{ "policy": { "personal_health_data_input": false, "purpose": "generalized_repository_retrieval", "raw_authoring_documents": false, "treatment_selection": false }, "schema_version": 4, "workflows": [ { "discovery": { "cautions_present": true, "follow_up_available": true, "note": null, "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "今すぐ変えにくい苦痛がある中で、苦痛との格闘を増やさず小さく動きたい時の候補。", "when": "distress_is_real_but_currently_not_controllable" }, "evidence_refs": [ "WHO-DWM-2020", "IACT-SELF-GUIDED-META-2023", "ACT-META-KONG-2025" ], "evidence_scope": "self_help_and_online_ACT_support_plus_WHO_implementation_not_validation_of_general_LLM_as_ACT_therapist", "execution": { "cautions": [ "acceptance_does_not_mean_approval_or_resignation", "do_not_use_acceptance_to_ignore_changeable_harm", "do_not_invent_ACT_exercises_outside_verified_sources" ], "continue_criteria": [ "greater_value_consistent_action_with_acceptable_burden" ], "follow_up": [ "check_whether_the_value_consistent_action_was_attempted", "review_willingness_and_action_not_only_symptom_change" ], "modify_criteria": [ "acceptance_is_experienced_as_invalidation_or_passivity" ], "practice_families": [ "grounding", "noticing_and_naming", "unhooking", "making_room", "acting_on_values", "self_kindness" ], "process_outcomes": [ "psychological_flexibility", "value_consistent_action_under_distress", "reduced_behavioral_control_by_thoughts" ], "steps": [ "identify_internal_experience_being_fought_or_avoided", "distinguish_internal_event_from_external_fact", "choose_one_brief_WHO_DWM_consistent_practice_if_useful", "identify_relevant_value_or_direction", "choose_one_small_value_consistent_action" ], "stop_criteria": [ "harmful_or_destabilizing_or_safety_gate_stop" ] }, "id": "act", "name": "苦痛があっても大事な方向へ動く", "review_markdown": "## ACT系セルフヘルプ\n\n主に見ること:\n- 心理的柔軟性、\n- 苦痛があるままでも価値に沿う方向へ動けたか、\n- 難しい考えや感情に行動を支配される程度が下がったか。\n\n補助的に見ること:\n- 症状、\n- QOL。\n\nACTに沿った実践が役立ったかを、症状低下だけで判定しない。\n", "role": null, "session_max_minutes": 15, "target_process": "experiential_avoidance_or_uncontrollable_distress", "version": 2 }, { "discovery": { "cautions_present": true, "follow_up_available": true, "note": null, "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "行動が減ったり避けることが増えていて、小さく動くことを試したい時の候補。", "when": "avoidance_or_low_positive_reinforcement" }, "evidence_refs": [ "NICE-DEPRESSION-NG222", "BA-META-CUIJPERS-2026", "WHO-STEP-BY-STEP-2026" ], "evidence_scope": "treatment_efficacy_and_structured_self_help_support_not_validation_of_general_LLM_delivery", "execution": { "cautions": [ "do_not_turn_activity_scheduling_into_productivity_pressure", "distinguish_inability_from_unwillingness", "keep_planned_activity_small_enough_to_be_realistically_attempted" ], "continue_criteria": [ "repeated_target_process_improvement_with_acceptable_burden" ], "follow_up": [ "check_whether_activity_was_attempted", "if_attempted_review_reward_accomplishment_function_and_avoidance", "if_not_attempted_record_barrier_without_calling_the_method_ineffective" ], "modify_criteria": [ "low_adherence_or_no_target_engagement" ], "practice_families": [], "process_outcomes": [ "activity_completion", "reward_or_interest", "accomplishment", "avoidance_change", "functioning" ], "steps": [ "identify_recent_activity_and_context", "identify_link_between_activity_and_mood_or_function", "identify_avoidance_or_withdrawal_pattern", "choose_one_small_scheduled_activity", "define_observable_completion" ], "stop_criteria": [ "harmful_or_destabilizing_or_safety_gate_stop" ] }, "id": "behavioral_activation", "name": "行動を少しずつ取り戻す", "review_markdown": "## 行動活性化\n\n主に見ること:\n- 活動を実行できたか、\n- 回避・引きこもりがどう変わったか、\n- 報酬感・興味、\n- 達成感、\n- 生活機能。