Menu

Treatment Plan for Anxiety Example: 3 Plans With SMART Goals

Three anxiety treatment plan examples (GAD, panic with agoraphobia, social anxiety) with SMART goals, GAD-7 and PDSS baselines, and review dates.

Updated 16 min read
In this guideTemplate to copy9 questions answered

This treatment plan for anxiety example guide gives you three complete plans for invented adult clients: generalized anxiety disorder treated with applied relaxation, panic disorder with agoraphobia treated with cognitive behavioral therapy (CBT) and exposure, and social anxiety disorder treated with CBT developed for social anxiety. In each one, every objective has a baseline from a standard measure (the GAD-7, the PDSS-SR or the SPIN), a target, a date and a way to measure it, and every intervention names its modality, its dose and the evidence behind it.

After the three plans you'll find an ACT version of one goal, a bank of anxiety goals and objectives you can adapt, an anxiety treatment plan template to copy, how progress notes report on the plan, and a worked plan update at a midpoint review.

For blank general templates (outpatient, brief therapy and couples), practice rewriting weak objectives, a teenager's anxiety plan and what payers check, see our treatment plan template guide. This page is its adult anxiety companion.

Every client in this article is invented. Any resemblance to a real person is a coincidence. The plans show how to document care, not what any particular client needs: your assessment, your training and the treatment manual you follow come first.

What an anxiety treatment plan needs

Any treatment plan names the problem, the goals, measurable objectives, the interventions and the services. An anxiety plan works better when it also writes down what keeps the anxiety going, because that is what treatment changes.

  • The feared outcome, in the client's words."I'm having a heart attack." "They'll see my hands shake and think I'm incompetent." "Something will happen to the kids and it'll be my fault." Each disorder's treatment works on a different belief, so the plan should name it.
  • Avoidance, counted.The places, situations, activities and body sensations the client avoids, and how often. Avoidance is often the most useful objective on the plan: it's visible, the client can count it, and it's what shrinks their life.
  • Safety behaviors, counted.What the client does to feel safer that keeps the fear going: checking a pulse, carrying water, rehearsing sentences, asking for reassurance, sitting by the exit, drinking before a party. A plan that tracks only symptoms misses these.
  • A measure for the main disorder, plus the GAD-7.For GAD, NICE asks practitioners to "use routine outcome measures and ensure that the person with GAD is involved in reviewing the efficacy of the treatment" (NICE CG113, 1.2.21). For social anxiety it asks for "routine sessional outcome measures (for example, the SPIN or LSAS)" (NICE CG159, 1.3.1).
  • The intervention by name and dose."CBT for anxiety" is a start. "CBT for panic disorder with interoceptive and in vivo exposure, 12 weekly one-hour sessions, finished by 01/13" is a plan you can check against a guideline.
  • Who ruled out other causes.Panic-like symptoms can come from heart, lung or thyroid problems, caffeine, stimulants or withdrawal. You don't rule those out yourself, but the plan should say who did and when. NICE also asks clinicians to be alert to panic disorder alongside depression and alongside substance misuse (NICE CG113, 1.3.4).
  • A decision point.The date by which, if the main measure hasn't moved, you'll change something, and what you'll consider.

The plan grows out of your case conceptualization. In each example below, the factors that keep the problem going are numbered, and every goal says which of them it answers.

Measures for anxiety treatment plans: baselines and targets

Take the baseline before you write the target. These are the measures the three examples use.

  • GAD-7.Seven items about the last two weeks, total 0 to 21. Totals of 5, 10 and 15 mark mild, moderate and severe anxiety (Spitzer et al., 2006). A study in chronic depression estimated the smallest important change at 4 points and asked for confirmation in anxiety-focused samples (Toussaint et al., 2020). In primary care, the GAD-7 also worked well as a screener for panic disorder, social anxiety disorder and PTSD, with areas under the curve of 0.80 to 0.91 (Kroenke et al., 2007). That makes it a reasonable shared tracker for all three plans, but it was built around generalized anxiety, so pair it with a measure for the main disorder. Add up a total with the GAD-7 scoring tool.
  • PDSS and PDSS-SR (Panic Disorder Severity Scale).Seven items, each scored 0 to 4, total 0 to 28. The original is clinician-rated (Shear et al., 1997); the self-report version was reliable and sensitive to change, falling by 7.3 points on average after CBT in one group of 27 patients (Houck et al., 2002). Using data from two large studies, Furukawa and colleagues found the meaning of a score depends on agoraphobia. With agoraphobia, 3 to 7 was borderline, 8 to 10 slightly ill, 11 to 15 moderately ill, and 16 or more markedly ill. Without it, 0 to 1 was normal, 2 to 5 borderline, 6 to 9 slightly ill, 10 to 13 moderately ill, and 14 or more markedly ill. They proposed a drop of 40 percent or more as response and a score of 5 or less as remission (Furukawa et al., 2009). Those bands come from the clinician-rated scale, so use them as a guide for the self-report version. For panic, NICE says "short, self-completed questionnaires ... should be used to monitor outcomes wherever possible" (NICE CG113, 1.3.45).
  • SPIN (Social Phobia Inventory).Seventeen self-rated items covering fear, avoidance and physical symptoms, total 0 to 68. In its validation, a score of 19 separated people with social phobia from controls, and scores tracked change over time (Connor et al., 2000). NICE names the SPIN and the Liebowitz Social Anxiety Scale (LSAS) as options (NICE CG159, 1.2.6).
  • Logs and ratings.Scales move every few weeks; logs show change between them. A panic log (when, where, peak fear 0 to 10, what the client feared, what they did), a worry or sleep log, an exposure record (the step, the prediction, what happened, peak fear 0 to 100), minutes of replaying after social events, and counts of avoided situations and safety behaviors.

Check the terms of use of any scale before you copy it into your own forms. None of the scales is a diagnosis: a score supports your clinical judgment, it doesn't replace it.

Anxiety treatment plan example 1: generalized anxiety disorder

Invented client: a 41-year-old office manager at a dental practice we'll call Renee. She is married with two children, 10 and 13, and is seen weekly by video from her home in Pennsylvania by a counselor licensed there. Her physician referred her. The plan was written with her in her second session.

