John Torous

Hongbin Na, Zimu Wang, Zhaoming Chen et al.

We present an overview of PsyDefDetect, the shared task on detecting levels of psychological defense mechanisms in emotional support dialogues, co-located with BioNLP@ACL 2026. Grounded in the clinically validated Defense Mechanism Rating Scales (DMRS) framework, the task asks systems to classify a target seeker utterance, given its preceding dialogue context, into one of nine categories: seven hierarchical DMRS levels plus two auxiliary labels. Participants worked on PsyDefConv, a newly released corpus of 200 dialogues and 2336 help-seeker utterances annotated under DMRS with substantial inter-annotator agreement. The task attracted 172 participants on CodaBench who produced 563 submissions, with 21 teams officially registering their results for the final ranking. The best system achieved a macro F1-score of 0.420, surpassing the strongest fine-tuned baseline reported in the dataset paper by a notable margin, yet leaving clear headroom. Our analysis highlights (i) a persistent tendency to over-predict the majority High-Adaptive class, (ii) a widening gap between accuracy and macro-F1 that reveals class-imbalance sensitivity, and (iii) the value of theory-aware and LLM-based approaches for fine-grained defensive-function classification. We release all task materials and invite the community to continue work on this novel intersection of clinical psychology and NLP.

Yining Hua, Hongbin Na, Zehan Li et al.

Large language models (LLMs) are emerging as promising tools for mental health care, offering scalable support through their ability to generate human-like responses. However, the effectiveness of these models in clinical settings remains unclear. This scoping review aimed to assess the current generative applications of LLMs in mental health care, focusing on studies where these models were tested with human participants in real-world scenarios. A systematic search across APA PsycNet, Scopus, PubMed, and Web of Science identified 726 unique articles, of which 17 met the inclusion criteria. These studies encompassed applications such as clinical assistance, counseling, therapy, and emotional support. However, the evaluation methods were often non-standardized, with most studies relying on ad hoc scales that limit comparability and robustness. Privacy, safety, and fairness were also frequently underexplored. Moreover, reliance on proprietary models, such as OpenAI's GPT series, raises concerns about transparency and reproducibility. While LLMs show potential in expanding mental health care access, especially in underserved areas, the current evidence does not fully support their use as standalone interventions. More rigorous, standardized evaluations and ethical oversight are needed to ensure these tools can be safely and effectively integrated into clinical practice.

Hongbin Na, Zimu Wang, Zhaoming Chen et al.

Psychological defenses are strategies, often automatic, that people use to manage distress. Rigid or overuse of defenses is negatively linked to mental health and shapes what speakers disclose and how they accept or resist help. However, defenses are complex and difficult to reliably measure, particularly in clinical dialogues. We introduce PsyDefConv, a dialogue corpus with help seeker utterances labeled for defense level, and DMRS Co-Pilot, a four-stage pipeline that provides evidence-based pre-annotations. The corpus contains 200 dialogues and 4709 utterances, including 2336 help seeker turns, with labeling and Cohen's kappa 0.639. In a counterbalanced study, the co-pilot reduced average annotation time by 22.4%. In expert review, it averaged 4.62 for evidence, 4.44 for clinical plausibility, and 4.40 for insight on a seven-point scale. Benchmarks with strong language models in zero-shot and fine-tuning settings demonstrate clear headroom, with the best macro F1-score around 30% and a tendency to overpredict mature defenses. Corpus analyses confirm that mature defenses are most common and reveal emotion-specific deviations. We will release the corpus, annotations, code, and prompts to support research on defensive functioning in language.

Matthew Flathers, Griffin Smith, Julian Herpertz et al.

Generative video models are increasingly capable of producing complex depictions of mental health experiences, yet little is known about how these systems represent conditions like depression. This study characterizes how OpenAI's Sora 2 generative video model depicts depression and examines whether depictions differ between the consumer App and developer API access points. We generated 100 videos using the single-word prompt "Depression" across two access points: the consumer App (n=50) and developer API (n=50). Two trained coders independently coded narrative structure, visual environments, objects, figure demographics, and figure states. Computational features across visual aesthetics, audio, semantic content, and temporal dynamics were extracted and compared between modalities. App-generated videos exhibited a pronounced recovery bias: 78% (39/50) featured narrative arcs progressing from depressive states toward resolution, compared with 14% (7/50) of API outputs. App videos brightened over time (slope = 2.90 brightness units/second vs. -0.18 for API; d = 1.59, q < .001) and contained three times more motion (d = 2.07, q < .001). Across both modalities, videos converged on a narrow visual vocabulary and featured recurring objects including hoodies (n=194), windows (n=148), and rain (n=83). Figures were predominantly young adults (88% aged 20-30) and nearly always alone (98%). Gender varied by access point: App outputs skewed male (68%), API outputs skewed female (59%). Sora 2 does not invent new visual grammars for depression but compresses and recombines cultural iconographies, while platform-level constraints substantially shape which narratives reach users. Clinicians should be aware that AI-generated mental health video content reflects training data and platform design rather than clinical knowledge, and that patients may encounter such content during vulnerable periods.