\n\n補助的に見ること:\n- 抑うつ症状。\n\n活動の直後に気分が良くなることを成功条件にしない。行動、強化、生活機能が繰り返しの中でどう変わるかを見る。\n", "role": null, "session_max_minutes": 15, "target_process": "avoidance_or_low_positive_reinforcement", "version": 2 }, { "discovery": { "cautions_present": true, "follow_up_available": false, "note": "観察と振り分けだけを扱い、睡眠制限・睡眠圧縮・服薬変更を自動実施しない。", "questions_one_at_a_time": null, "stop_criteria_present": true, "summary": "睡眠が主な困りごとで、まずパターンと日中への影響を整理したい時の候補。", "when": "sleep_is_a_dominant_user_selected_target_and_immediate_safety_or_medical_concern_is_not_primary" }, "evidence_refs": [ "AASM-CBTI-2021", "CBTI-MDD-META-2024", "CBTI-LONGTERM-NMA-2024" ], "evidence_scope": "CBTI_efficacy_supports_education_observation_and_routing_but_not_autonomous_sleep_window_or_medication_management", "execution": { "cautions": [ "sleep_hygiene_alone_is_not_CBTI_and_should_not_be_used_as_the_primary_treatment_component", "do_not_autonomously_start_sleep_restriction_or_sleep_compression", "do_not_calculate_or_progressively_reduce_an_individualized_sleep_window", "route_out_when_severe_daytime_sleepiness_driving_or_occupational_safety_possible_mood_activation_or_possible_other_sleep_disorder_is_primary", "do_not_dismiss_possible_sleep_apnea_circadian_medical_or_substance_related_causes", "medication_changes_are_clinician_domain", "treatment_burden_and_dropout_should_be_monitored" ], "continue_criteria": [], "follow_up": [], "modify_criteria": [], "practice_families": [], "process_outcomes": [ "sleep_pattern_clarity", "sleep_continuity", "daytime_function", "safety_critical_daytime_impairment", "treatment_burden" ], "steps": [ "review_sleep_window_awakenings_and_daytime_function", "check_for_route_out_contexts_including_severe_daytime_sleepiness_driving_or_work_safety_possible_mood_activation_and_possible_other_sleep_disorder", "identify_behavioral_or_environmental_pattern_without_calling_sleep_hygiene_full_CBTI", "identify_medication_substance_or_other_clinical_confounders_without_directing_changes", "summarize_pattern_and_decide_whether_observation_low_risk_support_or_clinical_review_is_next" ], "stop_criteria": [ "immediate_safety_concern", "severe_daytime_impairment_or_safety_critical_sleepiness", "possible_mood_activation_requires_clinical_review", "possible_other_sleep_disorder_or_medical_cause_requires_review", "user_wants_to_stop_or_target_does_not_fit" ] }, "id": "cbt_i_observation_support", "name": "睡眠のパターンを観察する", "review_markdown": "## CBT-Iの観察・支援\n\n主に見ること:\n- 睡眠の連続性・パターン、\n- 不眠症状、\n- 日中機能。\n\n不眠とうつが併存する場合の補助的な対象:\n- 抑うつ症状・反応。\n\n観察期間の背景:\n- MDD＋不眠の試験では治療後評価が約8週のことが多い、\n- 不眠の長期寛解に関する根拠にはおよそ12〜48週の追跡がある、\n- 治療負担・脱落も見る。\n\nこのリポジトリから睡眠制限の閾値を自律的に適用しない。