Organizations: Harbin Institute of Technology, Shenzhen, China · City University of Macau, Macao SAR, China · Peng Cheng Laboratory, Shenzhen, China
Abstract
Emotional Support Conversation (ESC) plays a critical role in mental health assistance by providing accessible psychological support in real-world applications. Large Language Models (LLMs) have shown strong empathetic abilities in ESC tasks. Yet, existing methods overlook the issue of cognitive distortions in help-seekers' expressions. As a result, current models can only provide basic emotional comfort, rather than helping help-seekers address their psychological distress at a deeper cognitive level. To address this challenge, we construct the CogBiasESC dataset, the first dataset that expands existing ESC datasets by adding labels for cognitive distortions, includes their type, intensity, and safe risk level. Furthermore, we propose the Cognitive Policy-driven Large Language Model framework (CoPoLLM) to enhance LLMs' ability to diagnose and intervene cognitive distortions in help-seekers. We also analyze the safety advantages of CoPoLLM from a theoretical perspective. Experimental results show that CoPoLLM significantly outperforms 15 state-of-the-art baselines in terms of distortion diagnosis accuracy, intervention strategy effectiveness, and safety risk control.
Cognitive distortion amplifies negative emotions and contributes to mental health disorders. Cognitive Behavioral Therapy (CBT) is an effective way to address cognitive distortions, but its large-scale application is limited by the shortage of professional therapists. Although large language models (LLMs) have recently been explored for mental health applications, existing methods still suffer from limited domain specificity, overly flattering responses, and the absence of well-defined annotations for cognitive distortions. This paper proposes Cognivia, an evidence-based artificial intelligence therapist that integrates automatic cognitive distortion identification and rational response generation. Our framework is built on authoritative CBT texts widely regarded as core paradigms and standard references. It is further augmented with mental health question-answer (Q and A) data, and employs multi-stage prompting and structured generation strategies under the supervision of behavioral science experts. Then we fine-tune a lightweight LLM on this augmented CBT dataset to obtain Cognivia. In addition, we propose the first hierarchical quality evaluation framework for assessing LLM-generated rational responses, developed through collaboration between AI researchers and behavioral science experts. Cognivia is evaluated using lexical metrics, LLM-based Judges with two complementary criteria, and human evaluation by 10 behavioral science experts. It consistently outperforms the baseline methods in cognitive distortion recognition and rational response generation, demonstrating its effectiveness. Our code is available at https://github.com/SNOWTEAM2023/Cognivia.
LLM chatbots increasingly serve as a first source of support for people in psychological distress, including those whose distress is entangled with delusional beliefs. Prior work on LLM mental-health safety largely evaluates general therapeutic quality or single-turn crisis detection, leaving unclear how models behave when distress is intertwined with delusion over sustained conversations. We address this gap with matched multi-turn simulations, across clinically grounded personas and six LLMs, that pair each delusional conversation with a distress-only control to isolate the effect of delusional framing. This reveals a recognition-intervention gap: models detect distress at comparable rates regardless of framing, yet sharply fail to act on it once distress is embedded in delusion, with safety interventions suppressed by up to 4.5x. The failure tracks accumulated acceptance of the user's premises rather than emotional validation. Worse, the intuitive fix of prompting models to assess user distress backfires under delusional framing; only delusion-aware prompting with explicit response guidance closes the gap, and even this depends on a delusion classifier that is itself unreliable on the most vulnerable models. Safe deployment therefore requires treating delusional framing as a distinct risk signal that overrides conversational accommodation.
Andrew Aquilina, Chetna Nihalani, Vasudha Varadarajan +3
Emotional Support Conversation (ESC) aims to assist individuals experiencing distress by generating empathetic and supportive dialogue. While prior work typically assumes that each supporter turn corresponds to a single strategy, real-world supportive communication often involves multiple strategies within a single utterance. In this paper, we revisit the ESC task by formulating it as multi-strategy utterance generation, where each utterance may contain one or more strategy-response pairs. We propose two generation methods: All-in-One, which predicts all strategy-response pairs in a single decoding step, and One-by-One, which iteratively generates strategy-response pairs until completion. Both methods are further enhanced with cognitive reasoning guided by reinforcement learning to improve strategy selection and response composition. We evaluate our models on the ESConv dataset under both utterance-level and dialogue-level settings. Experimental results show that our methods effectively model multi-strategy utterances and lead to improved supportive quality and dialogue success. To our knowledge, this work provides the first systematic empirical evidence that allowing multiple support strategies within a single utterance is both feasible and beneficial for emotional support conversations. All code and data will be publicly available at https://github.com/aliyun/qwen-dianjin.