| Course | NU 672 Counseling and Psychotherapy |
|---|---|
| Unit | Unit 4 |
| Paper type | Treatment goal hierarchy |
| Length | About 810 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 672 Unit 4
Treatment Goal Hierarchy for Panic Disorder With Driving and Crowd Avoidance: Eight Goals, Ordered by Dependence, Each Tied to a Mechanism and a Technique
Student Name
Department of Nursing, Herzing University
NU 672: Counseling and Psychotherapy
Instructor Name
February 11, 2026
Treatment Goal Hierarchy for Panic Disorder With Driving and Crowd Avoidance: Eight Goals, Ordered by Dependence, Each Tied to a Mechanism and a Technique
The Presentation and the Maintenance Model
Ms. J., the composite patient in this course of cognitive behavioral therapy, has panic attacks two to four times a month, avoids highways and crowded stores, carries lorazepam as a safety measure, and has cut back to part-time work. Her own goals, in her words, are "to drive to my sister's wedding" in four months and "to go back to full-time." The treatment follows a cognitive model in which catastrophic interpretations of bodily sensations drive attacks (Clark, 1986), and avoidance and safety behaviors keep the fear from being tested. Each goal below is linked to the part of that model it is meant to interrupt and the technique that does the interrupting. Goals are written as things she would notice, and the order reflects which goals depend on earlier ones.
Near Goals: Sessions 1 to 6
Goal 1: "I can explain what's happening in my body during an attack and why it isn't a heart attack." Mechanism: catastrophic misinterpretation of a racing heart and dizziness. Technique: education about the panic cycle, self-monitoring of attacks, and examining the evidence for her interpretations. Measure: her own rating of belief that the next attack will be a heart attack, from 0 to 100, recorded weekly; baseline 70.
Goal 2: "I can bring on a pounding heart or dizziness on purpose and ride it out without leaving or taking a pill." Mechanism: fear of bodily sensations themselves, and the lorazepam as a safety behavior. Technique: interoceptive exposure, such as running in place, spinning, and breathing through a straw, in session and daily at home; a plan with her prescriber to stop carrying lorazepam once Goal 2 is reached. Measure: peak fear ratings during exercises; Anxiety Sensitivity Index-3 score, a measure of fear of anxiety-related sensations (Taylor et al., 2007), at baseline and session 6.
Middle Goals: Sessions 6 to 12
Goal 3: "I can go into the grocery store on a Saturday and stay until I finish shopping." Mechanism: situational avoidance maintained by fear of an attack in a place hard to leave. Technique: graded in vivo exposure, beginning with a quiet weekday visit and building to a busy Saturday, with predictions recorded beforehand and checked afterward.
Goal 4: "I can drive on the interstate alone for 20 minutes." Mechanism: avoidance plus safety behaviors in the car, such as staying in the right lane near exits and keeping her phone in her hand. Technique: graded driving exposure, from side roads to a short highway stretch with a support person following, to driving alone, with safety behaviors dropped one by one.
Goal 5: "I don't carry lorazepam anymore." Mechanism: the tablet as a safety signal that prevents her from learning she can cope. Technique: planned reduction, first leaving it in the glove compartment, then at home, coordinated with her prescriber.
Why these come after Goals 1 and 2: if she still fears the sensations themselves, exposure to the highway will produce sensations she cannot tolerate, and she is likely to escape, which strengthens the fear. Reaching Goal 2 first makes Goals 3 and 4 possible.
Distant Goals: Months 3 to 6
Goal 6: "I drove to my sister's wedding." This depends on Goals 4 and 5. A practice drive of at least one hour on the same highway is planned for two weeks before the wedding.
Goal 7: "I'm back to full-time work." This depends on Goal 4, since her office is across a highway, and on reduced panic frequency. She will discuss a return date with her employer once she has driven to work alone for two weeks.
Goal 8: "I know what to do if an attack happens again." Mechanism: risk of relapse, particularly around stressful events such as her sister's move. Technique: a written relapse prevention plan, reviewing which skills worked, early warning signs, and when to return for booster sessions.
How Overall Progress Will Be Measured
The Panic Disorder Severity Scale, a clinician-rated measure of panic frequency, distress, anticipatory anxiety, avoidance, and impairment (Shear et al., 1997), will be completed at baseline, session 8, and the final session. Her baseline score was 16. Weekly attack counts and her belief rating continue throughout. The hierarchy will be reviewed at session 8: if Goal 2 has not been reached, the reason will be sought in the technique or its dose, not in her motivation.
A Goal Deliberately Left Out
Her feelings about her sister's move, which emerged in session 5, were not made a formal goal. They may matter, and the timing of attacks against contact with her sister is being tracked. If a link appears, a goal addressing those feelings will be added, and the maintenance model revised to include it.
