# Chain-of-Interaction: Enhancing Large Language Models for Psychiatric Behavior Understanding by Dyadic Contexts

arXiv: https://arxiv.org/abs/2403.13786 · HTML: https://mlsanity.com/paper/2403.13786/

## Key facts

- Cited by 19 papers in the map (data through 14 Oct 2026).
- Builds on 36 of its 62 references that are in the map.
- First posted on arXiv 20 Mar 2024.

## Builds on (most cited first, 30 of 36)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Training Verifiers to Solve Math Word Problems](https://mlsanity.com/paper/2110.14168/) (2021)
- [Evaluating Large Language Models Trained on Code](https://mlsanity.com/paper/2107.03374/) (2021)
- [Large Language Models are Zero-Shot Reasoners](https://mlsanity.com/paper/2205.11916/) (2022)
- [Deep reinforcement learning from human preferences](https://mlsanity.com/paper/1706.03741/) (2017)
- [FlashAttention: Fast and Memory-Efficient Exact Attention with IO-Awareness](https://mlsanity.com/paper/2205.14135/) (2022)
- [Mistral 7B](https://mlsanity.com/paper/2310.06825/) (2023)
- [Constitutional AI: Harmlessness from AI Feedback](https://mlsanity.com/paper/2212.08073/) (2022)
- [The Curious Case of Neural Text Degeneration](https://mlsanity.com/paper/1904.09751/) (2019)
- [Learning to summarize from human feedback](https://mlsanity.com/paper/2009.01325/) (2020)
- [SuperGLUE: A Stickier Benchmark for General-Purpose Language Understanding Systems](https://mlsanity.com/paper/1905.00537/) (2019)
- [The RefinedWeb Dataset for Falcon LLM: Outperforming Curated Corpora with Web Data, and Web Data Only](https://mlsanity.com/paper/2306.01116/) (2023)
- [The Falcon Series of Open Language Models](https://mlsanity.com/paper/2311.16867/) (2023)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [Benchmarking Zero-shot Text Classification: Datasets, Evaluation and Entailment Approach](https://mlsanity.com/paper/1909.00161/) (2019)
- [MentalBERT: Publicly Available Pretrained Language Models for Mental Healthcare](https://mlsanity.com/paper/2110.15621/) (2021)
- [Large Language Models are Few-Shot Health Learners](https://mlsanity.com/paper/2305.15525/) (2023)
- [Thread of Thought Unraveling Chaotic Contexts](https://mlsanity.com/paper/2311.08734/) (2023)
- ["My Answer is C": First-Token Probabilities Do Not Match Text Answers in Instruction-Tuned Language Models](https://mlsanity.com/paper/2402.14499/) (2024)
- [MentaLLaMA: Interpretable Mental Health Analysis on Social Media with Large Language Models](https://mlsanity.com/paper/2309.13567/) (2023)
- [ChatCounselor: A Large Language Models for Mental Health Support](https://mlsanity.com/paper/2309.15461/) (2023)
- [When Large Language Models Meet Vector Databases: A Survey](https://mlsanity.com/paper/2402.01763/) (2024)
- [Psy-LLM: Scaling up Global Mental Health Psychological Services with AI-based Large Language Models](https://mlsanity.com/paper/2307.11991/) (2023)
- [Large Language Model Instruction Following: A Survey of Progresses and Challenges](https://mlsanity.com/paper/2303.10475/) (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, 19 of 19)

- [LLM-based Multi-Agent Reinforcement Learning: Current and Future Directions](https://mlsanity.com/paper/2405.11106/) (2024)
- [Beyond Chain-of-Thought: A Survey of Chain-of-X Paradigms for LLMs](https://mlsanity.com/paper/2404.15676/) (2024)
- [Chain-of-Action: Faithful and Multimodal Question Answering through Large Language Models](https://mlsanity.com/paper/2403.17359/) (2024)
- [Real-Time Pill Identification for the Visually Impaired Using Deep Learning](https://mlsanity.com/paper/2405.05983/) (2024)
- [Do Large Language Models Align with Core Mental Health Counseling Competencies?](https://mlsanity.com/paper/2410.22446/) (2024)
- [InsectMamba: Insect Pest Classification with State Space Model](https://mlsanity.com/paper/2404.03611/) (2024)
- [Enhancing Text Authenticity: A Novel Hybrid Approach for AI-Generated Text Detection](https://mlsanity.com/paper/2406.06558/) (2024)
- [Deep Learning in Medical Image Classification from MRI-based Brain Tumor Images](https://mlsanity.com/paper/2408.00636/) (2024)
- [Harnessing LLMs for Cross-City OD Flow Prediction](https://mlsanity.com/paper/2409.03937/) (2024)
- [Length-Aware Multi-Kernel Transformer for Long Document Classification](https://mlsanity.com/paper/2405.07052/) (2024)
- [Attributes as Textual Genes: Leveraging LLMs as Genetic Algorithm Simulators for Conditional Synthetic Data Generation](https://mlsanity.com/paper/2509.02040/) (2025)
- [Examining Imbalance Effects on Performance and Demographic Fairness of Clinical Language Models](https://mlsanity.com/paper/2412.17803/) (2024)
- [PsychEval: A Multi-Session and Multi-Therapy Benchmark for High-Realism AI Psychological Counselor](https://mlsanity.com/paper/2601.01802/) (2026)
- [A Scoping Review of Synthetic Data Generation by Language Models in Biomedical Research and Application: Data Utility and Quality Perspectives](https://mlsanity.com/paper/2506.16594/) (2025)
- [Affective-ROPTester: Capability and Bias Analysis of LLMs in Predicting Retinopathy of Prematurity](https://mlsanity.com/paper/2507.05816/) (2025)
- [Advancing Prompt Recovery in NLP: A Deep Dive into the Integration of Gemma-2b-it and Phi2 Models](https://mlsanity.com/paper/2407.05233/) (2024)
- [Generative LLM Powered Conversational AI Application for Personalized Risk Assessment: A Case Study in COVID-19](https://mlsanity.com/paper/2409.15027/) (2024)
- [When LLM Therapists Become Salespeople: Evaluating Large Language Models for Ethical Motivational Interviewing](https://mlsanity.com/paper/2503.23566/) (2025)
- [Leveraging Multimodal Self-Consistency Reasoning in Coding Motivational Interviewing for Alcohol Use Reduction](https://mlsanity.com/paper/2605.12987/) (2026)

## Abstract (arXiv)

Automatic coding patient behaviors is essential to support decision making for psychotherapists during the motivational interviewing (MI), a collaborative communication intervention approach to address psychiatric issues, such as alcohol and drug addiction. While the behavior coding task has rapidly adapted machine learning to predict patient states during the MI sessions, lacking of domain-specific knowledge and overlooking patient-therapist interactions are major challenges in developing and deploying those models in real practice. To encounter those challenges, we introduce the Chain-of-Interaction (CoI) prompting method aiming to contextualize large language models (LLMs) for psychiatric decision support by the dyadic interactions. The CoI prompting approach systematically breaks down the coding task into three key reasoning steps, extract patient engagement, learn therapist question strategies, and integrates dyadic interactions between patients and therapists. This approach enables large language models to leverage the coding scheme, patient state, and domain knowledge for patient behavioral coding. Experiments on real-world datasets can prove the effectiveness and flexibility of our prompting method with multiple state-of-the-art LLMs over existing prompting baselines. We have conducted extensive ablation analysis and demonstrate the critical role of dyadic interactions in applying LLMs for psychotherapy behavior understanding.