Panic Attack SOAP Note Example for Therapists

A SOAP note about panic attacks needs to make clear which sensations the person reports, how she interprets them, which safety behaviours she maintains and what was practised in the session. It also helps to separate what is known from the medical assessment from what is only assumed.

The example below is fictional and educational. It is not a diagnostic assessment and does not replace professional judgement, medical assessment where appropriate, or applicable documentation requirements.

Fictional panic attack SOAP note example

Context: Sixth session of cognitive behavioural therapy. Presenting concern: recurrent panic attacks and avoidance of the metro and crowded places. No known medical contraindications to interoceptive exercises, reviewed during the initial assessment.

Subjective: The person reports two panic attacks this week, compared with four the previous week. The most intense occurred in the supermarket, with palpitations, a feeling of breathlessness and fear of fainting. She rates it 8 out of 10, and it subsided in about ten minutes. She still carries a bottle of water and sits near the door “just in case”. She travelled two stops on the metro accompanied. She mentions that her GP checked the palpitations last month and that, as it was explained to her, no abnormalities were found.

Objective: Arrives on time and participates actively. Brings the panic attack record completed on five of the seven days. During one minute of voluntary hyperventilation she reports dizziness and tingling, rates anxiety at 6 out of 10, and it falls to 2 out of 10 in about four minutes without leaving the consulting room. She identifies without help the sequence between palpitations, the thought of fainting and looking for an exit.

Assessment: The frequency of attacks is decreasing and there is a first approach to an avoided situation. The catastrophic interpretation of bodily sensations remains present. Safety behaviours may be preventing the person from finding out that the sensations do not lead to fainting. The response to the interoceptive exercise supports continuing exposure to sensations.

Plan: Repeat hyperventilation at home once a day, recording anxiety before, during and after. Try chair spinning at the next session before including it in home practice. Leave the bottle of water at home on one short journey, as a behavioural experiment. Repeat the metro journey accompanied and, at the next session, set a one-stop journey alone. Review the record and the experiment at the next session.

Why it is written this way

The medical information is attributed. The note records what the person says about the check-up, rather than stating “organic cause ruled out” as if the clinician had verified it.

Sensation, interpretation and behaviour are kept separate. This shows what is changing and what is not: the frequency of attacks is falling, but the catastrophic interpretation persists.

Safety behaviours, such as the bottle or the seat by the door, are recorded because they guide the next step in treatment. They are not an anecdotal detail.

The ratings are the person's own and are presented as such. They are useful for comparing sessions, not as an objective measure.

The same session as a progress note

Many practices work with progress notes written as continuous text. The same session could be recorded like this:

Sixth session. Two panic attacks this week (four the previous week), the most intense in the supermarket. First metro journey, accompanied. She maintains the bottle of water and the seat near the exit as safety behaviours. In session she tolerates hyperventilation, with anxiety falling from 6 to 2 out of 10 without escape behaviours. The interpretation of palpitations as a sign of fainting persists. Daily hyperventilation at home and a short journey without the bottle are agreed. Review at the next session.

Questions to use during review

• Is the bodily sensation distinguished from the person's interpretation of it?
• Is the medical information attributed to its source?
• Are the safety behaviours that may maintain the problem recorded?
• Were possible medical contraindications considered before proposing interoceptive exercises?
• Do the ratings allow this session to be compared with previous ones?
• Does the plan specify what will be practised, how often and how it will be reviewed?

To review the full structure, see the SOAP notes guide or the guide to mental health progress notes. You can also see the anxiety SOAP note example or the OCD example.

Clara prepares an editable draft of the note from the session, in each clinician's format and orientation. The therapist reviews attribution, assessment and plan before accepting it. See AI clinical notes with Clara.