Owner:

MH Head of Clinical

Review:

Annually

Classification:

1 (Proprietary)

Author:

BUPA Operational Lead

Version:

1.0

Status:

Published

Date Published:

31/05/2023

Code:

CPTS0116

Clients Forename:

Jenny

Clients Surname: 

Jen

Date of Session:

01/06/2023

Session Number:

2

Treating Clinician Full Name:

Therapy Therapist

Treatment Type:

CBT

Treatment Modaility:

Video

Current Pathway:

In Treatment

Current Work Status:

Full Duties

Primary Working Diagnosis/Primary Presentation:

Social Phobia

Agenda:

Review action plan – Behavioural Experiment – going to social event

Friends Birthday Party

Focus of attention experiment

Set action Plan

Feedback

Risk Review & Management Plan:

Client continues to report frequent suicidal thoughts about overdosing and has medication in the house. They deny any plans or preparations to act on these thoughts. Does not wish to destroy means as needed to manage LTC. They continue to rate their intent as 4/10 but confirm their daughter is a strong protective factor and their relationship with their daughter is strong. Confirm that they have strategies to manage their negative thoughts which they are confident about using. Safety plan previously discussed.

Risk Rating:

Medium

Review In-between Sessions:

Jenny had completed behavioural experiment in which she went to a coffee shop to observe/listen to “typical” conversations. Her anxious prediction “You have to say omething profound” belief rating declined from 90% to 30% before and after experiment. This led into  creating alternative belief “just being there is enough” (belief rating 35%) 

Jenny noted a tendency to become lost in her thoughts while doing expeiment which led to us adding this to formulation (Clark and Wells) and creating an in sesion experiment. 

Content of Session:

In todays session Jenny and I designed and compelted a “focus of attention” behavioural experiment. 

Jenny spoke about herself under two conditions. One scanning herself, noticing every thing she does, analysing her thoughts and pre planning everything she says. In the second condition Jenny moved her attention away from internal experience (thoughts, emotion, physical sensations) to the external environment (notice 5 things). We repeated this three times and recorded both scenarios. 

We compared and reflected on the learning from the experiemets. This was largely a felt sense that the second condition just felt better. We used formulation to suggest a rationale as to why this might be (noticing environmental cues, thoughts/emotions intensifying when we place attention on them.)

Agreed Between Session Tasks:

We agreed that Jenny will watch video of experiment back and make notes from an observer perspective. We spoke about the need to watch this like its somebody else and it may take a few watches to get used to observing self objectively. 

Treatment Plan:

6 more sessions using Clark and Wells social phobia protocol. Continuing behavioual experiments to increase approaching social interactions and dropping safety behavours while updating biased social anxiety beleifs and assumptons. 

Do you need to request additional sessions?

No

If “Yes” please input rationale for additional sessions and quantity: 

Request clinical review of case by VHG clinical team?

Yes

If “Yes” please input reason for clinical review:

I would really appreciate your clinical expertise whether I am using the correct protocol. I have been using Clark and Wells social phobia model and it appears to be effective however I am now questioning if I should shift to Heimberg or away from CBT altogeter for a more contextual appoach (e.g. ACT) Your advise would be gratefully received.

Version:

Date:

Summary of Changes

1.0

31/05/2023

Published