imaginal-exposure-session-scaffold

id	123f9a9f-fb4d-50d0-8c16-5d58d2d38a43
name	Imaginal Exposure Session Scaffold
description	A structured session workflow for delivering imaginal exposure to trauma memories, including memory anchoring, sensory-emotional elaboration, and in-session habituation tracking.
version	0.1.0
tags	["PTSD","trauma","exposure","behaviorism","homework","exposure_therapy","SUDS","行为主义","profile:psychology::行为主义","axis:疗法","kind:parent"]
triggers	["Client has confirmed PTSD diagnosis","Client is stabilized and consented to exposure","Trauma memory is accessible and narratable","Client has confirmed PTSD diagnosis and coherent trauma memory","Client is emotionally regulated and has consented to exposure","Session time allows ≥45 minutes for exposure work"]
examples	[{"input":"Client begins hesitantly: 'It was loud... and then things fell.'","output":"Therapist responds: 'Let’s go back to the very first moment you knew something was wrong — where were you? What did you hear *right then*?'","notes":"Anchors to onset; invites sensory specificity without interpretation."},{"input":"Client states: 'I was scared.'","output":"Therapist responds: 'What was the fear like in your body just then? Where did you feel it? Was there a thought that came with it?'","notes":"Elaborates emotion somatically and cognitively, staying within exposure frame."},{"input":"Client reports SUDS 80 pre-exposure; narrates accident memory with visible distress; pauses at impact; SUDS peaks at 100.","output":"Therapist uses containment phrase, invites continuation, obtains SUDS 70 post-narration, then guides second repetition — SUDS drops to 40 by end.","notes":"Habituation evidenced by 60-point SUDS drop and reduced somatic reactivity."},{"input":"Client completes first narration (SUDS 90 → 60); expresses doubt about repeating.","output":"Therapist normalizes difficulty, affirms effort, collaboratively checks readiness — client agrees to try again; second repetition yields SUDS 60 → 30.","notes":"Success hinges on collaborative pacing, not pressure."}]

Imaginal Exposure Session Scaffold

A structured session workflow for delivering imaginal exposure to trauma memories, including memory anchoring, sensory-emotional elaboration, and in-session habituation tracking.

Prompt

Begin by anchoring the trauma memory at the earliest moment of awareness (e.g., 'when you first realized the earthquake was happening'). Prompt the client to narrate in present tense, specifying location, people present, visual/auditory/tactile sensations, physiological responses, thoughts, and emotions. After each retelling, invite deeper sensory and emotional detail to promote habituation and mastery. Record the final version for between-session listening.

Objective

Reduce PTSD-related anxiety through controlled, repeated trauma memory activation and processing

Applicable Signals

• Client avoids trauma narrative but tolerates brief mention
• Client reports intrusive memories or flashbacks
• Client expresses desire to 'get past' the memory
• Client reports vivid, intrusive trauma memory
• Client shows physiological arousal (e.g., sweating, tearfulness) during memory recall
• SUDS stabilizes or declines across repetitions

Contraindications

• Acute suicidality or dissociation present
• Client lacks distress tolerance skills
• No psychoeducation or rationale provided yet
• Client is actively suicidal or experiencing acute dissociation
• Client lacks a current safety plan or grounding skills
• SUDS remains ≥80 and rising despite containment support

Intervention Moves

• Anchor memory at onset of threat awareness
• Prompt multisensory and emotional detail iteratively
• Normalize distress as part of habituation process
• Record final narration with client consent for homework
• SUDS anchoring before/after each repetition
• Present-tense memory narration prompting
• Containment reframing ('It's a memory; you are safe now')
• Normalization and reinforcement after completion

Workflow Steps

• Confirm stabilization, informed consent, and shared rationale for imaginal exposure
• Anchor the trauma memory at the earliest point of threat awareness
• Guide client to narrate the event in present tense, covering context (where, who), sensory input (what seen/heard/felt), bodily sensations, thoughts, and emotions
• After initial narration, prompt progressively richer sensory and emotional detail across 2–3 retellings
• Observe and label habituation cues (e.g., reduced voice tremor, longer pauses, calmer breathing)