In the last several posts on Anxiety I’ve covered a broad range of issues. I’ve written about the nature of anxiety and its purpose, the CBT model, automatic thoughts, core-beliefs, and cognitive distortions. It’s been a lot and if you’re still reading, I applaud you! Thank you for taking your time to do so.
As a wrap up to this series I thought I would present a case of a hypothetical client so you can see how all these ideas tie together in human terms. Sometimes clients ask me if their information will be shared with others or end up on this or any other website. The answer is a resounding no! I am bound by both ethics and laws to keep all my client information confidential. Anything I ever say in public or on my website in regard to a client is definitely a made up example. It may be an amalgamation of various experiences but in no way will it ever be a story of one of my clients.
Meet James. James is a 16 year-old student at Moosedrool High. Recently James has been losing a lot of sleep and his parents have brought him to therapy to try and help him with his problems. When I interviewed James, he shared with me that he’s set a goal for himself. James’s goal is to go to a good college and pursue an engineering degree. In addition, James would like to cover as much of the cost as possible by scoring academic scholarships so his parents don’t have to foot the entire bill. James is a smart and sensitive young man with good goals and a heart that’s in the right place. During the interview James admits that he’s been very stressed out lately and to help him sleep he’s started to smoke marijuana and night.
I ask James to describe what he feels like when he feels “stressed out”. He says that he has trouble concentrating on his school work, his shoulder and back muscles are really tight most of the day, and when he goes to sleep he can’t seem to “turn off” all of his thoughts and get some rest. James says “three weeks ago I failed a calculus test and it really freaked me out.” After a few more questions I ascertain that James is suffering from anxiety.
I ask James about what his thoughts were when he saw that he failed his calculus test. James responds “The first thing I thought was I’m never going to get into a good college.” After some more discussion James elaborates: “My parents have always been really good to me. It’s really going to disappoint them if I don’t get into Stanford. Maybe I’m as smart as I’ll ever be and I don’t know how to do this higher end math. I don’t know. I should have studied harder. Next time I have to study for six hours instead of four. I knew the test was going to be difficult but I could have put in another two or three hours. ”
Before I describe how James’s core-beliefs and cognitive distortions are creating his anxiety, take a moment and see if you can spot them. It’s a good exercise and sometimes understanding how others make cognitive errors can help us see our own.
Got them figured out? Great!
James’s physical symptoms indicate to be that he’s suffering from anxiety. Based on that I’m generally looking for thoughts and beliefs about the past or future. Most of what James has said indicates that his thoughts are in the future where he has no control and thus is anxious. Based on our conversation I believe that James has the core-belief “I’m going to disappoint my parents.” This is of course a very anxiety provoking core-belief because everyone wants and needs validation from their parents. Even teenagers who seem like they could care less need it! James is looking for confirmation of this belief in advance of anything happening in the here and now, so he’s naturally predisposed to feel anxiety. Of course if this were a real example I would confirm this core-belief with James, but since it’s made up we’ll assume this is the truth.
James gets his test results back and sees that he failed an important test. Since James’s first reaction is “I’m never going to get into a good college.” it seems as though James is overgeneralizing. It’s one test. James still has a very high GPA, he’s still participating in community service etc. Basically he’s still doing fine but this one negative result has become indicative of a future pattern of failure in James’s eyes.
Further discussion with James revealed how highly he prizes his parents’ admiration. He assumes that they will be horribly disappointed in him if he doesn’t go to Stanford. It appears that James is Jumping to Conclusions by reading his parents’ minds. James has actually never confirmed his fear that his parents will be disappointed in him. It’s possible they just want him to be happy and don’t care how he achieves that goal. It’s possible that they will be disappointed if he doesn’t go to a “good school” but they don’t care that school is Stanford. It’s possible that they may be disappointed if he doesn’t go to Stanford but James has not understood the distinction between being disappointed in an event and in a person. Likely, his parents will love him no matter what and not be disappointed in him at all. They may just be sad that he may not get what he wants and have no idea that what he wants is attributed to their desires!
Finally, James is beating himself up with should statements by saying he should have studied harder and committing to what he assumes he “must” do in order to pass. This is generating a lot of unnecessary anxiety and probably contributing to James’s inability to concentrate and focus on his studying. Perhaps James will study “harder”, making himself more exhausted, more anxious, and less able to perform when it comes to test time.
If James were a real client it would likely take a little bit longer to identify his thoughts and beliefs. I’d probably work for somewhere between four to eight weeks to help him with his anxiety. Obviously the marijuana use would be addressed as well as marijuana can produce an effect called “rebound anxiety” which may be contributing to James’s problem.
As you can see, the CBT model is very helpful in narrowing down the focus of therapy. It provides a helpful framework to help understand and treat all manner of psychological issues and isn’t just limited to treating anxiety.
You may be saying “Great Neil, now what?” I’ve carefully avoided anything that might be construed as giving therapy in this series because I can’t do that effectively, ethically, or legally via some articles on a website. Obviously I would be happy to be your therapist, but if you aren’t ready for therapy yet I would highly recommend some reading materials that you may find helpful. As I said before check out Dr. David D. Burns’ The Feeling Good Handbook. It’s a great guide for self-directed work. However, if you feel like the time is right to talk to therapist, please don’t hesitate to call or write me!
What Everybody Ought To Know About Anxiety:
Neil T. Hetzel, MS, LAC specializes in treating anxiety. He uses an evidence-based and research-supported technique called Cognitive Behavioral Therapy to help people identify thoughts that cause anxiety. Once anxiety producing thoughts are identified, Neil helps his clients modify or eliminate them and anxiety is reduced. Through behavioral techniques Neil helps his clients developing healthy coping skills that allow them to face life’s challenges without suffering debilitating stress and anxiety. Neil works with clients who have: Separation Anxiety, Phobias, Social Anxiety, Panic Disorder, Generalized Anxiety, Performance Anxiety, and OCD.
Neil T. Hetzel is a Licensed Associate Counselor and a Nationally Certified Counselor. Neil is also a member of the American Counseling Association. His office is located in Chandler, and is a short drive from Gilbert, Mesa, and Tempe. He is able to offer both daytime and evening hours. Contact Neil for your free, 20 minute phone consultation to ask any questions about anxiety treatment or his practice: 623-850-8103. You can also contact Neil via email at email@example.com.