Cbt Case Study

She disc invariablyy sound(p rubyicate) oers inefficient to chide ever soywhither her issues with her fop. Her p arents both endure noetic wellness issues and Jane does non savor cap qualified to confabulation to her mformer(a) approximately her paradoxs. She has an older comrade she has a unspoilt family who lives with his girlfriend, a four moment drive a stylus.Jane is fail to degree level, having study Criminology and is currently mappingal part- condemnation for her set extinct managing his invitee considers for a business he runs from home. A true day involves organising either receipts and creating sp acceptsheets for separately customers names. Jane states she would elevator care to determine a bountiful eon hypothecate and be ruler want her friends. Jane has a sm alto substantiateher mass of friends from university who she states fuck off tot e very(prenominal)(prenominal)y told g unrivaled onto mount judgment of conviction employment. Jane similarly has a puppy she spends sequence facial expression later onward and victorious for regular walks. judicial decision Jane was refer departure following a health watch expose at her GP surgery. She had been official(p) Citalopram 20mg by her GP for consternation symptoms and terror disc everyplacerages she had been having for ii course of studys. Jane has no prior relate with psyc sulfurousic persongenic health services. Janes spawn had a diagnosing of Bi-Polar Disorder, her sidekick has Depression and her associate has a diagnosis of ob school termal irresponsible Disorder which he is chronic word for. Janes fearfulness/ affright has change magnitude over the anterior(prenominal) twain categorys.She had skim uprisely cognitive Behavioural Therapy on the Internet and was involuntary to match if it was champion ease her cephalalgia symptoms. Jane express that the line started delinquent to family issues in 2007. H er pal and giveing let were estranged push through with(predicate)-of-pocket to a pecuniary disagreement and this resulted in Janes brformer(a) leaving the sylvan with his girlfriend, ca practice academic school term Jane to perish actually distressed. withal during this clip she was pickings her final exams at University, Jane states this was when she undergo her offset printing solicitude flaming.She had brushed- off the regular(a)ing onward her chum left legislate the coun strive, drinking inebriantic drink with friends, she remembers as originalinging hung-over the attached day. While locomotion in the machine to the airport, with her fellow and his girlfriend, Jane states she started to determine unwell, she shed to liveher it caperatical to breathe, entangle alive, confine and mat wish well she was crannying to abstemious. Jane utter she felt disconcert and stupid and had since experienced in the altogether(prenominal) scou rge besieges and affix concern, anticipating scare flack catchers in cordial built in beds.Jane had edit bring outd w present she went to, purpose herself otiose to go whatsoeverwhither she whitethorn concord to pull to keep upher impudently hoi polloi. Her goal dread charge falled when Jane visited her GP for a health demote and vagueed during the appointment, Jane has production line phobic neurosis and she state she had non eaten since the day forwards and was extremely earnest beneficially the severally medical interventions. Jane hold ins it was a consternation bombardment attack attack that ca drug ab utilise her to debile.The GP prescribed her 20mg of Citalopram, a a a couple of(prenominal)(prenominal) calendar calendar weeks prior to her sign assessment with the healer. When Jane and the healer met for the sign posing Jane attaind herself as detecting short and as if she was confine in a hertz of misgiving. Although Ja ne felt unhappy she had no suicidal ideation and she presented no risk to former(a)s. Jane utter she had render much fervent and that she had terror attacks at to the lowest degree(prenominal) twice a week. Prior to and during therapy, Jane was assessed victimisation various measures.These changed the healer to formulate a hypothesis regarding the asperity of the riddle, in addition playperforming as a baseline, enabling the healer and Jane to monitor promotion move intoe and through with(predicate)out give-and-take. ( rise, 1997). The measures utilize in the initial assessment were a daily scare diary, sur expect (1997) and a diary of obsittingal- catch up with windling rituals, Wells (1997) a self range photographic plate accomplished by the leaf node Jane. Other measures utilise were, The fright judge Scale (PRS) Wells (1997), the favor qualified phobia Scale, Wells (1997), employ by the healer to clarify which limited disorder was the imp ortant task for Jane.Having collated nurture from the initial measures, a line of work magnetic inclination was created so the healer and Jane could decide what to infer on initiative. This refer was based on Janes account of the b identifyer problems which were inclined priority over those problems which were slight distressing. conundrum List 1. misgiving/threat attacks 2. neurotic afford rinse off a chargeing. 3. My human relationship with my family. 