imaginal-exposure-safety-anchoring-protocol

# Imaginal Exposure Safety Anchoring Protocol A safety-critical micro-intervention where the therapist delivers two standardized verbal anchors—'It's just a memory' and 'You are safe here in the office'—during high-distress moments to prevent dissociation and reinforce present-moment orientation. ## Prompt When client SUDS ≥ 90 OR shows dissociative signs (blank stare, slowed speech, disorientation) OR begins narrating trauma in unguided present tense: deliver *both* anchors verbatim, calmly and firmly, without pausing for response; then immediately invite continuation ('keep going'). Do not paraphrase, omit either phrase, or delay delivery. ## Objective Prevent acute dissociation or panic during imaginal exposure by reinforcing reality testing and environmental safety at critical arousal thresholds. ## Applicable Signals - SUDS ≥ 90 - verbal or nonverbal dissociation cues - unprompted present-tense narration of trauma ## Contraindications - Client explicitly rejects grounding language or becomes visibly agitated by it - Client is in active flashback (e.g., loss of environmental awareness, motor freezing, perceptual distortion — requires physical grounding first) - Therapist has not yet established baseline rapport or explicit safety agreement for imaginal exposure ## Intervention Moves - Verbatim dual-anchor utterance - Immediate narrative re-engagement cue - 30-second reorientation check ## Workflow Steps - Assess real-time SUDS and observe for dissociative cues - If trigger met, state verbatim: 'Remember, it's just a memory. You are safe here in the office;' - Immediately follow with directive: 'keep going.' - Observe for reorientation (eye contact, verbal confirmation, environmental referencing) within 30 seconds - If no reorientation within 30 seconds, pause exposure and initiate physical grounding (e.g., 'Name three things you see in this room') ## Constraints - Anchors must be delivered verbatim — no synonyms, omissions, or reordering - Delivery must occur *before* client disengages or stops speaking - No more than one anchor pair per discrete dissociative surge; repeat only if re-dissociation occurs after initial reorientation ## Cautions - Do not use as substitute for full safety assessment or crisis intervention - Avoid anchoring if client has known trauma-related phobia of 'safety' language (e.g., history of betrayal in 'safe' environments) — screen during psychoeducation phase - Monitor for paradoxical arousal: if SUDS increases >10 points within 15 seconds of anchor, pause exposure and switch to somatic grounding ## Output Contract - Client demonstrates observable reorientation to present context (e.g., makes eye contact, names current date/location, responds verbally to therapist's next neutral question) within 30 seconds of anchor delivery. ## Example Therapist Responses ### Example 1 - Client/Input: Client pauses mid-narrative, gaze unfocused, whispering 'He’s still screaming...' (SUDS 95) - Therapist/Output: Therapist: 'Remember, it's just a memory. You are safe here in the office; keep going.' Client blinks rapidly, looks at therapist, says 'Okay... the horn was so loud.' - Notes: Reorientation observed at 12 seconds via eye contact and return to narrative. ### Example 2 - Client/Input: Client’s voice drops to monotone, head tilted slightly, no blink reflex (SUDS 100) - Therapist/Output: Therapist: 'Remember, it's just a memory. You are safe here in the office; keep going.' Client takes deep breath, nods, says 'Right — the truck hit the left door.' - Notes: Reorientation at 22 seconds via breath regulation and accurate spatial recall. ## Files - `references/evidence.md` - `references/evidence_manifest.json` ## Triggers - Client's SUDS rating ≥ 90 - Client exhibits dissociative signs (e.g., blank stare, slowed speech, disorientation) - Client spontaneously narrates traumatic memory in present tense without therapist prompting ## Examples ### Example 1 Input: Client pauses mid-narrative, gaze unfocused, whispering 'He’s still screaming...' (SUDS 95) Output: Therapist: 'Remember, it's just a memory. You are safe here in the office; keep going.' Client blinks rapidly, looks at therapist, says 'Okay... the horn was so loud.' Notes: Reorientation observed at 12 seconds via eye contact and return to narrative. ### Example 2 Input: Client’s voice drops to monotone, head tilted slightly, no blink reflex (SUDS 100) Output: Therapist: 'Remember, it's just a memory. You are safe here in the office; keep going.' Client takes deep breath, nods, says 'Right — the truck hit the left door.' Notes: Reorientation at 22 seconds via breath regulation and accurate spatial recall.