Leveraging Multimodal Self-Consistency Reasoning in Coding Motivational Interviewing for Alcohol Use Reduction
Authors: Guangzeng Han, James G. Murphy, Benjamin O. Ladd, Xiaolei Huang, Brian Borsari
Organizations: Department of Computer Science, University of Memphis, 3725 Norriswood Ave, Memphis, TN, 38152 · Department of Psychology, University of Memphis, Memphis, 400 Fogelman Drive, TN, 38152 · Department of Psychology, Washington State University Vancouver, 14204 NE Salmon Creek Ave, Vancouver, WA, 98686 · Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121 · Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 675 18th Street, San Francisco, CA 94143.
Abstract
BACKGROUND: Coding Motivational Interviewing (MI) sessions is essential for understanding client behaviors and predicting outcomes, but it requires substantial time and labor from trained MI professionals. Recent advances in audio-language models (ALMs) offer new opportunities to automate MI coding by capturing multimodal behavioral signals. OBJECTIVE: This study aims to develop an automatic MI coding approach based on ALMs that analyzes raw audio input and integrates predictions from multiple reasoning trajectories using self-consistency to improve coding robustness. METHODS: We experimented with five recorded sessions from de-identified MI audio tapes. We deployed ALMs with four complementary analytic prompts to support utterance-level reasoning: analytic prompting for verbal cues, prosody-aware prompting for acoustic cues, evidence-scoring prompting for quantitative hypothesis testing, and comparative prompting for contrastive reasoning. Three stochastic samples were drawn for each prompt, generating 12 independent reasoning trajectories per utterance. Final predictions were determined by majority voting across all trajectories. RESULTS: Performance was evaluated using accuracy, precision, recall, and macro-F1 scores. The proposed multimodal self-consistency approach achieved 52.56% accuracy, 54.03% precision, 47.45% recall, and a macro-F1 score of 46.40%, exceeding baseline methods. Systematic ablation experiments that removed individual modules consistently degraded performance on the primary metrics. CONCLUSIONS: Multimodal self-consistency outperforms single-pass baseline prompting approaches for MI coding. These findings suggest that incorporating both what clients say and how they say it can support more reliable automatic MI coding.
Reasoning large language models (LLMs) have recently made much progress in complex problem-solving, leveraging internal reasoning (or thought) to guide their solution generation. However, existing LLM-based counseling agents, including those using Motivational Interviewing (MI), generate responses without explicitly aligning thoughts with counseling techniques, limiting their effectiveness. We propose MIThinker, a lightweight thinking model that generates therapeutic thoughts to guide MI counseling agents in strategy selection and response generation. To overcome the lack of annotated thought data, we introduce AugR1-MI, an automated pipeline that reverse-engineers counselor's thoughts from observed responses. Through two-stage training combining supervised fine-tuning and reinforcement learning, MIThinker demonstrates improved theory-of-mind assessment and strategy alignment. Comprehensive evaluations show that MindfulMI, our agent leveraging MIThinker, achieves MI competency comparable to state-of-the-art systems with an order of magnitude less computation.
Large language models (LLMs) can generate fluent dialogue, but prior works lack situational grounding, dynamic strategy control, and evaluation aligned with clinical standards in motivational interviewing (MI). We introduce StoryMI, a multi-LLM agent framework for controllable MI dialogue generation, where questionnaire-based client profiles are expanded into situational stories that provide narrative context for the dialogue. Therapist and client agents generate MI-coded utterances guided by MI codes selected by the interaction agent, while an interaction agent dynamically coordinates exchanges to control MI strategies during a multi-turn conversation. We propose a two-level evaluation protocol: lexical metrics and MI-specific measures of macro-level counseling strategies, alongside LLM-as-judge and human expert assessments. We construct a dataset of 6K simulated MI dialogues grounded in 1K questionnaire-story pairs, covering 12 MI codes and 13 symptom domains, and benchmark six open- and closed-source LLMs. Our results show that situational grounding and macro-level control can improve MI adherence and clinical plausibility, demonstrating the effectiveness of a structured multi-agent workflow for psychotherapy dialogue generation. We provide code and data for reproducibility.
Automatic depression detection from doctor-patient conversations has gained momentum thanks to the availability of public corpora and advances in language modeling. However, interpretability remains limited: strong performance is often reported without revealing what drives predictions. We analyze three datasets: ANDROIDS, DAIC-WOZ, E-DAIC and identify a systematic bias from interviewer prompts in semi-structured interviews. Models trained on interviewer turns exploit fixed prompts and positions to distinguish depressed from control subjects, often achieving high classification scores without using participant language. Restricting models to participant utterances distributes decision evidence more broadly and reflects genuine linguistic cues. While semi-structured protocols ensure consistency, including interviewer prompts inflates performance by leveraging script artifacts. Our results highlight a cross-dataset, architecture-agnostic bias and emphasize the need for analyses that localize decision evidence by time and speaker to ensure models learn from participants' language.
Hasindri Watawana, Sergio Burdisso, Diego A. Moreno-Galván +4