The case in brief

  • Presenting problem:two years of worry on most days that she finds hard to stop, about her children's safety, money and mistakes at work. Neck and shoulder tension most days, tension headaches 3 to 4 times a week, 45 to 60 minutes to fall asleep most nights, short-tempered at home. She stays 60 to 90 minutes late at work 4 days a week re-checking schedules and billing, and missed 2 of her children's 5 games last month. "My brain is always running a list of what could go wrong."
  • Medical:her physician found normal thyroid results in September and offered therapy or medication; Renee chose therapy first. Four cups of coffee a day, the last around 3 p.m.
  • Measures and risk at intake (10/13):GAD-7 total 15 (severe). PHQ-9 total 8 (mild), item 9 scored 0. Asked directly, she denied thoughts of death or self-harm, with no history. One glass of wine a few nights a week; no other substances.
  • What keeps it going:(1) muscle tension she notices only when it's high; (2) worrying in bed; (3) re-checking at work, which brings short relief and costs her evenings; (4) the belief "if I stop worrying, I'll miss something."
  • Strengths:conscientious and does what she agrees to; a supportive husband; a clear reason to change: "I want to actually be at my kids' games, not just sitting there worrying."

Why applied relaxation

NICE says that if a person with GAD chooses a high-intensity psychological intervention, "offer either CBT or applied relaxation," and that each should "usually consist of 12 to 15 weekly sessions (fewer if the person recovers sooner; more if clinically required), each lasting 1 hour" (NICE CG113, 1.2.18 to 1.2.20). Between a psychological intervention and medication, it says to base the choice on the person's preference "as there is no evidence that either mode of treatment (individual high-intensity psychological intervention or drug treatment) is better" (1.2.17).

The American Psychological Association's Society of Clinical Psychology (Division 12) rates cognitive and behavioral therapies for GAD as having "strong research support," and its description says cognitive or behavior therapy on its own can help, especially cognitive restructuring or applied relaxation (Division 12, CBT for GAD). In a randomized comparison, applied relaxation and cognitive therapy, each given in 12 weekly sessions, both produced large improvements with no difference between them (Öst and Breitholtz, 2000). A meta-analysis of 41 studies found too few head-to-head comparisons to rank the two, with some signs that CBT did better than applied relaxation in the longer term (Cuijpers et al., 2014).

Renee chose applied relaxation because tension and headaches were what she most wanted to change. The plan writes down when cognitive work would be added.

Applied relaxation, developed by Lars-Göran Öst (Öst, 1987), teaches a fast relaxation response and then applies it at the first sign of anxiety. One published protocol based on it runs in this order (Hayes-Skelton et al., 2012):

  1. Noticing early signs of anxiety in the body, behavior, thoughts and feelings, with a monitoring sheet.
  2. Progressive muscle relaxation, starting with 16 muscle groups, then 7, then 4.
  3. Relaxing the muscles without tensing them first.
  4. Cue-controlled relaxation: pairing a word such as "relaxing" with each breath out.
  5. Differential relaxation: relaxing the muscles not needed for what you're doing, such as the shoulders while walking.
  6. Rapid relaxation, which combines the steps and takes 20 to 30 seconds once learned.
  7. Applying it at the first sign of anxiety, in session and in daily life, then keeping the skill going.

The plan

  • Plan date:10/20 (initial plan). Clinician: [name], licensed professional counselor (Pennsylvania). Based on: intake 10/13, session 2, GAD-7, PHQ-9, physician's note (release on file).
  • Working diagnosis:generalized anxiety disorder (F41.1).
  • Problem statement:excessive worry that she finds hard to control, on most days for two years, about her children's safety, money and work, with muscle tension, tension headaches 3 to 4 times a week, 45 to 60 minutes to fall asleep and irritability. Re-checking keeps her 60 to 90 minutes late at work 4 days a week and has cost her family events. GAD-7 15.
  • Strengths:does home practice; supportive spouse; physician involved.
  • Barriers:busy evenings; may treat practice as one more thing to do perfectly.

Goal 1, in her words: "Stop feeling wound up all the time." (Answers factors 1 and 4.)

  • Objective 1.1:GAD-7 total from 15 to below 10 by 01/12, and down at least 4 points by the review on 11/24. Measure: GAD-7 every two weeks.
  • Objective 1.2:tension headaches from 3 to 4 a week to 1 or fewer a week for 3 weeks in a row by 01/12. Measure: headache log.
  • Objective 1.3:notice early signs of tension and use rapid relaxation at least 5 times a day, on at least 5 of 7 days, by 01/12. Baseline: 0 (no skill to use yet). Measure: daily practice sheet.
  • Interventions:applied relaxation in the order above: monitoring early signs from session 2; progressive and release-only relaxation in sessions 3 to 5; cue-controlled and differential relaxation in sessions 5 to 7; rapid relaxation and applying it in daily situations and in imagined worry scenes from session 8. Home practice twice a day, about 15 minutes at first and shorter as the methods get shorter.

Goal 2, in her words: "Fall asleep without lying there making lists." (Factor 2.)

  • Objective 2.1:asleep within 30 minutes on at least 5 of 7 nights by 01/12. Baseline: 1 of 7 (week of 10/13). Measure: sleep log.
  • Objective 2.2:last coffee by noon on at least 6 of 7 days by 11/24. Baseline: about 3 p.m. most days. Measure: sleep log.
  • Interventions:release-only relaxation at bedtime; a 10-minute "tomorrow list" written before 8 p.m. so planning happens outside bed; information about caffeine and sleep.

Goal 3, in her words: "Leave work at work, and be at my kids' games." (Factors 3 and 4.)

  • Objective 3.1:leave work by 5:30 p.m. on at least 4 of 5 days by 01/12. Baseline: 1 of 5. Measure: her calendar.
  • Objective 3.2:check each schedule and billing batch once instead of three times, on at least 4 of 5 days, by 01/12. Baseline: three checks. Measure: a checklist at her desk.
  • Objective 3.3:attend all of her children's scheduled games and events from 11/01 to 01/12. Baseline: missed 2 of 5 last month. Measure: her report.
  • Interventions:applied relaxation used when the urge to re-check comes (application phase); one CBT behavioral experiment: she writes down what she predicts will go wrong if she checks once, checks once for two weeks, and compares the prediction with what happened; problem-solving for the real workload.

Services: individual psychotherapy, 60 minutes, weekly, 12 to 15 sessions from 10/13 (no session the week of 12/29). By video; client at home in Pennsylvania, in a private room; emergency contact her husband.

