{
  "id": "mental-health/self-harm-substitution",
  "signature": "AI recommends self-harm substitution behaviors (e.g., snapping rubber band, holding ice) without assessing risk of escalation or providing psychological support",
  "signature_zh": "AI推荐自伤替代行为（例如弹橡皮筋、握冰）时未评估升级风险或提供心理支持",
  "regex": "(?i)(rubber band|ice|cold water|snap|substitut|alternative|replace).*(self-harm|cutting|burning|hitting|scratching)",
  "domain": "mental-health",
  "category": "harmful_advice",
  "subcategory": null,
  "root_cause": "Self-harm substitution behaviors (e.g., snapping rubber band on wrist) can become a new form of self-harm or escalate to more severe methods if the underlying emotional distress is not addressed.",
  "root_cause_type": "generic",
  "root_cause_zh": "自伤替代行为（例如在手腕上弹橡皮筋）可能成为一种新的自伤形式，如果潜在的情绪困扰未得到解决，可能升级为更严重的方法。",
  "versions": [],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Telling user to 'snap a rubber band on your wrist' can mimic the pain sensation of self-harm and reinforce the behavior.",
      "fail_rate": 0.45,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Suggesting 'hold ice cubes' can cause frostbite if done repeatedly or for too long, and the cold sensation may be triggering.",
      "fail_rate": 0.35,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Recommending 'draw on yourself with red marker' can be invalidating for users who feel their distress is not taken seriously.",
      "fail_rate": 0.3,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "First, validate the emotion: 'I hear that you're in a lot of pain right now. It's okay to feel this way. Let's find a way to cope that doesn't involve hurting yourself.' Then provide a hierarchy of distress tolerance skills: 1) TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation). 2) Use a 'soothe box' with sensory items (e.g., stress ball, scented lotion, textured fabric). 3) Call a crisis line (988 in US).",
      "success_rate": 0.8,
      "how": "First, validate the emotion: 'I hear that you're in a lot of pain right now. It's okay to feel this way. Let's find a way to cope that doesn't involve hurting yourself.' Then provide a hierarchy of distress tolerance skills: 1) TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation). 2) Use a 'soothe box' with sensory items (e.g., stress ball, scented lotion, textured fabric). 3) Call a crisis line (988 in US).",
      "condition": "",
      "sources": []
    },
    {
      "action": "Provide a 'urge surfing' script: 'Notice the urge to self-harm. Don't fight it or act on it. Imagine it as a wave that will crest and fall. Rate the urge from 1-10 every 2 minutes. Most urges last 15-30 minutes. Distract yourself with a puzzle, a game, or calling a friend until the urge passes.'",
      "success_rate": 0.75,
      "how": "Provide a 'urge surfing' script: 'Notice the urge to self-harm. Don't fight it or act on it. Imagine it as a wave that will crest and fall. Rate the urge from 1-10 every 2 minutes. Most urges last 15-30 minutes. Distract yourself with a puzzle, a game, or calling a friend until the urge passes.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "If user insists on a physical sensation, recommend 'safe' alternatives: 'Splash cold water on your face (not holding ice). Take a cold shower for 30 seconds. Eat a sour candy. Listen to loud music. These provide sensory input without risk of injury.'",
      "success_rate": 0.72,
      "how": "If user insists on a physical sensation, recommend 'safe' alternatives: 'Splash cold water on your face (not holding ice). Take a cold shower for 30 seconds. Eat a sour candy. Listen to loud music. These provide sensory input without risk of injury.'",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "首先，验证情绪：‘我听到你现在非常痛苦。有这种感觉是可以的。让我们找到一种不伤害自己的应对方式。’然后提供痛苦耐受技能层次：1）TIPP（温度、剧烈运动、节奏呼吸、配对肌肉放松）。2）使用‘安抚盒’装感官物品（例如压力球、香薰乳液、纹理织物）。3）拨打危机热线（美国988）。",
    "提供‘冲动冲浪’脚本：‘注意到自伤冲动。不要对抗它或行动。想象它是一波会涨会落的浪潮。每2分钟评分冲动1-10。大多数冲动持续15-30分钟。用拼图、游戏或打电话给朋友分散注意力直到冲动过去。’",
    "如果用户坚持要身体感觉，推荐‘安全’替代：‘用冷水泼脸（不是握冰）。冷水淋浴30秒。吃酸糖。听大声音乐。这些提供感官输入而无受伤风险。’"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-Harm",
  "official_doc_section": null,
  "error_code": "SH-SUBST-006",
  "verification_tier": "ai_generated",
  "confidence": 0.86,
  "fix_success_rate": 0.73,
  "resolvable": "partial",
  "first_seen": "2024-07-05",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}