CBT Note

Session Summary

The session reviewed the client’s panic-related avoidance of supermarkets since the previous appointment. The client completed one planned short shop with a support person but avoided going alone. The main CBT work was a situation-specific analysis of a recent near-panic episode and planning a graded behavioural experiment to test the prediction that panic sensations would make them collapse or need to leave immediately.

Current Presentation and Functional Impact

The client reported continued anxiety before supermarket trips, especially when queues are long. They described shopping online more often, asking their partner to collect items, and feeling frustrated that errands take longer. They reported no new panic attacks at work and no missed shifts.

Target Situations and CBT Analysis

The main situation examined was entering a busy supermarket after work. The client noticed heat in their face, dizziness, a racing heart and the prediction that they would faint in front of others. Anxiety was rated 85 out of 100. Behaviours included gripping the trolley, scanning for exits, texting their partner, and leaving without buying all planned items. The immediate consequence was relief; the longer-term consequence was increased doubt about shopping alone.

CBT Formulation / Maintaining Cycles

The therapist and client agreed a maintaining cycle in which bodily sensations are interpreted as signs of collapse, leading to exit-scanning, reassurance texting and early departure. These behaviours reduce anxiety briefly but prevent the client from learning whether the sensations can peak and fall without escape.

Progress, Obstacles and Previous Practice Review

The client completed one short shop with their partner and stayed in the store for ten minutes longer than predicted. They said having a written list helped. The planned solo visit was not attempted because the client worried they would block the aisle if panic increased. The client identified evening tiredness as a practical barrier.

CBT Interventions and Client Learning

The therapist used guided discovery to examine evidence for fainting during previous panic episodes. The client identified that they had felt faint many times but had not collapsed. The therapist explained the rationale for a behavioural experiment focused on learning rather than forcing panic to disappear. The client said the learning aim made the task feel less like a test of willpower.

Behavioural Experiments, Exposure and In-Session Practice

The therapist and client planned a graded behavioural experiment for a small supermarket visit. The question being tested was whether dizziness would require the client to leave immediately. The client’s prediction was that anxiety would reach 90 out of 100 and they would need to leave within five minutes. The agreed task was to enter the shop alone, buy two items, stay for at least five minutes if safe to do so, avoid texting for reassurance, and record peak anxiety and what happened.

Assessment and Measures

The client rated current supermarket-related anxiety as 75 out of 100 before planned solo trips and 40 out of 100 when accompanied.

Between-Session Practice and Next Steps

• Client homework or behavioural task: Complete one five-minute solo supermarket experiment buying two items.

• Monitoring or worksheet: Record prediction, peak anxiety, safety behaviours used or resisted, outcome and learning.

• Next-session review or focus: Compare predicted and actual outcomes and refine the next hierarchy step.