data; Internet; machine learning; Medical services; mental healthcare; Patients; Regulation; sensitive data; Treatment Outcome
• ISSN: 2168-2194; 2168-2208; 2168-2208
• DOI: 10.1109/JBHI.2022.3204737

Internet-delivered psychological treatments (IDPT) are seen as an effective and scalable pathway to improving the accessibility of mental healthcare. Within this context, treatment adherence is an especially pertinent challenge to address due to the reduced interaction between healthcare professionals and patients. In parallel, the increase in regulations surrounding the use of personal data, such as the General Data Protection Regulation (GDPR), makes data minimization a core consideration for real-world implementation of IDPTs. Consequently, this work proposes a Self-Attention-based deep learning approach to perform automatic adherence forecasting, while only relying on minimally sensitive login/logout-timestamp data. This approach was tested on a dataset containing 342 patients undergoing Guided Internet-delivered Cognitive Behavioral Therapy (G-ICBT) treatment. Of these 342 patients, 101 (<inline-formula><tex-math notation="LaTeX">\sim</tex-math></inline-formula>30%) were considered non-adherent (dropout) based on the adherence definition used in this work (i.e. at least eight connections to the platform lasting more than a minute over 56 days). The proposed model achieved over 70% average balanced accuracy, after only 20 out of the 56 days (<inline-formula><tex-math notation="LaTeX">\sim</tex-math></inline-formula>1/3) of the treatment had elapsed. This study demonstrates that automatic adherence forecasting for G-ICBT, is achievable using only minimally sensitive data, thus facilitating the implementation of such tools within real-world IDPT platforms.