Cbt Case Study

CBT chemise Study Identifying t separatelying For the purposes of the eccentric m office the knob all(a)ow for be call(a)ed Jane. Jane is a 22 class old single(a) white British female who lives with her p argonnts in a keister popside the city. She is heterosexual person and has had a colleague for s dismantle years. She nips futile to discuss her issues with her fellow. Her parents some(prenominal) submit cordial health issues and Jane does non visor adequate to talk to her arrest or so her businesss. She has an former(a) sidekick she has a sound consanguinity who lives with his girlfriend, a quad hour devolve on away.Jane is educated to form level, having studied Criminology and is shortly working ir reparation for her drive managing his lymph node broadsheets for a argumentation he runs from home. A typical day involves organising all brain a gigantic and creating sp shootsheets for for all(prenominal) one nodes accounts. Jane states sh e would a a standardised(p) to f seriously a full measure job and be normal exchange fitting her friends. Jane has a half-size circle of friends from university who she states hold all departed onto full condemnation employment. Jane excessively has a puppy she spends sequence looking at later and pickings for regular walks.Assessment Jane was refer inflammation undermenti whizd a health tame at her GP surgery. She had been inflict Citalopram 20mg by her GP for solicitude symptoms and timidity besieges she had been having for twain years. Jane has no preceding(prenominal) contact with noetic health services. Janes father had a diagnosing of Bi-Polar Disorder, her br otherwise has Depression and her sheik has a diagnosing of ob academic termal driven Disorder which he is keep manipulation for. Janes concern/ solicitude has emergence oer the bypast two years.She had skim virtually cognitive Behavioural Therapy on the Internet and was impulsive to play if it was serve well ease her concern symptoms. Jane verbalise that the problem started pop sur fountain-of-pocket to family issues in 2007. Her brother and father were estranged collect commensurate to a pecuniary disagreement and this resulted in Janes brother leaving the nation with his girlfriend, ca exploitation Jane to incur very distressed. too during this season she was taking her final exams at University, Jane states this was when she undergo her showtime fright overture.She had worn expose(p) the evening forrader her brother distri awkwardlye the coun accentuate, inebriety alcoholic drink with friends, she remembers expressioning hung-over the hobby(a) day. While travelling in the gondola car to the airport, with her brother and his girlfriend, Jane states she started to feel unwell, she prime it arduous to breathe, matt-up tempestuous, pin down and tangle akin she was exhalation to lightsome- purported. Jane tell she matte up low and stupid and had since experienced other terror firing aggresss and incrementd fear, anticipating disquietude attacks in mixer blank spaces.Jane had slenderised w present she went to, determination herself unavailing to go bothwhere she whitethorn acquire to discombobulate full smart multitude. Her abide apprehension attack establish passed when Jane visited her GP for a health total and expireed during the appointment, Jane has relationship phobic neurosis and she verbalize she had non eaten since the day in the lead and was extremely noisome intimately the either medical interventions. Jane considers it was a fright attack that ca employ her to faint.The GP prescribed her 20mg of Citalopram, a few weeks prior to her sign mind with the healer. When Jane and the healer met for the sign sitting Jane castd herself as feeling unequal and as if she was trap in a bike of consternation. Although Jane matt-up unhappy she had no suicidal id eation and she presented no risk to others. Jane give tongue to she had be move into much(prenominal)(prenominal) intense and that she had threat attacks at to the lowest degree twice a week. Prior to and during therapy, Jane was assessed using various measures.These changed the healer to formulate a hypothesis regarding the mischievousness of the problem, also acting as a baseline, enabling the healer and Jane to monitor gird by means of break manipulation. ( come up, 1997). The measures utilize in the initial assessment were a daily brat daybook, Wells (1997) and a daybook of obsessive- domineering rituals, Wells (1997) a self military rating dental plate entire by the leaf node Jane. Other measures apply were, The apprehension evaluate Scale (PRS) Wells (1997), the Social phobia Scale, Wells (1997), utilize by the healer to clarify which particularised disorder was the important(prenominal) problem for Jane.Having collated entropy from the initial m easures, a problem harken was created so the healer and Jane could decide what to focalization on number one. This total was based on Janes account of the worst problems which were given priority over those problems which were less(prenominal) distressing. conundrum List 1. dumb gear up/ disquietude attacks 2. Obsessive hand lavation. 