A Systematic Review of Machine Learning for Assessment and Feedback of Treatment Fidelity

Many psychological treatments have been shown to be cost-effective and efficacious, as long as they are implemented faithfully. Assessing fidelity and providing feedback is expensive and time-consuming. Machine learning has been used to assess treatment fidelity, but the reliability and generalisability is unclear. We collated and critiqued all implementations of machine learning to assess the verbal behaviour of all helping professionals, with particular emphasis on treatment fidelity for therapists. We conducted searches using nine electronic databases for automated approaches of coding verbal behaviour in therapy and similar contexts. We completed screening, extraction, and quality assessment in duplicate. Fifty-two studies met our inclusion criteria (65.3% in psychotherapy). Automated coding methods performed better than chance, and some methods showed near human-level performance; performance tended to be better with larger data sets, a smaller number of codes, conceptually simple codes, and when predicting session-level ratings than utterance-level ones. Few studies adhered to best-practice machine learning guidelines. Machine learning demonstrated promising results, particularly where there are large, annotated datasets and a modest number of concrete features to code. These methods are novel, cost-effective, scalable ways of assessing fidelity and providing therapists with individualised, prompt, and objective feedback.