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EMNLP Findings2023

Empowering Psychotherapy with Large Language Models: Cognitive Distortion Detection through Diagnosis of Thought Prompting

Zhiyu Chen, Yujie Lu, William Yang Wang

Abstract

Mental illness remains one of the most critical public health issues of our time, due to the severe scarcity and accessibility limit of professionals. Psychotherapy requires high-level expertise to conduct deep, complex reasoning and analysis on the cognition modeling of the patients. In the era of Large Language Models, we believe it is the right time to develop AI assistance for computational psychotherapy. We study the task of cognitive distortion detection and propose the Diagnosis of Thought (DoT) prompting. DoT performs diagnosis on the patient's speech via three stages: subjectivity assessment to separate the facts and the thoughts; contrastive reasoning to elicit the reasoning processes supporting and contradicting the thoughts; and schema analysis to summarize the cognition schemas. The generated diagnosis rationales through the three stages are essential for assisting the professionals. Experiments demonstrate that DoT obtains significant improvements over ChatGPT for cognitive distortion detection, while generating high-quality rationales approved by human experts.

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Cited by top-tier papers7

  1. Psyche-R1: Towards Reliable Psychological LLMs through Unified Empathy, Expertise, and ReasoningChongyuan Dai, Jinpeng Hu, Hongchang Shi, Zhuo Li et al.ACL 2026 · 18 citations
  2. The Pursuit of Empathy: Evaluating Small Language Models for PTSD Dialogue SupportSuhas BN, Yash Mahajan, Dominik Mattioli, Andrew M. Sherrill et al.EMNLP 2025 · 1 citation
  3. Modeling Attributional Style at Scale: A Dataset and Analysis for Psychological Attribution Assessment and ReframingQiang Zhou, Hanzhen Zhu, Pan Wang, Rui Tu et al.ICML 2026
  4. HealMe: Harnessing Cognitive Reframing in Large Language Models for PsychotherapyMengxi Xiao, Qianqian Xie, Ziyan Kuang, Zhicheng Liu et al.ACL 2024
  5. Towards AI-Assisted Psychotherapy: Emotion-Guided Generative InterventionsKilichbek Haydarov, Youssef Mohamed, Emilio Goldenhersch, Paul OCallaghan et al.EMNLP 2025

Builds on10

  1. Large Language Models are Zero-Shot ReasonersTakeshi Kojima, Shixiang Shane Gu, Machel Reid, Yutaka Matsuo et al.NeurIPS 2022 · 8,168 citations
  2. The AI Doctor Is In: A Survey of Task-Oriented Dialogue Systems for Healthcare ApplicationsMina Valizadeh, Natalie PardeACL 2022 · 55 citations
  3. Inducing Positive Perspectives with Text ReframingCaleb Ziems, Minzhi Li, Anthony Zhang, Diyi YangACL 2022 · 46 citations
  4. Do Models of Mental Health Based on Social Media Data Generalize?Keith Harrigian, Carlos Alejandro Aguirre, Mark DredzeEMNLP Findings 2020 · 45 citations
  5. A Computational Approach to Understanding Empathy Expressed in Text-Based Mental Health SupportAshish Sharma, Adam S. Miner, David C. Atkins, Tim AlthoffEMNLP 2020 · 21 citations

Related papers

  1. Deciphering Cognitive Distortions in Patient-Doctor Mental Health Conversations: A Multimodal LLM-Based Detection and Reasoning FrameworkGopendra Vikram Singh, Sai Vemulapalli, Mauajama Firdaus, Asif EkbalEMNLP 2024 · 3 citations
  2. Multi-View Attention Multiple-Instance Learning Enhanced by LLM Reasoning for Cognitive Distortion DetectionJun Seo Kim, Hyemi Kim, Woo Joo Oh, Hongjin Cho et al.ACL 2026
  3. C2D2 Dataset: A Resource for the Cognitive Distortion Analysis and Its Impact on Mental HealthBichen Wang, Pengfei Deng, Yanyan Zhao, Bing QinEMNLP Findings 2023 · 7 citations
  4. Script-Strategy Aligned Generation: Aligning LLMs with Expert-Crafted Dialogue Scripts and Therapeutic Strategies for PsychotherapyXin Sun, Jan de Wit, Zhuying Li, Jiahuan Pei et al.CSCW 2025 · 6 citations
  5. Large Language Models Are Clinical Reasoners: Reasoning-Aware Diagnosis Framework with Prompt-Generated RationalesTaeyoon Kwon, Kai Tzu-iunn Ong, Dongjin Kang, Seungjun Moon et al.AAAI 2024 · 71 citations
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