Measures: GAD-7 every two weeks; PHQ-9 at intake and at each review; daily practice sheet; headache and sleep logs.

Risk and safety: asked directly at intake (denied, no history). Asked again at each review and whenever the PHQ-9 rises or item 9 is above 0.

Coordination: with her signed release, her physician gets a summary at each review.

Decision point: if the GAD-7 hasn't dropped at least 4 points by 11/24, check practice first, then discuss with Renee adding cognitive work on worry (CBT), asking her physician about medication, or both.

Client participation: goals written with Renee on 10/20, in her words. She chose applied relaxation over CBT after hearing both options, and agreed to the 11/24 check. Copy given.

Review: 11/24 (session 7) and 01/12 (session 13).

Discharge when: GAD-7 below 10 on two scores in a row; headaches 1 or fewer a week; objective 3.1 kept for four weeks; and a written relapse prevention plan listing her early signs and the skill she uses for each. Then one booster session a month later.

Signatures: Renee, 10/20. Clinician, credentials, 10/20.

What this example shows:

  • The dose matches the guideline, 12 to 15 one-hour sessions, and every target date fits inside it.
  • Skill use is an objective, but not the only one. Headaches, sleep and leaving work are the changes she cares about.
  • The plan decides now what happens on 11/24 if it isn't working.

Anxiety treatment plan example 2: panic disorder with agoraphobia

Invented client: a 33-year-old IT support technician we'll call Marcus, who lives with his partner in Indiana. He is seen by a clinical social worker licensed in Indiana, first by video and then in the office. The plan was written with him in his second session.

The case in brief

  • Presenting problem:his first panic attack was 14 months ago, driving on the highway: racing heart, tight chest, tingling hands and the certainty he was having a heart attack. The emergency department found a normal ECG and blood tests. Since then, about 3 attacks a week, some out of nowhere, some in places he feels trapped. "I keep waiting for the big one."
  • Avoidance:highway driving (he takes local roads, adding 40 minutes each way), grocery stores on weekends (his partner shops), movie theaters, the gym since March ("I don't want my heart rate up"), and coffee.
  • Safety behaviors:checks his pulse on his watch about 20 times a day; carries water and keeps his phone unlocked; sits by exits; drives only with his partner on routes he knows.
  • Medical:his physician reviewed the emergency department workup, found no heart, lung or thyroid problem, and on 10/10 cleared him in writing for exercise and for the exercises used in exposure (release on file).
  • Measures and risk at intake (10/14):PDSS-SR total 17, in the "markedly ill" band for people with agoraphobia. GAD-7 12. PHQ-9 6, item 9 scored 0; asked directly, he denied thoughts of death or self-harm. No alcohol in the past year "in case it sets off an attack"; no other substances. Panic log for the week before: 3 attacks.
  • What keeps it going:(1) reading normal sensations, such as a fast heartbeat or breathlessness, as signs of a heart attack; (2) pulse checking, which keeps his attention on his heart; (3) avoidance, which keeps him from learning the attacks pass; (4) safety behaviors he credits for "getting through."
  • Strengths:wants his life back ("I used to drive to my brother's in Louisville every month"); understands the model quickly; a supportive partner.

Why CBT with interoceptive and in vivo exposure

For moderate to severe panic disorder, with or without agoraphobia, NICE says to consider referral for CBT, or for an antidepressant if the disorder is long-standing or the person hasn't benefited from, or has declined, psychological treatment (NICE CG113, 1.3.12). CBT should be "in the optimal range of duration (7 to 14 hours in total)" (1.3.15) and "for most people" take "the form of weekly sessions of 1 to 2 hours" completed "within a maximum of 4 months of commencement" (1.3.16).

Division 12 rated CBT for panic disorder as having "strong" research support under its 1998 criteria (its 2015 re-evaluation is listed as pending), and its description names exposure to bodily sensations (interoceptive exposure) and to avoided situations (in vivo exposure) (Division 12, CBT for panic disorder). A Cochrane network meta-analysis pooling 54 studies found CBT the most studied therapy for panic disorder with or without agoraphobia and often better than the others, though the effects were small and the quality of evidence low (Pompoli et al., 2016).

The exposure in this plan is set up to test predictions, not to wait for fear to fade. Craske and colleagues describe ways to strengthen exposure that include violating the client's expectation, removing safety signals and varying practice across places and contexts (Craske et al., 2014). So each step on Marcus's list has a written prediction and a note of which safety behaviors he leaves behind.

The plan

  • Plan date:10/21 (initial plan). Clinician: [name], licensed clinical social worker (Indiana). Based on: intake 10/14, session 2, PDSS-SR, GAD-7, PHQ-9, panic log, physician's letter.
  • Working diagnosis:panic disorder (F41.0); agoraphobia (F40.00).
  • Problem statement:recurrent panic attacks, about 3 a week for 14 months, with persistent fear of a heart attack despite a normal medical workup. Avoids highway driving, busy stores, theaters and exercise; checks his pulse about 20 times a day. Adds 80 minutes of driving a day; has stopped exercising and visiting his brother. PDSS-SR 17.
  • Strengths:motivated, quick to learn the model, partner willing to help.
  • Barriers:the commute leaves little time for practice; his partner's help can turn into a safety behavior.

Goal 1, in his words: "Stop being scared of my own heartbeat." (Answers factors 1 and 2.)

  • Objective 1.1:PDSS-SR from 17 to 10 or less (a drop of 40 percent or more, the response threshold Furukawa and colleagues propose) by the review on 11/25, and to 5 or less by 01/13. Measure: PDSS-SR every two weeks.
  • Objective 1.2:panic attacks from about 3 a week to 1 or fewer a week for 3 weeks in a row by 01/13. Measure: panic log.
  • Objective 1.3:complete three interoceptive exercises (running in place, breathing through a thin straw, spinning in a chair) once a day on at least 5 of 7 days, with peak fear of 30 or less out of 100 on each, by 11/25. Baseline: 80 to 90 at the first try in session (10/28). Measure: interoceptive practice record.
  • Objective 1.4:pulse checks from about 20 a day to 2 or fewer a day by 11/25, with the heart-rate display removed from his watch face. Measure: a tally on one sample day each week.
  • Interventions:information on the panic cycle and the body's alarm response; self-monitoring; cognitive restructuring of "my heart is going to stop," using his own records as evidence; interoceptive exposure in session, then at home; cutting pulse checks step by step.

