I very much like the idea of using a "thought sheet" so that Gary can record the situations, thoughts, feelings, etc., associated with his anxiety flare-ups. Anxiety attacks that seem to arise out of the blue are often triggered by a seemingly minor but psychologically important event or thought that occurred 30-60 seconds previously. It can be helpful for a person's sense of self-control to recognize that such triggers exist, and a "thought sheet" could help in this regard. In addition, thoughts and memories that are relevant to a patient's problems usually attend anxiety attacks. (Also, I would have him record the events that led to his episodes of sudden anger.)
I am indicating that I would tend to advocate the "thought sheet" within a program of treatment that had Gary using his anxieties to better understand what's going on. I think that Gary is perhaps too afraid of his anxieties. Anxieties arise from conflicts, and Gary needs to understand the elements of his life that are in conflict and why. To do that, I feel he needs to embrace his anxieties and commit a part of his self-esteem to mastering them, at least to the point of functioning despite their presence.
Gary apparently continues living at home even though his job has got to pay enough for him to move out. I would do what I could to get him to move away from that damaging environment.
The MBA could be a two-edged sword. It could be a way of defying his parents, as Dr. Broitman suggests. But there could also be the fear of becoming more like his workaholic father. What surfaces as anxieties and other symptoms that define "I can't" sometimes do so in the service of a "I won't" attitude that the patient can't bring himself to overtly recognize. Does he really want this MBA?
The reason I ask this is that Gary seems to spend an inordinate amount of time worrying about what other people think of him and whether or not they will continue to support him. Who's he trying to please with this MBA?