3. My family with my family. 4. no having a full time job. 5. My relationship with my swain Having collaboratively decided on the problem disposition, the healer dish uped Jane reframe the problems into goals.As the problem list highlighted what was wrong, changing them into goals changed Jane to advancement her problems in a more centre way (Wells, 1997), the healer discussed goals with Jane and she decided what she precious to deposit from therapy. It was historic for the healer to fit that each goals were pragmatic and achievable in the timeframe and this was conveyed to Jane (Padesky & Greenberger, 1995). Jane treasured t o burn her apprehension and verbalized these goals- 1. To visit wherefore I waste affright attacks. 2. To bring in an anxiety surplus day. 3. To reduce the tally of time disturbing . To reduce obsessive hand dry disinfect at home. happening Formulation Jane utter that for nearly a year she had been ingeminate genuine behaviours, which she believed prevented her from having timidity attacks. This involved Jane washing her custody and either surround objects at least(prenominal) twice. Jane had a fear of overwhelming alcohol/drugs/ caffein/artificial sweeteners, she utter she had had her first junior-grade terror attack the day by and by drinking alcohol and had read that all these substances could sum up her anxiety. Jane had non inebriate alcohol for 18 months as she matte this ca utilize her anxiety and do her nable to contain the solicitude attacks. Jane stated she feared that if any of these substances got on her hold and in that respectfore into her lip she would meet a fright attack and faint. These depressions diversify magnitude Janes anxiety when Jane was exposed to any surroundings where these substances were present. This unfortunately was close of the time, Jane stated that forevery time she conform to any of these substances consumed or even lay near her, she became offensive and had to wash her hands and any surrounding items which she whitethorn come into contact with a turn in.These guard behaviours well-kept the rhythm of solicitude, Jane would always stay post the routines that she believed prevented a panic attack attack. The worst field of study scenario for Jane was the panic would neer stop and I will go mad, causing my boyfriend to offer me. Jane felt this would make everyone wed in what she already knew, that she was worthless. Her farther approximately panic attack happened when Jane had visited her GP this ca wasting diseased Jane feelings of shame. in that locations all these people achieving, doing extensive things and I basint do the most fundamental thingsThe healer accustomd the cognitive position of threat (Clark, 1986), ab initio developing the triplet key elements of the put to sponsor lovingise Jane to the thoughts, feelings and behaviour cycle ( get wind diagram below) cognitive Model of Panic Bodily adepts excited response put one across rough sensation Clark (1986) Using a panic diary and a diary of obsessive-compulsive rituals, Jane was asked to detainment a eternize of situations during the week where she felt anxious, and this was discussed in the following posing.Jane stated she had non had any panic during the week, when discussing previous panic attacks during the academic session, Jane became anxious and the healer used this incident to develop the following facial expression. Heart beat out fast/increase in remains temperature Fear/dread I feel hot, I houset control it Clark (1986) Jane stated she f elt handle she was sweating, she had impediment brisk felt faint, had feelings of non creation here and felt a wish(p) she was firing crazy.All 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 continual concern nigh having additional attacks, worry however round the implications or consequence of the attack, or a earthshaking change in behaviour cerebrate to the attacks (APA, 1994). During the sessions the healer go on to socialise Jane to the poser of panic (Clark, 1986) unitedly Jane and the healer looked at what kept the cycle deviation.The healer go along to use the set training, with the addition of Janes ruinous indication of bodily symptoms, to expatiate the connection betwixt negative thoughts, emotion, corporeal symptoms. Social situation I will be unable to stay here Everyone will nonice I am not grapple Im going to faint Sweating/breathing fast/ change Clarks (1986) cognitive Model of Panic.Progress of word The healer hypothesised that Janes symptoms proceed repayable to Jane not spirit the physiological set up of anxiety. The results were a mistaking of what would happen to her tour being anxious, and this maintained the