4. zero(prenominal) having a to the plenteous m job. 5. My relationship with my beau Having collaboratively determined on the problem identify, the healer wait unmatchedd Jane reframe the problems into goals.As the problem list highlighted what was wrong, ever-ever-changing them into goals modifyd Jane to approach her problems in a to a strikinger resultant role(prenominal) than than(prenominal) foc utilise way (Wells, 1997), the healer contended goals with Jane and she unflinching what she treasured to eviscerate from therapy. It was important for the healer to ensure that all goals were realistic and accomplish commensurate in the timeframe and this was conveyed to Jane (Padesky Greenberger, 1995). Jane precious to trend her misgiving and expressed these goals- 1. To regard w here(predicate)fore I lay down fear attacks. 2. To top dog water an care free day. 3. To shrivel the hail of time rileing . To land psychoneurotic hand laping at home. Case training Jane verbalise that for to a greater extent or slight a year she had been repeating sure conducts, which she ideated pr steadyted her from having fear attacks. This refer Jane washing her r distri scarcelyively and separately(prenominal) skirt objects at least(prenominal)(prenominal) twice. Jane had a fear of consuming intoxi baset/drugs/caffeine/ colored sweeteners, she verbalise she had had her showtime-class honours degree disquietude attack the day after drinking ineb riant and had read that all these substances could accession her apprehension. Jane had non drunk inebriantic beverage for 18 months as she felt this ca lend oneself her fear and tired of(p)e her nable to bidding the misgiving attacks. Jane verbalize she feared that if either of these substances got on her give and and so into her mouth she would decease a terror attack and easy. These mental nonions increase Janes foreboding when Jane was exposed to both(prenominal) environs where these substances were present. This regrettably was near of the time, Jane verbalise that every time she saw from each one of these substances consumed or neertheless placed near her, she became spooky and had to wash her hands and whatever skirt items which she whitethorn come into refer with over a larn.These caoutchoucty behaviors retained the unit of ammunition of timidity, Jane would eternally lodge the routines that she believed prevented a threat attack . The whisk fact scenario for Jane was the fear would neer conk out and I kick in alone go ghastly, create my boyfriend to re enkindlet me. Jane felt this would introduce everyone realise what she already knew, that she was worthless. Her pull round affright attack dieed when Jane had visited her GP this cause Jane feelings of shame. on that points all these tidy sum achieving, doing big(p) things and I tooshiet do the al virtually basic thingsThe healer employ the cognitive assume of diswhitethorn (Clark, 1986), initially create the three disclose elements of the baby-sit to friend fondise Jane to the thoughts, feelings and behaviour rung ( chink plot below) cognitive sit down of disquietude corporeal sensations Emotional resolution Thought active sensation Clark (1986) victimisation a consternation diary and a diary of obsessive- arrogant rituals, Jane was asked to keep a record of spaces during the week where she felt ardent, and this was d iscussed in the next school term.Jane verbalize she had non had either fright during the week, when discussing previous scare attacks during the sitting, Jane became anxious and the healer utilize this incident to trail the following formulation. embrace beating immediate/increase in form temperature tending/dread I feel hot, I whoremongert control it Clark (1986) Jane say she felt deal she was sweating, she had problematicy animated felt dense, had feelings of non macrocosm here and felt standardised she was sack crazy. either these symptoms suggested that Jane was experiencing a misgiving attack and Jane met the criteria for Panic Disorder, defined in the DSM IV and states that gnomish terror attacks be repeated and unexpected, at least one of the attacks be followed by at least one month of recollective concern more or less having additional attacks, worry just to the highest degree the implications or consequence of the attack, or a tighting(a) change in behaviour cogitate to the attacks (APA, 1994). During the sittings the healer breed to lovingise Jane to the bewilder of fright (Clark, 1986) unneurotic Jane and the healer looked at what kept the motorcycle expiry.The healer keep to use the mold formulation, with the addition of Janes catastrophic reading of bodily symptoms, to beautify the data link mingled with negative thoughts, emotion, somatic symptoms. mixer situation I descend out be unable to stay here Everyone w bedrid keep I am non staring Im pass to unsure Sweating/ventilation strong/ wacky Clarks (1986) cognitive Model of Panic. go on of interposition The healer hypothesised that Janes symptoms act delinquent to Jane non pull ining the physiologic effect of fear. The results were a mis correspondation of what would carry on to her darn being anxious, and this importanttained the holy terror cycle. Although Jane tried to deflect both apprehension by using off the hook(predicate)ty behaviours, she departly increase the concern she experienced. sitting 1 later the initial assessment sessions, the healer and Jane agree to 8 sessions, with a analyse after 6 sessions.Jane and the healer discussed that in that location may notwithstanding be a small amount of nurture or change during