Lesson 1Session-block goals: stabilization/engagement, skill-building (CBT core skills), exposure/interoceptive work, relapse preventionThis section defines goals for each session block, including stabilization and engagement, core CBT skill-building, exposure and interoceptive work, and relapse prevention, with guidance on measuring progress and transitioning between phases.
Stabilization and early engagement goalsSkill-building block: core CBT skillsExposure and interoceptive work blockRelapse prevention and consolidation blockCriteria for moving between treatment phasesLesson 2Skill modules: diaphragmatic breathing, progressive muscle relaxation, grounding, sleep optimization and activity schedulingThis section details key skill modules, including diaphragmatic breathing, progressive muscle relaxation, grounding strategies, sleep optimization, and activity scheduling, emphasizing practice guidelines and integration with exposure work.
Teaching diaphragmatic breathing skillsProgressive muscle relaxation trainingGrounding skills for acute anxiety spikesSleep hygiene and optimization methodsActivity scheduling to support recoveryLesson 3Relapse prevention and maintenance strategies: creating personalized relapse plans, booster session timing, and long-term self-monitoringThis section focuses on relapse prevention and maintenance, covering personalized relapse plans, identification of early warning signs, booster session scheduling, long-term self-monitoring routines, and strategies for responding effectively to symptom flare-ups.
Identifying personal relapse risk factorsDesigning written relapse prevention plansScheduling booster and follow-up sessionsLong-term self-monitoring of symptomsResponding to setbacks and flare-upsLesson 4Treatment structure and session sequencing: recommended 12–16 session roadmap and rationale for order of targetsThis section outlines a recommended 12–16 session roadmap, clarifying phases of treatment, the rationale for target ordering, how to balance exposure with skills training, and strategies for flexibly adapting the sequence while preserving core treatment elements.
Overview of 12–16 session treatment phasesCriteria for selecting initial treatment targetsRationale for ordering exposure and skillsBalancing structure with clinical flexibilityMonitoring progress and adjusting the planLesson 5Interoceptive exposure protocol: steps, common exercises, hierarchy development, and safety instructionsThis section presents an interoceptive exposure protocol, including assessment of feared sensations, hierarchy development, common exercises, safety and medical screening, and guidelines for debriefing and consolidating learning after each exposure trial.
Assessing feared bodily sensationsDeveloping an interoceptive hierarchyCore interoceptive exposure exercisesMedical screening and safety guidanceDebriefing and consolidating exposure gainsLesson 6Adaptations for high avoidance or low adherence: motivational interviewing, session pacing, behavioral activation, use of between-session support, and brief phone coachingThis section covers adaptations for high avoidance or low adherence, including motivational interviewing strategies, pacing and titrating exposure, behavioural activation, between-session support options, and brief phone or digital coaching to sustain engagement.
Identifying barriers to engagementUsing motivational interviewing techniquesAdjusting exposure intensity and pacingBehavioral activation to increase approachBetween-session support and brief coachingLesson 7Psychoeducation and motivational enhancement: explaining diagnosis, rationale for exposure, addressing ambivalence and readinessThis section explains psychoeducation and motivational enhancement, focusing on presenting diagnoses clearly, explaining the rationale for exposure and CBT, addressing fears and myths, and assessing readiness to change to collaboratively set treatment goals.
Explaining anxiety diagnoses clearlyPresenting the CBT and exposure rationaleAddressing fears and treatment mythsAssessing readiness and stages of changeCollaborative goal setting with patientsLesson 8Worry-focused interventions for GAD: stimulus control for worry, cognitive defusion, problem-solving training, and intolerance of uncertainty techniquesThis section addresses worry-focused interventions for GAD, including stimulus control for worry, cognitive defusion strategies, structured problem-solving training, and techniques targeting intolerance of uncertainty to reduce chronic, uncontrollable worry.
Assessing worry patterns and triggersStimulus control strategies for worryCognitive defusion and distancing toolsStructured problem-solving training stepsTechniques for intolerance of uncertaintyLesson 9In vivo exposure for elevator phobia: hierarchy construction, graded approach, therapist-supported vs. self-directed exposure, and use of VR or imaginal exposure if neededThis section details in vivo exposure for elevator phobia, including assessment, hierarchy building, graded exposure steps, therapist-supported versus self-directed formats, and when to use VR or imaginal methods to address practical or safety constraints.
Functional assessment of elevator fearsConstructing a detailed exposure hierarchyDesigning graded in vivo exposure stepsTherapist-assisted versus self-directed plansUsing VR or imaginal exposure when neededLesson 10Cognitive interventions: cognitive restructuring, worry time scheduling, worry scripts, behavioral experiments for catastrophic beliefsThis section reviews cognitive interventions, including cognitive restructuring for catastrophic beliefs, scheduled worry time, worry scripts, and behavioural experiments, with guidance on integrating these tools alongside exposure-based techniques.
Identifying and tracking anxious thoughtsCognitive restructuring step by stepScheduling and running daily worry timeDesigning and using worry scriptsBehavioral experiments for catastrophic beliefsLesson 11Exposure for panic-related avoidance and agoraphobia: situational exposures, homework structuring, and managing anticipatory anxietyThis section explains exposure for panic-related avoidance and agoraphobia, focusing on mapping avoided situations, designing situational exposure tasks, structuring homework, managing anticipatory anxiety, and troubleshooting common obstacles to real-world practice.
Mapping panic triggers and avoided placesDesigning situational exposure exercisesStructuring and reviewing exposure homeworkManaging anticipatory anxiety before tasksTroubleshooting avoidance and safety behaviors
