@inproceedings{bn-etal-2025-real,
    title = "How Real Are Synthetic Therapy Conversations? Evaluating Fidelity in Prolonged Exposure Dialogues",
    author = "Bn, Suhas  and
      Mattioli, Dominik O.  and
      Sherrill, Andrew M.  and
      Arriaga, Rosa I.  and
      Wiese, Christopher  and
      Abdullah, Saeed",
    editor = "Christodoulopoulos, Christos  and
      Chakraborty, Tanmoy  and
      Rose, Carolyn  and
      Peng, Violet",
    booktitle = "Findings of the Association for Computational Linguistics: EMNLP 2025",
    month = nov,
    year = "2025",
    address = "Suzhou, China",
    publisher = "Association for Computational Linguistics",
    url = "https://preview.aclanthology.org/author-page-yu-wang-polytechnic/2025.findings-emnlp.1144/",
    doi = "10.18653/v1/2025.findings-emnlp.1144",
    pages = "20986--20995",
    ISBN = "979-8-89176-335-7",
    abstract = "Synthetic data adoption in healthcare is driven by privacy concerns, data access limitations, and high annotation costs. We explore synthetic Prolonged Exposure (PE) therapy conversations for PTSD as a scalable alternative for training clinical models. We systematically compare real and synthetic dialogues using linguistic, structural, and protocol-specific metrics like turn-taking and treatment fidelity. We introduce and evaluate PE-specific metrics, offering a novel framework for assessing clinical fidelity beyond surface fluency. Our findings show that while synthetic data successfully mitigates data scarcity and protects privacy, capturing the most subtle therapeutic dynamics remains a complex challenge. Synthetic dialogues successfully replicate key linguistic features of real conversations, for instance, achieving a similar Readability Score (89.2 vs. 88.1), while showing differences in some key fidelity markers like distress monitoring. This comparison highlights the need for fidelity-aware metrics that go beyond surface fluency to identify clinically significant nuances. Our model-agnostic framework is a critical tool for developers and clinicians to benchmark generative model fidelity before deployment in sensitive applications. Our findings help clarify where synthetic data can effectively complement real-world datasets, while also identifying areas for future refinement."
}