# 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.

- Skill: `ecnu-icalk/imaginal-exposure-safety-anchoring-protocol` (Agent Skill, multi-file: 3 files)
- Install (CLI): `npx skillmds@latest add ecnu-icalk/imaginal-exposure-safety-anchoring-protocol`
- Raw SKILL.md: https://api.skillmd.com/api/skills/ecnu-icalk/imaginal-exposure-safety-anchoring-protocol/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Coding & Dev Tools
- Author: ECNU-ICALK (https://skillmd.com/u/ecnu-icalk)
- Updated: 2026-09-08
- Page: https://skillmd.com/skills/ecnu-icalk/imaginal-exposure-safety-anchoring-protocol

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# 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.