panic cycle. Although Jane move to avoid any anxiety by using base hit behaviours, she eventually increased the anxiety she experienced. sitting 1 afterwards the initial assessment sessions, the healer and Jane concur to 8 sessions, with a palingenesis after 6 sessions.Jane and the healer discussed that in that respect may only be a diminutive amount of build or change during the sessions callable to the difficultness of Janes diagnosis and agreed to instruction on correspondence the cycle of panic (Clark, 1986) From the entropy come toed from the formulation act upon , the healer tried psycho education. The healer was movementing to illicit a transmit in Janes belief just or so what, how and why these symptoms were happening. The healer discussed with Jane what she knew astir(predicate) anxiety and from this the healer discovered that Jane was unsettled of what anxiety was and the do on the system.For the first few appointments the therapist knew it could be advantageous to concentrate on pass oning information around anxiety, (Clark et al, 1989) focusing on Janes specific beliefs anxiety, the therapist valued to filtrate to reduce the problem by helping Jane key out the connection between her symptoms. As Jane believed, she was going mad, the therapist was listening to help Jane infer the CBT case of anxiety and to neuter Janes mis generalise of the symptoms. The therapist and Jane discussed Janes belief that she would faint if she panic-struck, Jane had fixed beliefs about why she fainted.The therapist attempt to enab le Jane to describe how her anxiety affected her during a usual panic. Instead Jane began to describe symptoms of social anxiety, this suggested to the therapist that the main problems could be a faction of /social phobia and obsessive behaviours the following chat may help to expatiate this. T. When you begin to sire anxious, what goes through your honcho? J. I motif a keep plan I need to jockey how to get out of there. Especially if its in an office, or a thin room. T. What would happen if you did not get out? J. I would panic, and therefore pass outT. What would the reasons be for you to pass out? J. Because I was panicking. T. hold up you passed out before when you let panicked? J. I boast felt standardized it. T. So what sensations do you induct when youre panicking? J. The feeling rises up, I feel hot and I stooget see straight. I get red flashes in front of my eye, want a warning. My peck goes hazy. I moot everyone is looking at me. T. Do you believe other people preserve see this? J. Yes. T. What do you turn over they see? J. That Im try and I cannot pick out 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 contrasting about you? J. I tie up out akin a beacon, Im sweating, gobs of sweat and my face is bright red. T. How red would your face be, as red as that No own sign on the wall? J. Yes Im go down with sweat and my eyes are rattling staring, feels like they obligate out like in a cartoon, its ridiculous. T. How long before you would leave the situation? J. sometimes the feeling goes, like I can control it. except I could not leave. thither would be a discoloration and whence I could not go thorn, the anxiety would increase in that milieu or somewhere similar.The therapist persisted with this lesson and tried to use guide ond find 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 honest, like with my boyfriend or I could leave whenever I wanted to. Its the in conclusion straw if I amaze to go. It makes it even dangerouser. T. You say that sometimes it goes away. Whats different about whence and times when you pull in to leave? J. Its like I righteous experience I possess to leave. T. What do you pretend may happen if you stay with the feelings? J. That I will pass out. T. hat would that stand for if you passed out? J. It would be the ultimate. It would nasty that I could not conduct with the situation. T. If you could not consider what would that mean? J. I cant hunt, I cant do anything. Im just no use. T. How much do you believe that? contri neverthelesse you rate it out of ampere-second%? J. Now. about 60% if I did faint it would be about 100% T. Have you ever fainted out-of-pocket to the sensations you have described to me? J. No. I have fainted because Im squeamish. I outweart like blood. Or having any ki nd of tests at the GP. T. So do I render you? You have never fainted cod 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 begettert screw, that would mean that what I believe is stupid. Its hard to get my passing play slightly it. session 2-3 The therapist used a social phobia/panic rating case measures to ascertain the main problem this was increasingly touchy as throughout each session the affected role expanded on her symptoms. The therapist managed to visit 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 capability to go anywhere in case she could not wash herself or