Praxical.Psych
Session simulator

Cognitive therapy: the maintenance cycle

Structure, socialisation, and a behavioural experiment. The whole session hangs on whether she leaves able to explain her own panic to somebody else.

Cognitive TherapyfoundationalSession 4 · Panic disorder~50 min

What you are practising

  • 1Run a structured session without letting the structure damage the alliance
  • 2Elicit an automatic thought at the point of maximum affect
  • 3Identify safety behaviours, including the ones the patient does not count
  • 4Design a behavioural experiment with a falsifiable prediction
  • 5Negotiate homework the patient will actually do

Briefing

Where you are

Session 4 of a planned 12. Sessions 1–3 covered assessment, the five-part model, and Clark’s panic cycle. Maya can describe the cycle back to you and she is engaged. Panic frequency has not changed.

PHQ-9 at intake 9, now 8. GAD-7 at intake 16, now 15. She still has not driven.

What you are trying to do today

  1. 1Review the homework, first, always.
  2. 2Get one specific episode in enough detail to find the catastrophic misinterpretation.
  3. 3Make the safety behaviours visible — particularly the unopened diazepam.
  4. 4Design one experiment she will actually run.

The case

Maya Ellison

29, she/her, veterinary nurse, lives with her partner

Panic attacks with increasing avoidance of driving, supermarkets and the underground.

Read the full case first

The phases

  1. 1

    Opening: mood, bridge, agenda

    Set up the session in five minutes without it feeling clerical.

  2. 2

    Homework review

    Review it first, in detail, every time.

  3. 3

    The episode

    Find the catastrophic misinterpretation and the safety behaviours that protect it.

  4. 4

    The safety behaviours

    Find all of them, including the ones she does not count.

  5. 5

    The behavioural experiment

    A specific, falsifiable prediction, and a plan she will actually carry out.

  6. 6

    Closing

    Summary by her, feedback from her, ending on time.

Educational use only

Praxical.Psych is a teaching tool. It is not medical, clinical, psychological or legal advice, not a diagnosis, not treatment, not supervision, and not a credential. Nothing here creates a clinician–patient or solicitor–client relationship. Every patient, case, transcript and simulated session is fictional. Clinical and legal requirements vary by jurisdiction and change over time — verify anything that bears on a real decision against your own regulator, statute and current professional guidance, and consult a qualified professional.

Do not enter real patient information. If you or someone else is in crisis: US & Canada 988 · UK & Ireland 116 123 · Australia 13 11 14 · elsewhere findahelpline.com · immediate danger, your local emergency number.

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Before you begin

What Praxical.Psych is, and is not

Praxical.Psych is an educational tool. It teaches the theory, evidence base and clinical method of psychotherapy at the level of an advanced survey course, and it lets you rehearse a complete session in a simulator.

It is not medical, clinical, psychological or legal advice. It cannot diagnose or treat anyone, and it does not state the law where you practise — requirements differ by jurisdiction and change. Nothing here creates a clinician–patient or solicitor–client relationship.

  • Every patient, transcript and case in this app is fictional — a composite written for teaching. None depicts a real person.
  • Praxical.Psych is not therapy, not a substitute for supervision, and not a credential. Competence to practise comes from training, supervised hours and licensure.
  • Scores from the instruments here are for learning how they behave. They are not a diagnosis and not a risk assessment, and must not inform a decision about a real person.
  • Do not enter real patient information. Everything you type stays in this browser, but that is not the same as a compliant clinical record system.
If you are in crisis

In the US and Canada, call or text 988. In the UK and Ireland, call 116 123 (Samaritans). Elsewhere, find a local line at findahelpline.com. In immediate danger, use your local emergency number.

Read the full disclaimer