What your voice reveals about your health

The U.S. Food and Drug Administration hasn’t approved psilocybin for commercial use, but Emory researchers join others around the globe studying the psychedelic drug for treating depression. About 5% of adults 18 and older have regular feelings of depression, according to the Centers for Disease and Prevention.

Early research shows psilocybin can be effective for some patients, said Roman Palitsky, an assistant professor of psychiatry and behavioral sciences at Emory School of Medicine and Emory’s principal investigator for the psilocybin clinical study using Fabla.

“I am often hamstrung by very rigid research methods that ask everyone the same set of questions,” Palitsky said, adding that participants tend to leave out important experiences when prompted to answer prescribed questions.

Study participants use Fabla — short for facil hablar or “easy to speak” in Spanish — in voice recording mode on their phone to freely express their daily reflections every evening for several weeks before and after psilocybin treatment, he explained.

“They are able to share a variety of experiences and in their own words talk about their day-to-day as if they are telling a friend,” Palitsky said.

Researchers can then analyze a patient’s tone, pitch, speed, and word patterns to detect emotional shifts, showing whether patients benefit or struggle with the treatment and trying to improve the effects of psilocybin on depression, he said.

Fabla is part of a larger study examining whether adding a noninvasive electrical stimulation of the vagus nerve, which sends signals to the brain, might enhance the antidepressant benefits of psilocybin. Palitsky expects the larger study to last three to four years. If the study is successful, it would improve the safety and effectiveness of psilocybin therapy, which the FDA has yet to review for approval to treat depression.

“In mental health care, people who have challenges with anxiety and depression have to cycle through different types of treatment to find the care that works,” said Deanna Kaplan, an Emory clinical psychologist who created the app later developed by Emory’s AppHatchery.

Credit: Emory University

Credit: Emory University

The app is encrypted to protect users’ sensitive information according to health research privacy laws, Kaplan explained. Users also have full control and access to the information they provide and can review, delete and edit at any point, she said.

“Fabla helps us understand people’s experiences better and target treatment more precisely,” said Kaplan, who is also an assistant professor in the department of family and preventive medicine in the School of Medicine.

Instead of fitting research into standard multiple-choice questionnaires, the app allows study participants to express in a natural way what they are experiencing and the challenges they are facing, Kaplan said. It is different from other technology researchers can use to gain patients’ voice recordings, whether through other smartphone apps or mobile devices patients use and return later. Fabla allows users to send their audio diary directly to research teams.

Kaplan said she conceived the app about three years ago after receiving a voice memo from a friend.

“I noticed my own human senses to the different language and tonal qualities, which signaled distress. I heard the depth of what she was sharing and thought, ‘I wish clinical research had a way to get that kind of information from people.”

The App Store released Fabla in late 2023 and Emory has been using it in various research projects, including a pilot study last year reviewing the emotional and spiritual support health care chaplains provide colleagues.

Current studies evaluate burnout in health care professionals and perinatal mental health in Black moms with future studies to explore post-traumatic stress disorder in veterans, daytime drowsiness in narcolepsy, and contact tracing to track the path of contagious infectious illnesses.

Kaplan said she’s already received requests from study participants to continue using the app after research is complete to track their progress and share key moments with their mental health therapists. That option may be available in the future, she said.

App developers also are creating other versions of the app to allow participants to communicate with researchers in their preferred language. Kaplan envisions opportunities, too, for a variety of health care researchers and clinicians to adapt Fabla to their goals with open-ended questions they pose to patients.

Shrikanth (Shri) Narayanan, a professor and engineering chair at the University of Southern California in Los Angeles, is considered a pioneer in the speech signal processing field. He recalled interacting with Kaplan on research in this specialty area and applauded her efforts to adapt speech and spoken language for broad relevant uses.

“Those are exciting and important topics that really allow us to innovate human-centered computing methods with great insight and impact.”

When it comes to Emory’s psilocybin study, Narayanan said, “The idea of using speech and spoken language as a biomarker for understanding the human mental state is not new.” But it’s an emerging and fast-evolving research area bolstered by smart technology and artificial intelligence, he said.

The research uses sounds and words to measure real circumstances and clinical conditions that reveal underlying symptoms, helping clinicians diagnose illness, disease, and disorders and treat them appropriately, Narayanan said.

Roni Robbins has been a journalist for 37 years. This is her second stint as a freelance reporter for the AJC. She also freelances for Medscape, where she was an editor. Her writing has appeared in WebMD, HuffPost, Forbes, NY Daily News, BioPharma Dive, MNN, Adweek, Healthline and others. She’s also the author of the multiaward-winning novel “Hands of Gold: One Man’s Quest to Find the Silver Lining in Misfortune.”