Therapy Dialogues #1
Sarah has an important upcoming project
Fictional dialogues based on real interactions. These didactic conversations aim to illustrate how CBT helps exercise more functional thoughts to achieve emotional balance and more efficient coping mechanisms.
Client: Sarah, a 32-year-old marketing manager, experiences recurring moments of unease and worry, recently feeling anxious related to work. We find out that she has been catastrophizing1 and focusing on the minimization of her coping abilities.
Therapist: Sarah, I see you've been feeling anxious today. Can you tell me more about what's been going on?
Sarah: Yeah, it's just this constant feeling of anxiety, you know? I have this important upcoming project that has been occupying my mind, and I feel like something's lurking in the shadows, but I can't put my finger on what it is.
Therapist: I understand. Anxiety can often be elusive, sneaking up on us without a clear cause. Have you noticed any physical sensations when this feeling arises?
Sarah: I feel my heart racing, sweaty palms, and sometimes a knot in my stomach. It's like my body is on alert, but I don't know exactly why.
Therapist: Those physical signs are common when our body prepares for a threat, even if it's not immediately apparent. Let's explore together. Tell me more about this project, is it the cause of your anxiety?
Sarah: Well, I've been feeling the pressure about it. It's like there's something lurking when I think about it. Like danger is approaching, and I have to protect myself.
Therapist: It sounds like the work project is indeed a factor, triggering your body's natural response to stress. Sometimes, anxiety can stem from a perceived threat, even if it's not entirely clear. Our minds are wired to protect us. They react to potential danger, whether it's real or just a worry in our thoughts. What about this project could be making you feel uneasy?
Sarah: That makes sense. I guess I've been overthinking things, trying to figure out what's wrong. I have been thinking a lot about the project and everything that is related to it. Remember I told you that we had those layoffs six months ago?
Therapist: I do. That was an important event at the time; you feared you would be fired too. In this scenario, it's natural to seek answers when we feel this way. Let's explore your thoughts about this project. What's been going through your mind when you think about it?
Sarah: Well, I worry about meeting the deadlines, making sure everything runs smoothly. And of course, during the layoffs, some people I knew got fired. So, what if I mess up? What if the client complains or rejects the project? Will I be the next one on the line of unenployment?
Therapist: Those thoughts about potential outcomes, the fear of making mistakes, that's a common thread. Being fired can be a very bad experience for a worker, you depend on your salary to provide for your family. Anxiety often arises from these thoughts and perceptions. Have you noticed any behaviors or changes in your routines as a response to these worries?
Sarah: I've been working longer hours, trying to anticipate every possible hiccup, even losing sleep over it. I want the client's approval without much criticism. In fact, I hope for positive feedback that could impress the director board. I want it to be perfect.
Therapist: It's understandable how that added pressure and altered routine can contribute to this anxious feeling. The body goes throught physiological changes. Let's continue exploring these thoughts and behaviors. Take a moment to reflect on your feelings and reactions in these situations.
Sarah: You know, talking about it like this, I think I've been putting way too much pressure on myself. This is an important project and after the layoffs, I have been worrying about my performance more than usual.
Therapist: Recognizing these patterns is a crucial step. When we investigate our thoughts and behaviors, we often gain insight into what's driving our emotions. Anxiety can be our mind's way of signaling that we need to pay attention to something important.
Sarah: Yeah, I see it now. I need to manage my thoughts and not let them spiral into overwhelming worry. I've been catastrophizing about everything that could go wrong and I think I have been cultivating irrealistic expectations about it. I can’t control upper manegement decisions, but I can do my job with competence and hope for the best. My body has been signaling to me that I should do more to avoid being punished for my performance, but there isn’t anything more I can do, except to keep doing what I do. I have alway gotten recognition for that, there is nothing special or mystirious that I should be looking for, just the regular routine.
Therapist: Exactly, Sarah. It's about understanding that anxiety is a signal, a natural response, but it's also something we can work on managing. Being aware of our thoughts, emotions, and behaviors empowers us to navigate these feelings more effectively. Our brain has this amazing defense mechanism called anxiety. It's like an alarm system that goes off when it perceives a threat, whether it's a real danger or something we imagine might happen. Our body gears up for action, preparing to face or escape the perceived threat. That's why you've been experiencing those physical sensations, like your racing heart or feeling on edge.
Your thoughts about the upcoming project, recent layoffs, and the fear of potential job loss have triggered this alarm system response. And when we do it, our mind tries to find a safe solution, to prevent the bad scenarios to come true. And many times the solutions are not necessary because we are not really in danger, like you are not now. You have told me about your previous performances at work and they have been really good. That past performance led to your promotion to manager.
Sarah: I can work with that! Making those vague feelings into something concrete really helps to not let the mind wander to weird places. I will focus on bringing my physical reactions to a more rational response to make my reations more focused on the real threat - in other words, my thoughts about my performance, that are disfunctional. I have been minimizing my skills. I am competent enough to go throught this challenge at work I have many evidence of that, from my previous performance.
Therapist: Perfect!
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Catastrophizing is a cognitive distortion where someone perceives a situation as far worse or more dire than it actually is. In the context of Cognitive Behavioral Therapy (CBT), catastrophizing is a thinking pattern that involves jumping to the worst possible conclusions and assuming the worst-case scenario will happen.
This distortion often involves two aspects:
Magnification: Blowing things out of proportion, seeing a problem as much bigger or more significant than it really is.
Minimization: Minimizing one's ability to cope or handle the situation, underestimating personal resources or strengths to deal with the perceived catastrophe.