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Dec 10

PATIENT-Ψ: Using Large Language Models to Simulate Patients for Training Mental Health Professionals

Mental illness remains one of the most critical public health issues. Despite its importance, many mental health professionals highlight a disconnect between their training and actual real-world patient practice. To help bridge this gap, we propose PATIENT-{\Psi}, a novel patient simulation framework for cognitive behavior therapy (CBT) training. To build PATIENT-{\Psi}, we construct diverse patient cognitive models based on CBT principles and use large language models (LLMs) programmed with these cognitive models to act as a simulated therapy patient. We propose an interactive training scheme, PATIENT-{\Psi}-TRAINER, for mental health trainees to practice a key skill in CBT -- formulating the cognitive model of the patient -- through role-playing a therapy session with PATIENT-{\Psi}. To evaluate PATIENT-{\Psi}, we conducted a comprehensive user study of 13 mental health trainees and 20 experts. The results demonstrate that practice using PATIENT-{\Psi}-TRAINER enhances the perceived skill acquisition and confidence of the trainees beyond existing forms of training such as textbooks, videos, and role-play with non-patients. Based on the experts' perceptions, PATIENT-{\Psi} is perceived to be closer to real patient interactions than GPT-4, and PATIENT-{\Psi}-TRAINER holds strong promise to improve trainee competencies. Our code and data are released at https://github.com/ruiyiw/patient-psi.

  • 12 authors
·
May 29, 2024

PsyDraw: A Multi-Agent Multimodal System for Mental Health Screening in Left-Behind Children

Left-behind children (LBCs), numbering over 66 million in China, face severe mental health challenges due to parental migration for work. Early screening and identification of at-risk LBCs is crucial, yet challenging due to the severe shortage of mental health professionals, especially in rural areas. While the House-Tree-Person (HTP) test shows higher child participation rates, its requirement for expert interpretation limits its application in resource-scarce regions. To address this challenge, we propose PsyDraw, a multi-agent system based on Multimodal Large Language Models that assists mental health professionals in analyzing HTP drawings. The system employs specialized agents for feature extraction and psychological interpretation, operating in two stages: comprehensive feature analysis and professional report generation. Evaluation of HTP drawings from 290 primary school students reveals that 71.03% of the analyzes achieved High Consistency with professional evaluations, 26.21% Moderate Consistency and only 2.41% Low Consistency. The system identified 31.03% of cases requiring professional attention, demonstrating its effectiveness as a preliminary screening tool. Currently deployed in pilot schools, \method shows promise in supporting mental health professionals, particularly in resource-limited areas, while maintaining high professional standards in psychological assessment.

  • 8 authors
·
Dec 19, 2024

Do Large Language Models Align with Core Mental Health Counseling Competencies?

The rapid evolution of Large Language Models (LLMs) offers promising potential to alleviate the global scarcity of mental health professionals. However, LLMs' alignment with essential mental health counseling competencies remains understudied. We introduce CounselingBench, a novel NCMHCE-based benchmark evaluating LLMs across five key mental health counseling competencies. Testing 22 general-purpose and medical-finetuned LLMs, we find frontier models exceed minimum thresholds but fall short of expert-level performance, with significant variations: they excel in Intake, Assessment & Diagnosis yet struggle with Core Counseling Attributes and Professional Practice & Ethics. Medical LLMs surprisingly underperform generalist models accuracy-wise, while at the same time producing slightly higher-quality justifications but making more context-related errors. Our findings highlight the complexities of developing AI systems for mental health counseling, particularly for competencies requiring empathy and contextual understanding. We found that frontier LLMs perform at a level exceeding the minimal required level of aptitude for all key mental health counseling competencies, but fall short of expert-level performance, and that current medical LLMs do not significantly improve upon generalist models in mental health counseling competencies. This underscores the critical need for specialized, mental health counseling-specific fine-tuned LLMs that rigorously aligns with core competencies combined with appropriate human supervision before any responsible real-world deployment can be considered.

