CASC: Explaining cognitive maintenance of panic and setting a behavioural experiment

Candidate instructions

You are the psychiatry registrar in outpatient clinic. Alex, 27, has panic attacks with racing heart. Always sits down and checks pulse; carries unused lorazepam “just in case.” Also says “I can’t remember anything you say in appointments — my brain is broken.” Your tasks in 10 minutes:^[9]

1. Engage collaboratively; set agenda; validate distress without agreeing the heart will stop.
2. Explain in plain language catastrophic misinterpretation of sensations and how safety behaviours keep the fear belief alive.
3. Rate a specific prediction (0–100%) for a planned mild interoceptive or real-world test.
4. Negotiate one behavioural experiment with a plan to partially fade a safety behaviour.
5. Address “broken brain” with a brief working-memory load explanation and one compensatory strategy (written single-step plan).
6. Brief risk screen (SI, benzo misuse, avoidance of medical care) without abandoning the cognitive-education task. Station prioritises Clark-model teaching, collaborative empiricism, and capacity-aware communication.^[2][9]