Describe Me Something You Do Not Remember - Challenges and Risks of Exposure Design Using Generative Artificial Intelligence for Therapy of Complex Post-traumatic Disorder

TL;DR

The paper addresses the accessibility gap in exposure-based therapy for Complex PTSD (CPTSD) by proposing Generative AI (GAI)-based, individualized exposure visualizations that can be created in-session. It analyzes the potential benefits of GAI for tailoring memories, enabling patient participation, and reducing costs, while detailing CPTSD-specific risks such as intense recall, retraumatization, and memory distortion. A focus is placed on safety, ethics, and the need for therapist-in-the-loop control, transparency, and trauma-informed design to mitigate risks (R2, R4, R5, R6). The authors argue for an iterative, clinician-guided design process and Explainable AI to build trust, with guidelines co-developed with CPTSD patients, to improve access to effective trauma therapy. The work highlights the practical potential and substantial safety and regulatory considerations needed to translate GAI-based exposure visualization into real-world CPTSD treatment.

Abstract

Post-traumatic stress disorder (PTSD) is associated with sudden, uncontrollable, and intense flashbacks of traumatic memories. Trauma exposure psychotherapy has proven effective in reducing the severity of trauma-related symptoms. It involves controlled recall of traumatic memories to train coping mechanisms for flashbacks and enable autobiographical integration of distressing experiences. In particular, exposure to visualizations of these memories supports successful recall. Although this approach is effective for various trauma types, it remains available for only a few. This is due to the lack of cost-efficient solutions for creating individualized exposure visualizations. This issue is particularly relevant for the treatment of Complex PTSD (CPTSD), where traumatic memories are highly individual and generic visualizations do not meet therapeutic needs. Generative Artificial Intelligence (GAI) offers a flexible and cost-effective alternative. GAI enables the creation of individualized exposure visualizations during therapy and, for the first time, allows patients to actively participate in the visualization process. While GAI opens new therapeutic perspectives and may improve access to trauma therapy, especially for CPTSD, it also introduces significant challenges and risks. The extreme uncertainty and lack of control that define both CPTSD and GAI raise concerns about feasibility and safety. To support safe and effective three-way communication, it is essential to understand the roles of patient, system, and therapist in exposure visualization and how each can contribute to safety. This paper outlines perspectives, challenges, and risks associated with the use of GAI in trauma therapy, with a focus on CPTSD.