Cultural Prompting Improves the Empathy and Cultural Responsiveness of GPT-Generated Therapy Responses

Large Language Model (LLM)-based conversational agents offer promising solutions for mental health support, but lack cultural responsiveness for diverse populations. This study evaluated the effectiveness of cultural prompting in improving cultural responsiveness and perceived empathy of LLM-generated therapeutic responses for Chinese American family caregivers. Using a randomized controlled experiment, we compared GPT-4o and Deepseek-V3 responses with and without cultural prompting. Thirty-six participants evaluated input-response pairs on cultural responsiveness (competence and relevance) and perceived empathy. Results showed that cultural prompting significantly enhanced GPT-4o's performance across all dimensions, with GPT-4o with cultural prompting being the most preferred, while improvements in DeepSeek-V3 responses were not significant. Mediation analysis revealed that cultural prompting improved empathy through improving cultural responsiveness. This study demonstrated that prompt-based techniques can effectively enhance the cultural responsiveness of LLM-generated therapeutic responses, highlighting the importance of cultural responsiveness in delivering empathetic AI-based therapeutic interventions to culturally and linguistically diverse populations.