CBT Session

Date: 24/10/2023 Patient: Sarah Jenkins, 34, Female

Session Overview

1. Objectives of the Session

• Review thought monitoring logs and introduce cognitive restructuring for social anxiety (SAD) triggers at work.

2. Review of Previous Session

• Progress: Completed 4 entries in the 5-column thought record. Attended one team morning tea for 15 mins without early exit.
• Challenges: Avoided speaking up during the Tuesday project meeting due to fear of trembling voice; struggled to identify hot thoughts in the moment.

3. Patient's Report

• Current Issues: Experiencing heightened anticipatory anxiety regarding an upcoming quarterly presentation next week. Compliant with sertraline (Zoloft®) 50 mg PO OD.
• Mood and Emotions: Reports mood as "anxious and tense" (SUDS 65/100); frustrated with ongoing avoidance behaviours.
• Behavioural Observations: Fidgeting with hands, frequent sighing, broken eye contact when discussing work evaluation. Speech normal rate and volume; oriented x3.

4. Cognitive Interventions

• Identified Cognitive Distortions: Mind reading ("My colleagues think I'm incompetent") and catastrophising ("If I stumble over my words, I will be fired").
• Challenging Thoughts: Used Socratic questioning and examined evidence for/against the hot thought regarding past performance reviews (which were consistently positive).
• New Cognitive Strategies: Introduced the "double-standard" technique (treating self as a friend) and developed a balanced alternative thought: "Stumbling over a word is normal and does not erase my professional competence."

5. Behavioural Interventions

• Behavioural Experiments: Planned an experiment for the next team meeting: ask one prepared question whilst dropping safety behaviours (not scripting it word-for-word beforehand) and observe colleague reactions.
• Skill Development: Practised progressive muscle relaxation (PMR) and box breathing (4-4-4-4) in-session; SUDS reduced from 65/100 to 35/100.

6. Homework Assignment

• Tasks Assigned: Complete 7-column thought records for 3 anxious situations; execute the meeting behavioural experiment; practise PMR for 10 mins BD.
• Purpose: To test the validity of catastrophic predictions in social settings and reduce baseline physiological arousal.

7. Plan for Next Session

• Topics to be Addressed: Debrief the meeting behavioural experiment and construct a graded exposure hierarchy for public speaking.
• Goals: Finalise the exposure hierarchy and conduct an in-session role-play of the upcoming presentation.

"Thank you,"

Dr Marcus Vance Clinical Psychologist Practice number: 4589210B