Session Transcript
11 exchangesHi Sarah, good to see you. How are you feeling coming in today?
Honestly, kind of frustrated with myself. I didn't do the team lunch thing again.
I appreciate you being honest about that. Can you walk me through what happened when you thought about going?
On Wednesday, Amy sent the group chat about Friday lunch. My first thought was like, they don't actually want me there, they're just being polite. And then I started thinking about what I'd say and I just... couldn't picture it going well.
So the automatic thought was 'they don't actually want me there.' Let's look at that the way we've been practicing. What's the evidence for that thought?
I mean... Amy did text me directly later and asked if I was coming. So that's probably evidence against it.
That's a really good catch. And what about the prediction that it wouldn't go well? What happened the last time you went to a team event?
The holiday party in December. It was actually fine. I talked to Marcus about his dog for like twenty minutes. But I keep thinking that was a fluke.
So we have evidence that Amy specifically reached out, and that the last event went well. The thought that it would go badly seems to be a prediction, not a fact. How does that land?
Logically I know you're right. But in the moment it feels so real. Like, I know I'm catastrophizing and I still can't stop.
That's actually a really important observation. Knowing the pattern and being able to interrupt it in real time are two different skills. Let's talk about some strategies for that in-the-moment piece.
Generated SOAP Note
Subjective
Patient reports frustration with inability to complete social exposure homework (team lunch). Describes persistent automatic thoughts about social rejection despite recognizing cognitive distortion pattern. Reports awareness of catastrophizing but difficulty intervening in the moment. Sleep hygiene routine maintained (6/7 nights). Thought records completed 3/7 days, discontinued after stressful manager interaction. Manager 1:1 went positively despite anticipatory anxiety.
Objective
Session 12 of 16-week CBT protocol for GAD. Patient engaged and reflective. Affect mildly anxious at baseline, brightened when discussing evidence against automatic thoughts. Homework completion mixed: sleep hygiene strong (86%), thought records partial (43%), social exposure not attempted. Between-session mood data shows dip mid-week (score 2/10 Thursday) with recovery by weekend.
Assessment
Cognitive restructuring skills developing but not yet accessible in high-arousal moments. Social avoidance pattern persists (3rd consecutive session without completing exposure task). Sleep improvements durable. GAD-7 trend: plateau at moderate range for 3 sessions. Consider graduated exposure recalibration and introduction of in-the-moment coping strategies (coping cards, grounding techniques).
Plan
- ▸Introduce coping card strategy for in-the-moment cognitive interruption
- ▸Recalibrate social exposure hierarchy: start with lower-stakes interaction (e.g., 5-minute coffee with one colleague) rather than group lunch
- ▸Continue daily thought records with emphasis on catching thoughts before avoidance decision
- ▸Continue sleep hygiene routine
- ▸Revisit GAD-7 next session to assess plateau