系统脱敏疗法操作流程

一个结构化的暴露-放松渐进式焦虑消退流程，用于帮助求助者逐步脱敏特定可分级的焦虑刺激源。

Prompt

1. Collaboratively construct an anxiety hierarchy (5–10 items) anchored to the client's specific trigger (e.g., initiating a text to a romantic interest, going on a first date). 2. Teach and rehearse progressive muscle relaxation or diaphragmatic breathing until client achieves reliable self-induction (≥3/5 mastery rating). 3. Begin imaginal exposure at the lowest hierarchy item while maintaining relaxed state; hold until SUDS drops ≥50% or reaches ≤2. 4. Repeat until habituation occurs (two consecutive trials with SUDS ≤1), then advance to next item. 5. Transition to in vivo exposure only after full imaginal habituation across all items. 6. Assign daily relaxation practice + hierarchy item rehearsal as between-session task.

Objective

reduce stimulus-bound anxiety through systematic desensitization

Applicable Signals

• client identifies discrete, repeatable anxiety-eliciting situations
• client demonstrates willingness to practice relaxation daily
• client reports anxiety is situationally bound rather than free-floating

Contraindications

• client has active panic disorder with unpredictable surges
• client lacks capacity to practice relaxation outside session

Intervention Moves

• hierarchy co-construction
• relaxation induction training
• imaginal exposure sequencing
• in vivo exposure progression
• SUDS monitoring

Workflow Steps

• Construct individualized anxiety hierarchy
• Teach and assess mastery of relaxation technique
• Conduct imaginal exposure starting from lowest hierarchy item
• Confirm habituation before advancing to next item
• Transition to in vivo exposure after full imaginal habituation
• Assign structured between-session practice

Constraints

• Must not skip hierarchy levels
• Relaxation must be maintained throughout exposure trial
• No advancement until SUDS ≤1 sustained across two trials

Cautions

• Avoid introducing new relaxation methods mid-hierarchy
• Do not proceed to in vivo without full imaginal habituation
• Monitor for avoidance disguised as 'relaxation' (e.g., dissociation)

Output Contract

• Client reports zero subjective units of distress (SUDS ≤ 1) across all hierarchy items during imaginal or in vivo exposure

Example Therapist Responses

Example 1

• Client/Input: Client identifies 'asking someone out' as SUDS=8/10 and learns diaphragmatic breathing
• Therapist/Output: Client achieves SUDS≤1 on 'imagining sending the message' after three relaxed exposures
• Notes: Habituation confirmed before moving to 'rehearsing the words aloud'

Example 2

• Client/Input: Client completes full imaginal hierarchy with SUDS≤1 on all items
• Therapist/Output: Client successfully attends a low-stakes group social event (in vivo level 3) with SUDS=1
• Notes: First in vivo trial conducted in-session with therapist support

Objective

消除特定刺激引发的条件性焦虑反应

Applicable Signals

• 求助者能清晰描述焦虑触发场景并排序强度
• 求助者在指导语下可完成5分钟渐进式肌肉放松且报告身体松弛感
• SUDS量表使用稳定（0–10分）

Contraindications

• 求助者当前处于急性危机或自杀风险状态
• 焦虑源不可具象化或无法分级
• 求助者拒绝暴露或放松练习

Intervention Moves

• hierarchy co-construction
• relaxation induction training
• imaginal exposure sequencing
• in vivo exposure progression
• SUDS monitoring

Workflow Steps

• 协同构建个体化焦虑等级表（含具体情境、感官细节、SUDS预估）
• 教学并练习深度肌肉放松（含呼吸同步、注意力锚定、放松反馈确认）
• 首次暴露：从最低级刺激开始，引导想象/实景接触+放松维持，记录SUDS变化与持续时间
• 阈值判定：SUDS ≤2且稳定维持≥30秒 → 升级；否则重复本级或微调刺激表述
• 逐级推进至最高级，全程记录各等级达标耗时与退阶次数
• 结束阶段：引导求助者复述‘我能在放松中面对X’的自我陈述，强化习得性控制感
• 在完全完成想象暴露所有等级后，过渡至结构化in vivo暴露

Constraints

• 必须在建立稳固咨访关系后启动
• 每次暴露需以放松为前提，禁止在紧张状态下强行暴露
• 单次咨询最多推进2个等级，避免疲劳性脱敏失败
• 必须不跳级，放松须全程维持，无 advancement until SUDS ≤1 sustained across two trials (imaginal or in vivo)

Cautions

• 警惕伪脱敏（表面平静但生理指标异常升高）
• 避免将等级表标准化，须由求助者自主生成并命名每一级刺激
• 若连续两次无法通过同一等级，需重新评估刺激定义或放松质量
• 避免引入新放松方法 mid-hierarchy
• 不得进入in vivo未完成全部imaginal habituation
• 监测回避伪装（如解离）

Output Contract

• 求助者在最高级别刺激下维持肌肉放松且无主观焦虑感（SUDS ≤ 1）

Example Therapist Responses

Example 1

• Client/Input: Client identifies 'asking someone out' as SUDS=8/10 and learns diaphragmatic breathing
• Therapist/Output: Client achieves SUDS≤1 on 'imagining sending the message' after three relaxed exposures
• Notes: Habituation confirmed before moving to 'rehearsing the words aloud'

Example 2

• Client/Input: Client completes full imaginal hierarchy with SUDS≤1 on all items
• Therapist/Output: Client successfully attends a low-stakes group social event (in vivo level 3) with SUDS=1
• Notes: First in vivo trial conducted in-session with therapist support

Files

• references/evidence.md

• references/evidence_manifest.json

Triggers

• 求助者存在可识别、可分级的焦虑刺激源
• 求助者已掌握基础放松技术
• 咨询目标聚焦于特定情境焦虑消退

Examples

Example 1

Input:

Client identifies 'asking someone out' as SUDS=8/10 and learns diaphragmatic breathing

Output:

Client achieves SUDS≤1 on 'imagining sending the message' after three relaxed exposures

Notes:

Habituation confirmed before moving to 'rehearsing the words aloud'

Example 2

Input:

Client completes full imaginal hierarchy with SUDS≤1 on all items

Output:

Client successfully attends a low-stakes group social event (in vivo level 3) with SUDS=1

Notes:

First in vivo trial conducted in-session with therapist support