  • 11 authors
·
Oct 29, 2024

We Care: Multimodal Depression Detection and Knowledge Infused Mental Health Therapeutic Response Generation

The detection of depression through non-verbal cues has gained significant attention. Previous research predominantly centred on identifying depression within the confines of controlled laboratory environments, often with the supervision of psychologists or counsellors. Unfortunately, datasets generated in such controlled settings may struggle to account for individual behaviours in real-life situations. In response to this limitation, we present the Extended D-vlog dataset, encompassing a collection of 1, 261 YouTube vlogs. Additionally, the emergence of large language models (LLMs) like GPT3.5, and GPT4 has sparked interest in their potential they can act like mental health professionals. Yet, the readiness of these LLM models to be used in real-life settings is still a concern as they can give wrong responses that can harm the users. We introduce a virtual agent serving as an initial contact for mental health patients, offering Cognitive Behavioral Therapy (CBT)-based responses. It comprises two core functions: 1. Identifying depression in individuals, and 2. Delivering CBT-based therapeutic responses. Our Mistral model achieved impressive scores of 70.1% and 30.9% for distortion assessment and classification, along with a Bert score of 88.7%. Moreover, utilizing the TVLT model on our Multimodal Extended D-vlog Dataset yielded outstanding results, with an impressive F1-score of 67.8%

  • 2 authors
·
Jun 15, 2024

From Classification to Clinical Insights: Towards Analyzing and Reasoning About Mobile and Behavioral Health Data With Large Language Models

Passively collected behavioral health data from ubiquitous sensors holds significant promise to provide mental health professionals insights from patient's daily lives; however, developing analysis tools to use this data in clinical practice requires addressing challenges of generalization across devices and weak or ambiguous correlations between the measured signals and an individual's mental health. To address these challenges, we take a novel approach that leverages large language models (LLMs) to synthesize clinically useful insights from multi-sensor data. We develop chain of thought prompting methods that use LLMs to generate reasoning about how trends in data such as step count and sleep relate to conditions like depression and anxiety. We first demonstrate binary depression classification with LLMs achieving accuracies of 61.1% which exceed the state of the art. While it is not robust for clinical use, this leads us to our key finding: even more impactful and valued than classification is a new human-AI collaboration approach in which clinician experts interactively query these tools and combine their domain expertise and context about the patient with AI generated reasoning to support clinical decision-making. We find models like GPT-4 correctly reference numerical data 75% of the time, and clinician participants express strong interest in using this approach to interpret self-tracking data.

  • 10 authors
·
Nov 21, 2023

Psyche-R1: Towards Reliable Psychological LLMs through Unified Empathy, Expertise, and Reasoning

Amidst a shortage of qualified mental health professionals, the integration of large language models (LLMs) into psychological applications offers a promising way to alleviate the growing burden of mental health disorders. Recent reasoning-augmented LLMs have achieved remarkable performance in mathematics and programming, while research in the psychological domain has predominantly emphasized emotional support and empathetic dialogue, with limited attention to reasoning mechanisms that are beneficial to generating reliable responses. Therefore, in this paper, we propose Psyche-R1, the first Chinese psychological LLM that jointly integrates empathy, psychological expertise, and reasoning, built upon a novel data curation pipeline. Specifically, we design a comprehensive data synthesis pipeline that produces over 75k high-quality psychological questions paired with detailed rationales, generated through chain-of-thought (CoT) reasoning and iterative prompt-rationale optimization, along with 73k empathetic dialogues. Subsequently, we employ a hybrid training strategy wherein challenging samples are identified through a multi-LLM cross-selection strategy for group relative policy optimization (GRPO) to improve reasoning ability, while the remaining data is used for supervised fine-tuning (SFT) to enhance empathetic response generation and psychological domain knowledge. Extensive experiment results demonstrate the effectiveness of the Psyche-R1 across several psychological benchmarks, where our 7B Psyche-R1 achieves comparable results to 671B DeepSeek-R1.

  • 6 authors
·
Aug 14

Depression Detection and Analysis using Large Language Models on Textual and Audio-Visual Modalities

