Colloquially, OCD is known as the doubting disorder. In his new book, Simone Stolzoff explores whether treating that uncertainty with magic mushrooms can help people through it. Adam Strauss is standing in his New York City apartment, holding the limp cord of his headphones, trying to choose between the two MP3 players on his desk: the iPod and the iRiver, its Korean counterpart. He tries different songs, different genres, different instruments. The iRiver tends to sound better overall, but the iPod offers a little more nuance in the midrange. The iPod has a better battery life, but the iRiver still lasts eight hours-- longer than he's ever continuously listened to music. Then again, he's never owned an MP3 player. He goes back and forth, back and forth, testing vocal ranges, button resistance, interface aesthetics. It would be one thing if it were just Adam's decision of which MP3 player to buy. After all, it was 2003, the height of the personal audio device revolution, and Adam was a 29-year-old audiophile. For Adam, it was also other decisions-- what shirt to wear to work, what to order for lunch, even what side of the street to walk down. At one point, in an effort to simplify his decisionmaking process for what to wear, Adam bought 11 identical blue button-down shirts. But he quickly found variations in each shirt's fit and fading. He believed there was a shirt to pick; each morning he would spend 20, 30, then 45 minutes trying to find it. If he could only determine which shirt was best, he could control his fate.

LLM agents have begun to appear as personal assistants, customer service bots, and clinical aides. While these applications deliver substantial operational benefits, they also require continuous access to sensitive data, which increases the likelihood of unauthorized disclosures. Moreover, these disclosures go beyond mere explicit disclosure, leaving open avenues for gradual manipulation or sidechannel information leakage. This study proposes an auditing framework for conversational privacy that quantifies an agent's susceptibility to these risks. The proposed Conversational Manipulation for Privacy Leakage (CMPL) framework is designed to stress-test agents that enforce strict privacy directives against an iterative probing strategy. Rather than focusing solely on a single disclosure event or purely explicit leakage, CMPL simulates realistic multi-turn interactions to systematically uncover latent vulnerabilities. Our evaluation on diverse domains, data modalities, and safety configurations demonstrates the auditing framework's ability to reveal privacy risks that are not deterred by existing single-turn defenses, along with an in-depth longitudinal study of the temporal dynamics of leakage, strategies adopted by adaptive adversaries, and the evolution of adversarial beliefs about sensitive targets. In addition to introducing CMPL as a diagnostic tool, the paper delivers (1) an auditing procedure grounded in quantifiable risk metrics and (2) an open benchmark for evaluation of conversational privacy across agent implementations.

Cognitive Behavioral Therapy (CBT) is a proven approach for addressing the irrational thought patterns associated with mental health disorders, but its effectiveness relies on accurately identifying cognitive pathways to provide targeted treatment. In today's digital age, individuals often express negative emotions on social media, where they may reveal cognitive distortions, and in severe cases, exhibit suicidal tendencies. However, there is a significant gap in methodologies designed to analyze these cognitive pathways, which could be critical for psychotherapists aiming to deliver timely and effective interventions in online environments. Cognitive Behavioral Therapy (CBT) framework leveraging acceptance, commitment and data augmentation to categorize and address both textual and visual content as positive or negative. Specifically, the system employs BERT, RoBERTa for Sentiment Analysis and T5, PEGASUS for Text Summarization, mT5 for Text Translation in Multiple Languages focusing on detecting negative emotions and cognitive distortions within social media data. While existing models are primarily designed to identify negative thoughts, the proposed system goes beyond this by predicting additional negative side effects and other potential mental health disorders likes Phobias, Eating Disorders. This enhancement allows for a more comprehensive understanding and intervention strategy, offering psychotherapists a powerful tool for early detection and treatment of various psychological issues.

