Typical treatment outline

Note: This is not a rigid, prescriptive list but an indicative treatment structure to enable the correct dose of the change method as homework during exposure and habituation within a Low Intensity CBT format. Exposure exercises should be front-loaded from the first session homework to ensure that a sufficient dose is provided, in line with the evidence. Session 1:

1. Agenda Setting 2. Socialisation to the maintenance model of fear, panic and agoraphobia and treatment rationale given for exposure and habituation 3. Hierarchy started and at least top, middle and bottom complete, with an exercise of at least 50-60% in the easier section to enable week 1 homework to be the change method task of exposure exercises 5. Homework task agreed, checked against the 4 essential conditions and the plan written down on a activity diary 6. Ending Session 1 Homework:

1. Completion of 4-5 exposure exercises as planned, meeting the 4 conditions 2. Completion of the hierarchy if not completed in session Session 2:

1. Agenda Setting 2. Review exposure and habituation exercise diary, drawing out each exercise ratings on the blank graphs as a visual learning tool for the patient. Any learning through using the intervention for the first week should be socratically discussed and consolidated, or any difficulties or misunderstandings in implementation reviewed in terms of internal or external barriers and managed accordingly. If hierarchy was completed as homework, review this and make any necessary changes. 3. Planning for week 2 homework based on week 1 progress. Discussion on how and when to step up independently using the information in the self-help material to guide the discussion. 4. Homework tasks agreed and plan written down on exercise diary, checked off against the conditions to check patient understanding 5. Ending Session 2 Homework:

1. Completion of 4-5 exposure exercises as planned, meeting the 4 conditions Session 3:

1. Agenda Setting 2. Review exposure and habituation exercise diary, drawing out each exercise ratings on the blank graphs as a visual learning tool for the patient. Any learning through using the

intervention for the first week should be socratically discussed and consolidated, or any difficulties or misunderstandings in implementation reviewed in terms of internal or external barriers and managed accordingly. 3. Planning for week 3 homework based on week 2 progress. Check understanding of when to step up the hierarchy. 4. Homework tasks agreed and plan written down on exercise diary, checked off against the conditions to check patient understanding 5. Ending Session 3 Homework:

1. Completion of 4-5 exposure exercises as planned, meeting the 4 conditions

Session 4 onwards:

Treatment is then continued as above, working up the hierarchy until progress towards goals is made, the patient is near recovery and relapse management can be initiated (usually 4-8 sessions of treatment).