A Simple Example of a CBT Case Study

Carol is a fictional character used to explain the ways in which I may work, she presented with anxiety and feelings of depression and hopelessness, I helped her challenge her thinking and fear.

Case Study

Facts of her situation

Carol has to give a presentation at work. She knows her subject thoroughly. The company director will be watching.

Her Feelings:

Fear, anxiety, lack of motivation, nervous, afraid of negative feedback and humiliated, self doubt.

Her Thinking:

“I’ll get tongue-tied and forget things . . . the boss and others will think I’m an idiot . . . then I will feel like dying . . ...others can do better . . .”

Her Beliefs:

I cannot do it, others will judge, others can do better.

Her Behaviour:

Experience of being Tongue tied, heart racing, sweating. Currently avoid-ent, lacks self confidence.

Consequences discussed:

Because of fear you may not present your work as required, you may phone in sick, and others will not see how well you know your subject. So you may be seen as an avoid-er.

My Response

Hi Carol,

I can hear your emotional distress and the presentation seems impossible for you at the moment. Let’s see if we can break things down and work on a little at a time, to hopefully make things feel more positive and manageable for you.

We are going to do this by using the ABC model of CBT.

This is based on the premise that an Activating event (A)

  • In your case it is your presentation at work.

Leads to emotional and behaviour Consequences (C)

  • Which you could avoid the presentation/ phone in sick and others will not see how well you know your stuff. This is discounting the positive.

The consequences are seen as arising from your individual belief (B)

  • You described self-doubt. It makes you feel nervous and afraid, you think you might feel humiliated in front of others and they might think you are an idiot.

From past experience you have shared some unpleasant physical symptoms: your heart racing, feeling tongue-tied, sweating.

  • These inferences could be seen as jumping to conclusions, every situation is different, and you are also describing emotional reasoning. If you do your presentation then symptoms will happen because it did last time.

You have evaluated that you cannot do it, others will judge you and others can do better. You are magnifying the negatives, discounting the positives.

Fact You have explained that you know your subject thoroughly and the management seem to have faith in you as they have asked you to do this. Let’s focus on this and aim to achieve your presentation.

To make this more manageable we’ll break things down into small tasks. We can work on these in our sessions and as homework.

  1. Practice your presentation in front of others trust the feedback, work on this and practice as necessary.
  2. While you concentrate on your knowledge, projection, confidence, delivery, body language and professionalism, record as necessary and we can discuss.
  3. Tap into the emotions and physical sensations you are feeling, we could look at grading them compared to your last time you spoke publicly, and each time you practice.
  4. We can practice relaxation strategies and positive thinking to help with physical symptoms and nervousness. You can continue to practice alone when in times of need.
  5. We will look at your common cognitive errors, look for evidence of them and disregard those that do not fit.
  6. We can check into your self-esteem and confidence levels and record results as we go along. Assessing progress and exploring and working on sticking points.
  7. I would like you to list all of the facts why you can complete your presentation, and we will explore results.

I will support you through this Carol. I have faith in this process and in you and evidence says you can do it. We can make a plan for the sessions / homework for the time we have before your presentation.

CBT Techniques and behavioural techniques used:  The ABC Model

  • Identifying faulty thoughts and feelings
  • Identifying faulty thinking and looking at how it affects feelings and behaviour
  • Challenging facts and focusing on positive
  • Setting homework and goal and revisiting to look at progress
  • Relaxation techniques
  • Looking for evidence and Correcting distorted thinking
  • Focusing on clients thoughts and feelings and underlying and irrational beliefs
  • Looking at self-defeating beliefs and unrealistic beliefs
  • Distinguishing between inferences and evaluations
  • Teaching the client understanding and CBT method of change
  • Triadic structure of CBT
  • To help the client overcome blocks to change and independence
  • To encourage positive thinking and change
  • Looking at Schemata- underlying beliefs
  • Applying distancing and decentring
  • Using graded task performance
  • Explaining and setting tasks/homework if client agrees and checking understanding
  • Explain and Test client commitment to tasks
  • Demonstrating how Carol might benefit from the sessions
  • Reality testing
  • Work on changing unhelpful work patterns
  • Highlighting gaps between fears, experience and reality
  • Review blocks and failure
  • Empowering client to successfully take control
  • Encouraging self- monitoring

So to summarise, we work in manageable chunks. We identify the negatives and work on the fears you feel, finding strategies for you to cope and be calmer. We focus on you feeling confident and well equipped to deliver your presentation as we know you can.

About the Author:

I have many years of experience counselling individuals, young people and couples, supporting them through their struggles. I hope this article is of some help to you.

Yours sincerely

Stephanie

BACP Accredited Counsellor Manchester