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Emotional Change as a Process Indicator in AI-Facilitated Cognitive Restructuring: Secondary Analysis of a Mixed Methods Feasibility Study
ABSTRACT
Background:
Generative AI tools designed to deliver mental health interventions have shown promising symptom outcomes, yet whether these tools engage the therapeutic mechanisms that make psychotherapy effective remains unknown. Cognitive behavioral therapy (CBT) posits that modifying maladaptive cognitions produces corresponding changes in emotional states, and within-session emotional change may serve as a process indicator of cognitive restructuring.
Objective:
This study examined whether users of Socrates 2.0, a multi-agent AI system designed to facilitate Socratic dialogue, showed within-session emotional changes consistent with cognitive restructuring and whether these changes predict symptom improvement.
Methods:
Participants (N=60) were drawn from a mixed-methods feasibility study. Text-based exchanges between users and Socrates 2.0 were analyzed using transformer-based natural language processing models to detect emotional valence and discrete emotion categories across therapeutic dialogues. Linear mixed effects models examined within-session and between-session changes in emotional content and their associations with changes in posttraumatic stress, depression, generalized anxiety, and obsessive-compulsive symptoms among participants with elevated baseline symptom severity.
Results:
As hypothesized, negative emotions (e.g., disappointment, sadness, fear) declined over the course of individual sessions while positive emotions (e.g., approval, gratitude, optimism) increased. Linear mixed effects models demonstrated a significant within-session increase in positive sentiment (b=0.02, p<.001), though no significant between-session change was observed. Within-session increases in positive emotional content were associated with greater reductions in posttraumatic stress symptoms (b=0.0002, p=.018) but not with changes in depression, generalized anxiety, or obsessive-compulsive symptoms.
Conclusions:
Users of Socrates 2.0 demonstrated within-session emotional shifts consistent with cognitive restructuring processes in CBT, and these shifts predicted improvement in posttraumatic stress symptoms. These findings provide preliminary evidence that AI-facilitated Socratic dialogue may engage the cognitive-emotional mechanisms theorized to underlie CBT, though the specificity of this association to trauma-related symptoms warrants further investigation in larger controlled trials with clinical populations.
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