This review evaluates the role of the large language model (LLM) in psychotherapy, emphasizing integration with theory of mind (ToM) and its influence on therapeutic outcomes and interactions.The current state-of-the-art in LLMs matches a 6-year-old’s ToM level, and thus encounters limitations in client interactions. Reinforcing the LLM ToM could improve interaction quality and can foster empathetic therapeutic settings vital for effective psychotherapy. However, significant gaps remain, especially in achieving contextual, human-like interactions. Key challenges include a lack of evaluation standards for LLM-based psychotherapies, insufficient clinical training data, and the need for a deeper exploration of therapeutic alliances between the LLM and the clients. This review emphasizes the transformative potential of the LLM in psychotherapy through integration with ToM, enhancing both the understanding of patients’ mental states and therapeutic interactions. Future research should focus on refining ToM benchmarks for the LLM, examining the therapeutic alliance, and addressing methodological issues to optimize ToM in LLM-based psychotherapy.

This review evaluates the role of the large language model (LLM) in psychotherapy, emphasizing integration with theory of mind (ToM) and its influence on therapeutic outcomes and interactions.The current state-of-the-art in LLMs matches a 6-year-old’s ToM level, and thus encounters limitations in client interactions. Reinforcing the LLM ToM could improve interaction quality and can foster empathetic therapeutic settings vital for effective psychotherapy. However, significant gaps remain, especially in achieving contextual, human-like interactions. Key challenges include a lack of evaluation standards for LLM-based psychotherapies, insufficient clinical training data, and the need for a deeper exploration of therapeutic alliances between the LLM and the clients. This review emphasizes the transformative potential of the LLM in psychotherapy through integration with ToM, enhancing both the understanding of patients’ mental states and therapeutic interactions. Future research should focus on refining ToM benchmarks for the LLM, examining the therapeutic alliance, and addressing methodological issues to optimize ToM in LLM-based psychotherapy.

This review evaluates the role of the large language model (LLM) in psychotherapy, emphasizing integration with theory of mind (ToM) and its influence on therapeutic outcomes and interactions.The current state-of-the-art in LLMs matches a 6-year-old’s ToM level, and thus encounters limitations in client interactions. Reinforcing the LLM ToM could improve interaction quality and can foster empathetic therapeutic settings vital for effective psychotherapy. However, significant gaps remain, especially in achieving contextual, human-like interactions. Key challenges include a lack of evaluation standards for LLM-based psychotherapies, insufficient clinical training data, and the need for a deeper exploration of therapeutic alliances between the LLM and the clients. This review emphasizes the transformative potential of the LLM in psychotherapy through integration with ToM, enhancing both the understanding of patients’ mental states and therapeutic interactions. Future research should focus on refining ToM benchmarks for the LLM, examining the therapeutic alliance, and addressing methodological issues to optimize ToM in LLM-based psychotherapy.

This review evaluates the role of the large language model (LLM) in psychotherapy, emphasizing integration with theory of mind (ToM) and its influence on therapeutic outcomes and interactions.The current state-of-the-art in LLMs matches a 6-year-old’s ToM level, and thus encounters limitations in client interactions. Reinforcing the LLM ToM could improve interaction quality and can foster empathetic therapeutic settings vital for effective psychotherapy. However, significant gaps remain, especially in achieving contextual, human-like interactions. Key challenges include a lack of evaluation standards for LLM-based psychotherapies, insufficient clinical training data, and the need for a deeper exploration of therapeutic alliances between the LLM and the clients. This review emphasizes the transformative potential of the LLM in psychotherapy through integration with ToM, enhancing both the understanding of patients’ mental states and therapeutic interactions. Future research should focus on refining ToM benchmarks for the LLM, examining the therapeutic alliance, and addressing methodological issues to optimize ToM in LLM-based psychotherapy.

OBJECTIVES: We aimed to examine whether mindfulness skills are mediating the improvements of depressive symptoms in patients with mood disorders who practiced Mindfulness-Based Cognitive Therapy (MBCT). METHODS: A total of 19 patients with mood disorder were included in this study. The participants were divided into two subgroups: a normal to mild depression group and a moderate depression group. The participants completed questionnaires to assess depressive symptoms, anxiety, quality of life, suicidal idea, and mindfulness skills which were measured by the Five Facets of Mindfulness Questionnaire (FFMQ) before and after MBCT course. RESULTS: The moderate depression group showed improvements through MBCT in depressive symptoms and suicidal idea, but not in anxiety and quality of life. The normal to mild depression group showed no significant change through MBCT. The improvement of depressive symptoms in the moderate depression group was predictable by improvements of the five facets of mindfulness, especially by ‘observe’ and ‘non-react’ components. CONCLUSIONS: This study showed that currently depressive patients with moderate severity but not with normal to mild severity benefit from MBCT in reducing depressive symptoms and suicidal idea. The improvement of depressive symptoms was mediated by improved mindfulness skills through MBCT.
Anxiety ; Cognitive Therapy* ; Depression* ; Humans ; Mindfulness* ; Mood Disorders* ; Negotiating ; Quality of Life

Background: Few studies have investigated unspecified or idiopathic pain associated with COIVD-19. This study aimed to provide the incidence rates of unspecified pain and idiopathic pain in patients with COVID-19 for 90 days after COVID-19 diagnosis. Methods: A propensity score matched cohort was used, including all patients with COVID-19 in South Korea, and analyzed their electronic medical records. The control group consisted of those who had not had tests for COVID-19 at all. Unspecified pain diagnoses consisted of diagnoses related to pain included in the ICD-10 Chapter XVIII. Idiopathic pain disorders included fibromyalgia, temporomandibular joint disorders, headaches, chronic prostatitis, complex regional pain syndrome, atypical facial pain, irritable bowel syndrome, and interstitial cystitis. Results: After matching, the number of participants in each group was 7,911. For most unspecified pain, the incidences were higher in the COVID-19 group (11.7%;95% confidence interval [CI], 11.0–12.5) than in the control group (6.5%; 95% CI, 6.0–7.1). For idiopathic pain, only the headaches had a significantly higher in-cidence in the COVID-19 group (6.6%; 95% CI, 6.1–7.2) than in the control group (3.7%; 95% CI, 3.3–4.1). However, using a different control group that included only patients who visited a hospital at least once for any reasons, the incidences of most unspecified and idiopathic pain were higher in the control group than in the COVID-19 group. Conclusions Patients with COVID-19 might be at a higher risk of experiencing unspecified pain in the acute phase or after recovery compared with individuals who had not had tests for COVID-19.