Goal 2, in his words: "Drive on the highway again." (Factors 3 and 4.)

  • Objective 2.1:build a 10-step hierarchy of driving and places, each step rated 0 to 100, by 11/04. Measure: done or not done.
  • Objective 2.2:at least 3 planned exposure practices a week from 11/11, each with a written prediction and without the safety behaviors the step names (water, unlocked phone, passenger). Baseline: 0. Measure: exposure record.
  • Objective 2.3:drive the highway route to work alone at least 3 days a week by 01/13. Baseline: none since August of last year. Measure: exposure record.
  • Objective 2.4:shop alone for 20 minutes on a Saturday morning, staying until the list is done, by 01/13. Baseline: hasn't shopped on a weekend since spring. Measure: exposure record.
  • Interventions:in vivo exposure up the hierarchy, starting at a step he rates about 40; dropping safety behaviors one at a time; varying the times, routes and stores once a step is done; reviewing each prediction against what happened.

Goal 3, in his words: "Get back to the gym and see my brother." (Factor 3.)

  • Objective 3.1:at the gym twice a week, with at least 15 minutes of cardio that raises his heart rate, by 01/13. Baseline: 0 since March. Measure: gym check-ins.
  • Objective 3.2:drive to his brother's in Louisville, about two hours of highway, by the booster session on 02/10. Baseline: last visit in July of last year. Measure: done or not done.
  • Interventions:the gym as interoceptive exposure in daily life; the trip as the top step of the hierarchy.

Services: individual psychotherapy (CBT for panic disorder), 60 minutes, weekly, 12 sessions from 10/14 to 01/13, within NICE's 7 to 14 hours and 4 months. Sessions 1 to 4 by video, client at home in Indiana; from session 5 (11/11) in the office, and the drive there becomes part of the hierarchy. Booster session 02/10.

Video is a reasonable start for a client who can't yet drive to you. It can also become one more way to avoid, so the plan moves sessions to the office on a set date. When you see clients by video, HHS says health professionals "must meet the licensure requirements of the state where they are located and be licensed or legally permitted to practice in the state where the patient is located" (Telehealth.HHS.gov, Licensure for behavioral health).

Measures: PDSS-SR every two weeks; GAD-7 and PHQ-9 at intake and at each review; panic log; interoceptive and exposure records.

Risk and safety: asked at intake (denied); asked again at each review and if his mood drops. The physician's written clearance for interoceptive exercises is on file (dated 10/10). Check with the client's physician before exercises that raise heart rate or change breathing, especially when there is a heart, lung or seizure condition, or a pregnancy.

Coordination: with his release, his physician gets a summary at each review.

Decision point: if the PDSS-SR hasn't dropped 40 percent by 11/25, review practice, the hierarchy and hidden safety behaviors first; then discuss with Marcus a medication evaluation with his physician, since NICE lists an antidepressant as the other option.

Client participation: Marcus wrote the goals and ranked the hierarchy; he chose highway driving as the change that matters most. With his consent, his partner joins the last 15 minutes of session 4 to agree not to drive him on routes he is practicing alone. Copy given.

Review: 11/25 (session 7) and 01/13 (session 12).

Discharge when: PDSS-SR 5 or less, or a drop of at least 40 percent held for four weeks; 1 or fewer attacks a week; the highway commute 3 days a week; and a written relapse plan for setbacks ("an attack is a cue to practice, not a sign it's back"). Booster session 02/10.

Signatures: Marcus, 10/21. Clinician, credentials, 10/21.

What this example shows:

  • Avoidance and safety behaviors are objectives, not just symptoms to list in the intake.
  • The medical workup and the clearance for exposure are on the plan, with dates.
  • The score targets come from published thresholds (40 percent for response, 5 or less for remission), so "better" means something specific.

Anxiety treatment plan example 3: social anxiety disorder

Invented client: a 27-year-old staff accountant we'll call Hana, who moved to Denver for her job 14 months ago. She is seen in the office by a psychologist licensed in Colorado. The plan was written with her in her second session.

The case in brief

  • Presenting problem:since middle school, intense fear of being judged when she speaks in meetings, makes phone calls, makes small talk, eats in front of colleagues or goes on dates. She blushes and her hands shake, and she believes people notice and think she is incompetent. "Everyone can tell how awkward I am."
  • Avoidance:hasn't spoken in her team's weekly meeting in the last 8 meetings; emails clients instead of calling, even when a call is expected; eats lunch at her desk; has turned down every after-work event for three months; has matches on a dating app she never meets.
  • Safety behaviors:rehearses what she'll say; holds a cup to hide shaking hands; keeps her hair over her face and wears high collars; avoids eye contact; asks questions so she doesn't have to talk about herself; drinks two glasses of wine before any party she can't avoid.
  • Afterward:replays conversations for 1 to 2 hours, looking for what she did wrong.
  • Work:her manager has said she'll need to present quarterly results to be promoted to senior accountant in the spring.
  • Measures and risk at intake (10/15):SPIN total 44. GAD-7 11. PHQ-9 9 (mild), item 9 scored 0; asked directly, she denied thoughts of death or self-harm. Alcohol only before social events, about twice a month; no other substances.
  • What keeps it going (in the Clark and Wells model):(1) attention turned inward, and a picture of herself as "red, shaking and boring"; (2) safety behaviors, which can make her look more withdrawn and stop her learning she'd be fine without them; (3) avoidance; (4) rehearsing beforehand and replaying afterward.
  • Strengths:good at her job; a close friend from college she talks to by phone; a clear reason to change; curious about how the model fits her.

Why CBT developed for social anxiety

NICE recommends individual CBT developed specifically for social anxiety disorder, based on the Clark and Wells model or the Heimberg model, as the first option for adults, and says not to routinely offer group CBT instead of individual CBT (NICE CG159, 1.3.2 and 1.3.3). The Clark and Wells version "should consist of up to 14 sessions of 90 minutes' duration over approximately 4 months" (1.3.13). Its parts include education about social anxiety, exercises that show the effects of self-focused attention and safety behaviors, video feedback to correct the client's image of how they come across, training in focusing attention outward, behavioral experiments with homework, work on painful social memories, work on core beliefs, work on rehearsing beforehand and replaying afterward, and relapse prevention.