Traditional in-person psychological counseling remains primarily niche, often chosen by individuals with psychological issues, while online automated counseling offers a potential solution for those hesitant to seek help due to feelings of shame. Cognitive Behavioral Therapy (CBT) is an essential and widely used approach in psychological counseling. The advent of large language models (LLMs) and agent technology enables automatic CBT diagnosis and treatment. However, current LLM-based CBT systems use agents with a fixed structure, limiting their self-optimization capabilities, or providing hollow, unhelpful suggestions due to redundant response patterns. In this work, we utilize Quora-like and YiXinLi single-round consultation models to build a general agent framework that generates high-quality responses for single-turn psychological consultation scenarios. We use a bilingual dataset to evaluate the quality of single-response consultations generated by each framework. Then, we incorporate dynamic routing and supervisory mechanisms inspired by real psychological counseling to construct a CBT-oriented autonomous multi-agent framework, demonstrating its general applicability. Experimental results indicate that AutoCBT can provide higher-quality automated psychological counseling services.

This paper presents the iterative development of Habit Coach, a GPT-based chatbot designed to support users in habit change through personalized interaction. Employing a user-centered design approach, we developed the chatbot using a Retrieval-Augmented Generation (RAG) system, which enables behavior personalization without retraining the underlying language model (GPT-4). The system leverages document retrieval and specialized prompts to tailor interactions, drawing from Cognitive Behavioral Therapy (CBT) and narrative therapy techniques. A key challenge in the development process was the difficulty of translating declarative knowledge into effective interaction behaviors. In the initial phase, the chatbot was provided with declarative knowledge about CBT via reference textbooks and high-level conversational goals. However, this approach resulted in imprecise and inefficient behavior, as the GPT model struggled to convert static information into dynamic and contextually appropriate interactions. This highlighted the limitations of relying solely on declarative knowledge to guide chatbot behavior, particularly in nuanced, therapeutic conversations. Over four iterations, we addressed this issue by gradually transitioning towards procedural knowledge, refining the chatbot's interaction strategies, and improving its overall effectiveness. In the final evaluation, 5 participants engaged with the chatbot over five consecutive days, receiving individualized CBT interventions. The Self-Report Habit Index (SRHI) was used to measure habit strength before and after the intervention, revealing a reduction in habit strength post-intervention. These results underscore the importance of procedural knowledge in driving effective, personalized behavior change support in RAG-based systems.

Cognitive Behavioral Therapy (CBT) is a well-established, evidence-based treatment for Major Depressive Disorder. Unfortunately, there exist significant barriers to individuals accessing CBT, including cost, scarcity of therapists and stigma. This study explores the feasibility of fine-tuning small open weight large language models (LLMs) to deliver CBT for depression. Using 58 sets of synthetic CBT transcripts generated by the Nous Research fine-tune of Llama 3.1 405b, we fine-tuned three models: Mistral 7b v0.3, Qwen 2.5 7b, and Llama 3.1 8b. CBT fidelity was evaluated through a modified Cognitive Therapy Rating Scale (CTRS). All fine-tuned models were compared against each other, as well as their instruct-tuned variants. Simulated patient transcripts were generated for the purpose of evaluating model performance, with the instruct and CBT-tuned models acting as the therapist and DeepSeek-V2.5 acting as the patient. These simulated transcripts were evaluated on a modified CTRS by Gemini 1.5 Pro-002. Our findings demonstrated that the CBT-tuned models significantly outperformed their instruct-tuned counterparts, with an average improvement of 11.33 points (p < 0.001) on total CTRS score. Llama 3.1 8b had the strongest performance (mean CTRS score 67.86 +/- 7.24), followed by Qwen 2.5 7b (64.28 +/- 9.55) and Mistral 7b v0.3 (64.17 +/- 9.79), with these differences between models being statistically significant. The CBT-tuned models were competent in implementing core CBT techniques and providing empathetic responses, however, there were limitations observed in agenda adherence, exploration depth and long-context coherence. This study establishes that CBT specific fine-tuning can effectively encode therapeutic competencies in small LLMs, though significant technical and ethical considerations must be resolved prior to clinical deployment.