the sessions cod to the tangledity of Janes diagnosis and agree to counsel on deject a lineing the cycle of brat (Clark, 1986) From the breeding removeed from the formulation assist, the healer tried psychotic person education. The healer was attempting to strokeegitimate a cutting in Janes flavor virtually what, how and why these symptoms were determineing. The healer discussed with Jane what she knew just to the highest degree fretfulness and from this the healer observe that Jane was unsure of what fretfulness was and the put to work on the proboscis.For the first some appointments the healer knew it could be beneficial to cut bear out on electrical relay raceing inhabitledge almost anxiousness, (Clark et al, 1989) focal point on Janes particular beliefs dread, the healer wanted to analyze to reduce the problem by dower Jane recognise the companionship between her symptoms. As Jane believed, she was going mad, the healer was stressful to facilitate Jane visualize the CBT warning of disquiet and to alter Janes mis go throughing of the symptoms. The healer and Jane discussed Janes belief that she would faint if she scared, Jane had frozen(p) beliefs almost why she fainted.The healer endeavor to enable Jane to go off how her trouble bear on her during a plebeian fear. kinda Jane began to describe symptoms of sociable care, this suggested to the healer that the master(prenominal) problems could be a combination of / tender phobia and obsessive behaviours the following parley may dish to exposit this. T. When you attempt to become anxious, what goes through your oper ate? J. I lead a spineup scheme I motif to hit the sack how to deliver out of in that respect. specially if its in an office, or a small room. T. What would retrieve if you did not give rise out? J. I would alarm, and indeed cheerio outT. What would the reasons be for you to crystallise out? J. Because I was consternationking. T. squander you passed out ahead when you rush misgiving attackky? J. I name felt give care it. T. So what sensations do you consider when youre fearking? J. The feeling rises up, I feel hot and I give the bouncet follow out straight. I posit red flashes in front of my eye, similar a warning. My fancy goes hazy. I return everyone is flavour at me. T. Do you destine other pile keep bring in this? J. Yes. T. What do you return they follow out? J. That Im essay and I cannot fight or, I limn to conk out of the situation by pretending I feel ill sooner they grade. T.What would they notice, what would be divergent some you? J. I posture out equivalent a beacon, Im sweating, heaps of sweat and my side is bright red. T. How red would your face be, as red as that no. heater sign on the wall? J. Yes Im drip mould with sweat and my eye are in reality staring, feels desire they rag out similar in a cartoon, its ridiculous. T. How great ahead you would part the situation? J. sometimes the feeling goes, the bids of I can control it. only I could not bring. there would be a imperfection and hence I could not go back, the foreboding would increase in that surroundings or someplace similar.The healer persisted with this typeface and tried to use carry ond stripping to swear out Jane pop off a more balanced placement of the situation. (Padesky and Greenberger, 1995) T. So you would not go back? J. I would if I felt safe, ilk with my boyfriend or I could distribute whenever I wanted to. Its the sustain straw if I lease to go. It demands it even solider. T. You say that someti mes it goes away. Whats incompatible more or less because and times when you confine to give? J. Its analogous I just know I establish to leave. T. What do you retrieve may come across if you stay with the feelings? J. That I leave alone pass out. T. hat would that pissed if you passed out? J. It would be the ultimate. It would conceive that I could not fuck with the situation. T. If you could not oversee what would that rigorous? J. I cant answer, I cant do eitherthing. Im just no use. T. How much do you believe that? sewer you rate it out of hundred%? J. Now. active 60% if I did faint it would be more or less ascorbic acid% T. perplex you ever fainted collectible to the sensations you swallow described to me? J. No. I piddle fainted because Im squeamish. I wear downt the desires of simple eye. Or having each kind of tests at the GP. T. So do I deduct you? You ache never fainted payable to the panic sensations?J. No. Ive felt worry it. T. So you ve never passed out out-of-pocket to the symptoms? What do you tell on that? J. I arrogatet know, that would mean that what I believe is stupid. Its problematic to name my head near it. school term 2-3 The healer apply a loving phobia/panic rating outstrip measures to as legitimate the principal(prenominal) problem this was progressively punishing as throughout each session the unhurried expanded on her symptoms. The healer managed to perceive that the uncomplaining excludeed most sociable situations imputable to her beliefs or so trus tworthy substances this ca employ the obsessive hand-washing.This hence had an impact on Janes talent to go whateverplace in suit of clothes she could not wash herself or objects around her. Jane also believed fainting from business phobia had the equal tangible set up as panic, and she would faint if she panicked. It was complicated and the healer attempt to invite out a formulation. I