Progress Note — Session 4 — Okonkwo, Terrence D.

Progress Note Draft Risk: Low

Summary

Client reports meaningful improvement in workplace anxiety management. Successfully used breathing techniques before a presentation for the first time. Defusion skills emerging — able to notice catastrophizing thoughts without engaging. Social avoidance persists outside work contexts. Behavioral activation via gym attendance is a positive step.

Session Summary

Fourth individual therapy session. Client arrived on time, engaged, and reported improvement since last session.

Key Developments

1. Successfully used 4-7-8 breathing before workplace presentation. 2. Demonstrated cognitive defusion during performance (noticed imposter thought without following it). 3. Gym attendance 3x/week (new behavior). 4. Avoided friend's birthday dinner (ongoing social avoidance).

Treatment Approach

ACT-based therapy. Reviewed defusion experience in detail. Explored approach vs. avoidance patterns. Validated gym attendance as graded exposure.

Clinical Impressions

Mr. Okonkwo continues to make measurable progress in managing social anxiety symptoms, particularly in occupational settings. The successful application of coping skills during a real-world presentation represents a significant milestone. His ability to describe the cognitive process (noticing the thought, choosing not to engage, returning to the task) suggests genuine integration of ACT principles rather than mere intellectual understanding. Social avoidance in non-occupational settings remains the primary treatment target. The gym attendance represents a promising intermediate step — exposure to social environments without performance demands.

Recommendations

1. Continue weekly sessions with ACT framework 2. Introduce graduated exposure hierarchy for social events 3. Build on gym success — consider group fitness class as next step 4. Continue breathing and defusion techniques 5. Revisit LSAS at session 6 for progress measurement

Report Details

Report Type: Progress Note
Status: Draft
Generated: Feb 17, 2026 at 6:29 AM

Diagnoses (DSM-5)

F40.10 PRIMARY

Social Anxiety Disorder

Risk Assessment

1/5

Low

Risk Level

Risk Factors

Social isolation risk if avoidance patterns persist

Source Session

Terrence D. Okonkwo

Feb 14, 2026 — 50 min

TDO-2026-0038

AI Analysis Confidence

Diagnostic Accuracy 92%

Treatment Relevance 88%

Risk Assessment 85%

Documentation Quality 95%