Pre-Session Briefing
David K. · 23, he/him · Social Anxiety Disorder · Exposure Therapy · Session 3/12 · Thu, 11:00 AM
Last Session — Apr 1, 2026
Key Themes
- ▸Collaboratively built fear hierarchy (15 items, SUDS range 20-95)
- ▸Discussed safety behaviors: phone scrolling, arriving early to avoid being seen entering
- ▸First in-session exposure: ordering coffee from therapist role-playing as barista (SUDS: 35 → 20)
Interventions Used
- Psychoeducation on habituation curve and why avoidance maintains anxiety
- In-session role-play exposure (low difficulty)
- Collaborative fear hierarchy construction
Clinician Note
“David engaged well with psychoeducation and showed good understanding of the exposure rationale. In-session exposure produced expected habituation curve. He is motivated but I expect resistance to increase as we move up the hierarchy.”
Client Check-In
“I did two exposures. I asked a stranger for directions (SUDS went from 40 to 25) and I ate lunch in the cafeteria instead of my car (started at 45, ended around 30). I noticed I kept checking my phone during the cafeteria one. I think that's a safety behavior?”
Journal Excerpts
Apr 3
Asked someone for directions to the library. Heart was pounding. They just... told me and walked away. Nobody cared. SUDS went from 40 to 25.
Apr 5
Ate in the cafeteria. Kept looking at my phone. I think I was using it as a shield so nobody would talk to me. Need to try it without the phone next time.
Suggested Threads
David completed 100% of assigned exposures and independently identified phone use as a safety behavior. Self-monitoring capacity at session 3 is above typical progression.
Source: Between-session data
David's independent identification of phone-as-safety-behavior shows strong treatment engagement. Craske (2014) recommends transitioning to exposure with safety behavior elimination once the client can self-identify. Consider adding 'no phone' as a condition for next cafeteria exposure.
Source: Domain knowledge: Craske's Exposure Therapy
Both exposures were solitary (stranger interaction, solo cafeteria). The fear hierarchy has interactive items starting at SUDS 50. Monitor whether David selects exposures that avoid sustained social interaction.
Source: Longitudinal analysis
Mood This Week
Avg: 5.7/10
Homework Status
2/2
2/2
2/2
Treatment Progress
Session 3 of 12· Started Mar 18, 2026