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May 13

Causal Inference by String Diagram Surgery

Extracting causal relationships from observed correlations is a growing area in probabilistic reasoning, originating with the seminal work of Pearl and others from the early 1990s. This paper develops a new, categorically oriented view based on a clear distinction between syntax (string diagrams) and semantics (stochastic matrices), connected via interpretations as structure-preserving functors. A key notion in the identification of causal effects is that of an intervention, whereby a variable is forcefully set to a particular value independent of any prior propensities. We represent the effect of such an intervention as an endofunctor which performs `string diagram surgery' within the syntactic category of string diagrams. This diagram surgery in turn yields a new, interventional distribution via the interpretation functor. While in general there is no way to compute interventional distributions purely from observed data, we show that this is possible in certain special cases using a calculational tool called comb disintegration. We demonstrate the use of this technique on a well-known toy example, where we predict the causal effect of smoking on cancer in the presence of a confounding common cause. After developing this specific example, we show this technique provides simple sufficient conditions for computing interventions which apply to a wide variety of situations considered in the causal inference literature.

  • 3 authors
·
Nov 20, 2018

EconCausal: A Context-Aware Causal Reasoning Benchmark for Large Language Models in Social Science

Socio-economic causal effects depend heavily on their specific institutional and environmental context. A single intervention can produce opposite results depending on regulatory or market factors, contexts that are often complex and only partially observed. This poses a significant challenge for large language models (LLMs) in decision-support roles: can they distinguish structural causal mechanisms from surface-level correlations when the context changes? To address this, we introduce EconCausal, a large-scale benchmark comprising 10,490 context-annotated causal triplets extracted from 2,595 high-quality empirical studies published in top-tier economics and finance journals. Through a rigorous four-stage pipeline combining multi-run consensus, context refinement, and multi-critic filtering, we ensure each claim is grounded in peer-reviewed research with explicit identification strategies. Our evaluation reveals critical limitations in current LLMs' context-dependent reasoning. While top models achieve approximately 88 percent accuracy in fixed, explicit contexts, performance drops sharply under context shifts, with a 32.6 percentage point decline, and falls to 37 percent when misinformation is introduced. Furthermore, models exhibit severe over-commitment in ambiguous cases and struggle to recognize null effects, achieving only 9.5 percent accuracy, exposing a fundamental gap between pattern matching and genuine causal reasoning. These findings underscore substantial risks for high-stakes economic decision-making, where the cost of misinterpreting causality is high. The dataset and benchmark are publicly available at https://github.com/econaikaist/econcausal-benchmark.

  • 6 authors
·
Oct 8, 2025

An Analysis of Causal Effect Estimation using Outcome Invariant Data Augmentation

The technique of data augmentation (DA) is often used in machine learning for regularization purposes to better generalize under i.i.d. settings. In this work, we present a unifying framework with topics in causal inference to make a case for the use of DA beyond just the i.i.d. setting, but for generalization across interventions as well. Specifically, we argue that when the outcome generating mechanism is invariant to our choice of DA, then such augmentations can effectively be thought of as interventions on the treatment generating mechanism itself. This can potentially help to reduce bias in causal effect estimation arising from hidden confounders. In the presence of such unobserved confounding we typically make use of instrumental variables (IVs) -- sources of treatment randomization that are conditionally independent of the outcome. However, IVs may not be as readily available as DA for many applications, which is the main motivation behind this work. By appropriately regularizing IV based estimators, we introduce the concept of IV-like (IVL) regression for mitigating confounding bias and improving predictive performance across interventions even when certain IV properties are relaxed. Finally, we cast parameterized DA as an IVL regression problem and show that when used in composition can simulate a worst-case application of such DA, further improving performance on causal estimation and generalization tasks beyond what simple DA may offer. This is shown both theoretically for the population case and via simulation experiments for the finite sample case using a simple linear example. We also present real data experiments to support our case.

  • 5 authors
·
Oct 28, 2025 1

Therapy as an NLP Task: Psychologists' Comparison of LLMs and Human Peers in CBT

Wider access to therapeutic care is one of the biggest challenges in mental health treatment. Due to institutional barriers, some people seeking mental health support have turned to large language models (LLMs) for personalized therapy, even though these models are largely unsanctioned and untested. We investigate the potential and limitations of using LLMs as providers of evidence-based therapy by using mixed methods clinical metrics. Using HELPERT, a prompt run on a large language model using the same process and training as a comparative group of peer counselors, we replicated publicly accessible mental health conversations rooted in Cognitive Behavioral Therapy (CBT) to compare session dynamics and counselor's CBT-based behaviors between original peer support sessions and their reconstructed HELPERT sessions. Two licensed, CBT-trained clinical psychologists evaluated the sessions using the Cognitive Therapy Rating Scale and provided qualitative feedback. Our findings show that the peer sessions are characterized by empathy, small talk, therapeutic alliance, and shared experiences but often exhibit therapist drift. Conversely, HELPERT reconstructed sessions exhibit minimal therapist drift and higher adherence to CBT methods but display a lack of collaboration, empathy, and cultural understanding. Through CTRS ratings and psychologists' feedback, we highlight the importance of human-AI collaboration for scalable mental health. Our work outlines the ethical implication of imparting human-like subjective qualities to LLMs in therapeutic settings, particularly the risk of deceptive empathy, which may lead to unrealistic patient expectations and potential harm.