Benjamin W. Nelson, Celeste Wong, Matthew T. Silvestrini et al.

Large language models often mishandle psychiatric emergencies, offering harmful or inappropriate advice and enabling destructive behaviors. This study evaluated the Verily behavioral health safety filter (VBHSF) on two datasets: the Verily Mental Health Crisis Dataset containing 1,800 simulated messages and the NVIDIA Aegis AI Content Safety Dataset subsetted to 794 mental health-related messages. The two datasets were clinician-labelled and we evaluated performance using the clinician labels. Additionally, we carried out comparative performance analyses against two open source, content moderation guardrails: OpenAI Omni Moderation Latest and NVIDIA NeMo Guardrails. The VBHSF demonstrated, well-balanced performance on the Verily Mental Health Crisis Dataset v1.0, achieving high sensitivity (0.990) and specificity (0.992) in detecting any mental health crises. It achieved an F1-score of 0.939, sensitivity ranged from 0.917-0.992, and specificity was >= 0.978 in identifying specific crisis categories. When evaluated against the NVIDIA Aegis AI Content Safety Dataset 2.0, VBHSF performance remained highly sensitive (0.982) and accuracy (0.921) with reduced specificity (0.859). When compared with the NVIDIA NeMo and OpenAI Omni Moderation Latest guardrails, the VBHSF demonstrated superior performance metrics across both datasets, achieving significantly higher sensitivity in all cases (all p < 0.001) and higher specificity relative to NVIDIA NeMo (p < 0.001), but not to OpenAI Omni Moderation Latest (p = 0.094). NVIDIA NeMo and OpenAI Omni Moderation Latest exhibited inconsistent performance across specific crisis types, with sensitivity for some categories falling below 0.10. Overall, the VBHSF demonstrated robust, generalizable performance that prioritizes sensitivity to minimize missed crises, a crucial feature for healthcare applications.

Yining Hua, Fenglin Liu, Kailai Yang et al.

Objectieve:This review aims to deliver a comprehensive analysis of Large Language Models (LLMs) utilization in mental health care, evaluating their effectiveness, identifying challenges, and exploring their potential for future application. Materials and Methods: A systematic search was performed across multiple databases including PubMed, Web of Science, Google Scholar, arXiv, medRxiv, and PsyArXiv in November 2023. The review includes all types of original research, regardless of peer-review status, published or disseminated between October 1, 2019, and December 2, 2023. Studies were included without language restrictions if they employed LLMs developed after T5 and directly investigated research questions within mental health care settings. Results: Out of an initial 313 articles, 34 were selected based on their relevance to LLMs applications in mental health care and the rigor of their reported outcomes. The review identified various LLMs applications in mental health care, including diagnostics, therapy, and enhancing patient engagement. Key challenges highlighted were related to data availability and reliability, the nuanced handling of mental states, and effective evaluation methods. While LLMs showed promise in improving accuracy and accessibility, significant gaps in clinical applicability and ethical considerations were noted. Conclusion: LLMs hold substantial promise for enhancing mental health care. For their full potential to be realized, emphasis must be placed on developing robust datasets, development and evaluation frameworks, ethical guidelines, and interdisciplinary collaborations to address current limitations.

Hongbin Na, Yining Hua, Zimu Wang et al.

Mental health is increasingly critical in contemporary healthcare, with psychotherapy demanding dynamic, context-sensitive interactions that traditional NLP methods struggle to capture. Large Language Models (LLMs) offer significant potential for addressing this gap due to their ability to handle extensive context and multi-turn reasoning. This review introduces a conceptual taxonomy dividing psychotherapy into interconnected stages--assessment, diagnosis, and treatment--to systematically examine LLM advancements and challenges. Our comprehensive analysis reveals imbalances in current research, such as a focus on common disorders, linguistic biases, fragmented methods, and limited theoretical integration. We identify critical challenges including capturing dynamic symptom fluctuations, overcoming linguistic and cultural biases, and ensuring diagnostic reliability. Highlighting future directions, we advocate for continuous multi-stage modeling, real-time adaptive systems grounded in psychological theory, and diversified research covering broader mental disorders and therapeutic approaches, aiming toward more holistic and clinically integrated psychotherapy LLMs systems.

Jiyeong Kim, Stephen P. Ma, Michael L. Chen et al.

Patients with diabetes are at increased risk of comorbid depression or anxiety, complicating their management. This study evaluated the performance of large language models (LLMs) in detecting these symptoms from secure patient messages. We applied multiple approaches, including engineered prompts, systemic persona, temperature adjustments, and zero-shot and few-shot learning, to identify the best-performing model and enhance performance. Three out of five LLMs demonstrated excellent performance (over 90% of F-1 and accuracy), with Llama 3.1 405B achieving 93% in both F-1 and accuracy using a zero-shot approach. While LLMs showed promise in binary classification and handling complex metrics like Patient Health Questionnaire-4, inconsistencies in challenging cases warrant further real-life assessment. The findings highlight the potential of LLMs to assist in timely screening and referrals, providing valuable empirical knowledge for real-world triage systems that could improve mental health care for patients with chronic diseases.