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.