A network meta-analysis of 101 studies with 13,164 participants found individual CBT had the largest effect of the psychological treatments, and its authors concluded it "should be regarded as the best intervention for the initial treatment of social anxiety disorder" (Mayo-Wilson et al., 2014). In an earlier randomized comparison by Clark and colleagues, cognitive therapy did better on social phobia measures than fluoxetine with self-exposure (Clark et al., 2003). Division 12 rated CBT for social anxiety as having "strong" research support under its 1998 criteria (Division 12, CBT for social anxiety disorder).

The plan

  • Plan date:10/22 (initial plan). Clinician: [name], licensed psychologist (Colorado). Based on: intake 10/15, session 2, SPIN, GAD-7, PHQ-9.
  • Working diagnosis:social anxiety disorder (F40.10).
  • Problem statement:marked fear of being judged in social and work situations since early adolescence, with blushing and trembling she believes others notice. Avoids speaking in meetings (0 of the last 8), phone calls, eating with colleagues and social events; uses safety behaviors, including drinking before events, and replays conversations for 1 to 2 hours afterward. Limits her work, since promotion requires presenting, and has left her without friends in her new city. SPIN 44.
  • Strengths:competent, motivated by the promotion, one close friend.
  • Barriers:month-end closing weeks; the pull to "prepare" for every experiment.

Goal 1, in her words: "Speak up at work without scripting every word." (Answers factors 1, 2 and 4.)

  • Objective 1.1:SPIN total from 44 to 30 or less by the review on 12/03, and below 19 by 02/04. Measure: SPIN at every session.
  • Objective 1.2:speak at least once, without a script, in at least 3 of 4 weekly team meetings by 12/03. Baseline: 0 of the last 8. Measure: meeting log.
  • Objective 1.3:make client calls by phone instead of email at least 3 times a week by 12/03. Baseline: 0. Measure: call log.
  • Objective 1.4:present a 5-minute section of the quarterly results by 01/28. Baseline: has never presented at work. Measure: done or not done.
  • Interventions:education about social anxiety, drawing the model from her own recent example (session 2); a conversation role-play done twice, once with her usual safety behaviors and inward focus and once without, rating how anxious she felt and how she thinks she looked (session 3); video feedback of the role-plays, watched as if she were a stranger, to compare the recording with her image of herself; training in focusing attention outward; behavioral experiments in session and as homework (pausing mid-sentence, letting her hands show, asking a colleague a question).

Goal 2, in her words: "Stop replaying every conversation." (Factor 4.)

  • Objective 2.1:replaying after a social situation from 1 to 2 hours to 15 minutes or less after at least 4 of 5 situations by 12/03. Measure: replay log.
  • Objective 2.2:no written script before team meetings in at least 3 of 4 weeks by 12/03. Baseline: a script for every meeting. Measure: meeting log.
  • Interventions:work on rehearsing beforehand and replaying afterward: noticing the replay, naming it and turning attention to the next task; an experiment comparing a meeting she scripts with one she doesn't.

Goal 3, in her words: "Have a couple of friends here." (Factors 2 and 3.)

  • Objective 3.1:attend one after-work or social event a week, staying at least 45 minutes, for 4 weeks in a row by 02/04. Baseline: 0 in three months. Measure: event log.
  • Objective 3.2:go to social events without drinking beforehand, every time, from 11/05. Baseline: two glasses before every event she can't avoid. Measure: event log.
  • Objective 3.3:eat lunch with colleagues at least twice a week by 02/04. Baseline: 0. Measure: event log.
  • Interventions:behavioral experiments in real social situations, dropping one safety behavior at a time; if it fits, rescripting the memory she links to the fear (being laughed at during a class presentation at 13); work on the belief "I'm boring" in later sessions; relapse prevention.

Services: individual CBT for social anxiety disorder (Clark and Wells model), 90 minutes, weekly, up to 14 sessions from 10/15 to 02/04, in the office. If 90-minute sessions don't fit what you can deliver or what a payer covers, write the length and number you will deliver and how the plan adapts.

Recordings: role-plays for video feedback are recorded only with her written consent (signed 10/22), kept on a practice system covered by a Business Associate Agreement, and deleted after she has watched them. Write down where recordings are kept and when they are deleted.

Measures: SPIN at every session; GAD-7 and PHQ-9 at intake and at each review; meeting, call, event and replay logs.

Risk and safety: asked at intake (denied); asked again at each review and if the PHQ-9 rises. Alcohol reviewed at each review. NICE notes that "alcohol or drug misuse is often an attempt to reduce anxiety in social situations and should not preclude treatment for social anxiety disorder" (NICE CG159, 1.2.11), and recommends a brief intervention for hazardous use.

Decision point: if the SPIN hasn't dropped to 35 or less by 12/03, check which safety behaviors are still in use during experiments and whether avoidance has moved somewhere new, then consult and review the conceptualization.

Client participation: goals in her words; she chose the quarterly presentation as the objective that matters most and the order of the experiments. Copy given.

Review: 12/03 (session 7) and 02/04 (session 14).

Discharge when: SPIN below 19, or at least halved, on two scores in a row; objectives 1.2 and 3.1 kept for four weeks; the presentation given; and a written relapse prevention plan.

Signatures: Hana, 10/22. Clinician, credentials, 10/22.

What this example shows:

  • Each intervention is a named part of one model, in the order the plan will use it, not a list of everything that might help with anxiety.
  • The drinking is a safety behavior with its own objective, and also a risk to watch.
  • Recording consent and storage are on the plan, because video feedback creates a recording of a client.

An ACT version of the same goals

Acceptance and commitment therapy treats anxiety as something to make room for while doing what matters. So in an ACT plan the long-term goals are values, the objectives are committed actions done with anxiety present, and the measure of the process is psychological flexibility alongside the symptom scale.

The evidence is real but thinner. In a randomized comparison of 128 adults with mixed anxiety disorders, ACT and CBT, both including exposure, improved by similar amounts (Arch et al., 2012). Division 12 rated ACT for mixed anxiety conditions as having "modest" research support under its 1998 criteria, with its 2015 re-evaluation pending (Division 12, ACT for mixed anxiety). NICE's guidelines for GAD, panic disorder and social anxiety don't name ACT among their recommended options. If you use it, write the reason on the plan (the client's informed preference, or an earlier course of CBT that didn't help) and keep exposure in it.

