Goals

• First: can this fit normal therapy workflow?
• Second: do we see early outcomes in emotion labeling and clarity?

Background

This study asks a practical question: Do visual emotion aids (text and graphical) improve emotion labeling during and after sessions?

Stress and trauma can deactivate Broca’s area (the speech center) during verbal recall. Visual tools can bypass the need for verbal generation, allowing clients to point to or recognize feelings when they cannot speak them.[1]

While there is no single large-scale clinical trial that tests “the emotion wheel” as a standalone mental health intervention (the way a drug trial would), there is substantial psychological research validating the mechanisms behind visual emotion labeling tools.

Why "name it to tame it" matters:

Alexithymia is a personality trait characterized by the inability to identify and describe emotions in the self. It is highly comorbid with PTSD, autism, and eating disorders. Assessments of alexithymia, like self-report questionnaires, can demand abstraction and self-awareness that are specifically strained in alexithymia.

Visual aids are considered a primary intervention for alexithymia. Because these clients cannot internally generate the label, the visual wheel provides a "menu" that allows them to recognize the feeling through elimination or intensity matching.[2]

Affect labeling has been shown to decrease skin conductance responses like sweating/stress more effectively than distraction or reappraisal in the short term.[3]

As that skill improves, the ability to precisely label emotions is repeatedly associated with better emotion regulation and mental health outcomes.[4]

What we’re testing

We’ve designed five visual tools (seen on a computer or mobile phone screen) to support clients during sessions and between sessions. These operate as adjunctive digital support alongside standard care, without changing the core therapy session.

Vocabulary Diversity

Study outline

We’re evaluating whether adding a simple in-session emotion wheel helps clients who struggle to identify and name feelings, and whether adding a fuller set of adjunctive post-session supports helps further.

Therapists join on a rolling basis. Everyone starts with a short baseline period where nothing changes in the therapy session, so we can understand the status quo before any tools are introduced. Each therapist follows the same week-by-week schedule starting from their own Week 0.

We use a stepped-wedge cluster randomized trial so that access is rolled out in steps and every participant can eventually receive the full suite.[5] This is how we handle the ethical tension of having a likely value add while still needing a clean baseline comparison.

• Weeks 0 to 6: baseline run-in. Therapy as usual. We collect baseline measures and establish each participant’s baseline language pattern from session transcripts.
• Weeks 6 to 12: intervention. Therapists are assigned to either Wheel-only (in-session emotion wheel) or Full suite (in-session emotion wheel plus adjunctive post-session supports).
• Weeks 12 to 18: crossover. Wheel-only therapists move to the full suite.
• Pace: steps are 6 weeks.
• Target sample: about 100 participants, depending on therapist recruitment and eligible client counts.
• Eligibility: ages 13+; therapist referral plus PAQ-24 screening. See inclusion criteria below.
• Analysis rule: For the main improvement analysis, we include clients who showed a clear baseline need during the 6-week run-in period.

What participation looks like in practice

The goal is to keep participation lightweight. Therapists and clients continue sessions as usual for 12-18 weeks/sessions.

• Initial intake:Client takes baseline PAQ-24 Questionnaire.5-10 minutes
• Platform setup:Therapist and client create accounts and share session link.< 2 min per week
• BAA:Therapist to sign the Business Associate Agreement for HIPAA compliance2 to 4 minutes
• Therapy session as usual:Sessions are transcribed for insights and study results
• Post-session:Therapist and client, optional review of any session insights.< 5 min per week
• End-of-study:Client retakes PAQ-24; therapist takes post-study survey.5-10 minutes

Provider inclusion criteria

To participate as a provider, you should meet the following requirements:

• Telehealth cadence: already providing weekly or every other week, recurring telehealth sessions with at least one eligible client.
• Platform flexibility: able and permitted to use an alternative video platform for sessions.
• Transcript-based participation: comfortable running sessions with transcription enabled. If a client declines transcription, they can still meet for sessions with Insights turned off, but they will not be enrolled in the study.
• Qualified practitioners: psychologists, LCSW, LMFT, LPC, and registered Associates/Residents under supervision.
• Also welcome: board-certified health & wellness coaches (NBC-HWC) and certified peer support specialists (CPS).

Client inclusion criteria

To be included, clients must meet the following baseline requirements (confirmed by provider discretion):

• Age: 13+.
• English: native English speaker or strong general English proficiency for therapy conversation.
• Tech readiness: has a working phone or computer with mic and speakers (camera not required).
• Cognitive ability: general capacity to participate in therapy conversations and complete brief questionnaires, as judged by the provider.
• Consent: agrees to sessions being transcribed on the platform for the study.

How we use transcripts and AI

To participate in this study, you should be comfortable with sessions being transcribed on our platform. This is necessary because the study relies on transcript-derived measures and post-session tools that are grounded in what was actually said.

Feelpath uses AI only on the written transcript. We do not do video, voice, or face analysis, and the AI does not coach, interrupt, or participate in the session.

If a client is not comfortable with transcription, Feelpath can still be used for sessions with Insights turned off and with the in-session emotion wheel. However, in that case, the client should not be enrolled in this study.

When AI is used, transcript text is sent to our model provider under Zero-Data-Retention. It is not stored by the provider and it is never used to train models.

We take confidentiality, privacy, and HIPAA compliance seriously. Feelpath is built with HIPAA-compliant privacy and security practices, and we request that providers sign our Business Associate Agreement (BAA).

Confidentiality of the sessions stays between therapist and client. Feelpath only uses transcripts to generate study insights when consent is given, and access is kept restricted.

After the study ends, transcripts and insights will be under user control: users can review transcripts and insights, download what is needed, and delete or redact where appropriate. During the study, we may retain study-specific exports until results are published; after that, study data will return to normal, user-managed controls.

How these tools fit into therapy

Our alexithymia-focused tools are adjunctive and therapist-reviewed; they do not provide therapy, diagnosis, or clinical decision-making.

They are designed to support reflection, bring clearer language into session, and make emotional language learning and progress easier to notice over time.

The benefits of these tools:

• Between-session support: post-session reflections grounded in the client's session material.
• Session-informed feedback: clients can review the information on their own, or it can be reviewed together in therapy.
• Progress signals: a way to make change easier to notice over time.

What we’ll measure

Main outcome we track

• PAQ-24: measured twice, at baseline and after the study period.

Other outcomes we track

• Engagement: whether clients actually use the tools (views, annotations, time spent).
• Transcript-derived baseline markers: emotion analytics during the run-in, then change over time.

Feasibility and acceptability outcomes

• Client usability: do clients find the visual aids easy to understand and navigate?
• Client usefulness: were the tools helpful for identifying or labeling emotions, and would clients recommend them?
• Clinician feasibility: can this be implemented during routine care without creating workflow burden?
• Clinician usefulness: do clinicians find the tools useful in session and between sessions?

PAQ-24 is our main outcome measure. We also track transcript-derived language outcomes and practical feedback from clients and clinicians to understand both impact and workflow fit.

Ethical considerations

Participation is voluntary. Clients can leave the study at any time, and that choice should not affect care.

We use a stepped-wedge design so everyone can eventually receive the full suite of features while we still capture a clean baseline comparison. Because clients may be 13+, consent and access should follow the provider’s legal and clinical requirements, including guardian involvement where required.

We’re running this as an early learning study to understand what works in routine care and what needs to improve. It is self-funded and not a formal IRB-reviewed efficacy trial.

These early results help us learn what works in routine care. They are early signals, not final proof.