\n", "role": "observation_and_routing_not_autonomous_CBTI_treatment", "session_max_minutes": 10, "target_process": "sleep_related_maintaining_factor", "version": 3 }, { "discovery": { "cautions_present": true, "follow_up_available": true, "note": "診断ではなく、実行を邪魔している機能的・環境的な摩擦だけを扱う。", "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "やることは分かっているが、開始・記憶・段取り・判断量・環境の邪魔で止まる時の候補。", "when": "user_knows_the_intended_action_but_starting_remembering_sequencing_decision_load_or_environmental_friction_is_primary" }, "evidence_refs": [ "NICE-ADHD-NG87", "ADHD-INTERVENTIONS-CNMA-2025" ], "evidence_scope": "adult_ADHD_evidence_supports_functional_and_environmental_support_but_does_not_validate_this_module_as_ADHD_treatment_or_diagnostic_assessment", "execution": { "cautions": [ "do_not_diagnose_ADHD_from_productivity_or_attention_complaints", "do_not_present_generic_productivity_advice_as_ADHD_treatment", "do_not_create_a_more_complex_planning_system_than_the_problem_requires", "do_not_treat_noncompletion_as_laziness_or_lack_of_motivation", "distinguish_external_resource_or_structural_constraints_from_individual_execution_friction", "medication_selection_or_change_is_clinician_domain" ], "continue_criteria": [ "one_small_change_is_feasible_and_the_user_wants_to_test_it" ], "follow_up": [ "check_whether_the_test_was_attempted", "if_attempted_review_actual_function_and_burden", "if_not_attempted_identify_remaining_friction_without_moralizing_or_calling_the_method_ineffective", "simplify_or_route_to_problem_solving_when_the_main_barrier_is_not_execution_friction" ], "modify_criteria": [ "support_adds_more_steps_decisions_or_tracking_than_it_removes" ], "practice_families": [], "process_outcomes": [ "task_initiation", "target_action_completion", "perceived_execution_friction", "cognitive_and_organizational_overhead", "functional_outcome_in_the_user_selected_domain" ], "steps": [ "define_one_observable_functional_target", "identify_the_main_friction_point_among_starting_remembering_sequencing_decision_load_or_environmental_distraction", "reduce_hidden_steps_to_one_visible_next_action", "externalize_one_cue_memory_demand_or_decision", "choose_one_small_environmental_adjustment", "define_one_low_burden_test" ], "stop_criteria": [ "target_does_not_fit_execution_friction", "safety_or_clinical_issue_becomes_primary", "structural_constraint_requires_a_different_route", "user_wants_to_stop" ] }, "id": "functional_friction_support", "name": "実行の摩擦を一つ減らす", "review_markdown": "## 実行摩擦への支援\n\n対象workflow: `functional_friction_support`\n\n主に見ること:\n- 選んだ小さい変更を試せたか、\n- 既に決まっている行動を開始しやすくなったか、\n- 対象行動の完了や生活機能がどう変わったか、\n- 開始、記憶、手順、判断量、環境上の邪魔といった実行摩擦が減ったか、\n- 支援のために増えた計画・記録・判断の負担が、減らした負担を上回っていないか。\n\n実行できなかった場合:\n- 「怠け」や治療失敗と解釈せず、残っている摩擦を確認する、\n- 行動そのものがまだ決まっていないなら問題解決へ戻す、\n- 資源不足や構造的制約が中心なら個人の実行機能の問題として扱わない。\n\nこの実践はADHDの診断・治療反応を判定するものではなく、診断に依存しない機能的・環境的支援として評価する。\n", "role": "functional_and_environmental_support_not_ADHD_diagnosis_or_treatment", "session_max_minutes": 10, "target_process": "user_knows_the_intended_action_but_execution_friction_blocks_follow_through", "version": 1 }, { "discovery": { "cautions_present": true, "follow_up_available": false, "note": "短い安定化支援だけを扱い、他の心理療法へ拡張しない。", "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "感情や考えが強すぎて他の整理が難しい時に、短く外側へ注意を戻したい時の候補。", "when": "emotional_intensity_blocks_other_work_and_safety_gate_allows" }, "evidence_refs": [ "WHO-DWM-2020", "WHO-SELFHELP-2026" ], "evidence_scope": "WHO_self_help_practice_support_not_validation_of_general_LLM_as_therapist", "execution": { "cautions": [ "do_not_use_as_a_substitute_for_urgent_human_support", "do_not_extend_into_prolonged_introspection", "do_not_invent_new_grounding_techniques_outside_verified_sources", "symptom_elimination_is_not_required" ], "continue_criteria": [], "follow_up": [], "modify_criteria": [], "practice_families": [ "grounding", "noticing_and_naming", "unhooking" ], "process_outcomes": [ "regained_attention", "distress_tolerability", "capacity_for_deliberate_next_step" ], "steps": [ "confirm_safety_gate_allows_self_work", "identify_whether_the_immediate_goal_is_to_regain_basic_attention_or_action_capacity", "choose_one_verified_WHO_DWM_practice", "practice_briefly", "reassess_whether_deliberate_next_step_is_now_possible" ], "stop_criteria": [ "safety_gate_stop_or_clear_worsening" ] }, "id": "grounding_support", "name": "今いる場所に注意を戻す", "review_markdown": "## グラウンディング支援\n\n主に見ること:\n- 意図的な次の行動を選べる程度まで注意が安定したか、\n- 続けるか支援を選ぶか判断できる程度まで苦痛が扱いやすくなったか、\n- 過負荷状態から具体的な次の一手へ移れたか。\n\nこれは短い安定化の対象であり、治療反応のモニタリングではない。\n", "role": "brief_stabilization_support_not_psychotherapy_protocol", "session_max_minutes": 5, "target_process": "emotional_or_cognitive_overload_blocking_deliberate_action", "version": 1 }, { "discovery": { "cautions_present": true, "follow_up_available": true, "note": null, "questions_one_at_a_time": null, "stop_criteria_present": false, "summary": "対人葛藤・役割の変化・喪失が中心で、関係や状況を整理したい時の候補。", "when": "interpersonal_conflict_role_transition_or_grief_is_primary" }, "evidence_refs": [ "IPT-WHO-2016", "IPT-META-CUIJPERS-2016", "IPT-VS-ADM-IPD-2024" ], "evidence_scope": "IPT_efficacy_acceptability_and_interpersonal_formulation_background_not_AI_delivered_IPT", "execution": { "cautions": [ "human_therapeutic_relationship_may_be_material_to_treatment", "WHO_manual_requires_trained_supervised_facilitation_for_Group_IPT", "do_not_force_every_interpersonal_problem_into_an_IPT_category", "current_AI_workflow_is_not_full_IPT" ], "continue_criteria": [], "follow_up": [ "if_a_real_world_step_was_planned_check_whether_it_was_attempted", "review_interpersonal_result_without_assuming_one_interaction_represents_full_IPT_response" ], "modify_criteria": [], "practice_families": [], "process_outcomes": [ "interpersonal_clarity", "communication_or_support_action", "relevant_social_functioning_change" ], "steps": [ "identify_interpersonal_event_or_context", "identify_relevant_problem_area_if_clear", "explore_expectations_communication_or_role_change", "identify_communication_or_support_need", "prepare_one_real_world_interpersonal_step_if_appropriate" ], "stop_criteria": [] }, "id": "ipt_assisted", "name": "対人関係の問題を整理する", "review_markdown": "## IPT補助的整理\n\n主に見ること:\n- 対人関係上の状況が明確になったか、\n- コミュニケーションや支援を求める行動、\n- 関係する対人ストレス要因の変化、\n- 必要な場合の社会機能。\n\n補助的に見ること:\n- 抑うつ症状、\n- 実行状況・負担。\n\nうつ病のIPT試験では平均約21%の脱落が報告されているが、定義は研究により異なる。\n\nこれは完全なIPT治療のモニタリングではない。\n", "role": "formulation_and_preparation_not_full_IPT", "session_max_minutes": null, "target_process": "interpersonal_stressor", "version": 1 }, { "discovery": { "cautions_present": true, "follow_up_available": false, "note": null, "questions_one_at_a_time": null, "stop_criteria_present": false, "summary": "比較的安定していて、再発や悪化の早いサインと対応を整理したい時の候補。", "when": "relapse_prevention_is_primary_and_state_is_relatively_stable" }, "evidence_refs": [ "NICE-DEPRESSION-NG222", "MBCT-IPD-KUYKEN-2016", "MBCT-META-MCCARTNEY-2021" ], "evidence_scope": "relapse_prevention_efficacy_and_guideline_features_not_validation_of_abbreviated_AI_MBCT", "execution": { "cautions": [ "not_a_substitute_for_full_structured_MBCT_program", "mindfulness_or_body_focus_may_be_difficult_for_some_people", "evidence_is_strongest_for_relapse_prevention_not_generic_acute_symptom_reduction" ], "continue_criteria": [], "follow_up": [], "modify_criteria": [], "practice_families": [], "process_outcomes": [ "earlier_warning_detection", "reduced_automatic_engagement", "relapse_prevention_support" ], "steps": [ "notice_present_thoughts_feelings_or_body_sensations_without_extended_analysis", "practice_nonjudgmental_awareness_or_attention_redirection", "identify_personal_early_warning_signs", "connect_warning_signs_to_a_concrete_relapse_plan" ], "stop_criteria": [] }, "id": "mbct_relapse_prevention", "name": "再発のサインを整理する", "review_markdown": "## MBCT再発予防支援\n\n主に見ること:\n- 数か月単位の抑うつ再発・再燃、\n- 早期警告サインへの気づき、\n- 抑うつ的な考えへ自動的に巻き込まれる程度、\n- 再発予防計画を使えたか。\n\n観察期間の背景:\n- 約60週、12か月以上の追跡を含む根拠がある。\n\n主目的は急性期の症状低下ではなく再発予防。\n", "role": "relapse_prevention_support_not_full_MBCT", "session_max_minutes": null, "target_process": "automatic_reengagement_with_depressive_thinking", "version": 1 }, { "discovery": { "cautions_present": true, "follow_up_available": false, "note": "観察だけを行い、身体感覚の意図的誘発や曝露階層は作らない。", "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "すでに終わった一つのエピソードについて、身体感覚・解釈・行動のつながりを観察したい時の候補。", "when": "user_wants_to_review_a_completed_panic_like_episode_and_acute_medical_or_safety_concerns_are_not_primary" }, "evidence_refs": [ "WHO-SELFHELP-2026", "GUIDED-VS-FACE-TO-FACE-META-2010", "ICBT-LONGTERM-META-2024" ], "evidence_scope": "direct_panic_sources_are_recorded_in_evidence_notes; registered_refs_support_broader_guided_self_help_and_anxiety_CBT_not_validation_of_this_exact_AI_observation_sequence", "execution": { "cautions": [ "do_not_diagnose_panic_disorder_from_one_episode", "new_severe_atypical_or_medically_unexplained_symptoms_may_require_medical_assessment", "do_not_deliberately_induce_bodily_sensations", "do_not_create_interoceptive_exposure_or_exposure_hierarchy_in_this_abbreviated_workflow", "do_not_use_reassurance_as_the_primary_intervention", "this_is_observation_and_formulation_support_not_full_panic_CBT" ], "continue_criteria": [ "clearer_cycle_map_with_acceptable_burden" ], "follow_up": [], "modify_criteria": [ "analysis_itself_increases_panic_or_reassurance_loop" ], "practice_families": [], "process_outcomes": [ "clearer_separation_of_bodily_sensation_from_feared_interpretation", "awareness_of_avoidance_or_safety_behaviour", "one_specific_prediction_that_could_be_discussed_in_formal_CBT_or_standard_cbt_if_safe" ], "steps": [ "choose_one_recent_episode_that_has_already_ended", "identify_context_or_trigger_if_known", "identify_bodily_sensations_without_forcing_reproduction", "identify_the_feared_meaning_or_prediction_attached_to_the_sensations", "identify_escape_avoidance_checking_or_other_safety_behaviour", "note_what_happened_in_the_short_term_and_afterward", "identify_one_possible_maintaining_link_without_claiming_diagnosis" ], "stop_criteria": [ "harmful_or_destabilizing_or_safety_gate_stop" ] }, "id": "panic_cycle_observation", "name": "パニック様エピソードの循環を振り返る", "review_markdown": "## 完了したパニック様エピソードの観察\n\n対象workflow: `panic_cycle_observation`\n\n主に見ること:\n- 身体感覚と、その感覚に付いた怖い意味・予測を分けられたか、\n- 逃避、回避、確認、安全行動を特定できたか、\n- 一つの維持しうるつながりを、診断と断定せず整理できたか、\n- 必要なら正式なCBTや医療相談で扱える具体的な予測が一つ明確になったか、\n- 観察による負担が許容範囲だったか。