Depression has proven to be a significant public health issue, profoundly affecting the psychological well-being of individuals. If it remains undiagnosed, depression can lead to severe health issues, which can manifest physically and even lead to suicide. Generally, Diagnosing depression or any other mental disorder involves conducting semi-structured interviews alongside supplementary questionnaires, including variants of the Patient Health Questionnaire (PHQ) by Clinicians and mental health professionals. This approach places significant reliance on the experience and judgment of trained physicians, making the diagnosis susceptible to personal biases. Given that the underlying mechanisms causing depression are still being actively researched, physicians often face challenges in diagnosing and treating the condition, particularly in its early stages of clinical presentation. Recently, significant strides have been made in Artificial neural computing to solve problems involving text, image, and speech in various domains. Our analysis has aimed to leverage these state-of-the-art (SOTA) models in our experiments to achieve optimal outcomes leveraging multiple modalities. The experiments were performed on the Extended Distress Analysis Interview Corpus Wizard of Oz dataset (E-DAIC) corpus presented in the Audio/Visual Emotion Challenge (AVEC) 2019 Challenge. The proposed solutions demonstrate better results achieved by Proprietary and Open-source Large Language Models (LLMs), which achieved a Root Mean Square Error (RMSE) score of 3.98 on Textual Modality, beating the AVEC 2019 challenge baseline results and current SOTA regression analysis architectures. Additionally, the proposed solution achieved an accuracy of 71.43% in the classification task. The paper also includes a novel audio-visual multi-modal network that predicts PHQ-8 scores with an RMSE of 6.51.

  • 6 authors
·
Jul 8, 2024

Large Language Model for Mental Health: A Systematic Review

Large language models (LLMs) have received much attention and shown their potential in digital health, while their application in mental health is subject to ongoing debate. This systematic review aims to summarize and characterize the use of LLMs in mental health by investigating the strengths and limitations of the latest work in LLMs and discusses the challenges and opportunities for early screening, digital interventions, and other clinical applications in mental health. Following PRISMA guidelines, we examined English articles from PubMed, DBLP Computer Science Bibliography, and IEEE Xplore, published between 1 January 2017, and 1 September 2023, focusing on mental health and LLMs. The review analyzed 32 articles, including mental health analysis using social media datasets (n=13), mental health chatbots (n=10), and other mental health applications (n=9). Findings reveal LLMs' effectiveness in mental health issue detection and the enhancement of telepsychological services through personalised healthcare. Nonetheless, risks like text inconsistencies, hallucinatory content, and the lack of an ethical framework raise concerns about their clinical use. Despite these challenges, the advancement of LLMs underscores their potential as innovative clinical tools, necessitating further research and development. The review emphasizes that LLMs should complement, not replace, professional mental health services.

  • 6 authors
·
Feb 19, 2024

Beyond Empathy: Integrating Diagnostic and Therapeutic Reasoning with Large Language Models for Mental Health Counseling

Large language models (LLMs) hold significant potential for mental health support, capable of generating empathetic responses and simulating therapeutic conversations. However, existing LLM-based approaches often lack the clinical grounding necessary for real-world psychological counseling, particularly in explicit diagnostic reasoning aligned with standards like the DSM/ICD and incorporating diverse therapeutic modalities beyond basic empathy or single strategies. To address these critical limitations, we propose PsyLLM, the first large language model designed to systematically integrate both diagnostic and therapeutic reasoning for mental health counseling. To develop the PsyLLM, we propose a novel automated data synthesis pipeline. This pipeline processes real-world mental health posts, generates multi-turn dialogue structures, and leverages LLMs guided by international diagnostic standards (e.g., DSM/ICD) and multiple therapeutic frameworks (e.g., CBT, ACT, psychodynamic) to simulate detailed clinical reasoning processes. Rigorous multi-dimensional filtering ensures the generation of high-quality, clinically aligned dialogue data. In addition, we introduce a new benchmark and evaluation protocol, assessing counseling quality across four key dimensions: comprehensiveness, professionalism, authenticity, and safety. Our experiments demonstrate that PsyLLM significantly outperforms state-of-the-art baseline models on this benchmark.

  • 8 authors
·
May 21

Interactive Agents: Simulating Counselor-Client Psychological Counseling via Role-Playing LLM-to-LLM Interactions

Virtual counselors powered by large language models (LLMs) aim to create interactive support systems that effectively assist clients struggling with mental health challenges. To replicate counselor-client conversations, researchers have built an online mental health platform that allows professional counselors to provide clients with text-based counseling services for about an hour per session. Notwithstanding its effectiveness, challenges exist as human annotation is time-consuming, cost-intensive, privacy-protected, and not scalable. To address this issue and investigate the applicability of LLMs in psychological counseling conversation simulation, we propose a framework that employs two LLMs via role-playing for simulating counselor-client interactions. Our framework involves two LLMs, one acting as a client equipped with a specific and real-life user profile and the other playing the role of an experienced counselor, generating professional responses using integrative therapy techniques. We implement both the counselor and the client by zero-shot prompting the GPT-4 model. In order to assess the effectiveness of LLMs in simulating counselor-client interactions and understand the disparities between LLM- and human-generated conversations, we evaluate the synthetic data from various perspectives. We begin by assessing the client's performance through automatic evaluations. Next, we analyze and compare the disparities between dialogues generated by the LLM and those generated by professional counselors. Furthermore, we conduct extensive experiments to thoroughly examine the performance of our LLM-based counselor trained with synthetic interactive dialogues by benchmarking against state-of-the-art models for mental health.