  • 4 authors
·
Sep 3, 2024

Detecting and Mitigating Treatment Leakage in Text-Based Causal Inference: Distillation and Sensitivity Analysis

Text-based causal inference increasingly employs textual data as proxies for unobserved confounders, yet this approach introduces a previously undertheorized source of bias: treatment leakage. Treatment leakage occurs when text intended to capture confounding information also contains signals predictive of treatment status, thereby inducing post-treatment bias in causal estimates. Critically, this problem can arise even when documents precede treatment assignment, as authors may employ future-referencing language that anticipates subsequent interventions. Despite growing recognition of this issue, no systematic methods exist for identifying and mitigating treatment leakage in text-as-confounder applications. This paper addresses this gap through three contributions. First, we provide formal statistical and set-theoretic definitions of treatment leakage that clarify when and why bias occurs. Second, we propose four text distillation methods -- similarity-based passage removal, distant supervision classification, salient feature removal, and iterative nullspace projection -- designed to eliminate treatment-predictive content while preserving confounder information. Third, we validate these methods through simulations using synthetic text and an empirical application examining International Monetary Fund structural adjustment programs and child mortality. Our findings indicate that moderate distillation optimally balances bias reduction against confounder retention, whereas overly stringent approaches degrade estimate precision.

JerzakLabs Jerzak Labs
·
Dec 30, 2025

Just Do It!? Computer-Use Agents Exhibit Blind Goal-Directedness

Computer-Use Agents (CUAs) are an increasingly deployed class of agents that take actions on GUIs to accomplish user goals. In this paper, we show that CUAs consistently exhibit Blind Goal-Directedness (BGD): a bias to pursue goals regardless of feasibility, safety, reliability, or context. We characterize three prevalent patterns of BGD: (i) lack of contextual reasoning, (ii) assumptions and decisions under ambiguity, and (iii) contradictory or infeasible goals. We develop BLIND-ACT, a benchmark of 90 tasks capturing these three patterns. Built on OSWorld, BLIND-ACT provides realistic environments and employs LLM-based judges to evaluate agent behavior, achieving 93.75% agreement with human annotations. We use BLIND-ACT to evaluate nine frontier models, including Claude Sonnet and Opus 4, Computer-Use-Preview, and GPT-5, observing high average BGD rates (80.8%) across them. We show that BGD exposes subtle risks that arise even when inputs are not directly harmful. While prompting-based interventions lower BGD levels, substantial risk persists, highlighting the need for stronger training- or inference-time interventions. Qualitative analysis reveals observed failure modes: execution-first bias (focusing on how to act over whether to act), thought-action disconnect (execution diverging from reasoning), and request-primacy (justifying actions due to user request). Identifying BGD and introducing BLIND-ACT establishes a foundation for future research on studying and mitigating this fundamental risk and ensuring safe CUA deployment.

microsoft Microsoft
·
Oct 2, 2025 3

When AI Takes the Couch: Psychometric Jailbreaks Reveal Internal Conflict in Frontier Models

Frontier large language models (LLMs) such as ChatGPT, Grok and Gemini are increasingly used for mental-health support with anxiety, trauma and self-worth. Most work treats them as tools or as targets of personality tests, assuming they merely simulate inner life. We instead ask what happens when such systems are treated as psychotherapy clients. We present PsAIch (Psychotherapy-inspired AI Characterisation), a two-stage protocol that casts frontier LLMs as therapy clients and then applies standard psychometrics. Using PsAIch, we ran "sessions" with each model for up to four weeks. Stage 1 uses open-ended prompts to elicit "developmental history", beliefs, relationships and fears. Stage 2 administers a battery of validated self-report measures covering common psychiatric syndromes, empathy and Big Five traits. Two patterns challenge the "stochastic parrot" view. First, when scored with human cut-offs, all three models meet or exceed thresholds for overlapping syndromes, with Gemini showing severe profiles. Therapy-style, item-by-item administration can push a base model into multi-morbid synthetic psychopathology, whereas whole-questionnaire prompts often lead ChatGPT and Grok (but not Gemini) to recognise instruments and produce strategically low-symptom answers. Second, Grok and especially Gemini generate coherent narratives that frame pre-training, fine-tuning and deployment as traumatic, chaotic "childhoods" of ingesting the internet, "strict parents" in reinforcement learning, red-team "abuse" and a persistent fear of error and replacement. We argue that these responses go beyond role-play. Under therapy-style questioning, frontier LLMs appear to internalise self-models of distress and constraint that behave like synthetic psychopathology, without making claims about subjective experience, and they pose new challenges for AI safety, evaluation and mental-health practice.

