Anxiety

David was a 57 year old mechanic who had been out of work for two years with anxiety and depression. He came to the surgery frequently with various physical complaints and symptoms and had been on Fluoxetine for several months with no noticeable improvement. David said he was reasonably happily married, had two grown up children and felt his own childhood had been unremarkable. He was keen to try a different approach as he was unhappy about taking medication. We decided to have a ten minute consultation every week for one month and review progress. We completed the CORE or MYMOP questionnaire for outcome audit and consent form.

In week two, David began to feel more positive. He’d learnt some self- hypnosis, and was wanting to know more about relaxation. What techniques might you use?

Visit Three: Feedback – on better days he got out of bed in the morning, rather than lying there for an hour or two; he felt better when meeting his friends or talking to them on the phone.  Setting Goals – get out of bed every morning and have a shower (he could always go back to bed afterwards).One specific goal a day – write it down. Do the mirror exercise. Keep a worry diary and set a worry time. In week four, David was doing well but started to want to know how to cope with stressful thoughts or events. What would you suggest?

We started with “become an observer” homework. David noticed that: Event: Mother late home from work Feelings: Tightness in chest Thoughts: “Maybe she’s been in an accident” “She’s dead and I’m on my own” Actions: Let go tension on the out breath. Think of alternative reasons Start to watch TV Result: All 3 things helped. In week five, David utilised some scaling question and client generated imagery ‘It’s as though I know what I need to do but there’s a brick wall in the way’. What would you do with this imagery?

In week six, he created a confidence anchor: Confidence anchor. He revisited three occasions when he had felt really good about himself – when he had learned to swim, when he had got married, and one time at work when someone he admired had congratulated him on a job well done. He linked these good positive feelings to clenching his right fist and to an internal ‘Yeah!’ In week seven, he’d had an argument with his boss and he felt quite anxious afterwards. This was linking back (affect bridge) to an earlier episode of bullying when he was much younger’. What would you suggest?

Case Two

Sandra is about forty years old, with a great fear of dental treatment that she relates to a previous traumatic incident with a “cruel and painful dentist” she went to for fillings when an adolescent. She worries about treatment and has made several attempts over the years to sort out her dental problem but always fails to attend once it comes to having fillings. A sharp edge on a molar was giving discomfort, which is why she had attended this time but was “Absolutely petrified…please don’t touch me!”     Whether you are a dentist or not, present a rationale for a treatment plan based on this and what you have learnt so far.