Session Transcript
6 exchangesDavid, how did the exposures go this week?
I actually did both of them. The directions one was easier than I expected. The cafeteria one was harder.
Tell me about the cafeteria. What was your SUDS when you walked in?
Like 45. I sat down and I kept checking my phone. I think that might have been a safety behavior?
That's an excellent observation. What do you think the phone was doing for you in that moment?
It was like a shield. If I'm looking at my phone, nobody's going to try to talk to me. And if I look busy, nobody's going to think I'm weird for sitting alone.
Generated SOAP Note
Subjective
Patient completed both assigned exposures (asking stranger for directions, eating in cafeteria). Reports SUDS reduction in both (40→25, 45→30). Independently identified phone use during cafeteria exposure as safety behavior. Describes phone as 'a shield' preventing social contact.
Objective
Session 3 of 12-session graded exposure for SAD. Patient engaged and insightful. Homework completion 100% across all three tasks. SUDS habituation curves as expected for hierarchy items. Safety behavior awareness emerging ahead of typical timeline.
Assessment
Excellent early engagement with exposure protocol. SUDS reductions confirm habituation is occurring. Patient's self-identification of safety behaviors is a positive indicator — typically doesn't emerge until sessions 4-5. Ready to move to mid-hierarchy items (SUDS 50-60) with safety behavior elimination. Monitor for pattern of selecting exposures that avoid sustained interaction.
Plan
- ▸Move to mid-hierarchy exposures (SUDS 50-60 range)
- ▸Repeat cafeteria exposure without phone (safety behavior elimination)
- ▸Introduce first interactive exposure: brief conversation with acquaintance
- ▸Continue SUDS tracking and safety behavior logging
- ▸Review fear hierarchy for accuracy — update ratings based on exposure data