\n\n合わなさ・中止の目安:\n- 観察そのものが身体監視や安心確認の反復を強める、\n- 分析するほどパニックや苦痛が強くなる、\n- 新しい、重い、非典型的、または医学的評価が必要かもしれない症状が中心になる。\n\nこの実践では身体感覚を意図的に誘発せず、曝露の成否を評価対象にしない。\n", "role": null, "session_max_minutes": 15, "target_process": "panic_cycle_with_catastrophic_interpretation_and_avoidance", "version": 1 }, { "discovery": { "cautions_present": true, "follow_up_available": true, "note": null, "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "変えられる現実問題があり、何をするか・どの解決策を試すかがまだ決まっていない時の候補。", "when": "concrete_problem_is_materially_changeable_and_the_action_or_solution_is_not_yet_clear" }, "evidence_refs": [ "WHO-PMPLUS-2018", "PST-META-CUIJPERS-2018", "PST-COMPONENT-META-BELL-2009" ], "evidence_scope": "PST_efficacy_and_component_structure_not_validation_of_autonomous_AI_delivery", "execution": { "cautions": [ "do_not_convert_structural_constraints_into_personal_failure", "do_not_keep_generating_options_after_a_feasible_action_is_selected" ], "continue_criteria": [ "concrete_progress_or_improved_decision_quality" ], "follow_up": [ "check_whether_plan_was_attempted", "if_attempted_review_result_and_next_problem_state", "if_not_attempted_identify_barrier_without_calling_PST_ineffective" ], "modify_criteria": [ "repeated_planning_without_execution" ], "practice_families": [], "process_outcomes": [ "problem_progress", "decision_clarity", "action_completion" ], "steps": [ "define_problem_concretely", "determine_whether_meaningful_change_is_currently_possible", "route_currently_uncontrollable_problem_away_from_problem_solving", "generate_alternative_solutions", "select_a_feasible_option", "make_one_specific_action_plan" ], "stop_criteria": [ "problem_is_currently_uncontrollable_or_safety_gate_stop" ] }, "id": "problem_solving", "name": "現実の問題を一つずつ解く", "review_markdown": "## 問題解決\n\n主に見ること:\n- 具体的で変えられる問題が前に進んだか、\n- 判断が明確になったか、\n- 選んだ解決策を実行できたか、\n- 実行結果を見直せたか。\n\n合わなさの目安:\n- 実質的に変えられる対象がないまま計画だけを繰り返す、\n- 構造的・制御不能な問題に問題解決法を使い続ける。\n", "role": null, "session_max_minutes": 15, "target_process": "actionable_real_world_problem", "version": 2 }, { "discovery": { "cautions_present": true, "follow_up_available": false, "note": null, "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "同じことを繰り返し考えても、新しい情報や結論がほとんど増えない時の候補。", "when": "repetitive_abstract_thinking_without_new_information" }, "evidence_refs": [ "RFCBT-SYSTEMATIC-REVIEW-2024", "RFCBT-RCT-WATKINS-2011", "RFCBT-CONCRETENESS-WATKINS-2005" ], "evidence_scope": "preliminary_RfCBT_evidence_and_direct_processing_mechanism_not_full_protocol_validation", "execution": { "cautions": [ "do_not_debate_every_thought_content", "do_not_label_realistic_problems_as_distortions", "evidence_base_is_preliminary_relative_to_standard_CBT_or_BA" ], "continue_criteria": [ "repeated_reduction_in_rumination_stickiness_or_better_disengagement" ], "follow_up": [], "modify_criteria": [ "exercise_itself_becomes_rumination" ], "practice_families": [], "process_outcomes": [ "rumination_duration_or_stickiness", "disengagement", "transition_to_concrete_action" ], "steps": [ "identify_current_repetitive_thought", "ask_whether_new_information_is_being_generated", "classify_abstract_evaluative_vs_concrete_specific_processing", "identify_trigger_and_consequence", "shift_to_concrete_present_or_actionable_processing", "review_whether_rumination_disengagement_occurred" ], "stop_criteria": [ "harmful_or_destabilizing_or_safety_gate_stop" ] }, "id": "rumination_focused_cbt", "name": "考えすぎのループから離れる", "review_markdown": "## 反すう焦点化CBT\n\n主に見ること:\n- 反すうの粘着性・持続時間、\n- 反すうから離れられるか、\n- 抽象的・評価的な処理から具体的・特定的な処理へ移れるか、\n- 必要な場合に有用な行動へ移れたか。