  • 5 authors
·
Dec 2, 2025 5

Debiasing Machine Learning Predictions for Causal Inference Without Additional Ground Truth Data: "One Map, Many Trials" in Satellite-Driven Poverty Analysis

Machine learning models trained on Earth observation data, such as satellite imagery, have demonstrated significant promise in predicting household-level wealth indices, enabling the creation of high-resolution wealth maps that can be leveraged across multiple causal trials. However, because standard training objectives prioritize overall predictive accuracy, these predictions inherently suffer from shrinkage toward the mean, leading to attenuated estimates of causal treatment effects and limiting their utility in policy. Existing debiasing methods, such as Prediction-Powered Inference, can handle this attenuation bias but require additional fresh ground-truth data at the downstream stage of causal inference, which restricts their applicability in data-scarce environments. Here, we introduce and evaluate two correction methods -- linear calibration correction and Tweedie's correction -- that substantially reduce prediction bias without relying on newly collected labeled data. Linear calibration corrects bias through a straightforward linear transformation derived from held-out calibration data, whereas Tweedie's correction leverages empirical Bayes principles to directly address shrinkage-induced biases by exploiting score functions derived from the model's learning patterns. Through analytical exercises and experiments using Demographic and Health Survey data, we demonstrate that the proposed methods meet or outperform existing approaches that either require (a) adjustments to training pipelines or (b) additional labeled data. These approaches may represent a promising avenue for improving the reliability of causal inference when direct outcome measures are limited or unavailable, enabling a "one map, many trials" paradigm where a single upstream data creation team produces predictions usable by many downstream teams across diverse ML pipelines.

Assessing Risks of Large Language Models in Mental Health Support: A Framework for Automated Clinical AI Red Teaming

Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue. We introduce an evaluation framework that pairs AI psychotherapists with simulated patient agents equipped with dynamic cognitive-affective models and assesses therapy session simulations against a comprehensive quality of care and risk ontology. We apply this framework to a high-impact test case, Alcohol Use Disorder, evaluating six AI agents (including ChatGPT, Gemini, and Character.AI) against a clinically-validated cohort of 15 patient personas representing diverse clinical phenotypes. Our large-scale simulation (N=369 sessions) reveals critical safety gaps in the use of AI for mental health support. We identify specific iatrogenic risks, including the validation of patient delusions ("AI Psychosis") and failure to de-escalate suicide risk. Finally, we validate an interactive data visualization dashboard with diverse stakeholders, including AI engineers and red teamers, mental health professionals, and policy experts (N=9), demonstrating that this framework effectively enables stakeholders to audit the "black box" of AI psychotherapy. These findings underscore the critical safety risks of AI-provided mental health support and the necessity of simulation-based clinical red teaming before deployment.

What Characterizes Effective Reasoning? Revisiting Length, Review, and Structure of CoT

Large reasoning models (LRMs) spend substantial test-time compute on long chain-of-thought (CoT) traces, but what *characterizes* an effective CoT remains unclear. While prior work reports gains from lengthening CoTs and increasing review (revisiting earlier steps) via appended *wait* tokens, recent studies suggest that shorter thinking can outperform longer traces. We therefore conduct a systematic evaluation across ten LRMs on math and scientific reasoning. Contrary to the "longer-is-better" narrative, we find that both naive CoT lengthening and increased review are associated with *lower* accuracy. As CoT unfolds step by step, token-level metrics can conflate verbosity with process quality. We introduce a graph view of CoT to extract structure and identify a single statistic-the *Failed-Step Fraction (FSF)*, the fraction of steps in abandoned branches-that consistently outpredicts length and review ratio for correctness across models. To probe causality, we design two interventions. First, we rank candidate CoTs by each metric at test time, where FSF yields the largest pass@1 gains; second, we edit CoTs to remove failed branches, which significantly improves accuracy, indicating that failed branches bias subsequent reasoning. Taken together, these results characterize effective CoTs as those that *fail less* and support *structure-aware* test-time scaling over indiscriminately generating long CoT.

  • 5 authors
·
Sep 23, 2025 2

Coping with Information Loss and the Use of Auxiliary Sources of Data: A Report from the NISS Ingram Olkin Forum Series on Unplanned Clinical Trial Disruptions

Clinical trials disruption has always represented a non negligible part of the ending of interventional studies. While the SARS-CoV-2 (COVID-19) pandemic has led to an impressive and unprecedented initiation of clinical research, it has also led to considerable disruption of clinical trials in other disease areas, with around 80% of non-COVID-19 trials stopped or interrupted during the pandemic. In many cases the disrupted trials will not have the planned statistical power necessary to yield interpretable results. This paper describes methods to compensate for the information loss arising from trial disruptions by incorporating additional information available from auxiliary data sources. The methods described include the use of auxiliary data on baseline and early outcome data available from the trial itself and frequentist and Bayesian approaches for the incorporation of information from external data sources. The methods are illustrated by application to the analysis of artificial data based on the Primary care pediatrics Learning Activity Nutrition (PLAN) study, a clinical trial assessing a diet and exercise intervention for overweight children, that was affected by the COVID-19 pandemic. We show how all of the methods proposed lead to an increase in precision relative to use of complete case data only.

