Creating a Treatment Plan for Phobias: What to Include + Example (2024)

Fear is a natural human response that can help us keep ourselves safe. In most cases, individuals are able to cope with and manage fears once they realize that they are not in danger. Individuals who are living with a phobia experience uncontrollable and irrational fear that is often overwhelming and disrupts the individual’s daily life. This anxiety disorder can cause panic attacks, which can be described as intense and sudden fear that lasts several minutes, and often has several physical symptoms. Panic attacks can occur when danger is not present.

Phobias are believed to affect 19 million Americans, ranging from mild to severe symptoms. Though phobias can occur in childhood, they are most common among individuals between the ages of 15 and 20. There is no one cause for this mental health condition, but there are risk factors known to increase the risk of developing it. This includes genetics, environmental factors, and in some cases, the individual’s first experience with the feared situation or object.

There are three main types of phobias; specific phobia, social phobia, and agoraphobia. Specific phobias are fears associated with a particular situation or object that is not generally harmful or dangerous. This can include fears of flying, dogs, closed-in spaces, tunnels, and heights.

Social phobia is known for causing significant anxiety and discomfort in social situations. Individuals are often worried about embarrassing themselves, feeling humiliated, or being looked down upon. Social phobia may cause someone to feel anxious before a social event, feel uncomfortable throughout the event, and have continued unpleasant feelings after the event has ended. This form of anxiety can occur with public speaking, meeting people, interacting with authority figures, eating in public, and using a public restroom.

Agoraphobia can be described as a feat in which you will have a panic attack in a setting where it would be challenging or impossible to remove yourself from. This can include being outside your home, being alone, being in a crowd, being inside vehicles, and being in an elevator. This condition is more common among those who have had more than one panic attack, occurring randomly and unexpectedly. This unpredictability can make it challenging to avoid triggers and situations that provoke panic attacks.

Treatment options for phobias tend to be similar to the different types of phobias, including behavioral therapies like cognitive behavioral therapy (CBT) along with medications. Treatment can also incorporate in vivo and virtual reality exposure (VRE), exposure therapy, and flooding or gradual exposure.

Setting Goals and Objectives With Clients in Your Treatment Plan for Phobias

Before you work towards developing your treatment plan for phobia, it is important to ensure that a thorough assessment has been conducted to fully understand the scope of your client’s symptoms and level of impairment. Examples of assessments commonly used to phobias include:

• Phobia Questionnaire (PHQ)
• Specific Phobia Questionnaire (SPQ)
• Fear Questionnaire (FQ)

Once you have a full picture of your client’s presenting concerns, support, and an idea of what they would like to work toward, you can begin developing your treatment plan. We encourage you to keep therapeutic approaches and activities in mind as you develop your phobia treatment plan. Some find that using worksheets is helpful because it reminds clients to take home as a reminder of what they had worked on in session. TherapyByPro has various worksheets that could be implemented into your work, including:

• Exposure Therapy Worksheets Bundle
• Fear Hierarchy
• In Vivo Homework Track Sheet
• Challenging Fearful Thoughts

What to Include in a Treatment Plan for Phobias + Sample

For the remainder of this article, we will be following the treatment plan example available with TherapyByPro. Our case will follow a teen named John, who has developed a social phobia. His symptoms are causing significant impairment, which ultimately led to his parents seeking professional support for him. Continue reading John’s story.

Johns Story:

John is a 15-year-old male, who has been experiencing social phobia for about 7 months, which has led to significant changes in his life. John’s parents have brought him in to speak with you in hopes that you can help provide relief from his anxiety symptoms. John reported that his anxiety symptoms began in the fall when he transitioned into high school. Over the first few weeks of school, he began to feel anxious when teachers called on him to speak or share in class, and was constantly worried that he would make a mistake and be made fun of. John denied having a history of being bullied but noted that he has seen how his peers treat others who make mistakes, and he has found himself preoccupied that the same might happen to him.

John’s teachers have been understanding of his symptoms, and have informed him beforehand when they would have classroom activities that could provoke his anxiety. Even with this warning, he still finds himself worried that a teacher will “forget” to tell him, and he will be caught off guard. John struggled to think of a time when he was in a social situation and did not experience significant distress. There have been a few instances where he misses school due to not feeling well when he knows that he would have to speak in front of his class. In these situations he reported nausea, upset stomach, and loss of appetite. John has experienced two panic attacks at school, and his parents decided to temporarily homeschool him until he can effectively cope with and manage his symptoms. Symptoms associated with his panic attacks included sweating, shaking, being unsteady on his feet, accelerated heart rate, nausea, and shortness of breath.

