# CCD-CBT: Multi-Agent Therapeutic Interaction for CBT Guided by Cognitive Conceptualization Diagram

arXiv: https://arxiv.org/abs/2604.06551 · HTML: https://mlsanity.com/paper/2604.06551/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 11 of its 28 references that are in the map.
- First posted on arXiv 8 Apr 2026.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 11 of 11)

- [On LLMs-Driven Synthetic Data Generation, Curation, and Evaluation: A Survey](https://mlsanity.com/paper/2406.15126/) (2024)
- [SoulChat: Improving LLMs' Empathy, Listening, and Comfort Abilities through Fine-tuning with Multi-turn Empathy Conversations](https://mlsanity.com/paper/2311.00273/) (2023)
- [Cognitive Reframing of Negative Thoughts through Human-Language Model Interaction](https://mlsanity.com/paper/2305.02466/) (2023)
- [Cactus: Towards Psychological Counseling Conversations using Cognitive Behavioral Theory](https://mlsanity.com/paper/2407.03103/) (2024)
- [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)
- [The opportunities and risks of large language models in mental health](https://mlsanity.com/paper/2403.14814/) (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)
- [PsyDT: Using LLMs to Construct the Digital Twin of Psychological Counselor with Personalized Counseling Style for Psychological Counseling](https://mlsanity.com/paper/2412.13660/) (2024)
- [Training Models to Generate, Recognize, and Reframe Unhelpful Thoughts](https://mlsanity.com/paper/2307.02768/) (2023)
- [Can You Share Your Story? Modeling Clients' Metacognition and Openness for LLM Therapist Evaluation](https://mlsanity.com/paper/2507.19643/) (2025)

## Built on by (most cited first, 1 of 1)

- [From Question Answering to Task Completion: A Survey on Agent System and Harness Design](https://mlsanity.com/paper/2606.20683/) (2026)

## Abstract (arXiv)

Large language models show potential for scalable mental-health support by simulating Cognitive Behavioral Therapy (CBT) counselors. However, existing methods often rely on static cognitive profiles and omniscient single-agent simulation, failing to capture the dynamic, information-asymmetric nature of real therapy. We introduce CCD-CBT, a multi-agent framework that shifts CBT simulation along two axes: 1) from a static to a dynamically reconstructed Cognitive Conceptualization Diagram (CCD), updated by a dedicated Control Agent, and 2) from omniscient to information-asymmetric interaction, where the Therapist Agent must reason from inferred client states. We release CCDCHAT, a synthetic multi-turn CBT dataset generated under this framework. Evaluations with clinical scales and expert therapists show that models fine-tuned on CCDCHAT outperform strong baselines in both counseling fidelity and positive-affect enhancement, with ablations confirming the necessity of dynamic CCD guidance and asymmetric agent design. Our work offers a new paradigm for building theory-grounded, clinically-plausible conversational agents.