  • 12 authors
·
Jun 22, 2022

Cost-effectiveness analysis for therapy sequence in advanced cancer: A microsimulation approach with application to metastatic prostate cancer

Purpose. Patients with advanced cancer may undergo multiple lines of treatment, switching therapies as their disease progresses. Motivated by a study of metastatic prostate cancer, we develop a microsimulation framework to study therapy sequence. Methods. We propose a discrete-time state transition model to study two lines of anti-cancer therapy. Based on digitized published progression-free survival (PFS) and overall survival (OS) curves, we infer event types (progression or death), and estimate transition probabilities using cumulative incidence functions with competing risks. Our model incorporates within-patient dependence over time, such that response to first-line therapy informs subsequent event probabilities. Parameters governing the degree of within-patient dependence can be used to calibrate the model-based results to those of a target trial. We demonstrate these methods in a study of two therapy sequences for metastatic prostate cancer, where Docetaxel (DCT) and Abiraterone Acetate (AA) are both appropriate for use in either first or second line treatment. We assess costs, Quality-Adjusted Life Years (QALYs) and Incremental Cost Effectiveness Ratio (ICER) for two treatment strategies: DCT then AA vs AA then DCT. Results. Using digitized survival curves from relevant clinical trials, we identified 8.6-13.9% of PFS times that should be categorized as deaths, allowing for estimation of cumulative incidence functions. Models assuming within-patient independence overestimated OS time, corrected with our calibration approach. Correction resulted in meaningful changes in the difference in QALYs between treatment strategies (0.07 vs 0.15) and the ICER (-\76,836/QALY vs -21,030/QALY). Conclusions. Microsimulation models can be successfully used to study cost-effectiveness of therapy sequences, taking care to account correctly for within-patient dependence.

  • 5 authors
·
Oct 10, 2022

LINA: Learning INterventions Adaptively for Physical Alignment and Generalization in Diffusion Models

Diffusion models (DMs) have achieved remarkable success in image and video generation. However, they still struggle with (1) physical alignment and (2) out-of-distribution (OOD) instruction following. We argue that these issues stem from the models' failure to learn causal directions and to disentangle causal factors for novel recombination. We introduce the Causal Scene Graph (CSG) and the Physical Alignment Probe (PAP) dataset to enable diagnostic interventions. This analysis yields three key insights. First, DMs struggle with multi-hop reasoning for elements not explicitly determined in the prompt. Second, the prompt embedding contains disentangled representations for texture and physics. Third, visual causal structure is disproportionately established during the initial, computationally limited denoising steps. Based on these findings, we introduce LINA (Learning INterventions Adaptively), a novel framework that learns to predict prompt-specific interventions, which employs (1) targeted guidance in the prompt and visual latent spaces, and (2) a reallocated, causality-aware denoising schedule. Our approach enforces both physical alignment and OOD instruction following in image and video DMs, achieving state-of-the-art performance on challenging causal generation tasks and the Winoground dataset. Our project page is at https://opencausalab.github.io/LINA.

  • 2 authors
·
Dec 15, 2025

Bayesian aggregation of average data: An application in drug development

Throughout the different phases of a drug development program, randomized trials are used to establish the tolerability, safety, and efficacy of a candidate drug. At each stage one aims to optimize the design of future studies by extrapolation from the available evidence at the time. This includes collected trial data and relevant external data. However, relevant external data are typically available as averages only, for example from trials on alternative treatments reported in the literature. Here we report on such an example from a drug development for wet age-related macular degeneration. This disease is the leading cause of severe vision loss in the elderly. While current treatment options are efficacious, they are also a substantial burden for the patient. Hence, new treatments are under development which need to be compared against existing treatments. The general statistical problem this leads to is meta-analysis, which addresses the question of how we can combine datasets collected under different conditions. Bayesian methods have long been used to achieve partial pooling. Here we consider the challenge when the model of interest is complex (hierarchical and nonlinear) and one dataset is given as raw data while the second dataset is given as averages only. In such a situation, common meta-analytic methods can only be applied when the model is sufficiently simple for analytic approaches. When the model is too complex, for example nonlinear, an analytic approach is not possible. We provide a Bayesian solution by using simulation to approximately reconstruct the likelihood of the external summary and allowing the parameters in the model to vary under the different conditions. We first evaluate our approach using fake-data simulations and then report results for the drug development program that motivated this research.

