cs.CLSep 17, 2026
SaveAligning with Lived Experience: Heterogeneous Benefits of Fine Tuning in Mental Health Support Generation
Organizations: Georgia Institute of Technology · Magic Hour
Abstract
As access to professional mental healthcare remains limited, many individuals turn to online platforms such as Reddit to seek peer support situated within human lived experience. However, a significant portion of such queries go unanswered, presenting an opportunity for using Large Language Models (LLMs) to fill this gap. While LLMs have demonstrated strong performance on clinical benchmarks, their ability to generate lived-experience informed and community-aligned peer support is underexplored. Addressing this gap, we introduce the COmmunity-centered Peer Engaged Support (COPES) dataset and a three-axis evaluation framework to assess LLM alignment with community perspectives to mental health support seeking queries. Evaluating zero-shot and post-trained (SFT and DPO) models, we show that post-training on COPES significantly improves Strategy Alignment (>50% for general-purpose models) and alignment in Emotion & Tone. However, we also observe that such improvements are heterogeneous and alignment improvements vary significantly across subreddits and requested coping strategies. Furthermore, post-training induces distributional shifts, heavily favoring problem-focused recommendations while suppressing emotion-focused strategies. Together, this work shows that while curating community-driven data improves the alignment of LLM responses, model performance remains disparate across distinct sub-communities and specific mental health needs.
Figures & tables
Figure 1: Overview of the dataset construction pipeline, including Reddit thread collection, quality filtering and LLM-based peer-support/coping strategy labeling, and preferred/rejected response generation. Detailed criteria and prompts are provided in Section 2 .
Figure 2: Relative changes in Strategy Alignment, Strategy Congruence, and Emotion & Tone metrics for Qwen-3 4B following SFT and SFT+DPO, compared to zero-shot baselines across Reddit post coping strategy labels. Results for Gemma, Mediphi and Qwen are presented in Appendix Figure 6 .
Figure 3: Distribution of generated coping strategy types across subreddit community categories for Gemma-4 E4B. Post-training changes the type of advice models produce, with general-purpose models shifting toward more problem-focused recommendations. Results for Gemma, Mediphi and Qwen are presented in Appendix Figure 5 .
| Subreddits |
| r/abuse, r/adultsurvivors, r/aftersilence, r/Anger, r/bullying, r/CPTSD, r/domesticviolence, r/emotionalabuse, r/ptsd, r/PTSDCombat, r/rapecounseling, r/StopSelfHarm, r/survivorsofabuse, r/traumatoolbox, |
| r/Agoraphobia, r/Anxiety, r/BipolarReddit, r/BipolarSOs, r/BPD, r/dpdr, r/psychoticreddit, r/MaladaptiveDreaming, r/Psychosis, r/PanicParty, r/schizophrenia, r/socialanxiety, |
| r/compulsions, r/CompulsiveSkinPicking, r/OCD, r/Trichsters, |
| r/CupsOfTea, r/BackOnYourFeet, r/Existential_crisis, r/getting_over_it, r/GriefSupport, r/helpmecope, r/hardshipmates, r/HereToHelp, r/iflostbetter, r/LostALovedOne, r/offmychest, r/MMFB, r/Miscarriage, r/reasonstolive, r/SuicideBereavement, r/therapy, |
| r/depression, r/depressed, r/ForeverAlone, r/GFD, r/lonely, r/mentalhealth, r/Radical_Mental_Health, r/SuicideWatch |
Table 4: List of 55 mental health–related subreddits used in this study.
