# DMT-CBT: Longitudinal Therapeutic State Modeling for CBT Counseling

arXiv: https://arxiv.org/abs/2606.03132 · HTML: https://mlsanity.com/paper/2606.03132/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 15 of its 34 references that are in the map.
- First posted on arXiv 2 Jun 2026.

## Builds on (most cited first, 15 of 15)

- [Generative Agents: Interactive Simulacra of Human Behavior](https://mlsanity.com/paper/2304.03442/) (2023)
- [Multimodal Transformer for Unaligned Multimodal Language Sequences](https://mlsanity.com/paper/1906.00295/) (2019)
- [Revisiting Pre-Trained Models for Chinese Natural Language Processing](https://mlsanity.com/paper/2004.13922/) (2020)
- [Cactus: Towards Psychological Counseling Conversations using Cognitive Behavioral Theory](https://mlsanity.com/paper/2407.03103/) (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)
- [Towards Multimodal Emotional Support Conversation Systems](https://mlsanity.com/paper/2408.03650/) (2024)
- [Toward Multi-Session Personalized Conversation: A Large-Scale Dataset and Hierarchical Tree Framework for Implicit Reasoning](https://mlsanity.com/paper/2503.07018/) (2025)
- [AnnaAgent: Dynamic Evolution Agent System with Multi-Session Memory for Realistic Seeker Simulation](https://mlsanity.com/paper/2506.00551/) (2025)
- [MIRROR: Multimodal Cognitive Reframing Therapy for Rolling with Resistance](https://mlsanity.com/paper/2504.13211/) (2025)
- [Psychological Counseling Cannot Be Achieved Overnight: Automated Psychological Counseling Through Multi-Session Conversations](https://mlsanity.com/paper/2506.06626/) (2025)
- [Multimodal Cognitive Reframing Therapy via Multi-hop Psychotherapeutic Reasoning](https://mlsanity.com/paper/2502.06873/) (2025)
- [TheraMind: A Strategic and Adaptive Agent for Longitudinal Psychological Counseling](https://mlsanity.com/paper/2510.25758/) (2025)
- [Psy-Insight: Explainable Multi-turn Bilingual Dataset for Mental Health Counseling](https://mlsanity.com/paper/2503.03607/) (2025)

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

- [MOCC-R1: Reinforcing Reasoning-Response Consistency for Multimodal Counselor Response Generation](https://mlsanity.com/paper/2609.17180/) (2026)

## Abstract (arXiv)

Large language models (LLMs) have shown growing potential for Cognitive Behavioral Therapy (CBT) counseling. However, most existing approaches still formulate counseling as a local response generation problem, focusing on empathetic replies within short, text-only, or single-session interactions. We argue that this formulation fundamentally mismatches the nature of real psychotherapy. In clinical CBT, therapy is a longitudinal process in which therapists continuously infer, update, and intervene on evolving therapeutic states across sessions. Realistic CBT further involves multimodal inference and delayed cross-session intervention effects, requiring models to capture longitudinal therapeutic state evolution under partial observability. We propose DMT-CBT, a framework for Dynamic Modeling of evolving Therapeutic states in CBT counseling. DMT-CBT maintains structured therapeutic states across sessions while incorporating multimodal behavioral grounding and tool-augmented intervention to support adaptive therapeutic reasoning. Based on this framework, we construct DMTCorpus, a synthetic multi-session multimodal CBT counseling dataset featuring evolving therapeutic states, image-grounded client behaviors, and cross-session intervention continuity. Experimental results show that DMT-CBT improves counseling fidelity and therapeutic alliance, produces more favorable longitudinal affective trajectories, and preserves therapeutic states more faithfully than post-hoc extraction approaches.