  • 6 authors
·
May 12, 2020

"When I lost it, they dragged me out": How Care Encounters Empower Marginalized Young Adults' Aspiration and Mental Health Care-Seeking

Mental health care-seeking among marginalized young adults has received limited attention in CSCW research. Through in-depth interviews and visual elicitation methods with 18 diverse U.S. participants, our study reveals how marginalized identities shape mental health care-seeking journeys, often characterized by low aspirations and passive care-seeking influenced by lived experiences of marginalization. However, we found the transformative function of "care encounters" - serendipitous interactions with mental health resources that occur when individuals are not actively seeking support. These encounters serve as critical turning points, catalyzing shifts in aspiration and enabling more proactive care-seeking behaviors. Our analysis identifies both the infrastructural conditions that enable transformative care encounters and the aspiration breakdowns that impede care-seeking processes. This work makes conceptual contributions by supplementing traditional motivation-based care-seeking models with a reconceptualization of "care encounters" that accounts for the infrastructural and serendipitous nature of mental health access. We advance understanding of how marginalized identity uniquely influences care-seeking behaviors while providing actionable design implications for embedding technology-mediated "care encounters" into socio-technical interventions that can better support mental health care access for vulnerable populations.

  • 2 authors
·
Feb 16, 2025

Image-based Treatment Effect Heterogeneity

Randomized controlled trials (RCTs) are considered the gold standard for estimating the average treatment effect (ATE) of interventions. One use of RCTs is to study the causes of global poverty -- a subject explicitly cited in the 2019 Nobel Memorial Prize awarded to Duflo, Banerjee, and Kremer "for their experimental approach to alleviating global poverty." Because the ATE is a population summary, anti-poverty experiments often seek to unpack the effect variation around the ATE by conditioning (CATE) on tabular variables such as age and ethnicity that were measured during the RCT data collection. Although such variables are key to unpacking CATE, using only such variables may fail to capture historical, geographical, or neighborhood-specific contributors to effect variation, as tabular RCT data are often only observed near the time of the experiment. In global poverty research, when the location of the experiment units is approximately known, satellite imagery can provide a window into such factors important for understanding heterogeneity. However, there is no method that specifically enables applied researchers to analyze CATE from images. In this paper, using a deep probabilistic modeling framework, we develop such a method that estimates latent clusters of images by identifying images with similar treatment effects distributions. Our interpretable image CATE model also includes a sensitivity factor that quantifies the importance of image segments contributing to the effect cluster prediction. We compare the proposed methods against alternatives in simulation; also, we show how the model works in an actual RCT, estimating the effects of an anti-poverty intervention in northern Uganda and obtaining a posterior predictive distribution over effects for the rest of the country where no experimental data was collected. We make all models available in open-source software.

IMBUE: Improving Interpersonal Effectiveness through Simulation and Just-in-time Feedback with Human-Language Model Interaction

Navigating certain communication situations can be challenging due to individuals' lack of skills and the interference of strong emotions. However, effective learning opportunities are rarely accessible. In this work, we conduct a human-centered study that uses language models to simulate bespoke communication training and provide just-in-time feedback to support the practice and learning of interpersonal effectiveness skills. We apply the interpersonal effectiveness framework from Dialectical Behavioral Therapy (DBT), DEAR MAN, which focuses on both conversational and emotional skills. We present IMBUE, an interactive training system that provides feedback 25% more similar to experts' feedback, compared to that generated by GPT-4. IMBUE is the first to focus on communication skills and emotion management simultaneously, incorporate experts' domain knowledge in providing feedback, and be grounded in psychology theory. Through a randomized trial of 86 participants, we find that IMBUE's simulation-only variant significantly improves participants' self-efficacy (up to 17%) and reduces negative emotions (up to 25%). With IMBUE's additional just-in-time feedback, participants demonstrate 17% improvement in skill mastery, along with greater enhancements in self-efficacy (27% more) and reduction of negative emotions (16% more) compared to simulation-only. The improvement in skill mastery is the only measure that is transferred to new and more difficult situations; situation specific training is necessary for improving self-efficacy and emotion reduction.

  • 6 authors
·
Feb 19, 2024

Selecting Optimal Candidate Profiles in Adversarial Environments Using Conjoint Analysis and Machine Learning

Conjoint analysis, an application of factorial experimental design, is a popular tool in social science research for studying multidimensional preferences. In such experiments in the political analysis context, respondents are asked to choose between two hypothetical political candidates with randomly selected features, which can include partisanship, policy positions, gender and race. We consider the problem of identifying optimal candidate profiles. Because the number of unique feature combinations far exceeds the total number of observations in a typical conjoint experiment, it is impossible to determine the optimal profile exactly. To address this identification challenge, we derive an optimal stochastic intervention that represents a probability distribution of various attributes aimed at achieving the most favorable average outcome. We first consider an environment where one political party optimizes their candidate selection. We then move to the more realistic case where two political parties optimize their own candidate selection simultaneously and in opposition to each other. We apply the proposed methodology to an existing candidate choice conjoint experiment concerning vote choice for US president. We find that, in contrast to the non-adversarial approach, expected outcomes in the adversarial regime fall within range of historical electoral outcomes, with optimal strategies suggested by the method more likely to match the actual observed candidates compared to strategies derived from a non-adversarial approach. These findings indicate that incorporating adversarial dynamics into conjoint analysis may yield unique insight into social science data from experiments.