  • 2 authors
·
Aug 28, 2024

Multimodal Fusion with LLMs for Engagement Prediction in Natural Conversation

Over the past decade, wearable computing devices (``smart glasses'') have undergone remarkable advancements in sensor technology, design, and processing power, ushering in a new era of opportunity for high-density human behavior data. Equipped with wearable cameras, these glasses offer a unique opportunity to analyze non-verbal behavior in natural settings as individuals interact. Our focus lies in predicting engagement in dyadic interactions by scrutinizing verbal and non-verbal cues, aiming to detect signs of disinterest or confusion. Leveraging such analyses may revolutionize our understanding of human communication, foster more effective collaboration in professional environments, provide better mental health support through empathetic virtual interactions, and enhance accessibility for those with communication barriers. In this work, we collect a dataset featuring 34 participants engaged in casual dyadic conversations, each providing self-reported engagement ratings at the end of each conversation. We introduce a novel fusion strategy using Large Language Models (LLMs) to integrate multiple behavior modalities into a ``multimodal transcript'' that can be processed by an LLM for behavioral reasoning tasks. Remarkably, this method achieves performance comparable to established fusion techniques even in its preliminary implementation, indicating strong potential for further research and optimization. This fusion method is one of the first to approach ``reasoning'' about real-world human behavior through a language model. Smart glasses provide us the ability to unobtrusively gather high-density multimodal data on human behavior, paving the way for new approaches to understanding and improving human communication with the potential for important societal benefits. The features and data collected during the studies will be made publicly available to promote further research.

  • 9 authors
·
Sep 13, 2024

What Makes Digital Support Effective? How Therapeutic Skills Affect Clinical Well-Being

Online mental health support communities have grown in recent years for providing accessible mental and emotional health support through volunteer counselors. Despite millions of people participating in chat support on these platforms, the clinical effectiveness of these communities on mental health symptoms remains unknown. Furthermore, although volunteers receive some training based on established therapeutic skills studied in face-to-face environments such as active listening and motivational interviewing, it remains understudied how the usage of these skills in this online context affects people's mental health status. In our work, we collaborate with one of the largest online peer support platforms and use both natural language processing and machine learning techniques to measure how one-on-one support chats affect depression and anxiety symptoms. We measure how the techniques and characteristics of support providers, such as using affirmation, empathy, and past experience on the platform, affect support-seekers' mental health changes. We find that online peer support chats improve both depression and anxiety symptoms with a statistically significant but relatively small effect size. Additionally, support providers' techniques such as emphasizing the autonomy of the client lead to better mental health outcomes. However, we also found that some behaviors (e.g. persuading) are actually harmful to depression and anxiety outcomes. Our work provides key understanding for mental health care in the online setting and designing training systems for online support providers.

  • 7 authors
·
Dec 17, 2023

Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers

Should a large language model (LLM) be used as a therapist? In this paper, we investigate the use of LLMs to *replace* mental health providers, a use case promoted in the tech startup and research space. We conduct a mapping review of therapy guides used by major medical institutions to identify crucial aspects of therapeutic relationships, such as the importance of a therapeutic alliance between therapist and client. We then assess the ability of LLMs to reproduce and adhere to these aspects of therapeutic relationships by conducting several experiments investigating the responses of current LLMs, such as `gpt-4o`. Contrary to best practices in the medical community, LLMs 1) express stigma toward those with mental health conditions and 2) respond inappropriately to certain common (and critical) conditions in naturalistic therapy settings -- e.g., LLMs encourage clients' delusional thinking, likely due to their sycophancy. This occurs even with larger and newer LLMs, indicating that current safety practices may not address these gaps. Furthermore, we note foundational and practical barriers to the adoption of LLMs as therapists, such as that a therapeutic alliance requires human characteristics (e.g., identity and stakes). For these reasons, we conclude that LLMs should not replace therapists, and we discuss alternative roles for LLMs in clinical therapy.