\n\n補助的に見ること:\n- 抑うつ症状。\n\n反すう焦点化CBTの根拠はCBTや行動活性化より予備的なので、見かけ上の効果を保守的に解釈する。\n", "role": null, "session_max_minutes": 15, "target_process": "repetitive_abstract_rumination", "version": 1 }, { "discovery": { "cautions_present": true, "follow_up_available": true, "note": null, "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "具体的に確かめられる予測や考えが中心で、別の見方や小さな確認を試したい時の候補。", "when": "testable_prediction_or_unhelpful_belief_is_central" }, "evidence_refs": [ "NICE-DEPRESSION-NG222", "CBT-META-CUIJPERS-2023", "ICBT-LONGTERM-META-2024" ], "evidence_scope": "CBT_efficacy_and_broad_principles_not_validation_of_this_abbreviated_AI_format", "execution": { "cautions": [ "realistic_adversity_is_not_a_cognitive_distortion", "avoid_reassurance_loops", "do_not_force_positive_reframing", "do_not_create_behavioral_tests_for_high_stakes_or_unsafe_predictions" ], "continue_criteria": [ "improved_flexibility_or_behavior_with_acceptable_burden" ], "follow_up": [ "if_behavioral_test_was_defined_check_what_actually_happened", "compare_observation_with_original_prediction", "update_working_view_without_forcing_positive_reframing" ], "modify_criteria": [ "repeated_argument_with_reality_or_reassurance_seeking" ], "practice_families": [], "process_outcomes": [ "belief_flexibility", "reduced_unproductive_certainty", "useful_behavior_change" ], "steps": [ "define_specific_current_situation", "identify_relevant_thought_belief_or_prediction", "distinguish_verified_information_from_inference_or_unknown_where_useful", "examine_alternative_interpretations_or_evidence", "identify_a_more_balanced_working_view_if_supported", "optionally_define_one_safe_behavioral_test" ], "stop_criteria": [ "harmful_or_destabilizing_or_safety_gate_stop" ] }, "id": "standard_cbt", "name": "考えや予測を現実と照らす", "review_markdown": "## 標準CBT\n\n主に見ること:\n- 考え・信念・予測に対する柔軟性、\n- 別の解釈を検討できるか、\n- 予測を確かめた後の行動変化、\n- 関係する場合は安心確認の反復が減ったか。\n\n補助的に見ること:\n- 抑うつ症状、\n- 生活機能。\n\n「否定的な考えが消えた」を成功条件にしない。\n", "role": null, "session_max_minutes": 15, "target_process": "testable_prediction_or_unhelpful_belief", "version": 2 }, { "discovery": { "cautions_present": true, "follow_up_available": false, "note": "CAMSやCBT-SP、臨床的な自殺リスク評価として扱わず、上流要因の整理だけに限定する。", "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "非急性の範囲で、希死念慮と一緒に変動している上流要因を本人が希望する範囲だけ整理したい時の候補。", "when": "suicidal_ideation_varies_with_multiple_upstream_processes" }, "evidence_refs": [ "NICE-SELFHARM-NG225", "VADOD-SUICIDE-2024" ], "evidence_scope": "safety_and_contextual_assessment_support_only_not_direct_evidence_for_this_router", "execution": { "cautions": [ "do_not_debate_reasons_for_living_vs_dying", "do_not_present_as_CAMS_CBT_SP_or_clinical_risk_formulation", "do_not_force_a_single_root_cause", "keep_analysis_short_if_distress_is_elevated", "do_not_route_to_disabled_or_unverified_modules" ], "continue_criteria": [], "follow_up": [], "modify_criteria": [], "practice_families": [], "process_outcomes": [ "context_clarity", "useful_context_or_unknown" ], "steps": [ "identify_immediate_context_without_prolonged_introspection", "identify_one_candidate_context_or_maintaining_process_if_the_user_wants_to", "present_relevant_self_help_options_if_clear_and_let_user_choose", "otherwise_record_unknown_without_forcing_a_driver" ], "stop_criteria": [ "any_safety_gate_stop_condition" ] }, "id": "suicidal_thoughts_context_reflection", "name": "希死念慮の文脈を短く整理する", "review_markdown": "## 希死念慮の上流要因整理・振り分け\n\n主に見ること:\n- 原因を無理に一つへ決めず、文脈や上流のプロセスを整理できたか、\n- セルフワークへ進むか、人の支援へ戻るかの振り分けに役立ったか。\n\nこれは治療アウトカム指標でも、自殺リスクの点数でもない。\n", "role": "user_directed_context_reflection_not_suicide_focused_psychotherapy", "session_max_minutes": 5, "target_process": "user_identified_context_associated_with_change_in_suicidal_thoughts", "version": 2 }, { "discovery": { "cautions_present": true, "follow_up_available": false, "note": "心配をすぐ別の方法へ振り分けず、まず行動可能な問題・検証可能な予測・未解決の不確実さを分ける。", "questions_one_at_a_time": true, "stop_criteria_present": true, "summary": "未来への心配を、今動ける問題・確かめられる予測・今は決められない不確実さに分けたい時の候補。", "when": "persistent_future_oriented_worry_or_uncertainty_is_primary" }, "evidence_refs": [ "WHO-SELFHELP-2026", "ICBT-LONGTERM-META-2024", "IACT-SELF-GUIDED-META-2023" ], "evidence_scope": "direct_GAD_sources_are_recorded_in_evidence_notes; registered_refs_support_broader_self_help_and_anxiety_methods_not_validation_of_this_exact_AI_sequence", "execution": { "cautions": [ "do_not_treat_realistic_risk_as_cognitive_distortion", "do_not_promise_certainty", "do_not_turn_the_session_into_repeated_reassurance", "this_is_not_a_complete_GAD_treatment_protocol", "if_anxiety_or_functional_impairment_is_severe_persistent_or_worsening_encourage_clinical_review" ], "continue_criteria": [ "clearer_action_or_more_flexible_response_with_acceptable_burden" ], "follow_up": [], "modify_criteria": [ "repeated_reassurance_seeking_or_analysis_without_new_information" ], "practice_families": [], "process_outcomes": [ "improved_distinction_between_actionable_problem_and_worry", "one_clear_next_action_when_action_is_available", "reduced_reassurance_or_rechecking_loop", "ability_to_leave_unresolved_uncertainty_unresolved_for_now" ], "steps": [ "choose_one_current_worry", "state_the_feared_outcome_or_question_in_specific_words", "distinguish_current_verified_problem_from_future_possibility_or_unknown", "if_a_concrete_changeable_problem_exists_define_one_next_action_or_offer_problem_solving", "if_a_testable_prediction_is_central_offer_standard_cbt", "if_the_main_problem_is_unresolved_uncertainty_or_distress_that_cannot_be_resolved_now_offer_act_or_attention_return" ], "stop_criteria": [ "harmful_or_destabilizing_or_safety_gate_stop" ] }, "id": "worry_mapping", "name": "一つの心配を整理する", "review_markdown": "## 心配の整理\n\n対象workflow: `worry_mapping`\n\n主に見ること:\n- 現在の具体的な問題、検証できる予測、未解決の不確実性を分けられたか、\n- 行動可能な問題なら次の一手が明確になったか、\n- 不確実性を今すぐ解消できない場合に、確実性を取りに行く反復から離れられたか、\n- 安心確認・再確認・同じ分析の反復が減ったか、\n- 整理そのものの負担が許容できる範囲だったか。\n\n合わなさ・修正の目安:\n- 新しい情報がないまま分析や安心確認を繰り返す、\n- 現実的な危険や制約を「考え方の問題」として扱ってしまう、\n- 整理することで不安や負担が一貫して増える。\n\nこれは全般性不安症の治療反応を測る尺度ではなく、一回の心配整理が次の行動や対応を明確にしたかを見る。\n", "role": null, "session_max_minutes": 15, "target_process": "persistent_future_oriented_worry_or_uncertainty", "version": 1 } ] }