226 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 21. Urge External Focus (21 ) A. The client was urged to keep his/her focus on external stimuli and behavioral responsibilities rather than be preoccupied with internal states and physiological changes. B. The client was reinforced as he/she had made a commitment to not allow panic symptoms to take control of his/her life and to not avoid and escape normal responsibilities and activities. C. The client has been successful at turning his/her focus away from internal anxiety states and toward behavioral responsibilities; he/she was r einforced for this progress. D. The client has not maintained an external focus in order to keep panic symptoms from taking control of his/her life and was reminded about this helpful technique. 22. Assign Information on Breathing and Relaxation (22) A. The client was assigned to read information about progressive muscle relaxation. B. The client was assigned information on paced diaphragmatic breathing. C. The client was directed to read portions of Mastery of Your Anxiety and Panic (Barlow and Craske). D. The client has read the assigned information on progressive muscle relaxation and paced diaphragmatic breathing, and his/her key learnings were reviewed. E. The client has not read the assigned information on progressive muscle relaxation and paced diaphragmatic breathing and was redirected to do so. 23. Counteract Panic Myths (23) A. The client was consistently reassured of the fact that there is no connection between panic symptoms and heart attack, loss of control over behavior, or serious mental illness. B. The client was reinforced as he/she verbalized an understanding that panic symptoms do not promote serious physical or mental illness. 24. Utilize Modeling/Behavioral Rehearsal (24) A. Modeling and behavioral rehearsal were used to train the client in positive self-talk that reassured him/her of the ability to work through and endure anxiety symptoms without serious consequences. B. The client has implemented positive self-talk to reassure himself/herself of the ability to endure anxiety wit hout serious consequences; he/she was reinforced for this progress. C. The client has not used positive self-talk to help endure anxiety and was provided with additional direction in this area. 25. Identify Distorted Thoughts (25) A. The client was assis ted in identifying the distorted schemas and related automatic thoughts that mediate anxiety responses. B. The client was taught the role of distorted thinking in precipitating emotional responses. C. The client was reinforced as he/she verbalized an und erstanding of the cognitive beliefs and messages that mediate his/her anxiety responses. D. The client was assisted in replacing distorted messages with positive, realistic cognitions. E. The client failed to identify his/her distorted thoughts and cogni tions and was provided with tentative examples in this area. 