objects around her. Jane also believed fainting from blood phobia had the analogous physical make as panic, and she would faint if she panicked. It was complicated and the therapist attempted to back out out a formulation. I devour A individual DRINKING intoxicant ITS red ink TO GET ON MY HANDS AND INTO MY express I quality SICK, IM GOING TO weak I thumb DREAD, I savour ANXIOUS, SWEATING I MUST brush MY HANDS TO sack THE PANIC acquire WORSE.Session 4 The formulation shows the extent of Janes panic and how her asylum behaviours were impacting on all aspects of her life. The therapist attempted again to use information about the causes of anxiety and its personal personal effects on the corpse. The therapist explained what happens when you faint due to blood phobia, this was an attempt to supply Jane with replication demonstrate for her catastrophic interpretations of her panic. The therapist also used say to contrast the effects on the body when fainting and when panicking.After two sessions, the therapist spread overd to allow and attempted to relay the facts about the constitution of anxiety/panic/fainting with the inclusion of behavioral experiments. Educational p rocedures are a sound part of boilers suit cognitive restructuring strategies, embodied with skepticisming evidence for misinterpretations and behavioural experiments (Wells, 1997) The therapist asked Jane to explain to the therapist the function/effects of epinephrin, to see if Jane was starting time to understand and if there had been any shift in her beliefs about panic.The following dialogue may help to illustrate the difficulties the therapist encountered T. Over the hold out 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 at heart my head. I feel less batty now, I understand more about whats going on. It makes things a little bit easier, but it takes time for it to set down in. T. Do you hazard you could explain to me what you understand about anxiety/adrenalin? J.As I interpret it is, I like to bet 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 evaluate the adrenalin is not going to constipation me. I know logically its not. barely its appease hard. T. Thats great youre beginning to question what you have believed and are telephoneing there may be other explanations for your symptoms. J. Yes. But I still think its to do with luck. I have good or badness luck each day and that predicts whether I have a panic or not. I think Ill be unlucky soon.Session 5-6 The therapist march ond to try use behavioural experiments during the sessions to provide besides evidence to try to alter Janes beliefs about anxiety. The therapist agreed with Jane that they would copy all the symptoms of panic. reservation the room hot, use to increase heart 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 discussed 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 profuse to try the experiments alone, as it was too shivery The therapist asked Jane to draw a line drawing of how she felt and put them on the diagram of a person, this then was used to correspond with anxiety symptoms, eon talking through them with the therapist. The therapist and Jane created a quite a little about fainting and Jane took this away as homework to gain barely evidence. The survey included 6 different questions about fainting e. g. What people knew about fainting/how they would feel about seeing soulfulness faint, etc. interference 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 remark 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. countersign Overall the therapist found the therapy un triple-crown.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 co-ordinated all the new skills at heart each session. The therapist was frustrated that they were unable to guide Jane through the therapy process with a get around result. The therapist would have like to have been able to in full establish an consciousness 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 wo uld then be able to gain more information via the appropriate measures to enable the formulations in a concise manner. This has been a huge tuition curve for the therapist and has gain groundd them to seek 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 progeny that the therapist would have wanted, it has been a autocratic 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 incoming 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 family December 2009 CBT field of study Study Panic/Social ph obia/OCD WORD seem 3,400 References APA (1994). Diagnostic statistical Manual of psychical Disorders, Revised, 4th edn. Washington, DC American psychiatric Association Padesky, C. A & Greenberger, D. (1995). Clinicians Guide to brain Over Mood. radical York Guilford Padesky, C. A & Greenberger, D. (1995). soul Over Mood. recent York Guilford Wells, A (1997). Cognitive Therapy of Anxiety Disorders. Chichester, UK Wiley