Perceive–Assess–Dose–Safeguard: a safety-gated state–action grammar for psychotherapy micro-decisions in computational psychiatry

Psychotherapy unfolds as a sequence of rapid micro-decisions under uncertainty. Within seconds, clinicians integrate verbal, paraverbal, embodied, and relational cues, estimate the patient’s momentary capacity for affective work, choose an intervention dose, and apply stop rules to prevent overwhelm and rupture. Computational psychiatry offers principled frameworks for sequential decision-making, but progress in computational psychotherapy remains constrained by the lack of clinically grounded, machine-readable grammars that capture therapist micro-decisions in context. I introduce the Perceive-Assess-Dose-Safeguard (PAD-S) decision matrix as a safety-gated state–action grammar for psychotherapy micro-decisions. PAD-S formalizes four “front-of-system” signals—defensive/avoidant organization (DEF), anxiety/arousal and tolerance (ANX), patient progression toward direct experience and action (PRO), and self-attack/shame processes (SUP)—together with three safety thresholds (A–C) that gate intervention dose. Each decision point can be logged as an “episode line” (trigger, state, threshold, action, and expected functional impact), enabling transcript annotation and structured datasets.