Subjective

Client reports feeling anxious about upcoming work presentation. Describes physical symptoms including rapid heartbeat and difficulty sleeping.

Objective

Client appeared fidgety during session, with visible hand tremors. Speech was rapid but coherent. PHQ-9 score: 12 (moderate depression).

Assessment

Symptoms consistent with adjustment disorder with anxiety. Client demonstrates insight into triggers but struggles with coping strategies.

Plan

Continue CBT techniques focusing on cognitive restructuring. Assign thought record for next session. Consider relaxation exercises for physical symptoms.