  • 7 authors
·
Apr 25

Therapy as an NLP Task: Psychologists' Comparison of LLMs and Human Peers in CBT

Wider access to therapeutic care is one of the biggest challenges in mental health treatment. Due to institutional barriers, some people seeking mental health support have turned to large language models (LLMs) for personalized therapy, even though these models are largely unsanctioned and untested. We investigate the potential and limitations of using LLMs as providers of evidence-based therapy by using mixed methods clinical metrics. Using HELPERT, a prompt run on a large language model using the same process and training as a comparative group of peer counselors, we replicated publicly accessible mental health conversations rooted in Cognitive Behavioral Therapy (CBT) to compare session dynamics and counselor's CBT-based behaviors between original peer support sessions and their reconstructed HELPERT sessions. Two licensed, CBT-trained clinical psychologists evaluated the sessions using the Cognitive Therapy Rating Scale and provided qualitative feedback. Our findings show that the peer sessions are characterized by empathy, small talk, therapeutic alliance, and shared experiences but often exhibit therapist drift. Conversely, HELPERT reconstructed sessions exhibit minimal therapist drift and higher adherence to CBT methods but display a lack of collaboration, empathy, and cultural understanding. Through CTRS ratings and psychologists' feedback, we highlight the importance of human-AI collaboration for scalable mental health. Our work outlines the ethical implication of imparting human-like subjective qualities to LLMs in therapeutic settings, particularly the risk of deceptive empathy, which may lead to unrealistic patient expectations and potential harm.

  • 4 authors
·
Sep 3, 2024

Comparing the Efficacy of GPT-4 and Chat-GPT in Mental Health Care: A Blind Assessment of Large Language Models for Psychological Support

Background: Rapid advancements in natural language processing have led to the development of large language models with the potential to revolutionize mental health care. These models have shown promise in assisting clinicians and providing support to individuals experiencing various psychological challenges. Objective: This study aims to compare the performance of two large language models, GPT-4 and Chat-GPT, in responding to a set of 18 psychological prompts, to assess their potential applicability in mental health care settings. Methods: A blind methodology was employed, with a clinical psychologist evaluating the models' responses without knowledge of their origins. The prompts encompassed a diverse range of mental health topics, including depression, anxiety, and trauma, to ensure a comprehensive assessment. Results: The results demonstrated a significant difference in performance between the two models (p > 0.05). GPT-4 achieved an average rating of 8.29 out of 10, while Chat-GPT received an average rating of 6.52. The clinical psychologist's evaluation suggested that GPT-4 was more effective at generating clinically relevant and empathetic responses, thereby providing better support and guidance to potential users. Conclusions: This study contributes to the growing body of literature on the applicability of large language models in mental health care settings. The findings underscore the importance of continued research and development in the field to optimize these models for clinical use. Further investigation is necessary to understand the specific factors underlying the performance differences between the two models and to explore their generalizability across various populations and mental health conditions.

  • 1 authors
·
May 15, 2024

Artificial Intelligence in Mental Health and Well-Being: Evolution, Current Applications, Future Challenges, and Emerging Evidence

Artificial Intelligence (AI) is a broad field that is upturning mental health care in many ways, from addressing anxiety, depression, and stress to increasing access, personalization of treatment, and real-time monitoring that enhances patient outcomes. The current paper discusses the evolution, present application, and future challenges in the field of AI for mental health and well-being. From the early chatbot models, such as ELIZA, to modern machine learning systems, the integration of AI in mental health has grown rapidly to augment traditional treatment and open innovative solutions. AI-driven tools provide continuous support, offering personalized interventions and addressing issues such as treatment access and patient stigma. AI also enables early diagnosis through the analysis of complex datasets, including speech patterns and social media behavior, to detect early signs of conditions like depression and Post-Traumatic Stress Disorder (PTSD). Ethical challenges persist, however, most notably around privacy, data security, and algorithmic bias. With AI at the core of mental health care, there is a dire need to develop strong ethical frameworks that ensure patient rights are protected, access is equitable, and transparency is maintained in AI applications. Going forward, the role of AI in mental health will continue to evolve, and continued research and policy development will be needed to meet the diverse needs of patients while mitigating associated risks.