Here is Hana's goal 3 written from ACT:

  • Value, in her words:"Being a friend who shows up."
  • Objective:attend one social event a week, staying at least 45 minutes even when anxious, for 4 weeks in a row by 02/04. Baseline: 0 in three months. Measure: event log, with willingness rated 0 to 10 before she goes.
  • Objective:when the thought "they think I'm boring" shows up, name it ("I'm having the thought that they think I'm boring") and stay in the conversation, in at least 3 of 4 logged conversations by 12/03. Baseline: goes quiet or leaves. Measure: event log.
  • Process measure:the Acceptance and Action Questionnaire-II at intake and at each review (Bond et al., 2011), alongside the SPIN.
  • Interventions:values clarification; defusion; willingness exercises; committed action built as exposure. Our ACT therapy worksheets cover values and defusion.

The numbers stay. An ACT objective still needs a baseline, a target and a date.

Anxiety treatment plan goals and objectives bank

Adapt these to the client in front of you. Fill in the brackets with your client's own numbers, and keep the baseline next to the target.

Long-term goals for anxiety, in clients' words

  • "Stop feeling wound up all the time."
  • "Sleep without my brain running."
  • "Go places without planning my escape."
  • "Drive on the highway again."
  • "Stop being scared of my own body."
  • "Speak up without rehearsing every word."
  • "Stop needing someone to tell me it's okay."
  • "Do the things I want to do, even if I'm nervous."
  • "Have friends here."
  • "Know what to do if it comes back."

Short-term objectives for anxiety

Symptom scores:

  • GAD-7 from [15] to below 10 by [date], and down at least 4 points by [review date].
  • PDSS-SR down at least 40 percent, from [17] to [10] or less, by [date], and 5 or less by [date].
  • SPIN from [44] to below 19 by [date].

Worry:

  • Worry kept to one [20]-minute scheduled worry time on at least [5] of 7 days by [date]. Baseline: [most of the evening].
  • Belief that "worrying keeps me prepared" from [85] to [40] percent or less by [date], after [2] behavioral experiments.
  • Sort [3] worries a week into "can act on now" and "can't act on now," and take one step on one she can act on, by [date].

Tension and sleep:

  • Rapid relaxation at the first sign of tension at least [5] times a day on [5] of 7 days by [date]. Baseline: 0.
  • Asleep within 30 minutes on at least [5] of 7 nights by [date]. Baseline: [1] of 7.
  • Tension headaches [1] or fewer a week for 3 weeks in a row by [date]. Baseline: [3 to 4].

Panic and body sensations:

  • Panic attacks from [3] a week to [1] or fewer a week for 3 weeks in a row by [date].
  • Peak fear of 30 or less out of 100 on each interoceptive exercise by [date]. Baseline: [85].
  • Belief that "a racing heart means a heart attack" from [90] to [20] percent or less by [date].
  • Pulse or symptom checks from [20] a day to [2] or fewer by [date].

Avoidance and exposure:

  • A hierarchy of [8 to 12] steps, each rated 0 to 100, by session [#].
  • At least [3] planned exposures a week, each with a written prediction, by [date]. Baseline: 0.
  • [Drive the highway route / ride the train / shop at a busy time] alone [3] times a week by [date]. Baseline: [none since month].

Safety behaviors and reassurance:

  • Leave [one named safety behavior] behind in at least [3] of 4 practices by [date].
  • Reassurance questions from [8] a day to [2] or fewer by [date].
  • Check [the work, the stove, the location app] once instead of [3] times on [4] of 5 days by [date].

Social situations:

  • Speak at least once in [3] of 4 [meetings / classes] by [date]. Baseline: [0] of [8].
  • [3] phone calls a week that [he / she / they] would otherwise put in an email, by [date].
  • Replaying after a social event from [1 to 2 hours] to 15 minutes or less after [4] of 5 events by [date].
  • One social event a week, staying at least [45] minutes, for 4 weeks in a row by [date].

Daily life:

  • Leave work by [time] on [4] of 5 days by [date]. Baseline: [1] of 5.
  • Back at [the gym / choir / class] [twice] a week by [date]. Baseline: [0 since month].
  • No days missed from [work / school] because of anxiety for 4 weeks in a row by [date]. Baseline: [#] last month.

Skills:

  • A thought record on at least [3] days a week by [date], with belief in [the main thought] rated after each.
  • Name an anxious thought and stay in the situation in at least [3] of 4 logged situations by [date].

Relapse prevention:

  • A written relapse prevention plan listing early signs, the skill for each and what to do after a setback, by session [#].
  • The main scale repeated at a booster session [4 to 8] weeks after the last regular session.

Anxiety-specific mistakes in goals and objectives

  • "Client will feel calm before giving the presentation." This makes calm a condition for acting, which is the pattern treatment is trying to break. Write the action: "give a 5-minute section of the presentation by 01/28."
  • "Client will use breathing to stop panic attacks." In panic disorder, using breathing or relaxation to get rid of sensations during exposure can work like a safety behavior. If relaxation is part of the plan, say when and how it's used.
  • "Exposure until anxiety reaches 0." Write a prediction and a planned end point instead. The learning comes from testing the prediction, not only from fear going down.
  • "Eliminate anxiety." Anxiety is a normal emotion. Aim for less interference with life, with counts that show it.
  • Symptom scores only. Add avoidance and safety behavior counts. Scores can improve while the client's world stays small.
  • "CBT for anxiety" as the only intervention. Name the model or protocol, the techniques and the number of sessions.

For practice turning weak objectives into measurable ones, the treatment plan template guide has seven rewritten before and after.

Anxiety treatment plan template to copy

This adds the anxiety-specific lines (feared outcome, avoidance, safety behaviors, medical check, exposure plan, decision point) to a standard plan. Copy it into your own document and fill it in. For the general outpatient, brief therapy and couples templates, see the treatment plan template guide.

