Entrainment, the responsive communication between interacting individuals, is a crucial process in building a strong relationship between a mental health therapist and their client, leading to positive therapeutic outcomes. However, so far entrainment has not been investigated as a measure of efficacy of large language models (LLMs) delivering mental health therapy. In this work, we evaluate the linguistic entrainment of an LLM (ChatGPT 3.5-turbo) in a mental health dialog setting. We first validate computational measures of linguistic entrainment with two measures of the quality of client self-disclosures: intimacy and engagement (p < 0.05). We then compare the linguistic entrainment of the LLM to trained therapists and non-expert online peer supporters in a cognitive behavioral therapy (CBT) setting. We show that the LLM is outperformed by humans with respect to linguistic entrainment (p < 0.001). These results support the need to be cautious in using LLMs out-of-the-box for mental health applications.

We present an end-to-end framework for generating synthetic users for evaluating interactive agents designed to encourage positive behavior changes, such as in health and lifestyle coaching. The synthetic users are grounded in health and lifestyle conditions, specifically sleep and diabetes management in this study, to ensure realistic interactions with the health coaching agent. Synthetic users are created in two stages: first, structured data are generated grounded in real-world health and lifestyle factors in addition to basic demographics and behavioral attributes; second, full profiles of the synthetic users are developed conditioned on the structured data. Interactions between synthetic users and the coaching agent are simulated using generative agent-based models such as Concordia, or directly by prompting a language model. Using two independently-developed agents for sleep and diabetes coaching as case studies, the validity of this framework is demonstrated by analyzing the coaching agent’s understanding of the synthetic users’ needs and challenges. Finally, through multiple blinded evaluations of user-coach interactions by human experts, we demonstrate that our synthetic users with health and behavioral attributes more accurately portray real human users with the same attributes, compared to generic synthetic users not grounded in such attributes. The proposed framework lays the foundation for efficient development of conversational agents through extensive, realistic, and grounded simulated interactions.