Case study clinical example: First session with a client with symptoms of social anxiety (CBT model)

hi Hannah nice to meet you hi so I understand that you were referred to me by your GP because you've been experiencing some anxiety difficulties yeah um yeah I guess kind it kind of started like five six years ago okay um it kind of it escalated a bit um I've just recently moved out um from living with my parents so it's made it a bit worse I think okay is this the first time that you've left home uh yeah I um yeah it is the first time actually yeah um I was going to a few

years ago I just thought it would be easier to stay home so okay so it's been quite a big stth and a big change and and it sounds like that that was what led you to go to your GP yeah so how has that uh changed things for you um you know it's kind of I haven't really told anyone so I mean it's made it like better in the sense I feel hopefully this is you know this is it like it will it will help but I don't know I don't like thinking that I've like

had to do this I never thought I'd like be the kind of person you'd have to actually go and like get help if that makes sense okay so how do you feel about being here today it's like scared I don't know hopefully it will help okay so you've been feeling a little bit anxious about today yeah okay so I guess just going back to um why you went to the GP and and how you've ended up kind of coming here today so it sounds like you've been experiencing anxiety for quite a few years um but

just recently you moved out of home for the first time and um and that was what kind of LED you to go to the GP so how did that change things how were things after you moved out um I thought that they'd be better but because I thought I'd have to kind of be independent and but it's actually a lot worse I'm I'm just kind of staying in the house a lot I don't really have any friends or anything I mean my family come and visit a bit but it's not I don't know it's kind

of scary because I've just been kind of literally just in the flat by myself which I always thought I'd like but I don't actually like it okay so what are the kind of difficulties that you have been experiencing um I mean I'm I'm a photographer um so I kind of it's It's been stopping me a bit my anxiety from being able to get work and because every time you know there's an opportunity that is kind of involving me having to interact with people I just tend to just turn it down so I was kind of

making things hard in that respect and um just kind of friends wise and everything I just feel like I'm just kind of increasingly more alone so it's kind of stopping me from making friends and you know like relationships and stuff okay so you said that um your difficulties are getting in the way of you doing certain things so they're they're stopping you from taking up kind of certain types of work and as a freelance photographer I guess that that can be kind of a problem and they're also stopping you or you feel like it's stunting

you uh socially you're not kind of able to make new friends and get to meet new people yeah yeah um it was kind of easier when I was at home because I was obviously I me and my parents and so that's fine but you know they would I'd go to places with them or I'd kind of have people there but more and more I'm just finding myself just staying in a lot I mean I went like two weeks give coffee with my friends and the whole time I was just kind of wanting to go home

again so I don't I just don't want to I don't want that to happen I don't want to lose everyone so so you're kind of worried about how where this is going to lead to yeah um yeah okay so you said that you first noticed the anxiety kicking in when about five or six years ago so you would have been about 19 yeah and what was happening around that time uh I guess I'd finished school about a year before that um and I mean I I've always been a bit shy um at school but it

was never ever like it didn't really affect things as much as not at all as much as it has been doing the last few years I guess it just started when it like my friends went to University and I don't know I felt like I was expected to kind of move out or just do something and then it just kind of escalated from there I'd just stop going to parties or I'd just say no to invitations or I don't know I thought my job would help because I mean I love it I really like doing

photography but I'm just kind of getting less and less work as it goes on so which is my fault I keep saying no but what kind work is the most difficult for you in your job I guess when it I have to kind of be working with other people um I don't like that it's like when I'm trying to kind of do an event or something where there's a lot of people there not just photographers but actual you know if I'm like taking photos of people that I don't know I just kind of find myself

saying no I mean I want to do them but just it's scary so I just don't do it so I tell me a bit more about what happens then so let's focus on maybe an invitation to do a job with uh you know it's going to involve uh photography with with a group of people and you're going to have to have social interaction what kind of thoughts go through your head um just I mean I get really hot and sweaty and I don't I feel like everyone's kind of looking at me and thinking that I'm

just like really stupid and I feel like they're all going to be staring and thinking I just can't do my job and I'm just an idiot and I mean they'll think that I just look like a weirdo and I just try and I mean I just kind of just try and get out of the situation or just focus on something else so that's why I like doing shots where it's just me and the camera because I then I can just put all my attention on that instead of having to you know be with other people