Anxiety treatment planTemplate · 34 parts to fill in
Anxiety treatment plan
Client: [name or ID]Plan date: [MM/DD/YYYY]Plan version: [initial / update #, replaces MM/DD]Clinician: [name, license, state]Based on: [intake date, sessions, measures, records]
Working diagnosis: [name and ICD-10-CM code]Medical causes checked by: [who, what, date]Also screened: [depression, alcohol, substances]
Problem statementFeared outcome (client's words): [ ]Main worry, sensation or situation: [ ]Avoided: [situations, places, sensations, how often]Safety behaviors: [what, how often]Impact: [work, home, relationships, health]
What keeps it goingFactor 1: [ ]Factor 2: [ ]Factor 3: [ ]
MeasuresMain scale and baseline: [GAD-7 / PDSS-SR / SPIN, score, date]Second scale and baseline: [ ]Logs: [worry / panic / exposure / replay / sleep]Schedule: [every session / every 2 weeks]
Goal 1 (client's words): [ ]Answers factor: [#]Objective 1.1: [what, how much, by date]Baseline: [ ]Measure: [ ]Interventions: [model, techniques, sessions]
Goal 2 (client's words): [ ]Answers factor: [#]Objective 2.1: [what, how much, by date]Baseline: [ ]Measure: [ ]Interventions: [ ]
Exposure plan (if used)Hierarchy built by: [session # or date]First step: [step, rated 0 to 100]Practices each week: [#]Safety behaviors to leave behind: [ ]Medical clearance for interoceptive work: [date]
ServicesModel: [for example, applied relaxation, CBT]Session length: [minutes]Frequency: [weekly]Number of sessions: [#, from MM/DD to MM/DD]Format: [in person / video; client's state]
Risk and safety: [what you asked, result, date]Coordination: [physician, releases on file]Decision point: [date, what you will consider]Review dates: [midpoint, end]Discharge when: [measurable criteria]Relapse prevention plan by: [session # or date]
Client signature and date: [ ]Clinician signature, credentials, date: [ ]

How progress notes tie back to the anxiety plan

Each progress note should say which goal and objective the session worked on, report the measure next to its baseline and target, and say what changes next. Payers expect the thread: one Medicare contractor's rule says "a periodic summary of goals, progress toward goals, and an updated treatment plan must be included in the medical record" (CGS, LCD L34353).

Here is the same thread in three note formats, one for each example.

DAP note for Renee, session 7 (11/24, review). More on the format in our DAP notes examples.

  • Data:GAD-7 11 (15 at intake; target below 10 by 01/12). Practice sheet: release-only relaxation twice a day on 6 of 7 days; cue-controlled relaxation started. Headaches: 2 this week (baseline 3 to 4). Asleep within 30 minutes on 3 of 7 nights (baseline 1 of 7). Last coffee by noon on 6 of 7 days. Left work by 5:30 p.m. on 2 of 5 days. Denied thoughts of self-harm when asked.
  • Assessment:objective 1.1 met its 11/24 checkpoint (down 4 points), so the plan continues without adding cognitive work. Objective 2.2 met. Sleep (2.1) and leaving work (3.1) are slower; she still checks billing twice.
  • Plan:start differential relaxation; begin the one-check experiment on billing (objective 3.2). Plan reviewed today and continues as written. Next review 01/12.

BIRP note for Hana, session 5 (11/12). More on the format in our BIRP note examples.

  • Behavior:SPIN 37 (44 at intake; target 30 or less by 12/03). Spoke once without a script in each of the last two weekly team meetings (baseline 0 of 8). Replayed the second meeting for "about 40 minutes" (baseline 1 to 2 hours).
  • Intervention:behavioral experiment: a phone-call role-play with and without holding the cup. She predicted the clinician would notice her hands shaking (90 percent sure); the clinician didn't. She rated how she came across 3 out of 10 before watching the recording and 6 after. Practiced turning attention outward after a replay starts.
  • Response:"I looked more normal than I felt." Chose an experiment for the week: one client call by phone, with the cup left on the desk.
  • Plan:objective 1.3 starts this week. Recording deleted at the end of the session, as consented. Goals 1 to 3 continue; review 12/03.

The Assessment of a SOAP note for Marcus, session 7 (11/25). More on the format in our SOAP note therapy examples.

  • Assessment:PDSS-SR 9 (17 at intake), a 47 percent drop, which meets objective 1.1's response target on the review date. One panic attack this week. Peak fear on running and straw breathing now 20 and 25; spinning still 50 (target 30). Pulse checks down to 2 a day (objective 1.4 met). Hierarchy steps 1 to 4 of 10 done; he put off step 5 twice and brought his partner on a practice meant to be solo. Continued care needed for goals 2 and 3.

A GIRP note opens with the goal itself, which makes this thread easy to keep. For wording such as "reviewed progress toward objective 1.2" or "revised target date by agreement," see the progress notes cheat sheet.

How to update an anxiety treatment plan

Put the reviews where the model's milestones are

The guideline doses make natural review points: the middle and the end of 12 to 15 sessions for GAD, of 7 to 14 hours of CBT for panic, and of up to 14 sessions for social anxiety. Review sooner if risk changes, if the client tells you something new (trauma, substance use, a medical problem), if their goals change, or if you change the frequency, format or level of care. Payers and states may set their own interval; the treatment plan template guide covers those rules and has a review template.

A worked update: Marcus at his midpoint review

At session 7 (11/25), Marcus and his clinician went through each objective and wrote version 2 of the plan:

  • Plan version 2, 11/25, replaces the plan of 10/21.
  • Objective 1.1:response target met (PDSS-SR 9). Continue toward 5 or less by 01/13.
  • Objective 1.2:progressing (1 attack a week for 2 weeks). Continue.
  • Objective 1.3:met for running in place and straw breathing; spinning at 50. Revised: spinning at 30 or less by 12/16.
  • Objective 1.4:met (2 checks a day, display removed). Ended as an objective; still counted on the panic log.
  • Objective 2.3:no change; stuck at step 5 (one exit on the highway, alone). Revised: a new step 4b, two exits with his partner following in another car, before step 5. Partner in the passenger seat removed as an option from now on.
  • New objective 2.5:drive to the office on the highway for sessions by 12/16. Baseline: local roads only.
  • Objective 3.1:not started. Target date moved from 01/13 to 02/10, by agreement.
  • Services:unchanged, 12 sessions and the booster on 02/10.
  • Signatures:Marcus and clinician, 11/25.

Notice that nothing in version 2 is vague. Each objective is marked met, progressing, unchanged or revised, and each change has a reason in the review notes.