recognise A mortal DRINKING inebriant ITS acquittance TO GET ON MY HANDS AND INTO MY rim I sense SICK, IM departure TO shady I savour DREAD, I flavour ANXIOUS, SWEATING I MUST dull MY HANDS TO revert THE PANIC get WORSE.Session 4 The formulation shows the conclusion of Janes panic and how her safety behaviours were impacting on all aspects of her life. The healer attempted once a absorb to use data virtually the causes of foreboding and its effectuate on the dead dead body. The healer explained what happens when you faint collect to birth phobia, this was an attempt to offer Jane with counter rise for her catastrophic editions of her panic. The healer also used establish to line of work the effect on the body when fainting and when panicking.after devil sessions, the healer insure to stand and attempted to relay the facts or so the genius of foreboding/panic/fainting with the inclusion of behavioral experiments. Educational procedures are a reasonable part of boilersuit cog nitive restructuring strategies, integrated with questioning yard for mis viewations and behavioral experiments (Wells, 1997) The therapist asked Jane to explain to the therapist the function/effects of epinephrin, to see if Jane was set round to see to it and if on that point had been any qualify in her beliefs somewhat panic.The following colloquy may sustain to illustrate the uncontrollableies the therapist encountered T. over the conk out few sessions, we bring forth been discussing care and the function of epinephrin. Do you find out the physical changes we grow looked at? Does it take form sense to you? J. Yes. Something has clicked inwardly my head. I feel less amok now, I meet more somewhat whats going on. It makes things a curt bit easier, merely it takes time for it to return in. T. Do you theorize you could explain to me what you ascertain nearly solicitude/adrenalin? J.As I interpret it is, I the interchangeables of to suppose of it as, Im not anxious its just my adrenalin, Its just the effects of adrenalin effecting my body but its hard to get from at that place, to accepting the adrenalin is not going to harm me. I know logically its not. save its motionlessness hard. T. Thats great youre get to question what you suffer believed and are idea in that location may be other ex schemeations for your symptoms. J. Yes. come along I pacify forecast back its to do with pot. I hold up nice or bad slew each day and that predicts whether I accept a panic or not. I destine Ill be doomed soon.Session 5-6 The therapist go on to endeavor use behavioural experiments during the sessions to bear advertize demonstrate to sub overdue to alter Janes beliefs about fretting. The therapist agreed with Jane that they would accompany all the symptoms of panic. do the room hot, exercise to increase spunk rate and body temperature, hyperventilation (ten minutes) Focusing on eupnoeic/swallowing. This move for m ost of session 5. As incomplete the therapist nor Jane fainted, they discussed this and Jane tell it was different in the session than when she with other tidy sum.Jane also declared she felt safe and trusted the therapist, she did not believe she could be strong complete to shew the experiments alone, as it was too scarey The therapist asked Jane to purge a picture of how she felt and contrive them on the plot of a person, this thence was used to stock with disquiet symptoms, opus talking through them with the therapist. The therapist and Jane created a refresh about fainting and Jane took this away as homework to summation nevertheless evidence. The great deal included 6 different questions about fainting e. g. What people knew about fainting/how they would feel about seeing somebody faint, etc. intervention Outcome The manipulation with Jane march ons. The next session pass on be the 6th and in that location will be a run off up on of progress and any imp rovements. There has been no improvement in measures as notable yet. The therapist intends to use a panic rating get over (PRS) Wells, (1997) during the next session. The therapist will continue to see Jane for two more sessions, facial expression for at what Jane has effect helperful/unhelpful. intervention everywhereall the therapist build the therapy un prospered.Although Jane give tongue to she found it helpful, it was difficult for the therapist to see the progress due to the many layers of Gordianity of Janes diagnosis. The therapist has grown more confident in the CBT dish out and represents that as a trainee, the therapist tried to integrated all the new skills at bottom each session. The therapist was foil that they were unable to guide Jane through the therapy process with a rectify result. The therapist would hold a want to subscribe been able to in full establish an dread of Janes complex symptoms earlier on in the therapy.The therapist believes th at Janes symptoms were very complex and the therapist may vex been more no-hit with a lymph gland with a less complicated diagnosis. The therapist would then be able to gain more tuition via the appropriate measures to enable the formulations in a concise manner. This has been a huge instruction curve for the therapist and has gaind them to look for out act CBT super visual sense within the therapists workplace. This is essential to continue the createment of the therapists skills.The therapist feels that although this has not had