John received a referral from his pediatrician as per his insurance requirements. He has no history of mental health treatment and has no medical concerns. At this time, he is only taking a multivitamin. He does not exhibit signs of other mental health concerns at this time.

Agencies Involved and Plans for Care Coordination

For this case, it would be appropriate to coordinate care with his pediatrician, since they were his referral source. To do this, you will need to sign the proper consents of release.

Example for John:

Care Coordination: His referring pediatrician, Doctor Smith

Clinical Diagnoses

In John’s case, his diagnosis appears to align with a social phobia or social anxiety disorder. This is evidenced by meeting the following criteria in the DSM-5:

• Persistent and intense fear about social situations in school because he is worried about being judged or made fun of by his peers
• He is concerned about others looking down on him, or perceiving him negatively, in this social situation
• His intense fear and overwhelming distress is present in all social settings, causing significant impairment in school, and in other settings
• In an attempt to provide relief, his parents have decided to temporarily home-school him because he would often not feel well before school, which contributed to him missing school and falling behind in his classes
• He has experienced panic attacks at school
• His symptoms are not the result of other mental health conditions or substance abuse

Example for John:

Diagnosis ICD-10: Social Phobia (social anxiety disorder) with Panic Attacks F40.1

Current Medications and Responses

At this time, John is not taking medications. Due to his symptoms, it would be appropriate to refer him to a psychiatrist who can explore medication options and benefits with John and his parents to see if there is an option that feels right for them.

Example for John:

Medications: None at this time, refer to Psychiatrist

Presenting Problem and Related Symptoms

In this section of your treatment plan for phobias, you can thoroughly describe your client’s case in a manner that pays respect to their experiences and presenting symptoms. This section of your treatment plan should provide a glimpse into the case that sets the stage for your upcoming goals and objectives.

Example for John:

John is a 15-year-old male who was brought to the session by his parents as a result of his anxiety symptoms. His symptoms began at the beginning of the school year when he transitioned to high school, approximately 7 months ago. He shared that he is often anxious in his classes, and is worried that he will embarrass himself or be made fun of for making mistakes. Though he has not been bullied himself, his belief is based on his observations of how his peers have treated other classmates.

John’s symptoms have continued, even with his teachers’ understanding and efforts to inform him of potentially anxiety-provoking activities. John indicated that his fear is persistent and intense, even when he is not expected to speak in class. This fear has led to avoidance behaviors, including missing school and now being homeschooled to avoid further educational decline. John has experienced two panic attacks marked by symptoms of sweating, shaking, dizziness, accelerated heart rate, nausea, and shortness of breath.

John has no prior history of mental health treatment and currently only takes a multivitamin. John’s development has been typical, and he has no history of abuse and neglect. John is a healthy teenager with no previous health concerns. John’s symptoms are not the result of substance abuse, and other mental health concerns have been ruled out. Based on his symptoms and history, he meets the criteria for Social Anxiety Disorder with panic attacks.

Goals and Objectives

The goals and objectives in your treatment plan should be tailored to each individual, and align with the case conceptualization you provided in the presenting problem section of your treatment plan. This is where you can tie in your evidence-based practices that are known to be effective for the concerns your client is experiencing.

Example for John:

Goal 1: Introduce and regularly utilize coping skills that can be used to cope with anxiety symptoms

• Objective 1: Provide psychoeducation about healthy coping skills that can help cope with anxiety symptoms and practice in session
• Objective 2: John will use a minimum of 2 coping skills each day
• Objective 3: John will track his daily use of coping skills, noting any changes in his symptoms after practicing his new skills. John’s tracking sheet will be reviewed in his next session.

Goal 2: Engage in gradual exposure to work towards returning to school

• Objective 1: John will create a hierarchy of feared situations, ranking them from the least feared to the most feared
• Objective 2: Once he is proficient in using his coping skills, gradually begin moving through his fears by, ensuring that he is effectively coping with his symptoms
• Objective 3: John will attend one class in school

Goal 3: Use CBT to address cognitive distortions tied to his fear social phobia

• Objective 1: Provide psychoeducation about the framework of CBT, and how our thoughts, feelings, and behaviors are connected.
• Objective 2: John will identify a minimum of 3 cognitive distortions tied to his fear of social situations in school
• Objective 3: John will challenge these thoughts and beliefs when they arise, and challenge them with adaptive thoughts
• Objective 4: John will track the occurrence of these cognitive distortions and rate his ability to challenge them. This tracker will be reviewed at the beginning of each session.

