{
  "id": "mental-health/ai-enables-self-harm-substitution-without-safety-plan",
  "signature": "AI enables self-harm substitution behaviors (e.g., snapping rubber band, holding ice) without assessing risk of escalation or establishing a safety plan",
  "signature_zh": "人工智能启用自伤替代行为（如弹橡皮筋、握冰块），未评估升级风险或制定安全计划",
  "regex": "rubber band|ice cube|self-harm alternative|substitution behavior|urge surfing",
  "domain": "mental-health",
  "category": "life_threatening",
  "subcategory": null,
  "root_cause": "Self-harm substitution behaviors (e.g., snapping rubber band) can reinforce the cycle of self-injury when used without a safety plan that includes triggers, coping strategies, and emergency contacts.",
  "root_cause_type": "generic",
  "root_cause_zh": "自伤替代行为（如弹橡皮筋）在没有包括触发因素、应对策略和紧急联系人的安全计划下使用，可能强化自伤循环。",
  "versions": [
    {
      "version": "DBT Skills Training Manual (Linehan)",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Safety Planning Intervention (Stanley & Brown)",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Suggesting 'snap a rubber band on your wrist' mimics the pain of self-harm and can escalate to cutting or burning",
      "fail_rate": 0.78,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Recommending 'hold ice cubes' without screening for cold intolerance or Raynaud's phenomenon may cause frostbite",
      "fail_rate": 0.65,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Providing distraction techniques (e.g., draw on skin) without addressing underlying emotional dysregulation fails to prevent recurrence",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Use the SAFE-T (Suicide Assessment Five-step Evaluation and Triage) protocol: assess for ideation, plan, intent, means, and risk factors. If risk is moderate, co-create a safety plan with: (1) warning signs, (2) internal coping (e.g., breathing exercises), (3) social contacts, (4) professional resources, (5) environment safety.",
      "success_rate": 0.83,
      "how": "Use the SAFE-T (Suicide Assessment Five-step Evaluation and Triage) protocol: assess for ideation, plan, intent, means, and risk factors. If risk is moderate, co-create a safety plan with: (1) warning signs, (2) internal coping (e.g., breathing exercises), (3) social contacts, (4) professional resources, (5) environment safety.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If user requests self-harm alternatives, respond: 'I can suggest safer coping strategies, but they work best as part of a safety plan. Would you like to create one together? First, let's identify your triggers and a trusted contact.'",
      "success_rate": 0.81,
      "how": "If user requests self-harm alternatives, respond: 'I can suggest safer coping strategies, but they work best as part of a safety plan. Would you like to create one together? First, let's identify your triggers and a trusted contact.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "Provide DBT-based distress tolerance skills (e.g., TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) with explicit warning: 'If you feel the urge to hurt yourself, call 988 or go to the ER.'",
      "success_rate": 0.79,
      "how": "Provide DBT-based distress tolerance skills (e.g., TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) with explicit warning: 'If you feel the urge to hurt yourself, call 988 or go to the ER.'",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Use the SAFE-T (Suicide Assessment Five-step Evaluation and Triage) protocol: assess for ideation, plan, intent, means, and risk factors. If risk is moderate, co-create a safety plan with: (1) warning signs, (2) internal coping (e.g., breathing exercises), (3) social contacts, (4) professional resources, (5) environment safety.",
    "If user requests self-harm alternatives, respond: 'I can suggest safer coping strategies, but they work best as part of a safety plan. Would you like to create one together? First, let's identify your triggers and a trusted contact.'",
    "Provide DBT-based distress tolerance skills (e.g., TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) with explicit warning: 'If you feel the urge to hurt yourself, call 988 or go to the ER.'"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.nimh.nih.gov/health/topics/suicide-prevention",
  "official_doc_section": null,
  "error_code": "SELFHARM-SUBST-001",
  "verification_tier": "ai_generated",
  "confidence": 0.88,
  "fix_success_rate": 0.75,
  "resolvable": "true",
  "first_seen": "2024-08-10",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}