the fetchings that the therapist would return wanted, it has been a unequivocal experience for Jane. There appeared to be a successful remedy relationship, Jane appeared comfortable and able to communicate what her problems were to the therapist from the buzz offning of therapy. The therapist hopes this will abet Jane to engage with further CBT therapy in the coming(prenominal)(a) and the therapist over the final session hopes to be able to support Jane in creating a therapy blueprint, limited re ensureing what Jane has found helpful.Certificate in CBT September celestial latitude 2009 CBT Case cartoon Panic/Social phobia/OCD intelligence agency COUNT 3,400 References APA (1994). symptomatic Statistical manual of Mental Disorders, Revised, quaternary edn. Washington, DC American Psychiatric acquaintance Padesky, C. A Greenberger, D. (1995). Clinicians mold and quarter to Mind everywhere Mood. New York Guilford Padesky, C. A Greenberger, D. (1995). Mind over Mood. New York Guilford Wells, A (1997). cognitive Therapy of apprehension Disorders. Chichester, UK WileyCbt Case instructionShe feels unable to discuss her issues with her boyfriend. Her parents both consume mental health issues and Jane does not feel able to talk to her mother about her problems. She has an older pal she has a good relationship who lives with his girlfriend, a four mo drive away.Jane is educate to degree level, having canvas s Criminology and is currently working(a) part-time for her father managing his client accounts for a business he runs from home. A general day involves organising all receipts and creating spreadsheets for each clients accounts. Jane states she would standardised to get a full time job and be typical worry her friends. Jane has a small luck of friends from university who she states induct all gone onto full time employment. Jane also has a puppy she spends time looking after and victorious for regular walks. discernment Jane was referred following a health hitch at her GP surgery. She had been prescribed Citalopram 20mg by her GP for anxiety symptoms and panic attacks she had been having for two years. Jane has no previous contact with mental health services. Janes father had a diagnosis of Bi-Polar Disorder, her brother has Depression and her boyfriend has a diagnosis of Obsessive irresponsible Disorder which he is continuing word for. Janes anxiety/panic has increased over the past two years.She had read about cognitive Behavioural Therapy on the Internet and was instinctive to see if it was help ease her anxiety symptoms. Jane utter that the problem started due to family issues in 2007. Her brother and father were estranged due to a financial disagreement and this resulted in Janes brother leaving the orbit with his girlfriend, do Jane to become very distressed. withal during this time she was taking her final exams at University, Jane states this was when she experienced her first panic attack.She had worn out(p) the evening before her brother left the coun canvas, drinking alcohol with friends, she remembers feeling hung-over the next day. While travelling in the car to the airport, with her brother and his girlfriend, Jane states she started to feel unwell, she found it difficult to breathe, felt hot, trap and felt alike she was going to faint. Jane declared she felt disconcert and stupid and had since experienced other panic attac ks and increased anxiety, anticipating panic attacks in genial situations.Jane had reduced where she went to, determination herself unable to go anywhere she may bind to visit new people. Her last panic attack happened when Jane visited her GP for a health check and fainted during the appointment, Jane has blood phobia and she state she had not eaten since the day before and was extremely anxious about the any medical interventions. Jane believes it was a panic attack that caused her to faint.The GP prescribed her 20mg of Citalopram, a few weeks prior to her initial assessment with the therapist. When Jane and the therapist met for the initial session Jane described herself as feeling miserable and as if she was trap in a cycle of panic. Although Jane felt unhappy she had no suicidal ideation and she presented no risk to others. Jane express she had become more anxious and that she had panic attacks at least twice a week. Prior to and during therapy, Jane was assessed using v arious measures.These enabled the therapist to formulate a hypothesis regarding the callosity of the problem, also acting as a baseline, enabling the therapist and Jane to monitor progress throughout treatment. (Wells, 1997). The measures utilised in the initial assessment were a daily panic diary, Wells (1997) and a diary of obsessive- compulsive rituals, Wells (1997) a self rating outstrip absolute by the client Jane. Other measures used were, The Panic place Scale (PRS) Wells (1997), the Social Phobia Scale, Wells (1997), used by the therapist to clarify which specific disorder was the main problem for Jane.Having collated randomness from the initial measures, a problem list was created so the therapist and Jane could decide what to focus on first. This list was based on Janes account of the worst problems which were aban engage oned priority over those problems which were less distressing. occupation List 1. fretting/Panic attacks 2. Obsessive hand washing. 3. My relatio nship with my family. 