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

Summary

Hannah, a young photographer, discusses her escalating anxiety with a therapist. Initially manageable, her anxiety has worsened since moving out of her parents' home, leading to social isolation and impacting her work. She avoids social interactions and opportunities that involve meeting new people, fearing judgment and feeling out of place. A recent job involving a fashion shoot in nature was particularly challenging, leaving her feeling exposed and judged, prompting an early departure to escape the social pressure.

Takeaways

• 😌 Hannah has been experiencing anxiety for about five to six years, which has recently escalated after moving out of her parents' home.
• 🏡 The transition to living independently has been more challenging than Hannah anticipated, leading to increased feelings of anxiety.
• 🤔 Hannah has not shared her anxiety struggles with many people, feeling a sense of shame or reluctance about seeking help.
• 📸 As a photographer, Hannah's anxiety is affecting her work, particularly in social settings where she has to interact with others.
• 👥 Hannah's anxiety is also impacting her social life, making it difficult for her to make new friends or maintain existing relationships.
• 👨‍👩‍👧‍👦 When Hannah was living with her parents, she felt more supported and had an easier time navigating social situations.
• 😓 During a recent work event, Hannah felt extremely anxious, experiencing physical symptoms like sweating and shaking, and felt judged by others.
• 📷 Hannah prefers working alone with her camera to avoid social interactions that trigger her anxiety.
• 🎭 Hannah tries to hide her anxiety symptoms by wearing dark clothes and multiple layers to conceal sweating.
• 🏠 After the work event, Hannah chose to leave immediately rather than socialize with others, highlighting her avoidance of social situations due to anxiety.

Q & A

What prompted Hannah to seek help for her anxiety?

Hannah sought help after moving out of her parents' home for the first time, which worsened her anxiety and led her to consult her GP.

How does Hannah describe her experience living alone?

Hannah finds living alone difficult and isolating. She stays inside her flat a lot, doesn't have friends nearby, and feels scared and lonely, even though she initially thought she would enjoy independence.

What impact has anxiety had on Hannah’s career as a photographer?

Hannah’s anxiety has significantly affected her work as a photographer. She turns down opportunities involving social interaction, which has limited her ability to take on jobs and build her career.

How does Hannah feel in social situations or when working with others?

Hannah feels extremely anxious in social situations or when working with others, experiencing physical symptoms like sweating, shaking, and feeling like everyone is watching and judging her.

What coping mechanisms does Hannah use when she's feeling anxious at work?

When feeling anxious, Hannah tries to focus solely on her camera, gripping it tightly to distract herself and avoid making eye contact with others. She also wears black and layers to hide her physical symptoms like sweating.

How does Hannah describe her physical symptoms during anxious episodes?

Hannah describes getting hot, sweaty, flushed, and shaky during anxious episodes. She feels like these symptoms are noticeable to everyone around her, which worsens her anxiety.

What social consequences does Hannah fear as a result of her anxiety?

Hannah fears that her anxiety is causing her to lose friends and relationships, as she avoids social interactions and feels increasingly isolated.

How has Hannah’s anxiety evolved over the years?

Hannah has always been shy, but her anxiety worsened after she finished school and her friends went to university. She began withdrawing from social activities and turning down invitations, and her anxiety has escalated in recent years.

What was Hannah’s experience during the recent nature/fashion shoot?

During the nature shoot, which turned out to be a fashion shoot with many people involved, Hannah felt highly anxious, sweating, shaking, and struggling to focus. She felt that everyone was judging her, and afterward, she left immediately to avoid socializing.

What are Hannah’s thoughts about how others perceive her during anxious moments?

Hannah believes that others see her as weird, stupid, and incapable during anxious moments. She feels like people are staring at her and judging her for her visible anxiety symptoms.