Therapy Blueprint for Panic: PDF Worksheet, Tools and Exercises

Patients near the end of panic work can articulate Clark's model fluently, complete interoceptive exposures without avoidance, and report significant symptom reduction, and then arrive at a wobble three months later with no map. This fiche PDF is designed for exactly that gap: a single visual consolidation tool the clinician uses in session to co-construct the patient's personal panic narrative across past, present, and future, leaving them with something concrete to return to on a bad day.

Why the End of Panic Work Is Clinically Tricky

The final phase of CBT for panic tends to collapse the explicit knowledge the patient has built. Discharge feels abstract. Patients know they improved, but the mechanism, what kept it going, what changed it, lives in scattered session notes and half-remembered metaphors. Without a structured consolidation, the panic maintenance cycle risks being forgotten precisely when it is most needed.

There is also a subtler problem: many patients confuse the absence of panic with the end of vulnerability. They stop monitoring early warning signs and discard the toolkit that built their gains. When a stressor reactivates symptoms, the relapse feels like proof they were never really better, not information to work with.

An oral summary at the end of a session rarely holds. The support visuel changes this: a patient who has written their own blueprint has encoded the formulation in their own language, in a format they can find.

What the Fiche Contains

The fiche is structured around four numbered panels that flow from formulation to action plan.

Panel 1 maps three time frames on a single page: PAST (triggers, feared sensations, catastrophic stories, the patient fills in their own specifics: "Shops, metro, motorway, meetings, exercise, being alone"), PRESENT (the reframe: "Panic is uncomfortable, not dangerous, a false alarm"; sensations and tools), and FUTURE (avoidance-free goals, warning signs, if-then scripts). This tri-temporal layout, visible at a glance, gives the patient a coherent account of where they were, what shifted, and where they are headed. It is far more legible than any verbal summary.

Panel 2 diagrams the panic loop explicitly, body sensation, scary story, fear spike, stronger signal, confirmation bias, alongside the three maintenance mechanisms that tend to be hardest to surrender: avoidance, safety behaviours, and body-scanning. Seeing all three together on a printable supports the conversation about which the patient is still carrying.

Panel 3 is the patient's personal toolkit: new interpretations in their own words, the interoceptive and situational experiments they completed, and the five moves now available to them (Catch, Name, Slow exhale, Drop one, Stay). Naming experiments they actually ran, "Breathing fast on purpose and not dying", "Dropping a safety behaviour, the panic still ended", consolidates the learning far better than generic instructions.

Panel 4 builds the if-then plan: early warning signs to watch for (pulse-checking, googling, cancelling, skipping exercise), scripted responses for specific scenarios, and a named support network with guidance on what not to ask of them. The fiche also includes a "To discuss in session" block specifying three clinical moments: drafting the blueprint mid-completion in session, flagging a warning sign before acting on it, and bringing a wobble as data rather than failure.

> Key takeaway: the Blueprint is not a homework form the patient completes alone. It is a visual support the clinician and patient build together, anchoring the full formulation in the patient's own language and leaving them with a one-page resource they can find and re-read.

When and How to Introduce It

Introduce the Blueprint in the penultimate or final session of active panic work, after the exposure hierarchy has been substantially completed and the patient has direct experiential evidence that panic subsides without escape. You might frame it: "What I'd like us to do today is write down everything you've learned about your panic in a format you can actually use on a difficult day." Framing it as a collaborative writing exercise, not an evaluation, keeps the alliance intact.

For patients with residual safety behaviours, panels 2 and 3 together support a direct conversation about what is still functioning as a crutch. For those with high relapse anxiety, the if-then scripts in panel 4 de-catastrophise the idea of a wobble before it happens.

A natural pairing: combine the Blueprint with your existing lapse and relapse framework and, where habituation was a core concept in the work, reference it in the panel 3 toolkit section. The Blueprint does not replace the therapeutic frame; it makes the patient's hard-won learning portable.

Sources

• Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural and Cognitive Psychotherapy, 19(1), 6-19.
• Clark, D. M., Salkovskis, P. M. (2009). Cognitive Therapy for Panic Disorder: IAPT Manual. Oxford Cognitive Therapy Centre.
• Craske, M. G., Barlow, D. H. (2022). Mastery of Your Anxiety and Panic: Workbook (5th ed.). Oxford University Press.
• National Institute for Health and Care Excellence (NICE) (2011). Generalised anxiety disorder and panic disorder in adults: management (CG113).