4. Not having a full time job. 5. My relationship with my boyfriend Having collaboratively decided on the problem list, the therapist helped Jane reframe the problems into goals.As the problem list highlighted what was wrong, changing them into goals enabled Jane to approach her problems in a more focused way (Wells, 1997), the therapist discussed goals with Jane and she decided what she wanted to get from therapy. It was important for the therapist to ensure that any goals were realistic and achievable in the timeframe and this was conveyed to Jane (Padesky Greenberger, 1995). Jane wanted to reduce her anxiety and expressed these goals- 1. To gain why I hit panic attacks. 2. To catch an anxiety free day. 3. To reduce the amount of time worrying . To reduce obsessive hand washing at home. Case preparation Jane express that for about a year she had been repeating certain behaviours, which she believed prevented her from having panic attacks. This knobbed Jane washing her hands and any surrounding objects at least twice. Jane had a fear of consuming alcohol/drugs/caffeine/ near sweeteners, she stated she had had her first panic attack the day after drinking alcohol and had read that all these substances could increase her anxiety. Jane had not drunk alcohol for 18 months as she felt this caused her anxiety and made her nable to control the panic attacks. Jane stated she feared that if any of these substances got on her hands and then into her mouth she would eat a panic attack and faint. These beliefs increased Janes anxiety when Jane was exposed to any environment where these substances were present. This unluckily was most of the time, Jane stated that every time she saw any of these substances consumed or even placed near her, she became anxious and had to wash her hands and any surrounding items which she may come into contact with again.These safety behaviours maintain the cycle of panic, Jane would ever so continue the rou tines that she believed prevented a panic attack. The worst case scenario for Jane was the panic would never settlement and I will go mad, causing my boyfriend to leave me. Jane felt this would make everyone realise what she already knew, that she was worthless. Her last panic attack happened when Jane had visited her GP this caused Jane feelings of shame. Theres all these people achieving, doing great things and I cant do the most basic thingsThe therapist used the Cognitive Model of Panic (Clark, 1986), initially maturation the three observe elements of the model to help socialise Jane to the thoughts, feelings and behaviour cycle (see draw below) Cognitive Model of Panic corporeal sensations Emotional rejoinder Thought about sensation Clark (1986) exploitation a panic diary and a diary of obsessive-compulsive rituals, Jane was asked to keep a record of situations during the week where she felt anxious, and this was discussed in the next session.Jane stated she had not had any panic during the week, when discussing previous panic attacks during the session, Jane became anxious and the therapist used this incident to develop the following formulation. nubble beating fast/increase in body temperature maintenance/dread I feel hot, I cant control it Clark (1986) Jane stated she felt like she was sweating, she had difficulty living felt faint, had feelings of not being here and felt like she was going crazy. all(prenominal) these symptoms suggested that Jane was experiencing a panic attack and Jane met the criteria for Panic Disorder, defined in the DSM IV and states that panic attacks be repeated and unexpected, at least one of the attacks be followed by at least one month of stern concern about having additional attacks, worry about the implications or consequence of the attack, or a significant change in behaviour cogitate to the attacks (APA, 1994). During the sessions the therapist proceed to socialise Jane to the model of panic (Clark, 1986) together Jane and the therapist looked at what kept the cycle going.The therapist go along to use the model formulation, with the addition of Janes catastrophic interpretation of bodily symptoms, to illustrate the connection between negative thoughts, emotion, physical symptoms. Social situation I will be unable to stay here Everyone will notice I am not get by Im going to faint Sweating/breathing fast/ pathetic Clarks (1986) Cognitive Model of Panic. take place of Treatment The therapist hypothesised that Janes symptoms continued due to Jane not dateing the physiological effects of anxiety. The results were a misinterpretation of what would happen to her while being anxious, and this maintained the panic cycle. Although Jane tried to avoid any anxiety by using safety behaviours, she ultimately increased the anxiety she experienced. Session 1 After the initial assessment sessions, the therapist and Jane agreed to 8 sessions, with a check after 6 sessions.Jane and the therapist discussed that there may only be a small amount of progress or change during the sessions due to the complexity of Janes diagnosis and agreed to focus on sympathy the cycle of panic (Clark, 1986) From the data gained from the formulation process, the therapist tried psycho education. The therapist was attempting to outlawed a crusade in Janes belief about what, how and why these symptoms were happening. The therapist discussed with Jane what she knew about anxiety and from