Linguistic Analysis of Communication in Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder

Abstract

Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) involves elements of expressive writing through secure messaging with a therapist. Expressive writing has been associated with psychological and physical health benefits in past research; furthermore, certain linguistic dimensions in expressive writing have been identified as particularly beneficial to health, such as less frequent use of negative emotion words and greater use of positive emotion words. No research, to date, has analyzed linguistic dimensions in client communication over the course of therapist-assisted ICBT for individuals with symptoms of generalized anxiety. This naturalistic study examined messages sent to therapists during the course of ICBT using linguistic analysis, and explored covariation of word use with symptom improvement. Data were obtained from patients with symptoms of generalized anxiety (N = 59) who completed 12 modules of therapist-assisted ICBT and rated symptoms of anxiety, depression, and panic at the beginning of each module. Linguistic analysis categorized text submitted to therapists into different word categories. Results found that patients' use of negative emotion, anxiety, causation, and insight words reduced over the course of treatment, while past tense words increased. Furthermore, negative emotion words significantly covaried with symptom ratings over the course of treatment. While causal statements cannot be made, findings improve our understanding of patient communication in ICBT and suggest that the further study of linguistic dimensions as psychological indicators and the potential utility of expressive writing strategies in therapist-assisted ICBT may be worthwhile.

Core belief content examined in a large sample of patients using online cognitive behaviour therapy

“…Researchers have examined stored text from interventions that are predominantly therapist administered or minimal-contact therapies. Dirkse et al (2014) analysed the content of client messages sent to therapists in supported internet delivered CBT for anxiety (n¼ 59 clients) using Linguistic Inquiry Word Count (LIWC, Pennebaker et al, 2007). Over the course of treatment, negative emotion, anxiety, causation, and insight words reduced, and past tense words increased.…”

Language in Consultation: The Effect of Affect and Verb Tense

“…Verb tense indicates a speaker's temporal orientation, whether that individual is thinking about the past, present, or future (Pennebaker, ; Tausczik & Pennebaker, ). Verb tense, and implied temporal orientation, is relevant to communicative interactions between physicians and patients (Falkenstein et al., ), and counselors/therapists and clients (Arntz et al., 2012; Dirkse, Hadjistavropoulos, Hesser, & Barak, ; Henretty, Currier, Berman, & Levitt, ). Verb tense also impacts how problem solvers understand problems, and how problems are approached (Salomon, Magliano, & Radvansky, ).…”

Dictionaries and Decision Trees for the 2019

“…Certain language categories have been implicated as markers of mental health conditions (such as anxiety; Dirkse et al, 2015). Relevant to this shared task, suicidal ideation tends to be positively correlated with rates of first-person singular pronoun use (Stirman and Pennebaker, 2001) and negative emotion word use (e.g., anger, sadness; Coppersmith et al, 2016).…”