Public perceptions and emotional trends of psychotherapy: a 15-year analysis across English and Spanish language communities on X (twitter).

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.