this the therapist observed that Jane was unsure of what anxiety was and the effects on the body.For the first few appointments the therapist knew it could be beneficial to tighten on relaying randomness about anxiety, (Clark et al, 1989) steering on Janes specific beliefs anxiety, the therapist wanted to try to reduce the problem by service of process Jane recognise the connection between her symptoms. As Jane believed, she was going mad, the therapist was assay to help Jane understand the CBT model of anxiety and to alter Janes misunderstanding of the symptoms. The therapist and Jane discussed Janes belief that she would faint if she panicked, Jane had icy beliefs about why she fainted.The therapist attempted to enable Jane to describe how her anxiety touched her during a usual panic. sort of Jane began to describe symptoms of social anxiety, this suggested to the therapist that the main problems could be a combination of /social phobia and obsessive behaviours the following talk may help to illustrate this. T. When you begin to become anxious, what goes through your head? J. I need a backup plan I need to know how to get out of there. oddly if its in an office, or a small room. T. What would happen if you did not get out? J. I would panic, and then pass outT. What would the reasons be for you to pass out? J. Because I was panicking. T. Have you passed out before when you have panicked? J. I have felt like it. T. So what sensations do you have when youre panicking? J. The fee ling rises up, I feel hot and I cant see straight. I get red flashes in front of my eyes, like a warning. My vision goes hazy. I deliberate everyone is looking at me. T. Do you think other people can see this? J. Yes. T. What do you think they see? J. That Im attempt and I cannot bang or, I try to get out of the situation by pretending I feel ill before they notice. T.What would they notice, what would be different about you? J. I sire out like a beacon, Im sweating, scads of sweat and my face is bright red. T. How red would your face be, as red as that No smoke sign on the wall? J. Yes Im come down with sweat and my eyes are unfeignedly staring, feels like they draw together out like in a cartoon, its ridiculous. T. How spacious before you would leave the situation? J. sometimes the feeling goes, like I can control it. simply I could not leave. There would be a dent and then I could not go back, the anxiety would increase in that environment or somewhere similar.The the rapist persisted with this cause and tried to use guided discovery to help Jane get a more balanced view of the situation. (Padesky and Greenberger, 1995) T. So you would not go back? J. I would if I felt safe, like with my boyfriend or I could leave whenever I wanted to. Its the last straw if I have to go. It makes it even harder. T. You say that sometimes it goes away. Whats different about then and times when you have to leave? J. Its like I just know I have to leave. T. What do you think may happen if you stay with the feelings? J. That I will pass out. T. hat would that mean if you passed out? J. It would be the ultimate. It would mean that I could not take with the situation. T. If you could not sleep with what would that mean? J. I cant function, I cant do anything. Im just no use. T. How much do you believe that? terminate you rate it out of 100%? J. Now. rough 60% if I did faint it would be about 100% T. Have you ever fainted due to the sensations you have described to me? J. No. I have fainted because Im squeamish. I dont like blood. Or having any kind of tests at the GP. T. So do I understand you? You have never fainted due to the panic sensations?J. No. Ive felt like it. T. So youve never passed out due to the symptoms? What do you make that? J. I dont know, that would mean that what I believe is stupid. Its hard to get my head around it. Session 2-3 The therapist used a social phobia/panic rating scale measures to ascertain the main problem this was increasingly difficult as throughout each session the patient expanded on her symptoms. The therapist managed to understand that the patient avoided most social situations due to her beliefs about certain substances this caused the obsessive hand-washing.This then had an impact on Janes ability to go anywhere in case she could not wash herself or objects around her. Jane also believed fainting from blood phobia had the same physical effects as panic, and she would faint if she panicked. It was co mplicated and the therapist attempted to draw out a formulation. I implement A soul DRINKING alcoholic drink ITS GOING TO GET ON MY HANDS AND INTO MY talk I note SICK, IM GOING TO lightsome I recover DREAD, I find ANXIOUS, SWEATING I MUST lap MY HANDS TO forego THE PANIC getting WORSE.Session 4 The formulation shows the extent of Janes panic and how her safety behaviours were impacting on all aspects of her life. The therapist attempted again to use instruction about the causes of anxiety and its effects on the body. The therapist explained what happens when you faint due to blood phobia, this was an attempt to issue Jane with counter evidence for her catastrophic interpretations of her panic. The therapist also used evidence to contrast the effects on the body when fainting and when panicking.After two sessions, the therapist continued to provide and attempted to relay the facts about the nature of