{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:27:45Z","timestamp":1787027265619,"version":"build-2736575974"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"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>Psychotherapy unfolds as a sequence of rapid micro-decisions under uncertainty. Within seconds, clinicians integrate verbal, paraverbal, embodied, and relational cues, estimate the patient\u2019s 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\u2013action grammar for psychotherapy micro-decisions. PAD-S formalizes four \u201cfront-of-system\u201d signals\u2014defensive\/avoidant organization (DEF), anxiety\/arousal and tolerance (ANX), patient progression toward direct experience and action (PRO), and self-attack\/shame processes (SUP)\u2014together with three safety thresholds (A\u2013C) that gate intervention dose. Each decision point can be logged as an \u201cepisode line\u201d (trigger, state, threshold, action, and expected functional impact), enabling transcript annotation and structured datasets. PAD-S is grounded in experiential dynamic psychotherapy (EDT\/ISTDP) yet expressed as an orientation-translatable representation layer: DEF can be read as avoidance\/safety behavior, ANX as arousal\/tolerance, PRO as approach and value-consistent action, and SUP as self-criticism\/shame. I show how PAD-S trajectories can interface with hybrid neural\u2013cognitive models such as SPICE to discover sparse, interpretable equations of process change, and I outline testable hypotheses and feasible pilot studies (reliability, outcome linkage, and modeling) to evaluate the framework. computational psychiatry; computational psychotherapy; psychotherapy process coding; interpretable AI; human-in-the-loop; active inference; SPICE; Mini-ICF-APP<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1749364","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T14:12:22Z","timestamp":1773411142000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Perceive\u2013Assess\u2013Dose\u2013Safeguard: a safety-gated state\u2013action grammar for psychotherapy micro-decisions in computational psychiatry"],"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":[[2026,3,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00140","article-title":"Under the hood: using computational psychiatry to make psychological therapies more mechanism-focused","volume":"11","author":"Nair","year":"2020","journal-title":"Front Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1162\/CPSY_a_00014","article-title":"Computation in psychotherapy, or how computational psychiatry can aid learning-based psychological therapies","volume":"2","author":"Moutoussis","year":"2018","journal-title":"Comput Psychiatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1038\/s44271-025-00251-4","article-title":"Using computational models of learning to advance cognitive behavioral therapy","volume":"3","author":"Berwian","year":"2025","journal-title":"Commun Psychol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-psych-021621-124910","article-title":"Computational psychiatry needs time and context","volume":"73","author":"Hitchcock","year":"2022","journal-title":"Annu Rev Psychol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191912358","article-title":"Computational methods in psychotherapy: a scoping review","volume":"19","author":"Cioffi","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B6","doi-asserted-by":"crossref","DOI":"10.18653\/v1\/2025.findings-acl.385","article-title":"A survey of large language models in psychotherapy: current landscape and future directions","volume-title":"Findings of the Association for Computational Linguistics: ACL 2025","author":"Na","year":"2025"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.31234\/osf.io\/v86q5_v1","article-title":"Automated discovery of sparse and interpretable cognitive equations","author":"Weinhardt","year":"2025","journal-title":"PsyArXiv"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e2401238121","DOI":"10.1073\/pnas.2401238121","article-title":"Automating the practice of science: opportunities, challenges, and implications","volume":"122","author":"Musslick","year":"2025","journal-title":"Proc Natl Acad Sci U.S.A"},{"key":"B9","volume-title":"Reaching Through Resistance: Advanced Psychotherapy Techniques","author":"Abbass","year":"2015"},{"key":"B10","volume-title":"Healing Through Relating: A Skill-Building Book for Therapists","author":"Frederickson","year":"2023"},{"key":"B11","volume-title":"Clinical Thinking in Psychotherapy: What It Is, How It Works, and Why and How to Teach It","author":"Frederickson","year":"2025"},{"key":"B12","volume-title":"Treating Affect Phobia: A Manual for Short-Term Dynamic Psychotherapy","author":"McCullough","year":"2003"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1687372","DOI":"10.3389\/fpsyt.2026.1687372","article-title":"A transdiagnostic conflict square algorithm: a four node computational framework for psychotherapy and functional diagnosis","volume":"17","author":"Niederlohmann","year":"2026","journal-title":"Front. 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