Case study: ending panic attacks in five sessions with brief strategic therapy

What follows is a composite, assembled from typical presentations and the published protocol literature rather than from one patient. It is laid out to show the mechanism described in the strategic protocol for panic running through a full and favourable course.

Session one

A woman in her late twenties describes panic attacks that began eight months ago, after a health scare that turned out to be nothing. She has stopped taking the underground. She keeps a strip of medication in every bag she owns. She texts her partner “just checking in” several times on any day they are apart.

Asked what happens after she checks her phone and sees a reply, she says: “I feel okay for maybe twenty minutes. Then I start wondering again.”

Naming that twenty-minute window out loud, the point where relief turns back into doubt, is the first moment she looks surprised rather than anxious. She had not noticed the pattern had a shape.

The session ends with the writing task. Twice a day, at set times, she writes out in full her worst fantasy of what an attack might do to her.

Session two, a fortnight later

She reports the exercise felt strange for a few days and then became boring. Writing the same catastrophe on a schedule had taken the urgency out of it, and the spontaneous version arrives less often.

This session turns to the underground. She chooses, herself, to ride one stop with her partner present.

Session three

The check-in texts, addressed without an instruction to stop. She agrees to delay the next one by fifteen minutes past the point she would normally send it, and to notice honestly whether the urge is still as strong by then.

She manages the delay four times out of five. Each time she manages it, she reports the urge is weaker by the fifteen-minute mark.

Sessions four and five

By the fourth she has ridden the underground alone twice and reports no attack in five weeks, though she still carries the medication “just in case”.

The fifth session takes that residual safety behaviour rather than treating the case as finished. She agrees to leave the medication at home for one specific low-stakes trip, as a test and not a gesture. She manages it, uneventfully. The sessions close there, with an explicit invitation to come back if anything resurfaces.

What might have gone differently

Had the writing task distressed her more, or had she lacked a partner willing to come along for early exposures, the same structure would have needed to slow considerably. More sessions on the writing alone before any exposure. A reassurance delay starting at five minutes instead of fifteen.

None of the techniques would have changed. Only the pacing. Say that to a client at the outset, or a slower course gets mistaken for the treatment not working.

Why five is not the number to promise

This composite closes cleanly because everything cooperated. She reported her own patterns accurately, tolerated the writing without excessive distress, and had a stable partner to practise with.

Published case reports describe real patients for whom the same mechanism took considerably longer to reach full cessation. The protocol article sets out those timelines, and they belong in the conversation with any client before the first task is assigned.

The composite also shows the model doing what strategic therapy claims to do and nothing more. Nobody asked why the health scare affected her as it did, or what made her vulnerable to it. The attempted solutions were identified, interrupted one at a time, and the panic stopped being fed. Whether the original question would still have been worth asking is a legitimate disagreement between this model and several others, and the case does not settle it.