Counterfactual explanations (CFEs) provide human-centric interpretability by identifying the minimal, actionable changes required to alter a machine learning model's prediction. Therefore, CFs can be used as (i) interventions for abnormality prevention and (ii) augmented data for training robust models. We conduct a comprehensive evaluation of CF generation using large language models (LLMs), including GPT-4 (zero-shot and few-shot) and two open-source models-BioMistral-7B and LLaMA-3.1-8B, in both pretrained and fine-tuned configurations. Using the multimodal AI-READI clinical dataset, we assess CFs across three dimensions: intervention quality, feature diversity, and augmentation effectiveness. Fine-tuned LLMs, particularly LLaMA-3.1-8B, produce CFs with high plausibility (up to 99%), strong validity (up to 0.99), and realistic, behaviorally modifiable feature adjustments. When used for data augmentation under controlled label-scarcity settings, LLM-generated CFs substantially restore classifier performance, yielding an average 20% F1 recovery across three scarcity scenarios. Compared with optimization-based baselines such as DiCE, CFNOW, and NICE, LLMs offer a flexible, model-agnostic approach that generates more clinically actionable and semantically coherent counterfactuals. Overall, this work demonstrates the promise of LLM-driven counterfactuals for both interpretable intervention design and data-efficient model training in sensor-based digital health. Impact: SenseCF fine-tunes an LLM to generate valid, representative counterfactual explanations and supplement minority class in an imbalanced dataset for improving model training and boosting model robustness and predictive performance
Counterfactual recourse aims to provide actionable feature changes that would alter an unfavorable decision made by a predictive model. In practice, affected individuals often benefit from multiple feasible alternatives rather than a single optimal explanation. A natural way to produce such alternatives is to prompt large language models (LLMs). However, prompting incurs a practical constraint: the number of LLM calls is often the dominant computational and economic cost. Together, the need for multiple alternatives and this cost constraint shift the problem from finding a single high-quality counterfactual to efficiently generating a set of oracle-validated counterfactuals under a fixed LLM-call budget. In this work, we study counterfactual recourse generation in the LLM-agentic setting as a fixed-budget search problem and propose Comp-MCTS, an agentic tree-search framework that maximizes the yield of unique, oracle-validated counterfactuals under this budget while maintaining favorable quantity--quality trade-offs. Comp-MCTS allocates the budget toward novel intervention directions via LLM-based proposal generation, oracle validation, and compression-guided pruning, in a training-free, oracle-only setting. Experiments on four real-world tabular datasets show that Comp-MCTS substantially outperforms single-candidate LATS-style baselines in the yield of unique, oracle-validated counterfactuals, and offers favorable quantity--quality--efficiency trade-offs against stronger multi-candidate variants: comparable or higher yield at similar or lower oracle-evaluation cost on three of four datasets, plus competitive proximity, sparsity, and novelty.
Large language models can easily generate explanations for their own outputs, but such self-explanations are not necessarily faithful to the model's behavior. We study this issue through counterfactual self-explanations, where a model minimally edits an input so that its own prediction changes. Across sentiment analysis and natural language inference, we evaluate ten instruction-tuned models from the LLaMA-3 and Qwen-2.5 families, measuring faithfulness, minimality, and alignment with human-annotated rationales. Our results show that model scale is the strongest determinant of explanation quality: larger models are substantially more likely to generate counterfactuals that flip their own predictions and target decision-relevant evidence. In contrast, the rationale-guided condition produces edit-minimal counterfactuals that are also more human-aligned. However, it does not consistently improve faithfulness. Overall, counterfactual self-explanations can provide useful behavioral evidence about model decisions, but their reliability depends strongly on model capacity and should be empirically validated rather than assumed.
Predicting the outcomes of prospective clinical trials remains a major challenge for large language models. Prior work has shown that both traditional correlational predictors, such as random forests and logistic regression, and strong commercial LLMs achieve limited performance on this task. In this paper, we propose DeepImagine, a framework for teaching LLMs biomedical reasoning through successive counterfactual imagining. The central idea is to approximate hidden causal mechanisms of clinical trials by training models to infer how observed trial results would change under controlled perturbations of experimental conditions, such as dosage, outcome measures, study arms, geography, and other trial attributes. To support this objective, we construct both natural and approximate counterfactual pairs from real clinical trials with reported outcomes. For settings where strict counterfactual supervision is available, such as paired outcome measures or dose-ranging study arms within the same trial, we train models with supervised fine-tuning. For broader settings where only approximate counterfactual pairs can be retrieved, we optimize models with reinforcement learning using verifiable rewards based on downstream benchmark correctness. We further augment training with synthetic reasoning traces that provide causally plausible explanations for local counterfactual transitions. Using this pipeline, we train language models under 10B parameters, including Qwen3.5-9B, and evaluate them on clinical trial outcome prediction. We aim to show that DeepImagine consistently improves over untuned language models and traditional correlational baselines. Finally, we aim to show that the learned reasoning trajectories provide interpretable signals about how models represent trial-level mechanisms, suggesting a practical path toward more mechanistic and scientifically useful biomedical language models.