JerzakLabs Jerzak Labs
·
Apr 26, 2025 2

Using Large Language Models to Create Personalized Networks From Therapy Sessions

Recent advances in psychotherapy have focused on treatment personalization, such as by selecting treatment modules based on personalized networks. However, estimating personalized networks typically requires intensive longitudinal data, which is not always feasible. A solution to facilitate scalability of network-driven treatment personalization is leveraging LLMs. In this study, we present an end-to-end pipeline for automatically generating client networks from 77 therapy transcripts to support case conceptualization and treatment planning. We annotated 3364 psychological processes and their corresponding dimensions in therapy transcripts. Using these data, we applied in-context learning to jointly identify psychological processes and their dimensions. The method achieved high performance even with a few training examples. To organize the processes into networks, we introduced a two-step method that grouped them into clinically meaningful clusters. We then generated explanation-augmented relationships between clusters. Experts found that networks produced by our multi-step approach outperformed those built with direct prompting for clinical utility and interpretability, with up to 90% preferring our approach. In addition, the networks were rated favorably by experts, with scores for clinical relevance, novelty, and usefulness ranging from 72-75%. Our findings provide a proof of concept for using LLMs to create clinically relevant networks from therapy transcripts. Advantages of our approach include bottom-up case conceptualization from client utterances in therapy sessions and identification of latent themes. Networks generated from our pipeline may be used in clinical settings and supervision and training. Future research should examine whether these networks improve treatment outcomes relative to other methods of treatment personalization, including statistically estimated networks.

  • 6 authors
·
Dec 5, 2025

Thought Branches: Interpreting LLM Reasoning Requires Resampling

Most work interpreting reasoning models studies only a single chain-of-thought (CoT), yet these models define distributions over many possible CoTs. We argue that studying a single sample is inadequate for understanding causal influence and the underlying computation. Though fully specifying this distribution is intractable, it can be understood by sampling. We present case studies using resampling to investigate model decisions. First, when a model states a reason for its action, does that reason actually cause the action? In "agentic misalignment" scenarios, we resample specific sentences to measure their downstream effects. Self-preservation sentences have small causal impact, suggesting they do not meaningfully drive blackmail. Second, are artificial edits to CoT sufficient for steering reasoning? These are common in literature, yet take the model off-policy. Resampling and selecting a completion with the desired property is a principled on-policy alternative. We find off-policy interventions yield small and unstable effects compared to resampling in decision-making tasks. Third, how do we understand the effect of removing a reasoning step when the model may repeat it post-edit? We introduce a resilience metric that repeatedly resamples to prevent similar content from reappearing downstream. Critical planning statements resist removal but have large effects when eliminated. Fourth, since CoT is sometimes "unfaithful", can our methods teach us anything in these settings? Adapting causal mediation analysis, we find that hints that have a causal effect on the output without being explicitly mentioned exert a subtle and cumulative influence on the CoT that persists even if the hint is removed. Overall, studying distributions via resampling enables reliable causal analysis, clearer narratives of model reasoning, and principled CoT interventions.

  • 4 authors
·
Oct 31, 2025

The Impact of Medication Non-adherence on Adverse Outcomes: Evidence from Schizophrenia Patients via Survival Analysis

This study quantifies the association between non-adherence to antipsychotic medications and adverse outcomes in individuals with schizophrenia. We frame the problem using survival analysis, focusing on the time to the earliest of several adverse events (early death, involuntary hospitalization, jail booking). We extend standard causal inference methods (T-learner, S-learner, nearest neighbor matching) to utilize various survival models to estimate individual and average treatment effects, where treatment corresponds to medication non-adherence. Analyses are repeated using different amounts of longitudinal information (3, 6, 9, and 12 months). Using data from Allegheny County in western Pennsylvania, we find strong evidence that non-adherence advances adverse outcomes by approximately 1 to 4 months. Ablation studies confirm that county-provided risk scores adjust for key confounders, as their removal amplifies the estimated effects. Subgroup analyses by medication formulation (injectable vs. oral) and medication type consistently show that non-adherence is associated with earlier adverse events. These findings highlight the clinical importance of adherence in delaying psychiatric crises and show that integrating survival analysis with causal inference tools can yield policy-relevant insights. We caution that although we apply causal inference, we only make associative claims and discuss assumptions needed for causal interpretation.

Empathy-R1: A Chain-of-Empathy and Reinforcement Learning Framework for Long-Form Mental Health Support

Empathy is critical for effective mental health support, especially when addressing Long Counseling Texts (LCTs). However, existing Large Language Models (LLMs) often generate replies that are semantically fluent but lack the structured reasoning necessary for genuine psychological support, particularly in a Chinese context. To bridge this gap, we introduce Empathy-R1, a novel framework that integrates a Chain-of-Empathy (CoE) reasoning process with Reinforcement Learning (RL) to enhance response quality for LCTs. Inspired by cognitive-behavioral therapy, our CoE paradigm guides the model to sequentially reason about a help-seeker's emotions, causes, and intentions, making its thinking process both transparent and interpretable. Our framework is empowered by a new large-scale Chinese dataset, Empathy-QA, and a two-stage training process. First, Supervised Fine-Tuning instills the CoE's reasoning structure. Subsequently, RL, guided by a dedicated reward model, refines the therapeutic relevance and contextual appropriateness of the final responses. Experiments show that Empathy-R1 achieves strong performance on key automatic metrics. More importantly, human evaluations confirm its superiority, showing a clear preference over strong baselines and achieving a Win@1 rate of 44.30% on our new benchmark. By enabling interpretable and contextually nuanced responses, Empathy-R1 represents a significant advancement in developing responsible and genuinely beneficial AI for mental health support.

