25 Session Overview
CBT SESSION 5 OVERVIEW
Worry Exposure, Problem-Solving, and Emotional Awareness
Mood & Presentation: Maggie arrived on time and walked quietly down the hall. Her body posture was fairly relaxed, with some facial tension noted, likely related to the upcoming anniversary of her father’s suicide. Affect was appropriate and slightly brighter than in previous sessions. She appeared motivated, reflective, and engaged throughout the session. Overall, her baseline emotional state showed improvement compared with earlier sessions.
CBT Skills
- Check in
- Therapeutic alliance/rapport building
- Psychoeducation
- Denial, emotional avoidance, metacognition, tension–relaxation physiology.
- SOLVE problem-solving model applied to interpersonal challenge with mother.
- Worry exposure practice in session with graduated hierarchy of feared situations.
- Cognitive restructuring targeting automatic negative thoughts and catastrophizing.
- Reinforcement of strengths and mastery experiences.
Encouragement of emotion-focused work and improved communication skills.
Fill in the Blanks
Session Agenda
- Review homework: worry record, thought record, therapy journal, PMR practice.
- Discuss insights about feelings, denial, and emotional avoidance.
- Introduce and practice problem-solving using the SOLVE method.
- Apply problem-solving strategies to emotionally challenging interpersonal situations, particularly with her mother.
- Practice worry exposure to reduce anxiety through graduated confrontation of feared situations.
- Discuss the impact of avoidance on anxiety and review standardized anxiety assessment scores.
- Homework assignment and session summary.
Symptoms Observed/Reported
- Cognitive: Emerging metacognition; insight into avoidance and denial; recognition of thought patterns; reassurance-seeking decreased.
- Physiological: Mild tension in face and shoulders; reported relaxation after PMR and other self-soothing techniques.
- Emotional: Anxiety related to father’s death anniversary; relief and pride following proactive problem-solving; shame and guilt reduced after journaling; increased emotional awareness.
- Behavioral: Consistent homework completion, proactive planning, use of PMR and relaxation, scheduling worry time, participation in in-session worry exposure and SOLVE exercises.
Homework Review
- Continued scheduled evening worry time successfully.
- PMR practice increasingly automatic and effective, including at work.
- Thought record completed daily with adaptive responses and risk assessment procedures.
- Journaling indicated greater insight into emotional avoidance, anxiety management, and self-reflective growth.
- Self-assessment highlighted personal strengths and progress.
- Completed relaxation self-assessment, noting jaw clenching at night but improved overall body awareness.
- Reported successful engagement in difficult conversation with mother; experienced initial anxiety peak (100/100) followed by relief once planning and action occurred.
Key Clinical Moments
- Insight into denial: anxiety connected to fear for her mother, not just father’s death anniversary.
- Recognition of “emotional one-trick pony” pattern—using anxiety to avoid other emotions.
- Application of SOLVE problem-solving to interpersonal stressor with mother, including contingency planning.
- Engagement in prolonged worry exposure exercise, maintaining distress while practicing anxiety tolerance.
- Connection between anxiety management, emotional processing, and growth in self-confidence.
- Observed relief and positive affect following proactive action with mother.
Identified Barriers
- Emotional avoidance and longstanding denial of feelings other than anxiety.
- Fear of mother’s reaction and potential interpersonal conflict.
- Residual tension related to father’s death anniversary.
- Potential schedule-related difficulty maintaining consistent PMR practice.
- Baseline anxiety remains elevated, though showing gradual reduction.
Cognitive-Behavioral Formulation
- Core Beliefs: “I must be vigilant to prevent harm to loved ones”; “I cannot manage strong emotions”; “If something bad happens, it’s my fault.”
- Automatic Thoughts: “If I address my mother, she might shut me down or I might fail”; “I can’t handle this”; catastrophizing around Theo’s future.
- Emotions: Anxiety, fear, shame, guilt.
- Behaviors: Avoidance of emotional topics, excessive worry, internalization of stress, reassurance-seeking.
- Maintaining Cycle: Anxiety → avoidance → lack of emotional processing → anxiety persists.
- Change Factors Emerging: Metacognition, worry containment, proactive problem-solving, engagement in exposure, improved emotion regulation.
Resources & Strengths
- Remains highly motivated and engaged in the CBT process
- Increased self-efficacy, self-awareness
- Reports improved emotional regulation
- Strong support system
- Insight into personal relationships
- Strong problem-solving skills
- Resilience
Progress / Clinical Impressions
- Maggie demonstrates increasing insight into cognitive and emotional patterns.
- Improved metacognition, emotional awareness, and behavioral engagement.
- Early behavioral changes observed: worry containment, PMR use, proactive problem-solving, engagement in exposure exercises.
- Emerging confidence in coping skills and interpersonal problem-solving.
- STAI and symptom review indicate meaningful reduction in anxiety despite continued elevation.
- Mid-to-late therapy stage shows a positive trajectory toward treatment goals.
Multiple Choice
