Stress-related anxiety in the work place is one of the biggest contributing factors for people signing-off sick or looking for alternative employment. When I first met my patient, he was suffering from very high levels of stress and anxiety, triggered by a fear of giving highly-scrutinised presentations at work.
His anxiety was affecting his ability to concentrate and he often experienced palpitations, sweating and stomach pains on the day (and days) prior to the presentation.
Although he was able to deliver the presentation, he felt his productivity and happiness at work was being affected and his anxiety was also impacting on his personal life.
His natural reaction was to resign, however the nature of his work meant that presentations would continue to be a significant part of his work, so he really needed a way to control his anxiety and move forward.
The first step in his treatment plan was to understand and recognise the symptoms of anxiety and to learn effective ways to self-manage his own symptoms.
CBT encouraged him to reflect on how he felt about delivering presentations and to document any thoughts, emotions and behaviours he experienced. The process helped to rewire his thinking and develop more a productive and positive mindset towards presentation day.
As a keen cyclist, increasing the amount of exercise he was doing on a weekly basis was advised, and he gradually started to create a new routine at work, with a fresh perspective towards the people he worked with.
Becoming more aware of his symptoms and implementing self-help measures at home, in- between sessions, helped my patient stay on track.
After 8 CBT sessions my patient reported significantly lower feelings of anxiety in build up to, and on presentation day. And, although he still experiences a level of anxiousness, he now understands this is normal for the situation and he is able to better control his thoughts and prevent any escalation in his anxiety levels.
His annual appraisal was very positive and is now considering promotion rather than resigning. He continues to practice CBT and mindfulness techniques and has kept up with the cycling.
One of my youngest patients was referred to me by her distraught mother after desperately trying to manage her daughter’s depression, refusal to go to school and suicidal thoughts.
She had been referred to the local CAMHS service and placed on a 4-month waiting list, however it was clear that she required immediate intervention to prevent her mental health condition from deteriorating further.
At the first appointment she was very miserable and withdrawn but after taking the time to get to know her and share interests, she relaxed. By the end of the session we had talked about a very difficult few months when she felt lonely and judged by others on social media.
She had good family support, and was encouraged to do things she enjoyed like baking, taking the dog for a walk and spending time with her family, instead of being alone in her bedroom.
She was also given information about social anxiety and depression, and advised to keep a daily diary of her mood. She was also encouraged to take some fresh air and exercise (not an easy ask of a teenager).
This was the easy bit. She found doing these things helped her feel more positive, and then she worked with me on changing her perception about how she thought and valued other people’s opinions. This involved reducing her use of social media and trying to be more face to face with her friends, and then not critically judging herself.
She returned to school, found things easier with some coping strategies developed in session with Joy and made the decision to continue with her University applications which she had put on hold over the summer. The negative thoughts were much reduced and her confidence began to rise. Her family felt they had their daughter back.
Delighted to say she has since been accepted at the two universities she wants to study at. She is better equipped to manage the stress of her mock exams and is now having bi-monthly sessions to maintain her progress until she has sat her A levels. Friendships are a source of support, rather than sorrow now and the future looks very different from 7 months ago.
My patient was referred to me after a break-down at work. She had been signed-off from work by her GP and was suffering with symptoms of social anxiety and depression.
Despite doing well in her job for over 10 years, she described feeling overcome with tiredness and very little willingness to do much, except the school run and basic errands.
She had been feeling low for a while prior to her break-down and was worried that she would never be able to return to work.
As part of her treatment, I recommended she went for regular walks after the school run, ideally with a friend, and encouraged her to keep a journal of all her positive feelings and experiences.
With time, she felt more confident talking to friends and family about her feelings and gradually increased her daily exercise, until she began enjoying her life and spending time her family again.
Once her depression started to subside, she could reflect on her social anxiety and low self-esteem, and realised she had been suffering with the symptoms for a long time.
The focus of her CBT treatment was to gradually build up her confidence and self-esteem. She followed a tailored programme designed to challenge her social anxiety and she started to plan her return to work with her employer.
She returned to work on reduced hours and her manager changed her attitude towards mental health, restoring trust in my patient.
Developing assertiveness was a key part of her recovery, enabling her to manage the demands of work and feel confident saying ‘no’ whenever she felt overwhelmed with the volume of work. After her initial 15 BCT sessions, BUPA agreed an extension of treatment, enabling her to maintain her progress. She continued to exercise regularly, and developed new social contacts and interests.
GJ is now back at work on her original hours. Despite some organisation hiccups she has coped well, and says “saying no” (politely) when necessary is part of her new persona. She maintains her daily journal, and regularly reviews the material and notes from Joy to keep her focus on the present and the future. She has become the mental health ambassador at her organisation and promotes mental health issues to the managers and employees.
My patient’s anxiety about contamination and cleanliness was affecting both her home and work life. So much so, that when we first met, she had been signed-off from work.
Keen to return to work and gain control over her OCD, we started to examine her intrusive thoughts and over the course of her 10 sessions, she was able to identify the triggers for her anxiety.
CBT helped her understand how her anxiety had developed into OCD. Her road to recovery started when she began to test out her ‘false’ predictions that “something awful would happen” if she did not clean and do her rituals and discovered that despite her misgivings nothing happened.
She created a pyramid of her anxieties and began to challenge the lowest ones first and gradually working up to the hardest. She used CBT to help challenge her thinking and her behaviour, and found that over time her anxious feelings diminished.
She returned to work and received the support she needed from her employers with a ‘return to work’ programme and did not resume her cleaning rituals in the workplace.
Within 6 months she has been promoted to a more senior role.
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