okay so it sounds like you have quite a lot of thoughts rushing through your head then at the point where you get that invitation you think people look people will stare people will think I'm a weirdo there's quite a lot about what you what you think are the people will think yeah um and how does that make you feel um just makes me feel like an idiot it makes me feel like I just shouldn't even bother trying to do it anymore I should just go home and I just I think I just don't want to

be in that situation I just feel like everyone else is fine and they're normal and I'm just the freak who can't like do normal things and okay can you give me an example of a recent situation maybe we can focus on that um like a work situation or just yeah time when you were maybe doing a job with some people and you felt the social anxiety you know that you describing you felt that kick in yeah um I was doing a job where it was kind of like a a nature shoot and I was having

to work with a lot of different people um and and when they told me about the job I thought it would be fine I thought it was just going to be a few other photographers but there actually people in you know as was taking photos of people kind of in the trees and stuff like that and I get they asked me to him that sounds quite interesting was was that a fashion shoot or something yeah yeah it was a fashion thing I think it was for some kind of I'm not sure if it was a

campaign or something but it was yeah it was really cool but I find it found it really hard to try and focus on that cuz I was so I was kind of feeling really anxious and so it wasn't what you expected no it was no so how long ago was that that was two weeks ago okay so it's quite recent so on that particular day what were the thoughts that you had in your head when you were in that situation I just felt really just really kind of hot I couldn't really breathe and just felt

like I wanted to just get out and I was kind of trying really really hard to just focus and just you know like kind of hold the camera and just not think about anything but I just felt like everyone was looking at me and like when they'd say action and they trying to get me to start and I was just felt like everyone was just thinking I was really stupid and I shouldn't have been there and I can tell you getting kind of anxious even just thinking about that day yeah okay so you're describing quite

a lot there to me so you're saying that you you kind of got hot and sweaty you said that you you held the camera yeah what was do you mean you kind of trying to hide behind it or I just trying to focus on it I was just thinking if I could just hold it really tightly it would just I don't know I'd kind of just be able to just get through it and just focus so you're holding the camera very tightly and why was that why was that helpful cuz I felt like I was

getting really like hot and flushed and I just thought at least if I can just I don't know it sounds weird but I was just trying to keep my hands still on it cuz my hands were kind of sweaty and like shaking like loads like and I could just tell everyone was looking and they could see and I just thought if I just managed to hold on to it it wouldn't be as noticeable but okay so okay so it sounds like you had a lot of thoughts going through your head um he said that you

worried that everyone was looking at you what other thoughts were there that were in your mind just I was just just stupid and it was just really just felt really like kind of like everyone was just going to be staring and just thinking that like I just felt like everyone was looking at me and just they could tell and just thinking what what she doing and they could tell what I was just really like sweaty and just oh so oh like that they could see that there was okay yeah um so I was trying to

wear black so this kind of tries to cover it up and just like a lot of layers so they can't tell but I mean my hands like they was so shaking I was really red and just just just wishing that I just wasn't there so I mean you've already described it to me a little bit but if you think about how you looked that day how how do you say how do you think you looked I think just really stupid and like I think my face was really red I could feel it flushing and I

knew that I was probably sweating and shaking like my hands were definitely really really shaking um and every it was like definitely really noticeable everyone could definitely see okay and what what did you do about how did you try and conceal that or hide that um well again I was trying to grip the camera just look down just trying not to do anything weird or cuz I mean they could probably tell I was being weird anyway but hopefully I I just tried really hard to just focus and look down not trying like not look at

anyone else and just yeah just kind of try and get on with it as best as I could but so you avoided looking at people it sounds like you wore black as well in kind of preparation anyway yeah no I I always do that even if it's really hot or I wear just loads of layers and just cuz otherwise like I'll just be really sweaty and like people would definitely be able to see so right and how did it end um well it kind of went on for like an hour or so and then um

people were going um just after every shoot people go out for drinks after just to kind of celebrate like that we've done it but I just I went home straight away just got in my car and went home I just didn't want to be around them especially after they would have seen me being weird and I just wanted to get get home straight away okay