# HealMe: Harnessing Cognitive Reframing in Large Language Models for Psychotherapy

arXiv: https://arxiv.org/abs/2403.05574 · HTML: https://mlsanity.com/paper/2403.05574/

## Key facts

- Cited by 47 papers in the map (data through 14 Oct 2026).
- Builds on 6 of its 33 references that are in the map.
- First posted on arXiv 26 Feb 2024.

## Builds on (most cited first, 6 of 6)

- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [GLM: General Language Model Pretraining with Autoregressive Blank Infilling](https://mlsanity.com/paper/2103.10360/) (2021)
- [Cognitive Reframing of Negative Thoughts through Human-Language Model Interaction](https://mlsanity.com/paper/2305.02466/) (2023)
- [Emotionally Numb or Empathetic? Evaluating How LLMs Feel Using EmotionBench](https://mlsanity.com/paper/2308.03656/) (2023)
- [Training Models to Generate, Recognize, and Reframe Unhelpful Thoughts](https://mlsanity.com/paper/2307.02768/) (2023)
- [Empowering Psychotherapy with Large Language Models: Cognitive Distortion Detection through Diagnosis of Thought Prompting](https://mlsanity.com/paper/2310.07146/) (2023)

## Built on by (most cited first, 30 of 47)

- [Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers](https://mlsanity.com/paper/2504.18412/) (2025)
- [Cactus: Towards Psychological Counseling Conversations using Cognitive Behavioral Theory](https://mlsanity.com/paper/2407.03103/) (2024)
- [Reasoning on a Spectrum: Aligning LLMs to System 1 and System 2 Thinking](https://mlsanity.com/paper/2502.12470/) (2025)
- [Large Language Models are Capable of Offering Cognitive Reappraisal, if Guided](https://mlsanity.com/paper/2404.01288/) (2024)
- [MIRROR: Multimodal Cognitive Reframing Therapy for Rolling with Resistance](https://mlsanity.com/paper/2504.13211/) (2025)
- [KokoroChat: A Japanese Psychological Counseling Dialogue Dataset Collected via Role-Playing by Trained Counselors](https://mlsanity.com/paper/2506.01357/) (2025)
- [A Survey of Large Language Models in Psychotherapy: Current Landscape and Future Directions](https://mlsanity.com/paper/2502.11095/) (2025)
- [Psychological Counseling Cannot Be Achieved Overnight: Automated Psychological Counseling Through Multi-Session Conversations](https://mlsanity.com/paper/2506.06626/) (2025)
- [The Imperative of Conversation Analysis in the Era of LLMs: A Survey of Tasks, Techniques, and Trends](https://mlsanity.com/paper/2409.14195/) (2024)
- [Crisp: Cognitive Restructuring of Negative Thoughts through Multi-turn Supportive Dialogues](https://mlsanity.com/paper/2504.17238/) (2025)
- [Feel the Difference? A Comparative Analysis of Emotional Arcs in Real and LLM-Generated CBT Sessions](https://mlsanity.com/paper/2508.20764/) (2025)
- [Synthetic Human Memories: AI-Edited Images and Videos Can Implant False Memories and Distort Recollection](https://mlsanity.com/paper/2409.08895/) (2024)
- [Can You Share Your Story? Modeling Clients' Metacognition and Openness for LLM Therapist Evaluation](https://mlsanity.com/paper/2507.19643/) (2025)
- [HamRaz: A Culture-Based Persian Conversation Dataset for Person-Centered Therapy Using LLM Agents](https://mlsanity.com/paper/2502.05982/) (2025)
- [MAGneT: Coordinated Multi-Agent Generation of Synthetic Multi-Turn Mental Health Counseling Sessions](https://mlsanity.com/paper/2509.04183/) (2025)
- [Exploring Safety Alignment Evaluation of LLMs in Chinese Mental Health Dialogues via LLM-as-Judge](https://mlsanity.com/paper/2508.08236/) (2025)
- [ChatThero: An LLM-Supported Chatbot for Behavior Change and Therapeutic Support in Addiction Recovery](https://mlsanity.com/paper/2508.20996/) (2025)
- [DiaCBT: A Long-Periodic Dialogue Corpus Guided by Cognitive Conceptualization Diagram for CBT-based Psychological Counseling](https://mlsanity.com/paper/2509.02999/) (2025)
- [PsychEval: A Multi-Session and Multi-Therapy Benchmark for High-Realism AI Psychological Counselor](https://mlsanity.com/paper/2601.01802/) (2026)
- [MADP: Multi-Agent Deductive Planning for Enhanced Cognitive-Behavioral Mental Health Question Answer](https://mlsanity.com/paper/2501.15826/) (2025)
- [Exploratory Study into Relations between Cognitive Distortions and Emotional Appraisals](https://mlsanity.com/paper/2503.15979/) (2025)
- [A Comprehensive Review of Datasets for Clinical Mental Health AI Systems](https://mlsanity.com/paper/2508.09809/) (2025)
- [PsychAgent: An Experience-Driven Lifelong Learning Agent for Self-Evolving Psychological Counselor](https://mlsanity.com/paper/2604.00931/) (2026)
- [A Generic Review of Integrating Artificial Intelligence in Cognitive Behavioral Therapy](https://mlsanity.com/paper/2407.19422/) (2024)
- [Does "Reasoning" with Large Language Models Improve Recognizing, Generating, and Reframing Unhelpful Thoughts?](https://mlsanity.com/paper/2504.00163/) (2025)
- [Empathy-R1: A Chain-of-Empathy and Reinforcement Learning Framework for Long-Form Mental Health Support](https://mlsanity.com/paper/2509.14851/) (2025)
- [Responsible Evaluation of AI for Mental Health](https://mlsanity.com/paper/2602.00065/) (2026)
- [Graph2Counsel: Clinically Grounded Synthetic Counseling Dialogue Generation from Client Psychological Graphs](https://mlsanity.com/paper/2604.20382/) (2026)
- [Metareasoning constraints couple narratives, affect and cognition](https://mlsanity.com/paper/2502.09487/) (2025)
- [EmoStage: A Framework for Accurate Empathetic Response Generation via Perspective-Taking and Phase Recognition](https://mlsanity.com/paper/2506.19279/) (2025)

## Abstract (arXiv)

Large Language Models (LLMs) can play a vital role in psychotherapy by adeptly handling the crucial task of cognitive reframing and overcoming challenges such as shame, distrust, therapist skill variability, and resource scarcity. Previous LLMs in cognitive reframing mainly converted negative emotions to positive ones, but these approaches have limited efficacy, often not promoting clients' self-discovery of alternative perspectives. In this paper, we unveil the Helping and Empowering through Adaptive Language in Mental Enhancement (HealMe) model. This novel cognitive reframing therapy method effectively addresses deep-rooted negative thoughts and fosters rational, balanced perspectives. Diverging from traditional LLM methods, HealMe employs empathetic dialogue based on psychotherapeutic frameworks. It systematically guides clients through distinguishing circumstances from feelings, brainstorming alternative viewpoints, and developing empathetic, actionable suggestions. Moreover, we adopt the first comprehensive and expertly crafted psychological evaluation metrics, specifically designed to rigorously assess the performance of cognitive reframing, in both AI-simulated dialogues and real-world therapeutic conversations. Experimental results show that our model outperforms others in terms of empathy, guidance, and logical coherence, demonstrating its effectiveness and potential positive impact on psychotherapy.