大语言模型在认知行为疗法引导的情感推理中存在哪些不足？
Where do LLMs Fall Short in CBT-Guided Affective Reasoning?
AI总结：
研究大语言模型在认知行为疗法引导的情感推理中的不足，采用知识引导框架，将用户叙述分解并基于临床概念验证，用协议杠杆力衡量引导效果，发现单链思维提示无效，多链思维能更好引导策略选择但效果有限。
摘要：
认知行为疗法（CBT）为理解用户心理状态提供框架。现成的大语言模型虽能流畅且共情地回应，但不管用户需求，陷入验证与反思。我们用知识引导框架探索差距，引入协议杠杆力衡量引导效果，结果表明单链思维提示无效，多链思维能更好引导策略选择但效果有限。
英文摘要：
Cognitive Behavioral Therapy (CBT) provides a structured framework for understanding a user's mental state by examining the interaction between cognitive and behavioral factors. However, out-of-the-box LLMs respond fluently and empathetically, yet collapse into validation & reflection, regardless of what the user actually needs. They know theoretical CBT (scoring up to 96% accuracy on licensing exam questions) but fail to apply it effectively. We explore this gap with a knowledge-guided framework that treats CBT dialogue as controlled affective reasoning: user narratives are decomposed into Beck's Cognitive Conceptualization structure, grounded in clinical SNOMED CT concepts validated via Natural Language Inference, and a Multiple Chain-of-Thought (MCoT) strategy selection between Validation & Reflection, Socratic Questioning, or Alternative Perspectives. To measure whether such guidance actually changes behavior, we introduce the Protocol Leverage Force (F), a behavior-level metric that captures how far an intervention shifts a model away from its default response. Across three open-weight LLMs and 14 RealCBT-derived case studies, evaluated with human experts, valence-arousal trajectories, and linguistic entrainment, F shows that simply introducing protocol definitions via single chain-of-thought prompting fails to change LLM behavior, while MCoT on these definitions guides strategy selection better. Still, the effect stays within 1% (approx. 1.2-1.3%), and all models remain biased toward Validation & Reflection. These results show CBT knowledge alone does not ensure effective application, giving the affective-computing community instrumentation to measure where LLMs fall short.
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