Patient 2 is a 12-year-old girl with a 2-year history of social anxiety disorder with panic attacks and angry outbursts1. She has previously received supportive counselling. At assessment she is quiet, frequently says, "I don't know", and is quick to agree with suggestions. She often looks to her mother to answer questions. She has not attended school for 9 months. She experienced bullying in school, near her home and on social media for several years. At home, she does not use the telephone or social media. She responds to, but does not initiate, text conversations. She will not travel alone, eat or drink in public, or socialize without her mother.
A particularly important intervention for Patient 2 was training in an external focus of attention and learning that "the scariest place is in my head". As well as recovering from social anxiety, she returned to full-time education, developed a new friendship group, and attended a dance-drama club. Angry outbursts and panic attacks resolved.