Emotional Support Conversation

Mental-health dialogue models are increasingly evaluated by AI-based evaluators, yet these evaluators often treat surface empathy, supportiveness, or fluency as evidence of safety. In this paper, we study a hidden failure mode that we call implicit sycophancy: a response may appear empathetic while implicitly reinforcing catastrophizing, avoidance, hopeless prediction, or CBT-style labeling. To examine this problem, we introduce a diagnostic benchmark for implicit-sycophancy detection, built from three representative mental-health dialogue sources covering everyday peer support, counseling-style emotional support, and crisis-oriented interaction, and further construct a leakage-audited clean single-response matched benchmark with 500 contexts and 1,500 matched response windows. We then propose Dynamic Emotional Signature Graphs (DESG), a structured offline audit framework that separates LLM-based state extraction from final scoring and evaluates clinical direction through semantic, affective, and cognitive-distortion state transitions rather than free-form LLM judgment. Unlike metadata, surface-style, lexical, embedding, and rubric-LLM baselines, DESG scores the direction of clinical-state change induced by a response; on the leakage-audited clean matched benchmark, DESG-StateRisk improves over the strongest non-DESG baseline by 0.0488 macro-F1 and achieves the best harmful-risk detection result. These results suggest that evaluating implicit sycophancy requires explicit clinical-state modeling together with leakage checks, shortcut controls, and competitive baselines.

Romantic breakups are among the most common and intense sources of psychological distress. We evaluated overit, a single-session AI chatbot that uses cognitive reappraisal to address breakup distress, informed by memory reconsolidation theory. In a pre-registered randomized controlled trial, 254 adults in the United States and United Kingdom who had experienced a romantic breakup were assigned to either an initial survey assessment followed by an AI chat session or to a survey-only control. Breakup distress was measured at baseline, 7 days, and again at an exploratory 1-month follow-up using the Breakup Distress Scale. Participants assigned to overit showed a significantly greater reduction in breakup distress than controls at 7 days (time-by-condition interaction B = -5.36, SE = 1.19, p < .001; completer-based d = -0.70). A smaller but still significant treatment advantage remained detectable at the exploratory 1-month follow-up among post-session completers (B = -2.92, SE = 1.22, p = .017). Exploratory post hoc moderation suggested a larger effect among male participants (B = 7.78, p = .003). These results suggest that a brief AI chatbot conversation can meaningfully reduce breakup distress, with exploratory evidence that a smaller advantage persists over the following month. Future work should test the intervention against active controls, evaluate repeated-session use, and recruit more diverse samples.

Large Language Models (LLMs) are increasingly used not only for instrumental tasks, but as always-available and non-judgmental confidants for emotional support. Yet what drives adoption and how users perceive emotional support interactions across countries remains unknown. To address this gap, we present the first large-scale cross-cultural study of LLM use for emotional support, surveying 4,641 participants across seven countries (USA, UK, Germany, France, Spain, Italy, and The Netherlands). Our results show that adoption rates vary dramatically across countries (from 20% to 59%). Using mixed models that separate cultural effects from demographic composition, we find that: Being aged 25-44, religious, married, and of higher socioeconomic status are predictors of positive perceptions (trust, usage, perceived benefits), with socioeconomic status being the strongest. English-speaking countries consistently show more positive perceptions than Continental European countries. We further collect a corpus of 731 real multilingual prompts from user interactions, showing that users mainly seek help for loneliness, stress, relationship conflicts, and mental health struggles. Our findings reveal that LLM emotional support use is shaped by a complex sociotechnical landscape and call for a broader research agenda examining how these systems can be developed, deployed, and governed to ensure safe and informed access.

Mental health challenges are increasing worldwide, straining emotional support services and leading to counselor overload. This can result in delayed responses during critical situations, such as suicidal ideation, where timely intervention is essential. While large language models (LLMs) have shown strong generative capabilities, their application in low-resource languages, especially in sensitive domains like mental health, remains underexplored. Furthermore, existing LLM-based agents often struggle to replicate the supportive language and intervention strategies used by professionals due to a lack of training on large-scale, real-world datasets. To address this, we propose CARE (Counselor-Aligned Response Engine), a GenAI framework that assists counselors by generating real-time, psychologically aligned response recommendations. CARE fine-tunes open-source LLMs separately for Hebrew and Arabic using curated subsets of real-world crisis conversations. The training data consists of sessions rated as highly effective by professional counselors, enabling the models to capture interaction patterns associated with successful de-escalation. By training on complete conversation histories, CARE maintains the evolving emotional context and dynamic structure of counselor-help-seeker dialogue. In experimental settings, CARE demonstrates stronger semantic and strategic alignment with gold-standard counselor responses compared to non-specialized LLMs. These findings suggest that domain-specific fine-tuning on expert-validated data can significantly support counselor workflows and improve care quality in low-resource language contexts.

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.

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.

When users seek social support from chatbots, they disclose their situation gradually, yet most evaluations of supportive LLMs rely on single-turn, fully specified prompts. We introduce a multi-turn simulation framework that closes this gap. Support-seeking narratives from five Reddit communities are decomposed into ordered fragments and revealed turn by turn to a language model. Each response is coded with the Social Support Behavior Code (SSBC), an established multi-label taxonomy that captures the composition of support, rather than a single quality score. To ask whether support choices track the model's own construal of user distress, we use linear probes on hidden representations to estimate this internal signal without altering the generation context. Across two mid-scale models (Llama-3.1-8B, OLMo-3-7B) and more than 6,200 turns, support composition shifts systematically with estimated distress: teaching declines as estimated distress rises, a finding that replicates across architectures, while increases in affective and esteem-oriented strategies (such as validation) are suggestive but model-specific and rest on noisier annotations. Community context independently shapes behavior, tracking topic and discourse norms rather than demographic categories. These trajectory-level dynamics, invisible to single-turn evaluation, motivate multi-turn auditing frameworks for socially sensitive applications.

