BIRP Note
Current behaviour and presentation, clinician interventions, supported response, risk, and treatment plan.
About this note
A structured Behaviour, Intervention, Response and Plan note for therapists who want a concise behavioural record of current presentation, clinician actions, supported client response, and future treatment. This template captures reported and directly observed behaviour, interventions and rationale, response and progress, risk, therapeutic practice, referrals, coordination, and follow-up while keeping each item in its proper BIRP section.
Example note
Behaviour
• The client reported avoiding supermarkets for two weeks after experiencing intense anxiety in a crowded checkout, relying on grocery deliveries and feeling less independent as a result.
• They rated anticipated anxiety about entering a small local shop at 8/10 and identified leaving immediately if anxiety rose as the response they most wanted to change.
• The client reported that the avoidance reduced anxiety in the moment but increased anticipatory worry and restricted their usual routine over the following days.
Intervention
• The therapist completed a functional analysis linking the crowded-checkout experience, threat predictions, rising physical sensations, escape and the short-term relief that reinforced subsequent avoidance.
• The therapist provided CBT-oriented psychoeducation about the avoidance cycle and collaborated with the client to build a graded exposure hierarchy focused on restoring independent shopping.
• The therapist guided a brief imaginal rehearsal of entering the local shop, noticing the urge to leave and following the first hierarchy step without requiring a purchase.
• The therapist directly assessed current suicidal ideation, self-harm thoughts and thoughts of harming others.
Response
• The client agreed that immediate relief after leaving had made the next shopping attempt feel more threatening, while noting that crowding rather than every shop remained the principal trigger.
• During the imaginal rehearsal, the client reported anxiety rising to 6/10 and reducing to 4/10 while remaining with the scenario; they described the exercise as manageable but remained uncertain about practising alone.
• The client selected a five-minute visit to the quieter local shop as the first step and rated confidence in attempting it at 6/10 after the hierarchy was revised to remove any requirement to buy something.
• In response to the direct risk assessment, the client denied current suicidal ideation, self-harm thoughts and thoughts of harming others.
Plan
• The client agreed to complete two five-minute visits to the local shop before the next session, leaving without a purchase if preferred and recording predicted, peak and end anxiety for each attempt.
• The next session will review what the client learned from the exposure attempts and adjust the hierarchy without treating anxiety reduction as the sole measure of progress.
• The weekly appointment was retained for the agreed time.
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