Client: Jane Doe
Date: May 15, 2026

Behavior (B):
Client arrived on time but appeared withdrawn. She reported a 6/10 anxiety level (0=calm, 10=panic). Behaviors observed: nail-biting, sighing, and difficulty sitting still for the first 15 minutes.

Intervention (I):

Therapist provided psychoeducation on the "avoidance-anxiety loop."

Therapist guided client through a 5-minute diaphragmatic breathing exercise.

Therapist modeled cognitive reframing of the thought: "I will fail my review" to "I can prepare for my review."

Therapist assigned graded exposure task related to email checking.

Response (R):
Client engaged well with psychoeducation, stating "That makes sense why avoiding email makes it worse." She was able to complete the breathing exercise and reported her anxiety dropped to 4/10 afterward. She was hesitant but agreed to the email exposure homework. At session end, mood was less guarded, and she made a brief joke about her "cat being a better employee."

Plan (P):

Focus next session on reviewing email exposure log.

Continue somatic coping skill building.

No change to medication (managed by outside psychiatrist).