Generating Clinical Vignettes that Preserve Cognitive Formulations

Large language models can generate fluent clinical case vignettes, but fluency alone does not ensure fidelity to a specifiable clinical structure. We introduce FORMA, a theory-grounded framework that compiles a cognitive model of a disorder into a directed weighted graph, samples a person-specific configuration of that graph, and validates whether the generated vignette preserves the specified components and causal links. We instantiate FORMA on Posttraumatic Stress Disorder using the Ehlers and Clark cognitive model, generating 16,500 vignettes across 500 personas, 11 generation models, and three ablation conditions. Evaluation combines an external edge-recovery probe, two clinical experts, a scaled LLM judge, and a clinician user study with 100 licensed practitioners. The cognitive graph is recoverable from full-condition vignettes (MCC = +0.41, AUC = 0.70) but not from zero-shot generation (MCC = +0.01, AUC = 0.50). Experts rate full vignettes substantially higher than zero-shot alternatives, and clinicians perceive them to be human-written 85% of the time, compared with 22% for zero-shot. FORMA also reduces demographic disparity in perceived quality by 1.5-7x. These results show that cognitive formulation can serve as an auditable specification for scalable synthetic clinical text generation. A repository with the data and code is available online: https://github.com/Amit-Oren/FORMA.

Using Cognitive Models to Improve Language Model Simulation of Human Persuasion Games

People make decisions differently in strategic interactions. Some update beliefs like a Bayesian; others exhibit biases like motivated reasoning. Although creators of large language models use simulated humans for safety evaluations and training, they often fail to cover this breadth of human behavior. We argue that cognitive science and economics provide a convenient tool for doing so, making use of mathematical models of human decision-making. We propose an approach that we call Equation-to-Behavior Prompting for guiding large language models to match cognitive models, and evaluate this approach on persuasion games based on legal decision-making. We find that large models can approximate equation-based specifications -- Bayesian updating, affine distortion, motivated updating, and Grether's $α$-$β$ model -- using prompting, but small models fail to do so. However, training small models with reinforcement learning to adhere to mathematical rules, Equation-to-Behavior RL, reduces belief error by 26.5% in out-of-distribution parameterizations. We show that these simulations can help create diverse training environments; training small models to consider different kinds of decision-makers improves average belief change by 2.5%--12% over Bayesian-only training, even when persuading GPT-5-mini. Our work could improve human simulations for training and evaluation in increasingly realistic settings, and could also enable novel research into more complicated mathematical models of human decision-making.