Individual Therapy

Client reports an increase in trauma-related nightmares this past week, occurring 4 out of 7 nights. States 'The dreams are back. I thought we were past this.' Reports associated daytime irritability and hypervigilance in crowded spaces. Identified trigger as anniversary of deployment date approaching. Denies substance use.

Client presented with flat affect and visible fatigue. Dark circles under eyes. Fidgeted throughout session. Maintained eye contact intermittently. Hyperstartle response noted when door closed in hallway. Speech pressured at times when discussing trauma content.

PTSD symptom exacerbation consistent with anniversary reaction pattern identified in treatment plan. Client's awareness of trigger is a therapeutic strength. Current coping strategies (grounding, 5-4-3-2-1) are being utilized but insufficiently managing sleep disturbance. No imminent safety concerns.

Process anniversary reaction using CPT framework. Review and strengthen nighttime grounding protocol. Consider recommending sleep hygiene consultation. Continue weekly therapy. Next session: 03/10/2026.