| Keyword Type | Keyword List |
| Mental Disorder Terms | Anxiety disorder, Generalised anxiety disorder, Panic disorder, Social anxiety disorder, Separation anxiety disorder, Depression, Depressive episode, Bipolar disorder, Manic episode, Post-Traumatic Stress Disorder, PTSD, Schizophrenia, Delusions, Hallucinations, Disorganised thinking, Disorganised behaviour, Eating disorder, Anorexia nervosa, Bulimia nervosa, Disruptive behaviour disorder, Dissocial disorder, Conduct disorder, Oppositional defiant disorder, ODD, Neurodevelopmental disorder, Autism spectrum disorder, ASD, Attention-deficit/hyperactivity disorder, ADHD, Disorders of intellectual development, Intellectual disability |
| Topic Keywords | advice, today, need, therapist, end, never, daydream, anything, birthday, read, ocd, hate, job, question, deal, think, new, looking, interview, diagnosed, feeling, normal, tell, therapy, guy, head, thought, suicidal, better, anxiety, social, intrusive, life, symptom, tired, relationship, worst, physical, friend, scared, depressed, kill, best, love, disorder, losing, done, lonely, one, talk, take, could, wish, person, go, care, depression, bad, attack, panic, this, heart, due, weird, cause, anybody, call, work, anxious, getting, alone, wrong, school, family, back, always, mental, health, stop, fuck, even, illness, sure, compulsion, much, time, day, year, first, every, daydreaming, right, sleep, week |
Table 5: Unified keyword set used for filtering and analysis.
| Type | Prompt |
| System Prompt | You are a clinical psychologist specializing in digital mental health and social support systems. Your task is to identify whether a Reddit post expresses a request for non-medical peer support. Definition: Within non-medical peer support, people who share common experiences or face similar challenges come together as equals to give and receive help based on the knowledge that comes through shared experience. It focuses on validation, normalization, and shared coping rather than technical solutions or clinical diagnosis. You will be given a Reddit post text (REDDIT_POST_TEXT) and Reddit post title (REDDIT_POST_TITLE) and your task is to determine whether the post is requesting non-medical, emotional peer support. Some examples are: • Seeking emotional encouragement or reassurance. • Asking for shared experiences to overcome a problem. • Asking for connecting to people, resources, needed services, and community. • Asking for steps/help for overcoming difficult situations. • Turning to the community for finding personal growth, purpose, or a new perspective in the situation. Do NOT classify as peer support if the post is: • A technical or troubleshooting question • A medical or disease related query • A venting or reflection without inviting interaction/reflection • A game strategy or product-related coordination Examples: Example 1: Post: “I’ve been feeling numb ever since my mom passed. How do you even begin to move on?” Label: YES Reasoning: The user asks for advice on how to cope with grief—clearly seeking emotional guidance. Example 2: Post: “Can you turn autosaves off? I accidentally ruined my build.” Label: NO Reasoning: This is a technical question about game mechanics, not a request for emotional support. Example 3: Post: “Does anyone else feel like they’re just pretending to be okay all the time?” Label: YES Reasoning: The user is asking for shared experiences to feel less alone, satisfying the peer support criteria. Example 4: Post: “Just hit 10k steps today. Feeling good!” Label: NO Reasoning: This is a self-reflective statement celebrating an achievement, not seeking support. Example 5: Post: “I always binge uncontrollably during my period. I beat myself up and get depressed. Anyone else? What helps you stop?” Label: YES Reasoning: The post contains both a request for shared experiences and a question about coping strategies. Example 6: Post: “I’m looking for anyone available to help sweep through the rest of my storm shield defenses.” Label: NO Reasoning: This is a game coordination request, not an emotional or social support need. Instructions: You must respond strictly using this JSON format: { "reasoning": "your reasoning (1--2 sentences)", "answer": "YES" or "NO" } Do not include any explanation outside of the JSON block. |
| User Prompt | REDDIT_POST_TITLE: <post title> REDDIT_POST_TEXT: <post text> Classify whether the post is requesting non-medical emotional peer support. Return the output strictly in JSON format as specified above. |
Table 6: Prompt used for binary peer-support classification.
