Jos A. Bosch

Xin Sun, Xiao Tang, Abdallah El Ali et al.

Recent advancements in large language models (LLMs) have shown promise in generating psychotherapeutic dialogues, particularly in the context of motivational interviewing (MI). However, the inherent lack of transparency in LLM outputs presents significant challenges given the sensitive nature of psychotherapy. Applying MI strategies, a set of MI skills, to generate more controllable therapeutic-adherent conversations with explainability provides a possible solution. In this work, we explore the alignment of LLMs with MI strategies by first prompting the LLMs to predict the appropriate strategies as reasoning and then utilizing these strategies to guide the subsequent dialogue generation. We seek to investigate whether such alignment leads to more controllable and explainable generations. Multiple experiments including automatic and human evaluations are conducted to validate the effectiveness of MI strategies in aligning psychotherapy dialogue generation. Our findings demonstrate the potential of LLMs in producing strategically aligned dialogues and suggest directions for practical applications in psychotherapeutic settings.

Xin Sun, Shu Wei, Ting Pan et al.

Modeling users' cognitive states (e.g., cognitive load and decision confidence) is essential for building adaptive AI in high-stakes decision-making. While eye tracking provides non-invasive behavioral signals correlated with cognitive effort, prior work has not systematically examined how AI assistance contexts, specifically varying advice reliability and user heterogeneity, can alter the mapping between gaze signals and cognitive states. We conducted a within-subject lab eye-tracking study (N=54) on factual verification tasks under three conditions: No-AI, Correct-AI advice, and Incorrect-AI advice. We analyze condition-dependent changes in self-reports and eye-tracking patterns and evaluate the robustness of eye-tracking-based user modeling. Results show that AI advice increases decision confidence compared to No-AI, while Correct-AI is associated with lower perceived cognitive load and more efficient gaze behavior. Crucially, predictive modeling is context-sensitive: the relationship between eye-tracking signals and cognitive states shifts across AI conditions. Finally, fusing eye-tracking features with user priors (demographics, AI literacy/experience, and propensity to trust technology) improves cross-participant generalization. These findings support condition-aware and personalized user modeling for cognitively aligned adaptive AI systems.

Xin Sun, Jan de Wit, Zhuying Li et al.

Chatbots or conversational agents (CAs) are increasingly used to improve access to digital psychotherapy. Many current systems rely on rigid, rule-based designs, heavily dependent on expert-crafted dialogue scripts for guiding therapeutic conversations. Although advances in large language models (LLMs) offer potential for more flexible interactions, their lack of controllability and explanability poses challenges in high-stakes contexts like psychotherapy. To address this, we conducted two studies in this work to explore how aligning LLMs with expert-crafted scripts can enhance psychotherapeutic chatbot performance. In Study 1 (N=43), an online experiment with a within-subjects design, we compared rule-based, pure LLM, and LLMs aligned with expert-crafted scripts via fine-tuning and prompting. Results showed that aligned LLMs significantly outperformed the other types of chatbots in empathy, dialogue relevance, and adherence to therapeutic principles. Building on findings, we proposed ``Script-Strategy Aligned Generation (SSAG)'', a more flexible alignment approach that reduces reliance on fully scripted content while maintaining LLMs' therapeutic adherence and controllability. In a 10-day field Study 2 (N=21), SSAG achieved comparable therapeutic effectiveness to full-scripted LLMs while requiring less than 40\% of expert-crafted dialogue content. Beyond these results, this work advances LLM applications in psychotherapy by providing a controllable and scalable solution, reducing reliance on expert effort. By enabling domain experts to align LLMs through high-level strategies rather than full scripts, SSAG supports more efficient co-development and expands access to a broader context of psychotherapy.