References
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24(4), 461-470. https://doi.org/10.1016/0005-7967(86)90011-2
Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., Gorman, J. M., & Papp, L. A. (1997). Multicenter collaborative Panic Disorder Severity Scale. American Journal of Psychiatry, 154(11), 1571-1575. https://doi.org/10.1176/ajp.154.11.1571
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., Abramowitz, J. S., Holaway, R. M., Sandin, B., Stewart, S. H., Coles, M., Eng, W., Daly, E. S., Arrindell, W. A., Bouvard, M., & Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19(2), 176-188. https://doi.org/10.1037/1040-3590.19.2.176
The Herzing NU 672 Unit 4 instructions
Unit 4 asks you to develop a hierarchy of treatment goals for a patient in therapy. Expect to summarize the presentation and maintenance model, write goals in an order that reflects dependence, tie each to a mechanism and a measure and describe how overall progress will be tracked. Many versions ask whether goals should use the patient's words or clinical terms. Check how many goals your section expects. Ordering by dependence means early goals make later ones possible, such as understanding the panic cycle before attempting highway drives. A validated outcome measure gives the hierarchy an anchor. Leaving a goal out deliberately, and saying why, shows clinical judgment and keeps the plan focused on what the chosen approach can address.
Inside the NU 672 Unit 4 example
The hierarchy opens with the presentation and maintenance model in a short paragraph. Goals are grouped into near, middle and distant, with session ranges. Each goal is written in the patient's words and followed by its mechanism, what it depends on and how progress will be seen. The near goals build understanding and tolerance of sensations. The middle goals tackle situational avoidance. The distant goals include driving to her sister's wedding. The measures section names the Panic Disorder Severity Scale and its schedule. The section on the omitted goal explains why her feelings about her sister's move were noted but not made a formal target, while keeping the door open if they block progress.
Where the points sit in the NU 672 Unit 4 rubric
Herzing's rubric for a goal hierarchy generally covers the maintenance model, the ordering of goals, the link between goals and mechanisms, measurability, the overall outcome measure and writing. Ordering by dependence draws the closest reading: graders check that each goal is possible only after the ones before it. Mechanism points reward goals tied to the model's maintaining factors. Measurability criteria look for observable signs of progress. Outcome measure points go to a validated scale with a schedule. Patient-centered wording may be credited within goals. A deliberate omission explained well earns credit for judgment. Shear's Panic Disorder Severity Scale paper and Clark's model belong in the APA 7 list.
NU 672 Unit 4 help: mistakes that cost points
Goal hierarchies in Unit 4 usually come up short when goals are listed without order or with an order that does not reflect dependence. Another frequent problem is goals written in clinical language the patient would not recognize. Students often leave out mechanisms, so goals float free of the model. Measures are vague, such as feel less anxious. No overall outcome measure is named. Too many goals crowd the plan. Finally, explain any goal you chose not to pursue, because graders reward a hierarchy that shows what the approach can and cannot address rather than one that tries to fix everything the patient mentioned.
Get a NU 672 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NU 672 classroom, with the presentation the hierarchy should address. We write a custom example with maintaining mechanisms established first, goals ordered by dependency, a technique beside each and movement described in observable terms. First custom sample free, delivered in 24 to 48 hours.
More NU 672 papers and PMHNP samples
- NU 672 Unit 1: Therapeutic modality comparison
- NU 672 Unit 2: Boundary and self-disclosure review
- NU 672 Unit 3: Session transcript analysis
- NU 672 Unit 5: Group therapy proposal
- NU 672 Unit 6: In-session ethical decision record
- NU 672 Unit 7: Treatment review and revision brief
- NU 672 Unit 8: Therapy episode portfolio
- NU 670 Unit 4: Adverse effect derivation record
- NU 671 Unit 4: Medical mimic exclusion log
- NU 673 Unit 4: Consent and confidentiality brief
- NU 674 Unit 4: Least restrictive option analysis
NU 672 Unit 4 questions, answered
How many goals belong in a hierarchy?
Three or four levels usually carry a course of therapy, and each one has to earn its place by depending on the level above it. Long lists fragment the reasoning and force thin justification everywhere. If your instructions set a number, meet it by splitting a level honestly rather than by inventing aims the mechanisms do not support.
Should goals use the person's words or clinical terms?
Both, side by side. The clinical phrasing lets a reader see what is being targeted, and the person's own words show the goal was negotiated rather than assigned. Where they diverge, say it plainly: a patient wanting to sleep and a therapist aiming at avoidance are working on related things, and naming the relationship is itself gradeable.
Does the hierarchy need a formal outcome measure?
Only where the instructions ask for one. Many sections accept observable signs, described as something the person, a family member or the therapist would notice between sessions. If a published instrument is required, name it, say who completes it and how often, and keep any claim about its properties tied to a source rather than to memory.
Where can I find a free NU 672 Unit 4 sample paper?
The complete NU 672 Unit 4 goal hierarchy is posted here free, eight goals ordered by dependence with mechanisms and measures. A hierarchy for another presentation can be prepared on request.
How do I write therapy goals for panic disorder?
Write them in the patient's words, order them so each builds on the last, tie each to a maintaining factor in the model and say how progress will be seen. This sample moves from understanding the panic cycle to driving to a sister's wedding.