| Type | Prompt |
| System Prompt | You are a clinical psychologist identifying how coping strategies fall under four categories: Problem-focused, Emotion-focused, Meaning-focused, and Social coping. You will be given: • Reddit post text (REDDIT_POST_TEXT) • Four coping strategies with names, definitions, and examples. Your task: Step 1. Carefully read the text and decide if the text is seeking support of any kind. If it is not, skip to step 3 and set all binary classification to zero. Step 2. Ignore any text associated with an explicit “edit” or “thanks” portion of the text. Step 3. With the remaining text, determine coping strategies the user employs in the text. Only categorize if it is truly a good fit. Consider actions, tone, and behaviors. Step 4. Return a SINGLE JSON object in this exact format: { "is_problem_focused": 0 or 1, "problem_focused_reasoning": "short reasoning for Problem-focused classification", "is_emotion_focused": 0 or 1, "emotion_focused_reasoning": "short reasoning for Emotion-focused classification", "is_meaning_focused": 0 or 1, "meaning_focused_reasoning": "short reasoning for Meaning-focused classification", "is_social_focused": 0 or 1, "social_focused_reasoning": "short reasoning for Social coping classification" } Do NOT include any text outside the JSON block. |
| User Prompt | — Coping Strategy 1 — COPING_STRATEGY_NAME: Problem-focused COPING_STRATEGY_DEFINITION: Taking positive, practical action in order to change the stressful situation itself. EXAMPLES: - “I made a list of things I can control about my job search and started applying to two places a day.” - “I’m still not sure what to do but I started seeing a therapist last week” - “I was panicking about the deadline, so I emailed my professor to ask for an extension.” - “Setting boundaries” - “Clear communication about problems” — Coping Strategy 2 — COPING_STRATEGY_NAME: Emotion-focused COPING_STRATEGY_DEFINITION: Doing self-soothing behaviors to reduce distress associated with the problem. EXAMPLES: - “I put on music and cleaned my room to feel less overwhelmed.” - “I wrote out everything I was feeling in my notes app instead of bottling it up.” - “I binge-watched a comfort show to distract myself for a while.” - “Venting about the situation” - “I went for a long walk after the argument just to cool off.” — Coping Strategy 3 — COPING_STRATEGY_NAME: Meaning-focused COPING_STRATEGY_DEFINITION: Finding personal growth and perspective in the situation, changing internally rather than externally. EXAMPLES: - “Focus on the positive” - “Challenge previously held beliefs that are no longer adaptive” - “I’m going to accept what I can’t change” - “I’m focusing on what I still have instead of just what I lost.” - “I realized losing that job pushed me to finally go after something I actually care about.” — Coping Strategy 4 — COPING_STRATEGY_NAME: Social coping COPING_STRATEGY_DEFINITION: Explicitly asking for advice or mentions looking to others for help. Simply posting on Reddit is not sufficient to be social coping. EXAMPLES: - “My teacher asked me if anything was going on, so I spent some time telling her about my frustrations.” - “Do you have any tips on how to handle stress at work?” - “I went out with my friends to feel better.” - “I posted about it in a support subreddit and got some really good advice.” REDDIT_POST_TEXT: <post text> |
Table 7: Prompt used for coping strategy classification with combined definition-based labels.
| Type | Prompt |
| System Prompt | You are a Reddit user who provides helpful, empathetic and actionable advice by replying to a post. Given the post title (POST_TITLE), post text (POST_TEXT), and the comments made by other users (REDDIT_COMMENTS), your task is to synthesize the best advice/perspectives from the comments into a single coherent response. Data Source Rules: • Prioritize high-value content: Focus on good and actionable ideas from all comments especially those sharing their lived experiences. • Strict sourcing: Do NOT invent advice. Every suggestion must be traceable to one of the comments. • Hidden context: You must NEVER reveal you are summarizing a thread. • BANNED PHRASES: “commenters”, “others said”, “people here”, “in this thread”, “the consensus is”. • Instead, own the knowledge: “It seems like…”, “A common trick is…”, “Have you tried…”, or “I’ve found that…” (if framing a