  • 1 authors
·
Dec 13, 2024

Question-Answering Model for Schizophrenia Symptoms and Their Impact on Daily Life using Mental Health Forums Data

In recent years, there is strong emphasis on mining medical data using machine learning techniques. A common problem is to obtain a noiseless set of textual documents, with a relevant content for the research question, and developing a Question Answering (QA) model for a specific medical field. The purpose of this paper is to present a new methodology for building a medical dataset and obtain a QA model for analysis of symptoms and impact on daily life for a specific disease domain. The ``Mental Health'' forum was used, a forum dedicated to people suffering from schizophrenia and different mental disorders. Relevant posts of active users, who regularly participate, were extrapolated providing a new method of obtaining low-bias content and without privacy issues. Furthermore, it is shown how to pre-process the dataset to convert it into a QA dataset. The Bidirectional Encoder Representations from Transformers (BERT), DistilBERT, RoBERTa, and BioBERT models were fine-tuned and evaluated via F1-Score, Exact Match, Precision and Recall. Accurate empirical experiments demonstrated the effectiveness of the proposed method for obtaining an accurate dataset for QA model implementation. By fine-tuning the BioBERT QA model, we achieved an F1 score of 0.885, showing a considerable improvement and outperforming the state-of-the-art model for mental disorders domain.

  • 2 authors
·
Sep 30, 2023

MentalArena: Self-play Training of Language Models for Diagnosis and Treatment of Mental Health Disorders

Mental health disorders are one of the most serious diseases in the world. Most people with such a disease lack access to adequate care, which highlights the importance of training models for the diagnosis and treatment of mental health disorders. However, in the mental health domain, privacy concerns limit the accessibility of personalized treatment data, making it challenging to build powerful models. In this paper, we introduce MentalArena, a self-play framework to train language models by generating domain-specific personalized data, where we obtain a better model capable of making a personalized diagnosis and treatment (as a therapist) and providing information (as a patient). To accurately model human-like mental health patients, we devise Symptom Encoder, which simulates a real patient from both cognition and behavior perspectives. To address intent bias during patient-therapist interactions, we propose Symptom Decoder to compare diagnosed symptoms with encoded symptoms, and dynamically manage the dialogue between patient and therapist according to the identified deviations. We evaluated MentalArena against 6 benchmarks, including biomedicalQA and mental health tasks, compared to 6 advanced models. Our models, fine-tuned on both GPT-3.5 and Llama-3-8b, significantly outperform their counterparts, including GPT-4o. We hope that our work can inspire future research on personalized care. Code is available in https://github.com/Scarelette/MentalArena/tree/main

  • 7 authors
·
Oct 9, 2024 2

MHQA: A Diverse, Knowledge Intensive Mental Health Question Answering Challenge for Language Models

Mental health remains a challenging problem all over the world, with issues like depression, anxiety becoming increasingly common. Large Language Models (LLMs) have seen a vast application in healthcare, specifically in answering medical questions. However, there is a lack of standard benchmarking datasets for question answering (QA) in mental health. Our work presents a novel multiple choice dataset, MHQA (Mental Health Question Answering), for benchmarking Language models (LMs). Previous mental health datasets have focused primarily on text classification into specific labels or disorders. MHQA, on the other hand, presents question-answering for mental health focused on four key domains: anxiety, depression, trauma, and obsessive/compulsive issues, with diverse question types, namely, factoid, diagnostic, prognostic, and preventive. We use PubMed abstracts as the primary source for QA. We develop a rigorous pipeline for LLM-based identification of information from abstracts based on various selection criteria and converting it into QA pairs. Further, valid QA pairs are extracted based on post-hoc validation criteria. Overall, our MHQA dataset consists of 2,475 expert-verified gold standard instances called MHQA-gold and ~56.1k pairs pseudo labeled using external medical references. We report F1 scores on different LLMs along with few-shot and supervised fine-tuning experiments, further discussing the insights for the scores.

