BIRP

Behavior

• Pt arrived on time, casually dressed, good hygiene. Mood reported as "anxious," affect constricted and congruent. Displayed psychomotor agitation (leg bouncing, wringing hands).
• Increased restlessness and avoidance of eye contact compared to previous session 2 weeks ago.
• Reported two acute panic episodes over the past week triggered by workplace deadlines, accompanied by palpitations and SOB; denied SI/HI.

Intervention

• Utilized CBT framework to explore triggers for recent panic attacks and provided supportive psychotherapy.
• Conducted cognitive restructuring to challenge catastrophic thinking regarding job performance, alongside in-session 4-7-8 diaphragmatic breathing exercises.
• Discussed current regimen; increased sertraline (Zoloft®) to 100 mg PO daily for baseline anxiety and reviewed PRN use of propranolol (Inderal®) 10 mg PO TID PRN for acute somatic symptoms.

Response

• Receptive to CBT techniques and engaged actively in identifying cognitive distortions. Agreed to medication titration after discussing potential SEs.
• Verbalized relief ("I feel like I have a tool to use now"). Non-verbally, posture relaxed and leg bouncing ceased following the breathing exercise.
• Affect brightened slightly by the end of the session; reported baseline anxiety decreased from 7/10 to 4/10.

Plan

• Continue CBT focusing on workplace stress management and exposure hierarchies; monitor response and tolerability to increased sertraline dose.
• RTC in 4 weeks on 12/06/2025 at 14:00 CST for med check and therapy; referral placed for outpatient group mindfulness therapy.
• Complete daily thought record focusing on workplace triggers and practice diaphragmatic breathing for 5 minutes BID.

Stage of Change

• Action