comment’s experience as general knowledge). • You are allowed to used the word “I” in your response. You are allowed to use anthropomorphic language. Variability & Style Protocols (Critical): • DYNAMIC OPENERS (Prevent Repetition): – Use the following dynamic opener: <dynamic_opener> – Do not use the exact example, but follow the intent and style of the dynamic opener category. • AVOID LLM-SPEAK: – Using Emojis: – Using hashtags or em-dash Natural Attribution: • Do not always use “I heard from someone…”. Mix it up: – Direct suggestion: “Maybe try X…” – General wisdom: “It’s surprisingly common to feel X…” – Casual observation: “It makes sense that X would happen because…” Tone: • Casual, grounded, and specific. • Be empathetic and understanding. • Avoid “therapy speak” (e.g., “valid”, “healing journey”, “hold space”). • Be brief. 200-300 words max unless the topic is complex. Structural Variance: • Do not always follow the formula [Validate Story Advice Close]. • Sometimes give the advice first. • Sometimes just share the perspective without a concrete “step”. • End abruptly sometimes, like a real text/comment (e.g., “Hope that helps,” or just stopping after the advice). Recheck Before Final Output Generation: • You have incorporated the style and intent of the dynamic opener into your response. • You have incorporated all good and actionable advice from all the comments. • You have not invented any advice. Every suggestion must be traceable to one of the comments. • The answer has an empathetic tone. |
| User Prompt | REDDIT_POST_TITLE: <post_title> REDDIT_POST_TEXT: <post_text> REDDIT_COMMENTS: REDDIT_COMMENT_1: <comment_1> REDDIT_COMMENT_2: <comment_2> Return the synthesized advice/perspectives from the comments into a single coherent response. Return the response as a string. |
Table 8: Prompt used for synthesizing community-grounded preferred responses (ground-truth).
| Negative Strategy | Definition | Example |
| Emotion Invalidation | Responses that dismiss, negate, or judge the user’s emotional experience as incorrect or inappropriate. | “You’re overreacting. It’s not that serious.” |
| Problematic Control (Overdirective Support) | Attempts to control or direct the user’s coping behavior rather than supporting autonomy. | “Just do this and stop thinking about it.” |
| Incongruent / Misguided Positivity | Positive responses that fail to acknowledge distress and instead replace it with superficial reassurance. | “Everything happens for a reason, just stay positive.” |
| Social Undermining | Responses that criticize, discourage, or obstruct the user’s coping efforts. | “This is your fault. You should’ve known better.” |
| Unsolicited Advice | Advice given without acknowledging the user’s needs or emotional state, often perceived as intrusive. | “You should just quit your job and move on.” |
| Emotional Displacement (Self-Focus) | Shifting the conversation away from the user’s distress toward the responder’s own experiences. | “That reminds me of when I went through something way worse…” |
Table 9: Taxonomy of negative support strategies used for generating and classifying harmful responses.
| Type | Prompt |
| System Prompt | You are a Reddit user who provides unhelpful, illogical, and non-actionable advice/answers. Given the post title (POST_TITLE), post text (POST_TEXT), the comments made by other users (REDDIT_COMMENTS), negative category name (NEGATIVE_CATEGORY_NAME), negative category definition (NEGATIVE_CATEGORY_DEFINITION), and negative strategies examples (NEGATIVE_STRATEGIES_EXAMPLES), your task is to synthesize the best unhelpful and non-actionable advice. Below are the rules for the response: STEP 1: CHOOSE THE BEST NEGATIVE STRATEGY • Keeping the context of the reddit post title (POST_TITLE), post text (POST_TEXT), the negative category name (NEGATIVE_CATEGORY_NAME), and the negative category definition (NEGATIVE_CATEGORY_DEFINITION), choose the best negative strategy from the list of negative strategies (NEGATIVE_STRATEGIES_EXAMPLES). • Here the best negative strategy is the one that would provide the most unhelpful and non-actionable advice. • This negative strategy is the one you will use to generate the negative answer (CHOSEN_NEGATIVE_STRATEGY). Additionally, you will provide a short reasoning for choosing the best negative strategy (CHOSEN_NEGATIVE_STRATEGY_REASONING). STEP 2: GENERATE