CBT Therapy Case Study - Worry

Worry

Background

Chris* is a 37-year-old Senior Manager in the Agriculture industry. He lives in his own home in Knutsford with his dog. His parents divorced when he was 12 years old following his dad having an affair.

Following this he was sent to attend boarding school due to both parents working a lot. His mum has recently completed treatment for breast cancer. He has a good group of friends and an active social life with plenty of hobbies.

He would like to meet a partner, but his anxiety impacts his dating life. He is financially secure. He is not sure he is in the right job for him, but change makes him anxious, he has been with the same employer for 16 years.

Presenting problem

Chris came to me via his Private Medical insurance AXA. He was looking for a local Therapist that was AXA Approved, offering CBT Therapy that also offered appointments in person.

He described struggling to cope in pretty much every area of his life due to overwhelming worry and anxiety. This was impacting him at work, with his family, in his dating life, and in day-to-day functioning.

Although his symptoms had worsened since his mum’s cancer diagnosis, he describes having been anxious and a worrier his whole life, it’s all he’s ever known.

Assessment

This was Chris’s 2nd experience of therapy. He had recently had a course of sessions with a local counsellor. Although he liked her, he felt like his anxiety wasn’t improving, and therefore was keen to try CBT Therapy for Anxiety.

He had been on Sertraline 100mg medication from the GP for a couple of years. Chris’s worrying existed in every area of his life. There are too many of these worries to list them all, as he literally spent hours every day worrying.

Here are just a few of the stream of worries we identified in the assessment:

Example worries:

What if I’ve made a mistake?
What if I’ve missed something important at work and something bad happens?
What if I’m late?
What if they think I’m rude?
What if my boss realises I’m not as good as he thinks I am?
What if I’ve got cancer?
What if I get sick and there’s no-one to support my mum as she gets older?
What if my dog falls into the river?
What if my dog gets attacked by another dog when we are out walking?
What if I’ve left the oven on?
What if I forgot to lock the door?
What if someone steals my money or defrauds me?
What if my mum has a car accident when she’s out driving?
What if I lose my job and I’ve not got enough savings?
What if I choose the wrong place and I don’t enjoy it?
What if I change my mind and it’s too late to cancel?
What if I marry the wrong person?
What if the person I’m seeing cheats on me?

Chris listed the following symptoms he was experiencing:

Difficulty relaxing
Poor quality sleep and regular nightmares
Occasional panic attacks
Reduced appetite and indigestion problems
Increased irritability
Reduced concentration
Worsening tiredness
Feeling on edge
A state of fear

We jointly identified the following target areas for treatment

To learn how to manage worry thoughts differently
To gain confidence and trust in himself
To remove unnecessary behaviours that are based on fears not truth
To improve his ability to make decisions
To experiment with change, spontaneity, and some low level of risk/unknowns

Treatment

CBT Therapy strategies were used across the course of 12 treatment sessions booked once a week at the cost of £1200. Following this he has decided to continue with 1x a month review sessions for the next few months to keep him on track and moving forwards. He is doing PAYG at £110 a session.

Outcome

Most importantly Chris no longer worries all the time
As a result he now has energy again, sleeps well, can relax, and has stopped having nightmares and indigestion
He hasn’t had a panic attack in 2 months
He came to understand how his history and upbringing contributed to his desire to always keep himself ‘safe’
As a result of increased trust in himself, he no longer checks doors, cookers or taps before leaving the house. He has stopped checking emails before sending them at work, and texts before sending them to friends. He has also stopped tracking his mum’s whereabouts, and no longer allows excessive extra time for travel. There are many more examples.
Chris is gradually increasing his confidence in decision making, with less research or reassurance seeking, and no longer feeling the need to avoid
He no longer feels trapped by fear, and is starting to feel like he is getting to live more of the life he’s always wanted
Because he no longer thinks about all the worst case scenarios for every situation, he also is feeling much happier and lighter
Chris is continuing to work on his ability to cope with change and uncertainty, and is considering applying for new job roles in the near future, and getting back to dating.

* This is a fictionalised client that takes little elements from many clients I’ve worked with over many years to demonstrate an example of a client’s problems I work with and what therapy offers.