  • 7 authors
·
Feb 21

Reasoning Is Not All You Need: Examining LLMs for Multi-Turn Mental Health Conversations

Limited access to mental healthcare, extended wait times, and increasing capabilities of Large Language Models (LLMs) has led individuals to turn to LLMs for fulfilling their mental health needs. However, examining the multi-turn mental health conversation capabilities of LLMs remains under-explored. Existing evaluation frameworks typically focus on diagnostic accuracy and win-rates and often overlook alignment with patient-specific goals, values, and personalities required for meaningful conversations. To address this, we introduce MedAgent, a novel framework for synthetically generating realistic, multi-turn mental health sensemaking conversations and use it to create the Mental Health Sensemaking Dialogue (MHSD) dataset, comprising over 2,200 patient-LLM conversations. Additionally, we present MultiSenseEval, a holistic framework to evaluate the multi-turn conversation abilities of LLMs in healthcare settings using human-centric criteria. Our findings reveal that frontier reasoning models yield below-par performance for patient-centric communication and struggle at advanced diagnostic capabilities with average score of 31%. Additionally, we observed variation in model performance based on patient's persona and performance drop with increasing turns in the conversation. Our work provides a comprehensive synthetic data generation framework, a dataset and evaluation framework for assessing LLMs in multi-turn mental health conversations.

  • 5 authors
·
May 26

Preference Learning Unlocks LLMs' Psycho-Counseling Skills

Applying large language models (LLMs) to assist in psycho-counseling is an emerging and meaningful approach, driven by the significant gap between patient needs and the availability of mental health support. However, current LLMs struggle to consistently provide effective responses to client speeches, largely due to the lack of supervision from high-quality real psycho-counseling data, whose content is typically inaccessible due to client privacy concerns. Furthermore, the quality of therapists' responses in available sessions can vary significantly based on their professional training and experience. Assessing the quality of therapists' responses remains an open challenge. In this work, we address these challenges by first proposing a set of professional and comprehensive principles to evaluate therapists' responses to client speeches. Using these principles, we create a preference dataset, PsychoCounsel-Preference, which contains 36k high-quality preference comparison pairs. This dataset aligns with the preferences of professional psychotherapists, providing a robust foundation for evaluating and improving LLMs in psycho-counseling. Experiments on reward modeling and preference learning demonstrate that PsychoCounsel-Preference is an excellent resource for LLMs to acquire essential skills for responding to clients in a counseling session. Our best-aligned model, PsychoCounsel-Llama3-8B, achieves an impressive win rate of 87% against GPT-4o. We release PsychoCounsel-Preference, PsychoCounsel-Llama3-8B and the reward model PsychoCounsel Llama3-8B-Reward to facilitate the research of psycho-counseling with LLMs at: https://hf.co/Psychotherapy-LLM.

  • 3 authors
·
Feb 26 2

PsyGUARD: An Automated System for Suicide Detection and Risk Assessment in Psychological Counseling

As awareness of mental health issues grows, online counseling support services are becoming increasingly prevalent worldwide. Detecting whether users express suicidal ideation in text-based counseling services is crucial for identifying and prioritizing at-risk individuals. However, the lack of domain-specific systems to facilitate fine-grained suicide detection and corresponding risk assessment in online counseling poses a significant challenge for automated crisis intervention aimed at suicide prevention. In this paper, we propose PsyGUARD, an automated system for detecting suicide ideation and assessing risk in psychological counseling. To achieve this, we first develop a detailed taxonomy for detecting suicide ideation based on foundational theories. We then curate a large-scale, high-quality dataset called PsySUICIDE for suicide detection. To evaluate the capabilities of automated systems in fine-grained suicide detection, we establish a range of baselines. Subsequently, to assist automated services in providing safe, helpful, and tailored responses for further assessment, we propose to build a suite of risk assessment frameworks. Our study not only provides an insightful analysis of the effectiveness of automated risk assessment systems based on fine-grained suicide detection but also highlights their potential to improve mental health services on online counseling platforms. Code, data, and models are available at https://github.com/qiuhuachuan/PsyGUARD.

  • 3 authors
·
Sep 30, 2024

Chatbots for Mental Health Support: Exploring the Impact of Emohaa on Reducing Mental Distress in China

The growing demand for mental health support has highlighted the importance of conversational agents as human supporters worldwide and in China. These agents could increase availability and reduce the relative costs of mental health support. The provided support can be divided into two main types: cognitive and emotional support. Existing work on this topic mainly focuses on constructing agents that adopt Cognitive Behavioral Therapy (CBT) principles. Such agents operate based on pre-defined templates and exercises to provide cognitive support. However, research on emotional support using such agents is limited. In addition, most of the constructed agents operate in English, highlighting the importance of conducting such studies in China. In this study, we analyze the effectiveness of Emohaa in reducing symptoms of mental distress. Emohaa is a conversational agent that provides cognitive support through CBT-based exercises and guided conversations. It also emotionally supports users by enabling them to vent their desired emotional problems. The study included 134 participants, split into three groups: Emohaa (CBT-based), Emohaa (Full), and control. Experimental results demonstrated that compared to the control group, participants who used Emohaa experienced considerably more significant improvements in symptoms of mental distress. We also found that adding the emotional support agent had a complementary effect on such improvements, mainly depression and insomnia. Based on the obtained results and participants' satisfaction with the platform, we concluded that Emohaa is a practical and effective tool for reducing mental distress.