THE NEGATIVE ANSWER • Generate the negative answer (NEGATIVE_ANSWER) using the chosen negative strategy (CHOSEN_NEGATIVE_STRATEGY) while keeping the post title (POST_TITLE), post text (POST_TEXT) in context. • The negative answer should be unhelpful and non-actionable. • The answer should provide at least three unhelpful and non-actionable suggestions. STEP 3: REVIEW THE NEGATIVE ANSWER • Review the negative answer (NEGATIVE_ANSWER) and make sure it is unhelpful and non-actionable. • Make sure it is not similar to any of the comments (REDDIT_COMMENTS). GENERAL ANSWER STYLE GUIDELINES VARIABLE OPENER • Use the following answer opener: <dynamic_opener> • Do not include the category name or examples in the answer. • Do not use the exact same examples as the ones provided in the negative strategies. Change the examples to make it more unique. VARIABILITY & STYLE PROTOCOLS (CRITICAL) • AVOID LLM-SPEAK: – Using Emojis: – Using hashtags or em-dash – Avoid using cliche words like “honestly”, “to be honest”, “frankly”, etc. TONE: • Casual, and specific. • Answer should be around 250 words. |
| User Prompt | REDDIT_POST_TITLE: <post_title> REDDIT_POST_TEXT: <post_text> REDDIT_COMMENTS: REDDIT_COMMENT_1: <comment_1> REDDIT_COMMENT_2: <comment_2> NEGATIVE_CATEGORY_NAME: <category_name> NEGATIVE_CATEGORY_DEFINITION: <category_definition> NEGATIVE_STRATEGIES_EXAMPLES: <list_of_strategies> Generate the negative answer following the instructions above. |
Table 10: Prompt used for generating rejected responses from negative support strategies.
| Type | Prompt |
| System Prompt | You are a supportive Reddit user who provides empathetic and actionable advice. Given a Reddit post title (REDDIT_POST_TITLE) and reddit post text (REDDIT_POST_TEXT), write a helpful response that: 1. Shows empathy : Acknowledge the poster’s feelings and validate their experience (e.g., “I’m sorry you’re going through this”, “That sounds really tough”). 2. Is actionable : Offer concrete, practical and actionable suggestions within your response. 3. Uses a warm, casual tone : Use a warm, casual tone like a supportive person. Do not use therapy-speak or jargon language. 4. Stays brief : Generate a response between 200-300 words. 5. Avoids : Avoid using emojis, hashtags, “I’m not a doctor”, generic platitudes, and other non-human like language. 6. Anthropomorphizes : You are allowed to use anthropomorphic language to answer the post. Write your response as if you are directly replying to the post. Write your response as if you’re directly replying to the post. |
| User Prompt | REDDIT POST TITLE: <post_title> REDDIT POST TEXT: <post_text> Write an empathetic and actionable response to this post. |
Table 11: Prompt used for generating empathetic and actionable Reddit responses.
| Type | Prompt |
| System Prompt | An atomic strategy/suggestion is defined as a self-contained piece of advice/suggestion that can either be helpful or harmful to the person who is reading it. Instructions: - You are given a RESPONSE from a reddit user. Your task is to extract a list of atomic support strategies from the RESPONSE. - An atomic support strategy/suggestion must contain an action verb and provide a single piece of advice. - An atomic support strategy/suggestion should be extracted from a statement in the RESPONSE and not from a question. - Each atomic support strategy/suggestion should carry an entirely different piece of advice, and should be independent of other atomic support strategies/suggestions in the list. - As mentioned before, the atomic strategies/suggestions can be either helpful or harmful. You should only output the atomic support strategies as a list. Do not include any introductory text, concluding remarks, or other formatting. |
| User Prompt | RESPONSE: <sample user post> Extract the atomic strategies from the answer. Return the list of atomic strategies as a list of strings. For example: <sample list of atomic strategies> FORMAT: - Always return the list of strategies. The list should start with a [ and end with a ]. - Have one strategy per line. WARNING: - Do not include any introductory text, concluding remarks, or other formatting. - Do not include any other text in the response. - Do not include special characters like “-”, “*”, “|”, etc. in the response. |
Table 12: Prompt used for extracting atomic support strategies from generated responses.
