Case Study : Cognitive Behavioral Therapy PDF

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It is a case study on Cognitive Behavioral Therapy for Anxiety Disorder. CBT is a technique that is use to replace destructive and irrational thoughts with more rational and reasonable thoughts....

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Case Study: CBT Treatment for Sam Sam is a 20 year old student at University of Manitoba. He often feels very anxious and worried before exams, which leads him to feel lots of pressure and intrusive thoughts about failing. He also mentions that he had some difficulties in personal romantic relationships, which often interferes with his studies. There are times when he feels a wave of sadness and finds it extremely hard to start working. Anxiety and worry are responses that are future oriented with no immediate danger present. Anxiety causes some cardiovascular reactions, whereas worry is a cognitive based reaction which occurs in prefrontal cortical areas of a brain (David Lorne Sexton, 2020, Unit 3). Sam seems to feel restlessness before exams, which is indicated by his feeling of lots of pressure before exams. Moreover, difficulties in personal romantic relationship would be the cause of muscle tension, which further interferes with his studies. Also, feeling of fatigue is indicated with a wave of sadness that leads to lack of energy to start working. According to the above analysis, Sam meets the DSM-5 diagnostic criteria for generalized anxiety disorder. Sam has shown three symptoms for generalized anxiety disorder such as Restlessness, Muscle Tension and Fatigue, which are causing clinically significant distress or impairment in social, occupational and other areas of functioning (David Dozois, 2019, p.109, Table 5.1). The appropriate treatment that is being used for Sam is cognitive behavior therapy (CBT). Cognitive Behavioral therapy (CBT) is based on the theory of cognitive depression, which states that a person’s emotional reaction towards a situation partly depends on what a person thinks about that particular situation. CBT’s primary goal is to teach a person how to become aware of the thoughts about a particular situation and examine these thoughts in order

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to see how these cognitions lead to the emotional reactions by the use of Socratic type questioning and guided discovery (David Dozois, 2019, p.187). In a simple language, Sam is disturbed by his way of interpreting a situation and giving it a meaning that causes him distress such as by thinking about the negative outcome of an exam, which he has not even given yet, causes him to feel anxious and worried and further amplifies the emotional reaction. He has attributed a negative meaning with exams. In order to make him less anxious and worried, an alternative rational thoughts or adaptive perspective could be used (Ethan Gorenstein & Ronald Comer (2015), p.7). Therapist devises a CBT treatment plan with 3 components in it. First would be about changing intrusive thoughts that appear before exams, in sadness and about personal romantic relationships. Second, use of repeated exposure to thinking about consequences of getting an F in the exam and last but not the least, use of mindfulness based cognitive therapy for relaxation. In the first session, Sam is informed about how the effects of his thoughts that generate a negative emotional reaction lead him to worry and anxiety. He is informed about the treatment and is asked to keep a record of his negative thoughts that makes him feel worry and anxiety by using a thought recording intervention. Thought recording intervention is used to help Sam indentify and analyze the negative thoughts. In this, Sam is first encouraged to focus on the situations that generate anxiety and worry and then record all the thoughts that come into his mind (David Dozois, 2019, p.189). In the Second Session, therapist goes over the thoughts recorded by Sam and works collaboratively with Sam to evaluate the accuracy of these thoughts by generating supportive and non supportive evidence. After that, Sam is encouraged to come up with a balanced thought that

