Public Perceptions and Emotional Trends of Psychotherapy: A 15-Year Analysis across English and Spanish Language Communities on X (Twitter)

Javier Goena^1,2Juan Chart^3,4,5,6*Francisco Jesus Lara Abelenda⁷David Chushig- Muzo⁷María Montero-Torres^8,9Ana González Pinto^10,4,5,6Guillermo Lahera Forteza^11,6,8,9Ana Catalán^1,12,2,6Miguel Ángel Gonzalez-Torres^1,12,2,6Mariana Pinto da Costa^13,14Melchor Alvarez De Mon^15,16,8,9Miguel Angel Alvarez-Mon^17,6,8,9

• ¹Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Basque Country, Spain
• ²Biobizkaia Health Research Institute, Bilbao, Spain
• ³Araba University Hospital, Vitoria-Gasteiz, Spain
• ⁴University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
• ⁵BioAraba Health Research Institute - OSI Araba, Vitoria-Gasteiz, Basque Country, Spain
• ⁶Center for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, Madrid, Spain
• ⁷Department of Theory of Signal and Communications and Telematic Systems and Computing, Rey Juan Carlos University, Madrid, Asturias, Spain
• ⁸Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Madrid, Spain
• ⁹Ramón y Cajal Institute for Health Research, Madrid, Madrid Community, Spain
• ¹⁰Psychiatry Department, Araba University Hospital, Osakidetza Basque Health Service, Vitoria-Gasteiz, Spain
• ¹¹Psychiatry Service, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain, Alcalá de Henares, Spain
• ¹²University of the Basque Country, Bilbao, Basque Country, Spain
• ¹³Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
• ¹⁴Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
• ¹⁵Psychiatry Service, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
• ¹⁶Service of Internal Medicine and Rheumatology-Autoimmune Diseases, Príncipe de Asturias University Hospital, Madrid, Madrid, Spain
• ¹⁷Department of Psychiatry and Medical Psychology, Hospital Universitario Infanta Leonor, Madrid, Asturias, Spain

Background: Mental health disorders have been rising globally, and social media platforms provide a unique opportunity to examine public perceptions of psychotherapy. However, little is known about how different therapeutic modalities are discussed across linguistic and cultural contexts. Objective: To analyse how psychotherapies are discussed on X (formerly Twitter) over a 15-year period, comparing thematic content and emotional tone between English and Spanish-speaking communities' tweets. Methods: We collected 102,946 public tweets from 2008 to 2022, including 76,878 in English (74.7%) and 26,068 in Spanish (25.3%), related to four therapies: Acceptance and Commitment Therapy (ACT), Cognitive Behavioural Therapy (CBT), Psychoanalytic/Psychodynamic Therapy (PAT), and Narrative Therapy (NT). Topic modelling was performed using BERTopic. Emotion classification was conducted using DistilRoBERTa and Robertuito pre-trained transformer-based language models based on Ekman's six basic emotions. Results: CBT was the most frequently mentioned therapy (51,250 tweets, 49.8%), followed by ACT (18,196 tweets, 17.7%). In English tweets, the main theme was professional therapy promotion (CBT: 29,383 tweets), and fear was the most prevalent emotion. In Spanish tweets, personal experiences were more common, particularly in ACT (2,528 tweets), while anger dominated tweets about PAT (2,825 tweets), linked to a lack of understanding. Joy emerged as the dominant emotion in Spanish tweets about ACT and NT. The volume of tweets increased notably from 2020 onwards, especially in English, coinciding with the COVID-19 pandemic. Conclusions: Clear linguistic differences shape the public discourse around psychotherapy. English tweets emphasise clinical utility and are marked by fear, whereas Spanish tweets focus on individual experiences, with emotions ranging from joy to frustration. These findings underscore the importance of culturally adapted mental health communication strategies on social media.