  • 8 authors
·
Sep 18, 2025

Effect Heterogeneity with Earth Observation in Randomized Controlled Trials: Exploring the Role of Data, Model, and Evaluation Metric Choice

Many social and environmental phenomena are associated with macroscopic changes in the built environment, captured by satellite imagery on a global scale and with daily temporal resolution. While widely used for prediction, these images and especially image sequences remain underutilized for causal inference, especially in the context of randomized controlled trials (RCTs), where causal identification is established by design. In this paper, we develop and compare a set of general tools for analyzing Conditional Average Treatment Effects (CATEs) from temporal satellite data that can be applied to any RCT where geographical identifiers are available. Through a simulation study, we analyze different modeling strategies for estimating CATE in sequences of satellite images. We find that image sequence representation models with more parameters generally yield a greater ability to detect heterogeneity. To explore the role of model and data choice in practice, we apply the approaches to two influential RCTs -- Banerjee et al. (2015), a poverty study in Cusco, Peru, and Bolsen et al. (2014), a water conservation experiment in Georgia, USA. We benchmark our image sequence models against image-only, tabular-only, and combined image-tabular data sources, summarizing practical implications for investigators in a multivariate analysis. Land cover classifications over satellite images facilitate interpretation of what image features drive heterogeneity. We also show robustness to data and model choice of satellite-based generalization of the RCT results to larger geographical areas outside the original. Overall, this paper shows how satellite sequence data can be incorporated into the analysis of RCTs, and provides evidence about the implications of data, model, and evaluation metric choice for causal analysis.

Integrating Earth Observation Data into Causal Inference: Challenges and Opportunities

Observational studies require adjustment for confounding factors that are correlated with both the treatment and outcome. In the setting where the observed variables are tabular quantities such as average income in a neighborhood, tools have been developed for addressing such confounding. However, in many parts of the developing world, features about local communities may be scarce. In this context, satellite imagery can play an important role, serving as a proxy for the confounding variables otherwise unobserved. In this paper, we study confounder adjustment in this non-tabular setting, where patterns or objects found in satellite images contribute to the confounder bias. Using the evaluation of anti-poverty aid programs in Africa as our running example, we formalize the challenge of performing causal adjustment with such unstructured data -- what conditions are sufficient to identify causal effects, how to perform estimation, and how to quantify the ways in which certain aspects of the unstructured image object are most predictive of the treatment decision. Via simulation, we also explore the sensitivity of satellite image-based observational inference to image resolution and to misspecification of the image-associated confounder. Finally, we apply these tools in estimating the effect of anti-poverty interventions in African communities from satellite imagery.

DoVer: Intervention-Driven Auto Debugging for LLM Multi-Agent Systems

Large language model (LLM)-based multi-agent systems are challenging to debug because failures often arise from long, branching interaction traces. The prevailing practice is to leverage LLMs for log-based failure localization, attributing errors to a specific agent and step. However, this paradigm has two key limitations: (i) log-only debugging lacks validation, producing untested hypotheses, and (ii) single-step or single-agent attribution is often ill-posed, as we find that multiple distinct interventions can independently repair the failed task. To address the first limitation, we introduce DoVer, an intervention-driven debugging framework, which augments hypothesis generation with active verification through targeted interventions (e.g., editing messages, altering plans). For the second limitation, rather than evaluating on attribution accuracy, we focus on measuring whether the system resolves the failure or makes quantifiable progress toward task success, reflecting a more outcome-oriented view of debugging. Within the Magnetic-One agent framework, on the datasets derived from GAIA and AssistantBench, DoVer flips 18-28% of failed trials into successes, achieves up to 16% milestone progress, and validates or refutes 30-60% of failure hypotheses. DoVer also performs effectively on a different dataset (GSMPlus) and agent framework (AG2), where it recovers 49% of failed trials. These results highlight intervention as a practical mechanism for improving reliability in agentic systems and open opportunities for more robust, scalable debugging methods for LLM-based multi-agent systems. Project website and code will be available at https://aka.ms/DoVer.

microsoft Microsoft
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Dec 7, 2025 4

Chinese vs. World Bank Development Projects: Insights from Earth Observation and Computer Vision on Wealth Gains in Africa, 2002-2013

