SIMPLE Note Example: Exposure and Response Prevention (ERP)

Quill generated this note with AI from the summary that was provided. The therapist can then copy-and-paste the note into their current EHR platform.

The session was a 60-minute virtual meeting. Client appeared exhausted and reported worsening compulsions, stating, "It's taking over my whole day now." Client described intrusive thoughts about contamination and noted that attempts to suppress them intensified the compulsions. He reported washing his hands dozens of times daily, avoiding certain objects, and experiencing difficulty focusing at work. Avoidance behaviors have escalated from avoiding public bathrooms to avoiding going out entirely due to anxiety about germs. Therapist explained how avoidance and compulsions reinforce OCD over time and introduced ERP as a gradual approach to face feared situations without engaging in compulsions. Together, an ERP hierarchy was created, ranging from touching a doorknob at home without washing to using a public restroom and not washing hands after. Client agreed to start with lower-anxiety tasks and work upward. Therapist rehearsed response prevention language with the client, emphasizing that anxiety is uncomfortable but not dangerous and will pass. Client practiced this language during the session. Homework assigned includes attempting one lower-level hierarchy item twice this week and using response prevention language during urges. Client appeared nervous but expressed some hopefulness about the process. The next session is scheduled for next week to review progress and adjust the plan as needed.

Client Session Summary:

Here's the summary of this client session. Remember, Quill does not record the client session. A therapist would provide a summary (like the one below) after the session is over, and then Quill would generate a note similar to the one above.

We had a 60-minute virtual session today. Daniel logged in looking exhausted and said the compulsions have been getting worse. He said quote 'It's taking over my whole day now' unquote. He described how he's been having these intrusive thoughts about contamination, and the more he tries to push them away, the stronger the compulsions get. He's washing his hands dozens of times a day, avoiding touching certain things, and it's starting to affect his work because he can't focus. He said the avoidance has been growing, he used to just avoid public bathrooms, but now he's avoiding going out at all because he's so anxious about germs.

We talked about how avoidance and compulsions actually make OCD stronger over time, even though they feel like they're helping in the moment. I explained how ERP works, gradually facing the feared situations without doing the compulsion, which teaches the brain that the anxiety will come down on its own. We started building an ERP hierarchy together, rating different situations from least to most anxiety-provoking. At the bottom was something like touching a doorknob at home without washing right away, and at the top was using a public restroom and not washing hands after. We agreed to start small and work our way up.

We also rehearsed some response prevention language for those high anxiety moments. I told him that when the urge to wash comes up, he can remind himself that the anxiety is uncomfortable but not dangerous, and it will pass. We practiced it a few times so it would feel more natural. His homework is to pick one item from the lower end of the hierarchy and try it twice this week, and to use that response prevention language when the urge comes up. He seemed nervous but also a little hopeful, like there's finally a way forward. We'll meet again next week to see how the first exposures went and adjust the plan as needed.

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More About SIMPLE Notes:

From even more examples, to an overview of the format in general, to templates, to a cheat sheet, here's everything you need to know about SIMPLE notes.