4 P's
Created by
Rebecca Thompson
Specialty
Behaviour Therapist
Last edited
10/20/2026
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0 times
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About this template
A structured template for behavior therapists to document client goals, presenting problems, the four categories of contributing factors, identified problems, treatment goals, case formulation, and interventions. It supports organized case conceptualization and treatment planning.
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Client Goals
Return to full-time work, improve sleep onset and maintenance, and reduce daily worry and panic episodes.
Presenting Problem/S
34yo female (MRN: 482-910-38) presenting with 3/12 hx of escalating generalised worry, initial insomnia, restlessness, and situational panic attacks (characterised by SOB, palpitations, and paraesthesia). Taken 2/52 stress leave from accounting role due to impaired concentration and fear of making errors. Commenced sertraline (Zoloft®) 50 mg PO OD via GP 10 days ago.
Predisposing Factors
FHx of maternal anxiety and depression. Premorbid perfectionistic traits, high need for control, and history of childhood emotional invalidation (high parental academic expectations).
Precipitating Factors
Corporate restructuring 4/12 ago resulting in a 40% increased workload, ambiguous role expectations, and an unsupportive new line manager.
Perpetuating Factors
Maladaptive coping strategies including excessive checking behaviours at work, avoidance of team meetings, and working unpaid overtime. Cognitive distortions (catastrophising, all-or-nothing thinking). Poor sleep hygiene (late-night screen use, 4–5 cups of coffee/day) and social withdrawal.
Protective Factors
Supportive husband, stable housing and finances, strong therapeutic alliance, good psychological insight, and regular adherence to prescribed pharmacotherapy.
Problem List
- Occupational burnout and workplace avoidance
- Autonomic hyperarousal and situational panic attacks
- Initial and middle insomnia
- Perfectionism and maladaptive checking behaviours
Treatment Goals
- Reduce frequency of panic attacks from 3x/week to 0x/week within 6 weeks.
- Establish consistent sleep routine to increase total sleep time from 5 hrs to 7 hrs/night.
- Develop and implement assertive communication strategies to negotiate workload boundaries with management prior to phased return to work on 24/11/2023.
Case Formulation
Client with premorbid perfectionism and biological vulnerability to anxiety (FHx), whose core beliefs regarding competence ("If I make a mistake, I am a failure") were activated by recent workplace restructuring and increased demands. This precipitated acute autonomic arousal and insomnia. Symptoms are currently maintained by a cycle of hypervigilance, safety behaviours (over-checking, working late), workplace avoidance (stress leave), and excessive caffeine intake, which prevent disconfirmation of catastrophic beliefs and exacerbate physiological exhaustion. Strong spousal support, high insight, and recent initiation of SSRI therapy serve as key protective factors to facilitate engagement in psychological intervention.
Treatment Mode/Interventions
Cognitive Behavioural Therapy (CBT) delivered fortnightly:
- Psychoeducation regarding the fight-or-flight response and cognitive model of anxiety.
- Somatic management: progressive muscle relaxation (PMR) and slow breathing retraining.
- Sleep hygiene education and stimulus control therapy.
- Cognitive restructuring targeting catastrophic thoughts and perfectionistic standards.
- Graded exposure and behavioural experiments (e.g., submitting low-stakes emails without re-reading).
How to use this template
This template can be used to assist with various tasks in the medical field. You can use it to generate notes, manage patient information, or assist with diagnosis and the Assessment and Plan. To use this template, simply click the “Use Template” button above. If you have any questions or need assistance, feel free to reach out to the support team or refer to the description and example output provided above.