# Cactus: Towards Psychological Counseling Conversations using Cognitive Behavioral Theory

arXiv: https://arxiv.org/abs/2407.03103 · HTML: https://mlsanity.com/paper/2407.03103/

## Key facts

- Cited by 60 papers in the map (data through 14 Oct 2026).
- Builds on 14 of its 39 references that are in the map.
- First posted on arXiv 3 Jul 2024.

## Builds on (most cited first, 14 of 14)

- [QLoRA: Efficient Finetuning of Quantized LLMs](https://mlsanity.com/paper/2305.14314/) (2023)
- [SOTOPIA: Interactive Evaluation for Social Intelligence in Language Agents](https://mlsanity.com/paper/2310.11667/) (2023)
- [AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments](https://mlsanity.com/paper/2405.07960/) (2024)
- [Evaluating Large Language Models in Theory of Mind Tasks](https://mlsanity.com/paper/2302.02083/) (2023)
- [SODA: Million-scale Dialogue Distillation with Social Commonsense Contextualization](https://mlsanity.com/paper/2212.10465/) (2022)
- [PsyQA: A Chinese Dataset for Generating Long Counseling Text for Mental Health Support](https://mlsanity.com/paper/2106.01702/) (2021)
- [Cognitive Reframing of Negative Thoughts through Human-Language Model Interaction](https://mlsanity.com/paper/2305.02466/) (2023)
- [Human Evaluation of Conversations is an Open Problem: comparing the sensitivity of various methods for evaluating dialogue agents](https://mlsanity.com/paper/2201.04723/) (2022)
- [Is this the real life? Is this just fantasy? The Misleading Success of Simulating Social Interactions With LLMs](https://mlsanity.com/paper/2403.05020/) (2024)
- [Can Large Language Models be Good Emotional Supporter? Mitigating Preference Bias on Emotional Support Conversation](https://mlsanity.com/paper/2402.13211/) (2024)
- [HealMe: Harnessing Cognitive Reframing in Large Language Models for Psychotherapy](https://mlsanity.com/paper/2403.05574/) (2024)
- [CBT-LLM: A Chinese Large Language Model for Cognitive Behavioral Therapy-based Mental Health Question Answering](https://mlsanity.com/paper/2403.16008/) (2024)
- [Training Models to Generate, Recognize, and Reframe Unhelpful Thoughts](https://mlsanity.com/paper/2307.02768/) (2023)
- [AI-TA: Towards an Intelligent Question-Answer Teaching Assistant using Open-Source LLMs](https://mlsanity.com/paper/2311.02775/) (2023)

## Built on by (most cited first, 30 of 60)

- [Detecting Conversational Mental Manipulation with Intent-Aware Prompting](https://mlsanity.com/paper/2412.08414/) (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)
- [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)
- [MindEval: Benchmarking Language Models on Multi-turn Mental Health Support](https://mlsanity.com/paper/2511.18491/) (2025)
- [XInsight: Integrative Stage-Consistent Psychological Counseling Support Agents for Digital Well-Being](https://mlsanity.com/paper/2603.06583/) (2026)
- [Dialogue Systems for Emotional Support via Value Reinforcement](https://mlsanity.com/paper/2501.17182/) (2025)
- [How Real Are Synthetic Therapy Conversations? Evaluating Fidelity in Prolonged Exposure Dialogues](https://mlsanity.com/paper/2504.21800/) (2025)
- [Can You Share Your Story? Modeling Clients' Metacognition and Openness for LLM Therapist Evaluation](https://mlsanity.com/paper/2507.19643/) (2025)
- [TheraMind: A Strategic and Adaptive Agent for Longitudinal Psychological Counseling](https://mlsanity.com/paper/2510.25758/) (2025)
- [HamRaz: A Culture-Based Persian Conversation Dataset for Person-Centered Therapy Using LLM Agents](https://mlsanity.com/paper/2502.05982/) (2025)
- [MIND: Towards Immersive Psychological Healing with Multi-agent Inner Dialogue](https://mlsanity.com/paper/2502.19860/) (2025)
- [MAGneT: Coordinated Multi-Agent Generation of Synthetic Multi-Turn Mental Health Counseling Sessions](https://mlsanity.com/paper/2509.04183/) (2025)
- [Multi-Session Client-Centered Treatment Outcome Evaluation in Psychotherapy](https://mlsanity.com/paper/2410.05824/) (2024)
- [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)
- [Roleplaying with Structure: Synthetic Therapist-Client Conversation Generation from Questionnaires](https://mlsanity.com/paper/2510.25384/) (2025)
- [PsychEval: A Multi-Session and Multi-Therapy Benchmark for High-Realism AI Psychological Counselor](https://mlsanity.com/paper/2601.01802/) (2026)
- [PsychEthicsBench: Evaluating Large Language Models Against Australian Mental Health Ethics](https://mlsanity.com/paper/2601.03578/) (2026)
- [PatientHub: A Unified Framework for Patient Simulation](https://mlsanity.com/paper/2602.11684/) (2026)
- [Do No Harm: Exposing Hidden Vulnerabilities of LLMs via Persona-based Client Simulation Attack in Psychological Counseling](https://mlsanity.com/paper/2604.04842/) (2026)
- [Thanos: Enhancing Conversational Agents with Skill-of-Mind-Infused Large Language Model](https://mlsanity.com/paper/2411.04496/) (2024)
- [A Comprehensive Review of Datasets for Clinical Mental Health AI Systems](https://mlsanity.com/paper/2508.09809/) (2025)
- [CALM-IT: Enhancing Synthetic Motivational Interviewing Dialogue Quality with Conversational Dynamics](https://mlsanity.com/paper/2601.10085/) (2026)
- [PsychAgent: An Experience-Driven Lifelong Learning Agent for Self-Evolving Psychological Counselor](https://mlsanity.com/paper/2604.00931/) (2026)
- [Towards Privacy-aware Mental Health AI Models: Advances, Challenges, and Opportunities](https://mlsanity.com/paper/2502.00451/) (2025)
- [Responsible Evaluation of AI for Mental Health](https://mlsanity.com/paper/2602.00065/) (2026)

## Abstract (arXiv)

Recently, the demand for psychological counseling has significantly increased as more individuals express concerns about their mental health. This surge has accelerated efforts to improve the accessibility of counseling by using large language models (LLMs) as counselors. To ensure client privacy, training open-source LLMs faces a key challenge: the absence of realistic counseling datasets. To address this, we introduce Cactus, a multi-turn dialogue dataset that emulates real-life interactions using the goal-oriented and structured approach of Cognitive Behavioral Therapy (CBT). We create a diverse and realistic dataset by designing clients with varied, specific personas, and having counselors systematically apply CBT techniques in their interactions. To assess the quality of our data, we benchmark against established psychological criteria used to evaluate real counseling sessions, ensuring alignment with expert evaluations. Experimental results demonstrate that Camel, a model trained with Cactus, outperforms other models in counseling skills, highlighting its effectiveness and potential as a counseling agent. We make our data, model, and code publicly available.