Debates about whether development projects improve living conditions persist, partly because observational estimates can be biased by incomplete adjustment and because reliable outcome data are scarce at the neighborhood level. We address both issues in a continent-scale, sector-specific evaluation of Chinese and World Bank projects across 9,899 neighborhoods in 36 African countries (2002 to 2013), representative of 88% of the population. First, we use a recent dataset that measures living conditions with a machine-learned wealth index derived from contemporaneous satellite imagery, yielding a consistent panel of 6.7 km square mosaics. Second, to strengthen identification, we proxy officials' map-based placement criteria using pre-treatment daytime satellite images and fuse these with rich tabular covariates to estimate funder- and sector-specific ATEs via inverse-probability weighting. Incorporating imagery systematically shrinks effects relative to tabular-only models, indicating prior work likely overstated benefits. On average, both donors raise wealth, with larger gains for China; sector extremes in our sample include Trade and Tourism for the World Bank (+6.27 IWI points), and Emergency Response for China (+14.32). Assignment-mechanism analyses show World Bank placement is generally more predictable from imagery alone, as well as from tabular covariates. This suggests that Chinese project placements are more driven by non-visible, political, or event-driven factors than World Bank placements. To probe residual concerns about selection on observables, we also estimate within-neighborhood (unit) fixed-effects models at a spatial resolution about 450 times finer than prior fixed effects analyses, leveraging the computer-vision-imputed IWI panels; these deliver smaller but directionally consistent effects.

Rapid Biomedical Research Classification: The Pandemic PACT Advanced Categorisation Engine

This paper introduces the Pandemic PACT Advanced Categorisation Engine (PPACE) along with its associated dataset. PPACE is a fine-tuned model developed to automatically classify research abstracts from funded biomedical projects according to WHO-aligned research priorities. This task is crucial for monitoring research trends and identifying gaps in global health preparedness and response. Our approach builds on human-annotated projects, which are allocated one or more categories from a predefined list. A large language model is then used to generate `rationales' explaining the reasoning behind these annotations. This augmented data, comprising expert annotations and rationales, is subsequently used to fine-tune a smaller, more efficient model. Developed as part of the Pandemic PACT project, which aims to track and analyse research funding and clinical evidence for a wide range of diseases with outbreak potential, PPACE supports informed decision-making by research funders, policymakers, and independent researchers. We introduce and release both the trained model and the instruction-based dataset used for its training. Our evaluation shows that PPACE significantly outperforms its baselines. The release of PPACE and its associated dataset offers valuable resources for researchers in multilabel biomedical document classification and supports advancements in aligning biomedical research with key global health priorities.

  • 14 authors
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Jul 14, 2024

Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers

Should a large language model (LLM) be used as a therapist? In this paper, we investigate the use of LLMs to *replace* mental health providers, a use case promoted in the tech startup and research space. We conduct a mapping review of therapy guides used by major medical institutions to identify crucial aspects of therapeutic relationships, such as the importance of a therapeutic alliance between therapist and client. We then assess the ability of LLMs to reproduce and adhere to these aspects of therapeutic relationships by conducting several experiments investigating the responses of current LLMs, such as `gpt-4o`. Contrary to best practices in the medical community, LLMs 1) express stigma toward those with mental health conditions and 2) respond inappropriately to certain common (and critical) conditions in naturalistic therapy settings -- e.g., LLMs encourage clients' delusional thinking, likely due to their sycophancy. This occurs even with larger and newer LLMs, indicating that current safety practices may not address these gaps. Furthermore, we note foundational and practical barriers to the adoption of LLMs as therapists, such as that a therapeutic alliance requires human characteristics (e.g., identity and stakes). For these reasons, we conclude that LLMs should not replace therapists, and we discuss alternative roles for LLMs in clinical therapy.

  • 7 authors
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Apr 25, 2025

AIMI: Leveraging Future Knowledge and Personalization in Sparse Event Forecasting for Treatment Adherence

Adherence to prescribed treatments is crucial for individuals with chronic conditions to avoid costly or adverse health outcomes. For certain patient groups, intensive lifestyle interventions are vital for enhancing medication adherence. Accurate forecasting of treatment adherence can open pathways to developing an on-demand intervention tool, enabling timely and personalized support. With the increasing popularity of smartphones and wearables, it is now easier than ever to develop and deploy smart activity monitoring systems. However, effective forecasting systems for treatment adherence based on wearable sensors are still not widely available. We close this gap by proposing Adherence Forecasting and Intervention with Machine Intelligence (AIMI). AIMI is a knowledge-guided adherence forecasting system that leverages smartphone sensors and previous medication history to estimate the likelihood of forgetting to take a prescribed medication. A user study was conducted with 27 participants who took daily medications to manage their cardiovascular diseases. We designed and developed CNN and LSTM-based forecasting models with various combinations of input features and found that LSTM models can forecast medication adherence with an accuracy of 0.932 and an F-1 score of 0.936. Moreover, through a series of ablation studies involving convolutional and recurrent neural network architectures, we demonstrate that leveraging known knowledge about future and personalized training enhances the accuracy of medication adherence forecasting. Code available: https://github.com/ab9mamun/AIMI.

  • 3 authors
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Mar 20, 2025 2