Bilateral thalamic gliomas (BTGs) are rare brain tumors. In general, the prognosis is poor because of the involvement of bilateral thalami and limitations of surgical excision. Consequently, patients with symptoms of personality changes and memory impairment must be differentiated from others. Magnetic resonance imaging (MRI) is essential for the diagnosis of BTGs and reveals a hypo-intense lesion on T1-weighted images and a hyper-intense lesion on T2 images. We report a case of a 17-year-old female patient suffering from progressive cognitive dysfunction and personality changes and subsequent rehabilitation treatment. Brain MRI showed an enlarged bilateral thalamus, with hyperintensity on T2-weighted images and iso-intensity on T1-weighted images. A biopsy was performed, and the pathology revealed a high-grade glioma. The patient was referred for radiotherapy and chemotherapy. She also underwent rehabilitation treatment for 5 weeks and showed improvement in standing balance, endurance, and speech fluency. The patient's Modified Barthel Index scores also improved. Cancer rehabilitation is important in brain tumor patients because they have a higher incidence of neurological sequelae than others. Rehabilitation of patients with a malignant brain tumor is also important for improving health-related quality of life by maintaining the general condition and preventing complications during and after cancer treatment.
Adolescent ; Biopsy ; Brain ; Brain Neoplasms ; Diagnosis ; Drug Therapy ; Female ; Glioma ; Humans ; Incidence ; Magnetic Resonance Imaging ; Memory ; Memory Disorders ; Neurobehavioral Manifestations ; Pathology ; Prognosis ; Quality of Life ; Radiotherapy ; Rehabilitation ; Thalamus

Good's syndrome is a rare disease characterized by thymoma associated with combined B- and T-cell immunodeficiency in adults. Due to the lack of early onset of symptoms, it is difficult to diagnose this disorder. A 44-year-old man diagnosed with thymic carcinoma was admitted to the hospital with quadriplegia for 6 months. Brain abscess and meningoencephalitis were identified in the magnetic resonance imaging (MRI) of the brain.Antibiotics, steroid, and intravenous immunoglobulin treatment were provided for 3 months.Follow-up MRI showed progression to C7-level. The radiologic findings were consistent with tuberculosis infection and thus, the patient was treated with anti-tuberculosis medication.MRI of the brain and spine showed an improved state of meningoencephalomyelitis. In a laboratory study, there were decreased levels of peripheral B-cell and CD4 T-cell and decreased CD4:CD8 ratio; therefore, it confirmed that cellular immunity deteriorated. In addition to clinical findings, we were able to diagnose the patient with Good's syndrome.Good's syndrome is a highly suspicious disease in patients with thymoma who have recurrent unusual infections. Immunologic tests should be performed for diagnosis in which it can prevent delayed diagnosis and allow timely treatment.

Bilateral cerebral peduncular infarction (BCPI) is a very rare disorder among stroke patients.The main clinical manifestations in the previously reported BCPI case reports was associated with locked-in syndrome or persistent vegetative state. Here, we present a 51-year-old woman who had pseudobulbar palsy and quadriplegia. Magnetic resonance imaging showed an acute infarction in the middle areas of the cerebral peduncle with a unique “Mickey Mouse ears” sign. Diffusion tensor imaging and tractography showed relatively preserved corticospinal tracts, but the corticobulbar tracts were not detected. Magnetic resonance angiography showed posterior cerebral artery and vertebrobasilar artery occlusion. Cerebral perfusion insufficiency due to stenosis or occlusion of the vertebrobasilar artery and its branches may lead to BCPI. The prognosis and clinical manifestations of BCPI are related to the extent of the infarction in the involved cerebral peduncle and whether other territories are involved.Isolated BCPI may present a severe pseudobulbar palsy with relatively preserved limb function depending on the involvement pattern.

Good's syndrome is a rare disease characterized by thymoma associated with combined B- and T-cell immunodeficiency in adults. Due to the lack of early onset of symptoms, it is difficult to diagnose this disorder. A 44-year-old man diagnosed with thymic carcinoma was admitted to the hospital with quadriplegia for 6 months. Brain abscess and meningoencephalitis were identified in the magnetic resonance imaging (MRI) of the brain.Antibiotics, steroid, and intravenous immunoglobulin treatment were provided for 3 months.Follow-up MRI showed progression to C7-level. The radiologic findings were consistent with tuberculosis infection and thus, the patient was treated with anti-tuberculosis medication.MRI of the brain and spine showed an improved state of meningoencephalomyelitis. In a laboratory study, there were decreased levels of peripheral B-cell and CD4 T-cell and decreased CD4:CD8 ratio; therefore, it confirmed that cellular immunity deteriorated. In addition to clinical findings, we were able to diagnose the patient with Good's syndrome.Good's syndrome is a highly suspicious disease in patients with thymoma who have recurrent unusual infections. Immunologic tests should be performed for diagnosis in which it can prevent delayed diagnosis and allow timely treatment.