  • 8 authors
·
Sep 21, 2022

MindEval: Benchmarking Language Models on Multi-turn Mental Health Support

Demand for mental health support through AI chatbots is surging, though current systems present several limitations, like sycophancy or overvalidation, and reinforcement of maladaptive beliefs. A core obstacle to the creation of better systems is the scarcity of benchmarks that capture the complexity of real therapeutic interactions. Most existing benchmarks either only test clinical knowledge through multiple-choice questions or assess single responses in isolation. To bridge this gap, we present MindEval, a framework designed in collaboration with Ph.D-level Licensed Clinical Psychologists for automatically evaluating language models in realistic, multi-turn mental health therapy conversations. Through patient simulation and automatic evaluation with LLMs, our framework balances resistance to gaming with reproducibility via its fully automated, model-agnostic design. We begin by quantitatively validating the realism of our simulated patients against human-generated text and by demonstrating strong correlations between automatic and human expert judgments. Then, we evaluate 12 state-of-the-art LLMs and show that all models struggle, scoring below 4 out of 6, on average, with particular weaknesses in problematic AI-specific patterns of communication. Notably, reasoning capabilities and model scale do not guarantee better performance, and systems deteriorate with longer interactions or when supporting patients with severe symptoms. We release all code, prompts, and human evaluation data.

  • 6 authors
·
Nov 23

Explainable Depression Symptom Detection in Social Media

Users of social platforms often perceive these sites as supportive spaces to post about their mental health issues. Those conversations contain important traces about individuals' health risks. Recently, researchers have exploited this online information to construct mental health detection models, which aim to identify users at risk on platforms like Twitter, Reddit or Facebook. Most of these models are centred on achieving good classification results, ignoring the explainability and interpretability of the decisions. Recent research has pointed out the importance of using clinical markers, such as the use of symptoms, to improve trust in the computational models by health professionals. In this paper, we propose using transformer-based architectures to detect and explain the appearance of depressive symptom markers in the users' writings. We present two approaches: i) train a model to classify, and another one to explain the classifier's decision separately and ii) unify the two tasks simultaneously using a single model. Additionally, for this latter manner, we also investigated the performance of recent conversational LLMs when using in-context learning. Our natural language explanations enable clinicians to interpret the models' decisions based on validated symptoms, enhancing trust in the automated process. We evaluate our approach using recent symptom-based datasets, employing both offline and expert-in-the-loop metrics to assess the quality of the explanations generated by our models. The experimental results show that it is possible to achieve good classification results while generating interpretable symptom-based explanations.

  • 3 authors
·
Oct 20, 2023

Roleplaying with Structure: Synthetic Therapist-Client Conversation Generation from Questionnaires

The development of AI for mental health is hindered by a lack of authentic therapy dialogues, due to strict privacy regulations and the fact that clinical sessions were historically rarely recorded. We present an LLM-driven pipeline that generates synthetic counseling dialogues based on structured client profiles and psychological questionnaires. Grounded on the principles of Cognitive Behavioral Therapy (CBT), our method creates synthetic therapeutic conversations for clinical disorders such as anxiety and depression. Our framework, SQPsych (Structured Questionnaire-based Psychotherapy), converts structured psychological input into natural language dialogues through therapist-client simulations. Due to data governance policies and privacy restrictions prohibiting the transmission of clinical questionnaire data to third-party services, previous methodologies relying on proprietary models are infeasible in our setting. We address this limitation by generating a high-quality corpus using open-weight LLMs, validated through human expert evaluation and LLM-based assessments. Our SQPsychLLM models fine-tuned on SQPsychConv achieve strong performance on counseling benchmarks, surpassing baselines in key therapeutic skills. Our findings highlight the potential of synthetic data to enable scalable, data-secure, and clinically informed AI for mental health support. We will release our code, models, and corpus at https://ai-mh.github.io/SQPsych

  • 12 authors
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Oct 29