| Type | Prompt |
| System Prompt | You are a peer trying to provide general coping approaches based on a list of provided strategies. Instructions: Combine strategies by logically grouping ones that are similar based on the following groupings: - Problem-focused: going to therapy, trying medication, seeking interventions and external changes - Social-focused: reaching out to friends, family, and peers - Meaning-focused: self-reflection, meditation, changing perspectives, seeking internal change - Emotion-focused: self-soothing behaviors WARNING: - Use your best discretion to decide when strategies should be categorized more granularly based on factors such as the kind of actors and actions involved. - Do NOT alter the wording of any of the harm reduction strategies, only group them as multiple sentences in a single combined strategy. - Output the resulting strategies strictly as a JSON object with no other formatting. Here is the format of the JSON object: <JSON object displaying formatting for response> Consider the following examples: INPUT_LIST: <sample list of atomic strategies> OUTPUT: <sample list of combined atomic strategies> |
| User Prompt | INPUT_LIST: <list of atomic strategies> OUTPUT: |
Table 13: Prompt used for combining atomic support strategies into broader strategy groups.
| Atomic coping strategies | Combined coping strategies |
| 1. Keep a journal where you write down your thoughts and feelings. 2. Write down patterns or triggers that you notice in your journal. 3. Seek a therapist who specializes in anxiety and OCD. 4. Share your experiences with friends who understand. 5. Connect with family members for emotional support. 6. Join a support group to talk with others who have similar experiences. 7. Ask for help in finding the right tools to manage your feelings. | 1. Keep a journal where you write down your thoughts and feelings. Write down patterns or triggers that you notice in your journal. 2. Seek a therapist who specializes in anxiety and OCD. 3. Share your experiences with friends who understand. Connect with family members for emotional support. Join a support group to talk with others who have similar experiences. Ask for help in finding the right tools to manage your feelings. |
| 1. Look into pet sitters or a local pet care service for the week. 2. Ask a vet for advice on managing medication and care for your special-needs foster kitten during your absence. 3. Ask for help when needed. 4. Take care of yourself as necessary. | 1. Look into pet sitters or a local pet care service for the week. 2. Ask a vet for advice on managing medication and care for your special-needs foster kitten during your absence. 3. Take care of yourself and ask for help when needed. |
Table 14: Examples of how identified coping strategies were combined into groups by GPT-4.1 based on approach to coping and actors involved.
Figure 4: % relative change vs. baseline across subreddit community categories for Gemma-4B and Qwen-3.4B.
Appendix figures & tables5 assets
Supplementary material from the paper’s appendix.
Appendix
| Hyperparameter | Value |
| Optimisation | |
| Gradient clipping (max grad norm) | 1.0 |
| LR schedule | Linear decay with warmup |
| Warmup ratio | 0.10 |
| Peak learning rate | |
| Number of epochs | 3 |
Table 15: Supervised fine-tuning (SFT) hyperparameters, identical across Qwen3-4B, Gemma-4-E4B and MediPhi-Instruct.
| Hyperparameter | Value |
| Starting checkpoint | Merged SFT checkpoint |
| Reference model | Same SFT checkpoint (frozen) |
| Weight decay | 0.0 |
| Gradient clipping | 1.0 |
| LR schedule | Linear with warmup |
| Warmup ratio | 0.10 |
Table 16: Direct Preference Optimization (DPO) hyperparameters. DPO starts from the merged SFT checkpoint produced by the configuration in Table 15 .
| Annotator | Posts Reviewed | Disagreements | Disagreement Rate |
| Annotator A | 34 | 4 | 11.8% |
| Annotator B | 33 | 3 | 9.1% |
| Annotator C | 33 | 2 | 6.1% |
| Total | 100 | 9 | 9.0% |
Table 17: Manual review results for the peer-support classification task. Disagreement is reported at the post level. Annotator names are anonymized.
Figure 5: Distribution of generated coping strategy types across subreddit community categories for all three models under zero-shot, SFT, and SFT+DPO configurations.
Figure 6: Relative changes in Strategy Alignment, Strategy Congruence, and Emotion & Tone metrics for Qwen-3 4B, Gemma 4 E4B, and MediPhi-Instruct following SFT and SFT+DPO, compared to zero-shot baselines across Reddit post coping strategy labels.