Pre-Session Briefing

Sarah M. · 29, she/her · Generalized Anxiety Disorder · CBT · Session 12/16 · Today, 2:00 PM

View session notes →

Last Session — Mar 29, 2026

Key Themes

  • ▸Catastrophizing about upcoming performance review at work
  • ▸Reported improved sleep after implementing sleep hygiene routine (5 of 7 nights)
  • ▸Avoidance of social events with coworkers persists

Interventions Used

  • Cognitive restructuring: examined evidence for/against catastrophic predictions
  • Behavioral experiment: agreed to attend one team lunch before next session

Clinician Note

“Sarah showed good engagement with cognitive restructuring but became visibly anxious when discussing the behavioral experiment. Monitor avoidance patterns closely.”

Client Check-In

“Hi Dr. Anand, this week was rough. I did the thought records on Monday and Tuesday but then my manager scheduled a 1:1 and I spiraled. I didn't go to the team lunch. I did keep up with the sleep routine though, and I journaled about the manager meeting. I think I'm starting to see the catastrophizing pattern but I can't seem to stop it in the moment.”

Journal Excerpts

Mar 31

Manager scheduled a 1:1 for Thursday. My first thought was 'she's going to tell me I'm underperforming.' I know this is catastrophizing but knowing it doesn't make it stop.

Apr 2

The 1:1 was fine. She actually said I was doing well. I feel stupid for worrying so much. But also I know I'll do the same thing next time.

Suggested Threads

Pattern alert

Avoidance of social exposure homework has occurred in 3 of last 4 sessions. Consider whether graduated exposure hierarchy needs recalibration.

Source: Longitudinal analysis

Clinical insight

Sarah's journal entry shows awareness of catastrophizing pattern but reports inability to intervene in the moment. This is consistent with the cognitive restructuring plateau described in Beck (2011), Ch. 12. Consider introducing real-time coping cards or behavioral experiments targeting in-the-moment intervention.

Source: Domain knowledge: Beck's CBT for Depression & Anxiety

Positive signal

Sleep hygiene adherence has been above 80% for 4 consecutive weeks. This is a durable behavioral change worth reinforcing.

Source: Between-session data

Mood This Week

Mon
Tue
Wed
Thu
Fri
Sat
Sun

Avg: 4.3/10

Homework Status

Daily thought recordPartial

3/7

Attend social eventNot done

0/1

Sleep hygiene routineComplete

6/7

Treatment Progress

16-week CBT protocol for GAD

Session 12 of 16· Started Jan 14, 2026