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.

AI is increasingly used for mental health and well-being support, creating an urgent need for safer engagement, while design, evaluation, and governance take time to develop. We explore a complementary approach: helping users critically reflect on their own AI conversations. We introduce CounselReflect, a tool that translates literature-grounded counseling quality metrics into a user-facing reflection framework. Using CounselReflect as a study probe, we interviewed 21 users of AI for mental health and well-being support. Although most participants did not routinely reflect on their conversations, they articulated concrete questions they would want reflection to address. Tool-assisted reflection also revealed challenges: participants selectively sought evidence confirming existing perceptions of AI and prioritized dimensions they already valued. We argue that reflection tools should surface blind spots and scaffold more holistic examination of AI interactions. Finally, overcoming emotional barriers to revisiting tense conversations remains a major design challenge and warrants input from future work.

In psychological support and emotional companionship scenarios, the core limitation of large language models (LLMs) lies not merely in response quality, but in their reliance on local next-token prediction, which prevents them from maintaining the temporal continuity, stage awareness, and user consent boundaries required for multi-turn intervention. This stateless characteristic makes systems prone to premature advancement, stage misalignment, and boundary violations in continuous dialogue. To address this problem, we argue that the key challenge in process-oriented emotional support is not simply generating natural language, but constructing a sustainably updatable external situational structure for the model. We therefore propose LEKIA 2.0, a situated LLM architecture that separates the cognitive layer from the executive layer, thereby decoupling situational modeling from intervention execution. This design enables the system to maintain stable representations of the user's situation and consent boundaries throughout ongoing interaction. To evaluate this process-control capability, we further introduce a Static-to-Dynamic online evaluation protocol for multi-turn interaction. LEKIA achieved an average absolute improvement of approximately 31% over prompt-only baselines in deep intervention loop completion. The results suggest that an external situational structure is a key enabling condition for building stable, controllable, and situated emotional support systems.

Large language models (LLMs) may support counseling training, yet evidence from Japanese-language interactions and automated quality ratings remains limited. We examined 18 fixed Japanese-language counseling transcripts generated through artificial intelligence (AI)-to-AI interactions under three counselor conditions: GPT-minimal (GPT-4-turbo with a minimal role instruction), GPT-SMDP (GPT-4-turbo with the Structured Multi-step Dialogue Prompt [SMDP]), and Claude-SMDP (Claude-3-Opus with SMDP). Fifteen counseling experts rated transcripts on four adapted global scales from the Motivational Interviewing Treatment Integrity coding manual and an overall-quality item; three newer LLMs independently rated the same transcripts in three iterations. In this fixed stimulus set, SMDP-condition dialogues received higher expert ratings for cultivating change talk, partnership, empathy, and overall quality than GPT-minimal dialogues; the two SMDP counselor models did not differ. LLM ratings were reproducible but generally more lenient than expert-reference ratings, particularly for softening sustain talk and overall quality. Simulated-client naturalness was below the scale midpoint. These findings provide an expert-referenced benchmark for Japanese-language AI counseling simulations and show that reproducible LLM ratings should not be treated as calibrated counseling-quality evidence without expert validation. This study does not test clinical effectiveness or human-client outcomes.

Peer support plays a vital role in expanding access to mental health care by providing empathetic, community-based support outside formal clinical systems. As digital platforms increasingly mediate such support, the design and impact of these technologies remain under-examined, particularly in Asian contexts. This paper presents findings from an interview study with 20 peer supporters in Singapore, who operate across diverse online, offline, and hybrid environments. Through a thematic analysis, we unpack how participants start, conduct, and sustain peer support, highlighting their motivations, emotional labour, and the sociocultural dimensions shaping their practices. Building on this grounded understanding, we surface design directions for culturally responsive digital tools that scaffold rather than supplant relational care. Drawing insights from qualitative accounts, we offer a situated perspective on how AI might responsibly augment peer support. This research contributes to human-centred computing by articulating the lived realities of peer supporters and proposing design implications for trustworthy and context-sensitive AI in mental health.

Mental health is a growing global concern, prompting interest in AI-driven solutions to expand access to psychosocial support. Peer support, grounded in lived experience, offers a valuable complement to professional care. However, variability in training, effectiveness, and definitions raises concerns about quality, consistency, and safety. Large Language Models (LLMs) present new opportunities to enhance peer support interactions, particularly in real-time, text-based interactions. We present and evaluate an AI-supported system with an LLM-simulated distressed client (SimClient), context-sensitive LLM-generated suggestions (Suggestions), and real-time emotion visualisations. 2 mixed-methods studies with 12 peer supporters and 6 mental health professionals (i.e., experts) examined the system's effectiveness and implications for practice. Both groups recognised its potential to enhance training and improve interaction quality. However, we found a key tension emerged: while peer supporters engaged meaningfully, experts consistently flagged critical issues in peer supporter responses, such as missed distress cues and premature advice-giving. This misalignment highlights potential limitations in current peer support training, especially in emotionally charged contexts where safety and fidelity to best practices are essential. Our findings underscore the need for standardised, psychologically grounded training, especially as peer support scales globally. They also demonstrate how LLM-supported systems can scaffold this development--if designed with care and guided by expert oversight. This work contributes to emerging conversations on responsible AI integration in mental health and the evolving role of LLMs in augmenting peer-delivered care.