用思维链与动态抵抗机制,生成更真实的认知行为治疗对话。
ODRA: Synthesizing Cognitive Behavioral Therapy Sessions with Structured Chain-Of-Thought and Dynamic Patient Resistance

- 基于认知行为疗法指南构建思维链,确保治疗流程规范。
- 引入抵抗调控器,避免患者过度顺从,提升行为真实性。
- 适合训练临床鲁棒性模型,尤其对抵抗型患者有效。
认知行为疗法(CBT)会话的合成面临两大挑战:既要遵循严格的治疗结构,又要模拟真实患者动态、不可预测的抗拒行为。现有基于脚本的方法无法捕捉互动变化,多智能体方法则难以保持CBT的顺序性,二者均存在患者过于顺从的问题,无法反映真实临床场景。本文提出ODRA框架,通过基于经典CBT指南(Beck, 2020)的思维链策略生成会话,并引入抵抗调控器,采用引导技术激发与患者抵抗水平相符的行为。自动评估与专家评估均表明,ODRA在治疗技能、CBT契合度和患者行为真实性上显著优于现有方法,13项临床指标中有12项获持证心理医生青睐。此外,基于该数据集微调的模型在应对合作型与抗拒型患者时表现更优,验证了在合成数据中显式建模抵抗行为可直接提升下游临床鲁棒性。
原文摘要 · Abstract (English)
Synthetic generation of Cognitive Behavioral Therapy (CBT) sessions is challenged by two competing demands: adhering to strict therapeutic structure while modeling the resistant, unpredictable behavior of real patients. Existing script-based methods fail to capture dynamic therapeutic interactions, while multi-agent approaches struggle to adhere to CBT's sequential structure; both suffer from sycophancy, producing overly compliant patients that misrepresent real clinical settings. In this work we introduce ODRA, a novel framework for synthesizing therapy dialogues through a Chain-of-Thought (CoT) strategy grounded in foundational CBT guidelines (Beck, 2020). ODRA further incorporates a resistance orchestrator to solve patient sycophancy, which employs steering techniques to elicit behaviors aligned with their resistance level. Automated and expert evaluations show that ODRA significantly outperforms existing methods across therapeutic skills, CBT alignment, and patient behavioral fidelity, with licensed psychologists preferring ODRA sessions across 12 of 13 clinical metrics. Furthermore, models fine-tuned on our dataset demonstrate superior therapeutic performance against both cooperative and resistant patients, validating that explicit resistance modeling in synthetic training data directly translates to downstream clinical robustness.
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