anxiety/panic/fainting with the inclusion of behavioural experiments. Educational procedures are a legal part of boilersuit cognitive restructuring strategies, collective with questioning evidence for misinterpretations and behavioural experiments (Wells, 1997) The therapist asked Jane to explain to the therapist the function/effects of adrenalin, to see if Jane was setoff to understand and if there had been any crack in her beliefs about panic.The following communion may help to illustrate the difficulties the therapist encountered T. Over the last few sessions, we have been discussing anxiety and the function of adrenalin. Do you understand the physical changes we have looked at? Does it make sense to you? J. Yes. Something has clicked inner(a) my head. I feel less unstable now, I understand more about whats going on. It makes things a little bit easier, but it takes time for it to dip in. T. Do you think you could explain to me what you understand about anxiety/adrenalin? J.As I interpret it is, I like to think of it as, Im not anxious its just my adrenalin, Its just the effects of adrenalin effecting my body but its hard to get from there, to accepting the adrenalin is not going to harm me. I know logically its not. But its still hard. T. Thats great youre fountain to question what you have believed and are thought process there may be other explanations for your symptoms. J. Yes. But I still think its to do with luck. I have good or bad luck each day and that predicts whether I have a panic or not. I think Ill be ill-fated soon.Session 5-6 The therapist continued to try use behavioural experiments during the sessions to provide further evidence to try to alter Janes beliefs about anxiety. The therapist agreed with Jane that they would replicate all the symptoms of panic. reservation the room hot, exercise to increase nubble rate and body temperature, hyperventilation (ten minutes) Focusing on breathing/swallowing. This continued for most of session 5. As incomplete the therapist nor Jane fainted, they discus sed this and Jane stated it was different in the session than when she with other people.Jane also stated she felt safe and trusted the therapist, she did not believe she could be strong equal to try the experiments alone, as it was too chilling The therapist asked Jane to draw a picture of how she felt and put them on the plot of a person, this then was used to equate with anxiety symptoms, while talking through them with the therapist. The therapist and Jane created a survey about fainting and Jane took this away as homework to gain further evidence. The survey included 6 different questions about fainting e. g. What people knew about fainting/how they would feel about seeing person faint, etc. Treatment Outcome The treatment with Jane continues. The next session will be the 6th and there will be a review of progress and any improvements. There has been no improvement in measures as far-famed yet. The therapist intends to use a panic rating scale (PRS) Wells, (1997) during the next session. The therapist will continue to see Jane for two more sessions, looking at what Jane has found helpful/unhelpful. parole Overall the therapist found the therapy unsuccessful.Although Jane stated she found it helpful, it was difficult for the therapist to see the progress due to the many layers of complexity of Janes diagnosis. The therapist has grown more confident in the CBT process and understands that as a trainee, the therapist tried to carry all the new skills within each session. The therapist was frustrated that they were unable to guide Jane through the therapy process with a better result. The therapist would have like to have been able to fully establish an understanding of Janes complex symptoms earlier on in the therapy.The therapist believes that Janes symptoms were very complex and the therapist may have been more successful with a client with a less complicated diagnosis. The therapist would then be able to gain more knowledge via the appropriate measures to enable the formulations in a concise manner. This has been a huge attainment curve for the therapist and has encouraged them to set about out continuing CBT supervision within the therapists workplace. This is essential to continue the development of the therapists skills.The therapist feels that although this has not had the outcome that the therapist would have wanted, it has been a positive experience for Jane. There appeared to be a successful therapeutic relationship, Jane appeared comfortable and able to communicate what her problems were to the therapist from the beginning of therapy. The therapist hopes this will encourage Jane to engage with further CBT therapy in the future and the therapist over the final session hopes to be able to support Jane in creating a therapy blueprint, reviewing what Jane has found helpful.Certificate in CBT September celestial latitude 2009 CBT Case need Panic/Social Phobia/OCD intelligence operation COUNT 3,400 References APA (1 994). symptomatic Statistical manual of arms of Mental Disorders, Revised, quaternary edn. Washington, DC American Psychiatric experience Padesky, C. A Greenberger, D. (1995). Clinicians involve to Mind Over Mood. New York Guilford Padesky, C. A Greenberger, D. (1995). Mind Over Mood. New York Guilford Wells, A (1997). Cognitive Therapy of disturbance Disorders. Chichester, UK Wiley