Patient-State Prediction and Progressive Profile Disclosure for Long-Horizon Patient Simulation长时域患者模拟中的患者-状态预测与渐进式特征披露
Abstract
Long-horizon patient simulation requires more than profile consistency: a simulated patient may remain factually faithful while exhibiting implausible behavioral changes or revealing personal information prematurely, repeatedly, or excessively. We frame these trajectory-level failures as two coupled temporal controls: patient-state prediction, which models how attitude, emotion, and topic evolve with interaction, and progressive profile disclosure, which controls when patient-specific information becomes available. We introduce UNFOLD, a psychotherapy patient simulator that predicts the next behavioral state from structured interaction history and controls access to independently addressable profile evidence before response generation. On 8,397 held-out patient turns, UNFOLD improves attitude, emotion, and topic prediction over a supervised text-encoder reference. Across 30 matched long-horizon simulations, it produces broader, more gradual, and less repetitive information trajectories than full-profile simulators, with differences persisting under longer baseline horizons. Mechanism-targeted ablations isolate the roles of state control, progressive selection, and the disclosure bottleneck, while blinded therapist raters prefer UNFOLD overall in pairwise evaluation. Together, these results suggest that long-horizon simulation should treat both behavioral state and information availability as explicit time-varying controls, a principle that may extend to interactive systems combining evolving behavior with persistent information.
摘要
长周期患者模拟不仅需要保持人物档案的一致性：模拟患者在保持事实准确性的同时，仍可能表现出不合情理的行为变化，或过早、反复或过度地透露个人信息。我们将这些轨迹层面的缺陷归结为两个相互关联的时间控制机制：患者状态预测（该机制建模了态度、情绪和话题随交互过程的演变）；以及渐进式人物档案披露（该机制控制着患者特定信息何时被披露）。我们推出 UNFOLD（一款心理治疗患者模拟器），它能够根据结构化的交互历史预测下一个行为状态，并在生成响应前控制对可独立调用的患者档案证据的访问权限。在 8,397 个保留的患者回合中，UNFOLD 在态度、情绪和话题预测方面优于基于监督学习的文本编码器基准模型。在30次匹配的长时域模拟中，与全档案模拟器相比，UNFOLD生成的信息轨迹范围更广、变化更平缓、重复性更低，且在更长的基线时域下，这些差异依然显著。针对机制的消除实验分别揭示了状态控制、渐进选择和信息披露瓶颈的作用，而采用盲评的治疗师评分员在成对评估中总体上更倾向于UNFOLD。综合来看，这些结果表明，长时域模拟应将行为状态和信息可用性均视为显式的时变控制变量，这一原则可能延伸至将演化行为与持久信息相结合的交互式系统。
