Fine-Tuning Large Audio-Language Models with LoRA for Precise Temporal Localization of Prolonged Exposure Therapy Elements

Abstract

Prolonged Exposure (PE) therapy is an effective treatment for post-traumatic stress disorder (PTSD), but evaluating therapist fidelity remains labor-intensive due to the need for manual review of session recordings. We present a method for the automatic temporal localization of key PE fidelity elements, identifying their start and stop times, directly from session audio and transcripts. Our approach fine-tunes a large pre-trained audio-language model, Qwen2-Audio, using Low-Rank Adaptation (LoRA) to process focused 30-second windows of audio-transcript input. Fidelity labels for three core protocol phases, therapist orientation (P1), imaginal exposure (P2), and post-imaginal processing (P3), are generated via LLM-based prompting and verified by trained raters. The model is trained to predict normalized boundary offsets using soft supervision guided by task-specific prompts. On a dataset of 308 real PE sessions, our best configuration (LoRA rank 8, 30s windows) achieves a mean absolute error (MAE) of 5.3s across tasks, within typical rater tolerance for timestamp review, enabling practical fidelity QC. We further analyze the effects of window size and LoRA rank, highlighting the importance of context granularity and model adaptation. This work introduces a privacy-preserving, scalable framework for fidelity tracking in PE therapy, with potential to support clinician training, supervision, and quality assurance.