CASC: Explaining exposure and dropping safety behaviours in panic

Candidate instructions

You are the psychiatry registrar in outpatient clinic. Sam, 31, has panic attacks in supermarkets. Leaves when heart races, feels better, now only shops with partner and always carries lorazepam “just in case” (rarely takes it). Wants help but fears exposure will “give me a heart attack.” Your tasks in 10 minutes:^[6][9]

1. Engage collaboratively; set agenda.
2. Explain in plain language how panic cues and escape maintain the problem (classical + operant / safety behaviours).
3. Outline exposure that tests predictions (expectancy violation), not “scare me until I calm.”
4. Negotiate a plan to fade partner/lorazepam-as-talisman carefully.
5. Agree one specific next-step behavioural experiment with a prediction to rate.
6. Briefly screen risk (avoidance of care, substance misuse of benzo, suicidal ideation) without abandoning the educational task. Station tasks prioritise inhibitory-learning teaching and safety-behaviour work over advice stacks.^[5][6][9]