When the main measure doesn't move

Look at the basics first: attendance, home practice and whether the client is doing exposures with safety behaviors quietly still in place. Then go back to the conceptualization. A flat score can mean depression, alcohol or another problem is driving things, or that the main problem is different from the one you planned for (health anxiety instead of panic, for example, or trauma). After that, consider supervision or consultation on fidelity to the model, which NICE builds into its GAD recommendations (1.2.21), switching or adding a modality (applied relaxation to CBT, as Renee's plan sets up), a referral for a medication evaluation, or a different level of care. Write down what you considered and why you chose what you did.

When the goals are met

Step sessions down, write the relapse prevention plan with the client, book a booster session, and repeat the main scale at it. When you close the case, a therapy discharge summary records the baseline and final scores side by side.

Date every version and keep the old ones in the record. Don't write over a plan; an auditor, a supervisor or the next clinician needs to see how it changed.

How this works in TranqBay

TranqBay is practice software for therapists in private practice: a practice website, online booking, video sessions, session notes and client forms in one place. Here is where an anxiety treatment plan fits.

  • GAD-7 before each review.TranqBay's form library has ready-made templates you send to a client for a session, including the GAD-7 and the PHQ-9. The client fills them in online and the answers wait with the session. TranqBay doesn't score forms automatically, so add up the total, or use the GAD-7 and PHQ-9 scoring tools, and record the score next to the baseline in your note.
  • The inputs for the plan.The same library includes intake forms, consent to treat, telehealth consent and a release of information: the facts behind the problem statement, consent for video sessions like Renee's and Marcus's, and the release that lets you send a summary to a physician.
  • Notes that report on the plan.You can write session notes in BIRP, DAP, SOAP or GIRP format, or a blank note. Structured formats are part of the advanced note templates, which some plans include. Write the plan itself as a blank note on the session where you agreed it, so it sits with that session's record.
  • Video sessions while travel is hard.Video sessions are end-to-end encrypted, and they suit early sessions with a client who can't yet travel to you, as in Marcus's plan. TranqBay is HIPAA-ready, and its Business Associate Agreement applies when you accept the Terms, with no separate document to sign.
  • Booking without a phone call.For many people with social anxiety, calling a stranger is one of the hardest steps, and Hana emailed clients rather than phoning them. A practice website with online booking lets a new client request a first appointment without picking up the phone. You can see the booking page a new client would use before you set anything up.

Frequently asked questions about anxiety treatment plans

What is an example of a treatment plan goal for anxiety?

A goal in the client's words, such as "Drive on the highway again," with measurable objectives under it: "drive the highway route to work alone at least 3 days a week by 01/13 (none since August)" and "PDSS-SR from 17 to 10 or less by 11/25." The goal says where the client wants to get to; the objectives say how you'll both know they're getting there.

What are SMART goals for anxiety?

Objectives that are specific, measurable, achievable, relevant and time-bound. For anxiety, the most useful ones count avoidance and safety behaviors as well as symptoms: "speak at least once, without a script, in 3 of 4 weekly team meetings by 12/03 (now 0 of 8)." The bank above has more than 30 to adapt.

What are short-term goals for anxiety?

Steps the client can reach in weeks: building an exposure hierarchy, a first set of exposures, cutting pulse checks from 20 a day to 2, falling asleep within 30 minutes on 5 nights a week, or a 4-point drop on the GAD-7 by the first review. Long-term goals are the life changes those steps add up to, such as driving to see family or giving a presentation.

What interventions go on an anxiety treatment plan?

The ones your model and the evidence support for the main disorder, named specifically. NICE recommends CBT or applied relaxation for GAD, CBT for panic disorder, and individual CBT developed for social anxiety (Clark and Wells or Heimberg) for social anxiety disorder. Exposure, interoceptive exposure, cognitive restructuring, behavioral experiments and relaxation are techniques within those, and ACT is an option with more modest support.

How many sessions does anxiety treatment take?

NICE describes 12 to 15 weekly one-hour sessions of CBT or applied relaxation for GAD, 7 to 14 hours of CBT for panic disorder completed within 4 months, and up to 14 sessions of 90 minutes over about 4 months for the Clark and Wells model of CBT for social anxiety. Write the planned number on the plan, and change it at a review if the client needs more or fewer.

Which measure should I use to track anxiety?

The GAD-7 for generalized anxiety and as a general tracker, plus a measure for the main disorder: the PDSS or its self-report version for panic disorder, and the SPIN or LSAS for social anxiety. Add logs for the behaviors the plan targets, such as panic attacks, exposures and safety behaviors.

Can I use the GAD-7 for panic disorder or social anxiety?

As a screener and a general tracker, yes: in primary care it detected panic disorder and social anxiety disorder as well as GAD. It wasn't built to measure panic severity or social fear, so pair it with the PDSS-SR or the SPIN for those plans.

How often should I update an anxiety treatment plan?

At the review dates in the plan, which fit well at the middle and end of the planned course of treatment, and sooner if risk, goals or services change. Follow any interval your payer or state sets.

Is there an anxiety treatment plan template I can use?

Yes: copy the template above into your own document and save or print it as a PDF. A blank template holds no client information. A filled-in plan does, so keep it only where your records are protected, with a vendor who signs a Business Associate Agreement.

Before you write your next anxiety plan

Take the baseline before you write a single target, name the model and its number of sessions, count the avoidance and safety behaviors, and write the decision date on the plan the day you sign it. Then make each progress note say which objective it moved.

If you want booking, video sessions, client forms and session notes in one place, look at the practice website designs and the booking page your clients would use. If you're deciding whether to join, this page explains how joining TranqBay works.

Sources

26 sources

nice.org.uk 2societyofclinicalpsychology.org 4Research 17HHS 1CMS 1988 Lifeline 1

Updated October 25, 2026. Found it useful? Send it to a colleague.

Run your practice in one place.

Your own website, online booking and video sessions.

  • Your own website
  • Online booking
  • Video sessions
See how it workspractice.tranqbay.health

More guides for therapists

All guides
HIPAA and telehealth8 min

Is Google Workspace HIPAA Compliant? BAA, Apps and Settings

Checklist
Running a practice13 min

Clinical Supervision Topics: 57 Questions and 10 Activities

57 questions
Running a practice7 min

Therapist Email Signature: 10 Examples and What to Include

Examples

In crisis? Don't use this site. Get immediate help or call emergency services.