arXiv subjects

Michael L. Birnbaum

Publications and source records attributed to Michael L. Birnbaum.

4 recordsLinked to original sources

arXiv2026

CALM-IT: Generating Realistic Long-Form Motivational Interviewing Dialogues with Dual-Actor Conversational Dynamics Tracking

Therapeutic dialogue is not a sequence of isolated responses: client goals, motivation, resistance, and therapeutic alliance evolve over time. Yet current LLM-based mental health dialogue systems often lack explicit mechanisms for tracking these dynamics across extended interactions, which can lead to poorly timed interventions or premature goal resolution. We introduce CALM-IT, a framework for generating and evaluating long-form Motivational Interviewing dialogues through explicit modeling of evolving client and counselor states, guiding both counseling strategy selection and utterance generation. We evaluate CALM-IT on a large-scale corpus of 8,232 synthetic dialogues spanning multiple dialogue lengths and frameworks. Compared with all baselines, CALM-IT achieves the best performance on most MITI 4.2 global ratings, including Empathy, Partnership, and Softening Sustain Talk, as well as on other key performance metrics while exhibiting minimal performance degradation as dialogue length increases. Notably, although CALM-IT initiates fewer change-directed prompts, it produces the highest client acceptance rate (64.3%) on average across different length conditions. We release a reproducible generation framework, a MITI-grounded process-level evaluation protocol, and a large-scale synthetic corpus for studying therapeutic LLMs under realistic long-form interaction conditions.

cs.CL↗

arXiv2025

Do Large Language Models Align with Core Mental Health Counseling Competencies?

The rapid evolution of Large Language Models (LLMs) presents a promising solution to the global shortage of mental health professionals. However, their alignment with essential counseling competencies remains underexplored. We introduce CounselingBench, a novel NCMHCE-based benchmark evaluating 22 general-purpose and medical-finetuned LLMs across five key competencies. While frontier models surpass minimum aptitude thresholds, they fall short of expert-level performance, excelling in Intake, Assessment & Diagnosis but struggling with Core Counseling Attributes and Professional Practice & Ethics. Surprisingly, medical LLMs do not outperform generalist models in accuracy, though they provide slightly better justifications while making more context-related errors. These findings highlight the challenges of developing AI for mental health counseling, particularly in competencies requiring empathy and nuanced reasoning. Our results underscore the need for specialized, fine-tuned models aligned with core mental health counseling competencies and supported by human oversight before real-world deployment. Code and data associated with this manuscript can be found at: https://github.com/cuongnguyenx/CounselingBench

cs.CL↗

arXiv2025

Lived Experience Not Found: LLMs Struggle to Align with Experts on Addressing Adverse Drug Reactions from Psychiatric Medication Use

Adverse Drug Reactions (ADRs) from psychiatric medications are the leading cause of hospitalizations among mental health patients. With healthcare systems and online communities facing limitations in resolving ADR-related issues, Large Language Models (LLMs) have the potential to fill this gap. Despite the increasing capabilities of LLMs, past research has not explored their capabilities in detecting ADRs related to psychiatric medications or in providing effective harm reduction strategies. To address this, we introduce the Psych-ADR benchmark and the Adverse Drug Reaction Response Assessment (ADRA) framework to systematically evaluate LLM performance in detecting ADR expressions and delivering expert-aligned mitigation strategies. Our analyses show that LLMs struggle with understanding the nuances of ADRs and differentiating between types of ADRs. While LLMs align with experts in terms of expressed emotions and tone of the text, their responses are more complex, harder to read, and only 70.86% aligned with expert strategies. Furthermore, they provide less actionable advice by a margin of 12.32% on average. Our work provides a comprehensive benchmark and evaluation framework for assessing LLMs in strategy-driven tasks within high-risk domains.

cs.CL↗

arXiv2024

Supporters and Skeptics: LLM-based Analysis of Engagement with Mental Health (Mis)Information Content on Video-sharing Platforms

Over one in five adults in the US lives with a mental illness. In the face of a shortage of mental health professionals and offline resources, online short-form video content has grown to serve as a crucial conduit for disseminating mental health help and resources. However, the ease of content creation and access also contributes to the spread of misinformation, posing risks to accurate diagnosis and treatment. Detecting and understanding engagement with such content is crucial to mitigating their harmful effects on public health. We perform the first quantitative study of the phenomenon using YouTube Shorts and Bitchute as the sites of study. We contribute MentalMisinfo, a novel labeled mental health misinformation (MHMisinfo) dataset of 739 videos (639 from Youtube and 100 from Bitchute) and 135372 comments in total, using an expert-driven annotation schema. We first found that few-shot in-context learning with large language models (LLMs) are effective in detecting MHMisinfo videos. Next, we discover distinct and potentially alarming linguistic patterns in how audiences engage with MHMisinfo videos through commentary on both video-sharing platforms. Across the two platforms, comments could exacerbate prevailing stigma with some groups showing heightened susceptibility to and alignment with MHMisinfo. We discuss technical and public health-driven adaptive solutions to tackling the "epidemic" of mental health misinformation online.

cs.SI↗