{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T19:05:30Z","timestamp":1783796730256,"version":"3.55.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Clinical services need more than categorical labels to guide safe dosing, maintain alliance, and plan functional recovery. The Conflict-Square Algorithm (CSA) offers a compact bedside grammar for moment-to-moment decisions during psychotherapy. Clinicians track four observable signals\u2014defense, anxiety\/affect tolerance, progression, and superego\/shame\u2014and gate intervention intensity by three safety thresholds (A\u2013C). Each clinically meaningful moment is summarized as one auditable episode line in plain language: trigger, observable response, threshold, action, and expected functional impact (Mini-ICF-APP). To strengthen reproducibility, we provide i) operational threshold definitions with observable markers and common misclassification errors, grounded in established anxiety-channel descriptions [striated muscle, smooth muscle, and cognitive-perceptual disruption (CPD)]; ii) a short scope and contraindication checklist; iii) several consecutive worked micro-episodes demonstrating node shifts, threshold transitions, and dose modulation over time; and iv) a minimal machine-readable schema plus a threshold-gating state diagram. As a proof-of-concept feasibility demonstration, we report aggregate coding statistics from three published psychotherapy training videos distributed by the ISTDP Institute (transcribed for analysis with written permission; N = 2,809 speaker turns) using a three-label therapist intervention mapping (invite progression\/defense work\/anxiety regulation) aligned with CSA nodes. CSA is presented as a teachable, testable decision framework\u2014not as a validated diagnostic instrument\u2014and we outline a pragmatic validation program (rater agreement, safety-rule adherence, usability, and functional outcomes) and future multimodal extensions (e.g., optional physiological monitoring for biofeedback and threshold detection).<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1687372","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T06:39:30Z","timestamp":1773643170000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["A transdiagnostic conflict-square algorithm: a four-node computational framework for psychotherapy and functional diagnosis"],"prefix":"10.3389","volume":"17","author":[{"given":"Eik","family":"Niederlohmann","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Kliniken Erlabrunn","place":["Breitenbrunn, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2013"},{"key":"B2","volume-title":"DSM-5 Section III: Assessment Measures and the Alternative Model for Personality Disorders","year":"2013"},{"key":"B3","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1186\/s12888-023-05186-w","article-title":"ICD-11 and mental disorders: Important changes, controversies, and future directions","volume":"23","author":"Seem\u00fcller","year":"2023","journal-title":"BMC Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2015.14101220","article-title":"The alternative DSM-5 model for personality disorders","volume":"172","author":"Skodol","year":"2015","journal-title":"Am J Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.2206","article-title":"Identification of a common neurobiological substrate for mental illness","volume":"72","author":"Goodkind","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"B6","article-title":"Self\u2011rating of capacity limitations in mental disorders: The \u201cMini\u2011ICF\u2011APP\u2011S\u201d. 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