# Leveraging Multimodal Self-Consistency Reasoning in Coding Motivational Interviewing for Alcohol Use Reduction

arXiv: https://arxiv.org/abs/2605.12987 · HTML: https://mlsanity.com/paper/2605.12987/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 7 of its 22 references that are in the map.
- First posted on arXiv 13 May 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 7 of 7)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [Robust Speech Recognition via Large-Scale Weak Supervision](https://mlsanity.com/paper/2212.04356/) (2022)
- [Qwen3-Omni Technical Report](https://mlsanity.com/paper/2509.17765/) (2025)
- [Chain-of-Interaction: Enhancing Large Language Models for Psychiatric Behavior Understanding by Dyadic Contexts](https://mlsanity.com/paper/2403.13786/) (2024)
- [Seeing and hearing what has not been said; A multimodal client behavior classifier in Motivational Interviewing with interpretable fusion](https://mlsanity.com/paper/2309.14398/) (2023)
- [M3TCM: Multi-modal Multi-task Context Model for Utterance Classification in Motivational Interviews](https://mlsanity.com/paper/2404.03312/) (2024)

## Abstract (arXiv)

BACKGROUND: Coding Motivational Interviewing (MI) sessions is essential for understanding client behaviors and predicting outcomes, but it requires substantial time and labor from trained MI professionals. Recent advances in audio-language models (ALMs) offer new opportunities to automate MI coding by capturing multimodal behavioral signals. OBJECTIVE: This study aims to develop an automatic MI coding approach based on ALMs that analyzes raw audio input and integrates predictions from multiple reasoning trajectories using self-consistency to improve coding robustness. METHODS: We experimented with five recorded sessions from de-identified MI audio tapes. We deployed ALMs with four complementary analytic prompts to support utterance-level reasoning: analytic prompting for verbal cues, prosody-aware prompting for acoustic cues, evidence-scoring prompting for quantitative hypothesis testing, and comparative prompting for contrastive reasoning. Three stochastic samples were drawn for each prompt, generating 12 independent reasoning trajectories per utterance. Final predictions were determined by majority voting across all trajectories. RESULTS: Performance was evaluated using accuracy, precision, recall, and macro-F1 scores. The proposed multimodal self-consistency approach achieved 52.56% accuracy, 54.03% precision, 47.45% recall, and a macro-F1 score of 46.40%, exceeding baseline methods. Systematic ablation experiments that removed individual modules consistently degraded performance on the primary metrics. CONCLUSIONS: Multimodal self-consistency outperforms single-pass baseline prompting approaches for MI coding. These findings suggest that incorporating both what clients say and how they say it can support more reliable automatic MI coding.