Cognitive Behavioral Therapy (CBT) is a well-established intervention for mitigating psychological issues by modifying maladaptive cognitive and behavioral patterns. However, delivery of CBT is often constrained by resource limitations and barriers to access. Advancements in artificial intelligence (AI) have provided technical support for the digital transformation of CBT. Particularly, the emergence of pre-training models (PTMs) and large language models (LLMs) holds immense potential to support, augment, optimize and automate CBT delivery. This paper reviews the literature on integrating AI into CBT interventions. We begin with an overview of CBT. Then, we introduce the integration of AI into CBT across various stages: pre-treatment, therapeutic process, and post-treatment. Next, we summarized the datasets relevant to some CBT-related tasks. Finally, we discuss the benefits and current limitations of applying AI to CBT. We suggest key areas for future research, highlighting the need for further exploration and validation of the long-term efficacy and clinical utility of AI-enhanced CBT. The transformative potential of AI in reshaping the practice of CBT heralds a new era of more accessible, efficient, and personalized mental health interventions.

While models trained on data from mental health service platform have achieved preliminary success, challenges persist in areas such as data scarcity, quality, and ensuring a solid foundation in psychological techniques. To address these challenges, this study introduces a novel approach to enhance the precision and efficacy of psychological support through large language models. Specifically, we design a specific prompt derived from principles of Cognitive Behavioral Therapy (CBT) and have generated the CBT QA dataset, specifically for Chinese psychological health Q&A based on CBT structured intervention strategies. Unlike previous methods, our dataset emphasizes professional and structured response. Utilizing this dataset, we fine-tuned the large language model, giving birth to CBT-LLM, the large-scale language model specifically designed for Cognitive Behavioral Therapy techniques. Empirical evaluations demonstrate that CBT-LLM excels in generating structured, professional, and highly relevant responses in psychological health support tasks, showcasing its practicality and quality. The model is available on Hugging Face: https://huggingface.co/Hongbin37/CBT-LLM.

Dialogue systems controlled by predefined or rule-based scenarios derived from counseling techniques, such as cognitive behavioral therapy (CBT), play an important role in mental health apps. Despite the need for responsible responses, it is conceivable that using the newly emerging LLMs to generate contextually relevant utterances will enhance these apps. In this study, we construct dialogue modules based on a CBT scenario focused on conventional Socratic questioning using two kinds of LLMs: a Transformer-based dialogue model further trained with a social media empathetic counseling dataset, provided by Osaka Prefecture (OsakaED), and GPT-4, a state-of-the art LLM created by OpenAI. By comparing systems that use LLM-generated responses with those that do not, we investigate the impact of generated responses on subjective evaluations such as mood change, cognitive change, and dialogue quality (e.g., empathy). As a result, no notable improvements are observed when using the OsakaED model. When using GPT-4, the amount of mood change, empathy, and other dialogue qualities improve significantly. Results suggest that GPT-4 possesses a high counseling ability. However, they also indicate that even when using a dialogue model trained with a human counseling dataset, it does not necessarily yield better outcomes compared to scenario-based dialogues. While presenting LLM-generated responses, including GPT-4, and having them interact directly with users in real-life mental health care services may raise ethical issues, it is still possible for human professionals to produce example responses or response templates using LLMs in advance in systems that use rules, scenarios, or example responses.

You are free to share this article under the Attribution 4.0 International license. Cognitive behavioral therapy for chronic pain supported by artificial intelligence can yield the same results as programs delivered by therapists, a new study shows. Cognitive behavioral therapy (CBT) is an effective alternative to opioid painkillers for managing chronic pain. But getting patients to complete those programs is challenging, especially because psychotherapy often requires multiple sessions and mental health specialists are scarce. AI-supported therapy requires substantially less clinician time, making it more accessible to patients, the researchers report.