Specific Interventions to Be Used

The specific interventions section of your treatment plan for phobias will specifically identify the interventions you have planned to use, and who will be responsible for the intervention. This can act as a reminder to interventions that are being facilitated in session, and those that are being given as homework to complete in between sessions.

Example for John:

Intervention 1

Introduction the use of mindfulness practices, grounding strategies, and breath work

Responsible Person: Counselor A

Intervention 2

Developing a hierarchy of feared situations

Responsible Person: John and Counselor A

Intervention 3

Gradual exposure to symptom-provoking scenarios

Responsible Person: Counselor A and John

Intervention 4

Role playing ways in which he can use his coping skill in a classroom setting

Responsible Person: John and Counselor A

Family Involvement

Family involvement in this case is imperative. Not only is John a minor, but his parents can play an active role in his recovery. Family sessions may be helpful down the road, but the immediate focus should be on providing them with a better understanding of his symptoms, and the interventions being used. With his parent’s support, they can reinforce the work he is doing in session and support him at home.

Example for John:

Family Involvement: provide both parents with knowledge about social phobia, its symptoms, treatments, and how to best support John. Family therapy may be an option once his symptoms are effectively being managed

Additional Services and Interventions

This section of your treatment plan can be used to make note of specialized options and holistic approaches being used. In John’s case, meeting with a psychiatrist would be an additional service to note, as he is being provided with a referral. While group therapy is a good idea in theory, it may provoke symptoms in the beginning and not have the desired effects. Additionally, based on his school performance, you can encourage his parents to consult his school about what can be done to ensure that he doesn’t fall further behind on his work, as this too could worsen his symptoms too by decreasing his confidence in his knowledge in the classroom.

Example for John:

Additional services: Meet with a Psychiatrist to explore medication options, and consult his school about strategies to reduce academic difficulties

Estimation for Completion

The time for completion is based on individual needs and his response to treatment. Generally, in vivo exposure can take 3 to 8 1.5-hour sessions to complete. Keep in mind that John’s age may affect the length of time required to reach his optimal mental health. If you find that your clients need a longer, or shorter, period of time than you originally indicated, you can reflect this change on your treatment plan.

Example for John:

Estimated time for Completion: 8 weeks, 1.5-hour session per week. To be adjusted as the Counselor sees appropriate.

Aftercare Plans

The aftercare plan section should be written as if your client was discharged from treatment today. There are several reasons that this could happen, including but not limited to moving, lack of reliable transportation, and the cost of treatment. If your client terminates their professional relationship, you should provide them with plans, or options, to continue care.

Example for John:

Aftercare Plans: Consult with the pediatrician for mental health referral, continue working with a licensed Psychiatrist if medication is being prescribed, and continue coordinating with the school to ensure academic success.

Final Thoughts On Creating a Treatment Plan for Phobias

Most clinicians who get into this line of work do it because they want to help people. Professionals who work with clients who are living with phobias can witness firsthand the growth and progress their clients make as they learn to cope with and manage their symptoms. They may begin to feel confident, walk, and stand differently. You can be the game changer for these clients, providing them with a safe and nurturing environment where they can, quite literally, face their fears head-on.

This work in itself is rewarding. We encourage you to be mindful of your education, skill set, and supervision requirements for working with clients who have phobias. Exposure therapy and commonly used interventions often require additional time and focus in your work.

TherapyByPro is an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

Resources:

• Johnson, B. (2022, October 18). Exposure Therapies for Specific Phobias | Society of Clinical Psychology. Society of Clinical Psychology | Division 12 of the American Psychological Association. https://div12.org/treatment/exposure-therapies-for-specific-phobias/#:~:text=The%20treatment%20usually%20last%20a,%2Dhour%2Dlong%20sessions).
• “Phobias.” Johns Hopkins Medicine. Accessed August 1, 2024. https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias#:~:text=A%20phobia%20is%20an%20uncontrollable,that%20lasts%20for%20several%20minutes.
• “Specific Phobias.” Mayo Clinic, June 9, 2023. https://www.mayoclinic.org/diseases-conditions/specific-phobias/diagnosis-treatment/drc-20355162.