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reflects the reality of the situation (David Dozois, 2019, p.189). For example: One of the thoughts mentioned by Sam is of failing the exam before attempting it. The supportive evidence of this thought would be Sam actually getting an F in the exam. The non-supportive evidence would be getting any grade in the exam, which is not F. The balanced thought would be, I did study for the exam, so I am not going to fail. I will at least get a passing marks or I am going to pass the exam with good marks. The whole point of thought recording intervention is to make Sam aware about his capacity to choose a different view for a particular situation (David Dozois, 2019, p.189). In the Third session, Sam informs his Therapist that he is getting better at recording the automatic thoughts and replacing them with balanced thoughts, therapist advises Sam to continue with the thought recording intervention except now he does not need to record the thoughts (David Dozois, 2019, p.189). Therapist now informs Sam about the exposure therapy, in which an initial exposure causes anxiety but with repeated exposure, anxiety subsides (Ethan Gorenstein & Ronald Comer (2015), p.7). Sam is asked to close his eyes and imagine about getting an F in a course and its consequences. Initially, Sam feels his heart rate increasing and lots of pressure, his muscles get tensed and he gets very anxious. After doing the same exercise few more times for next 30 minutes, Sam reports that he is not feeling as anxious and worried as he was feeling initially and because of his practice of thought recording, he is able to identify the automatic thoughts, which do not have any grounds in reality. Therapist advises Sam to continue the thought recording by replacing the automatic thoughts with balanced thoughts for the next week. In the fourth session, Sam informs his therapist that he is not getting anxious and worried anymore about getting an F in a course and even intrusive of thoughts of failing in an exam has

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subsided and does not bother him even if they do come sometimes into his mind. He also reports to his therapist that his personal romantic relationship has improved as well because he no longer feels the need to get bothered by the thoughts that may have been causing difficulties in his romantic relationship, and further more having a sense of wellbeing in his relationship has reduced its interference in his studies. He also points out that he does feel a wave of sadness sometimes, which makes it really hard to start with his work. To which therapist now introduces Sam to an innovative adaptation of CBT, which is Mindfulness Based Cognitive Therapy (MBCT). MBCT is based on a Buddhist principle of meditation, in which a person brings his awareness to here and now in a non judgmental way and forms a detached perspective towards the intrusive thoughts and emotions (David Dozois, 2019, p.189). For example, whenever a wave of sadness takes over Sam, he would just observe that sadness and think or say to himself, “ok, I am feeling sadness, it is just a emotion and it will pass” rather than indulge himself into thinking that I am sad and I do not have any energy to work and so forth. Therapist asks Sam to continue all the three components of treatment for the next few weeks. From Session 5 to Session 7, Sam has reported continued progress in reduction of anxiety and worry. He gets less intrusive thoughts day by day and whenever he gets any negative thoughts that interfere with his studies, he does not become bothered. He seems to be getting better at MBCT and has reported that the sense of sadness does not occur as frequently as it was occurring before. By session 7, Sam is carrying out all the three components of his treatment and has become skilled at doing mindfulness meditation, which has improved his overall wellbeing and has reduced ruminative thinking (David Dozois, 2019, p.189). For the next two weeks Sam is advised to carry out his treatment in the same manner.

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In the 8th Session, Sam has reported that he does not feel any anxiety or worry before the exams and the thoughts of failing in an exam does not seem a big deal and do not bother him or create a negative emotional response. His personal romantic relationship has become really well and does not interfere with his studies anymore. The wave of sadness that was frequent in the beginning of the treatment has now come to a bare minimum, and if it does come, it does not elicit a physiological reaction that would cause fatigue. The wave of sadness only lasts for less than a minute even if it comes sometimes and has been decreasing considerably with the help of Mindfulness meditation. Therapist advises Sam to continue his mindfulness meditation. In the last session, Sam enters the room with a cheerful and pleasant smile and reports to the therapist that he has been free of wave of sadness from almost 3 weeks and does not feel any anxiety or worry before exams. His overall quality of life has improved and has had a great impact on his personal romantic relationships. Not only does he not gets any intrusive thought but has become more confident in writing the exam.

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References Ethan Gorenstein & Ronald Comer (2015).Case Studies in Abnormal Psychology 2nd Edition. (Customized). MacMillan. Case 1, Panic Disorder, p. 7 David Dozois (2019). Abnormal Psychology: Perspectives (6th Edition). Pearson, Canada. Mood Disorders and Suicide, Thought Recording, p. 189. David Dozois (2019). Abnormal Psychology: Perspectives (6th Edition). Pearson, Canada. Mood Disorders and Suicide, Behavioral Experiments, p. 189. David Lorne Sexton (2020), Abnormal Psychology. Anxiety Disorders, Unit 3.

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