The Covid pandemic has shown people how debilitating anxiety can be, and helped organisations realise they need to assist their employees, at whatever level in the organisation, with mental health issues.
In May 2020 my patient held a demanding role in large global company facing acute demands on its business services due to the Covid pandemic and lockdown restrictions in the UK.
Prior to March 2020 he was managing a large team with pressures on the delivery of contracts and services. He had been brought in to stabilize the team and noticed that over previous months he was not sleeping well and working long hours. The March lockdown then started, and he was working from home, along with the rest of the organisation. He was still working long hours in his home office (at least he had one!) and struggling to keep various balls in the air.
The tipping point came when at a large meeting to discuss the company’s failure to land a big contract, he felt under pressure and unable to respond to general questions. Luckily his boss noticed and quickly ended the meeting and after a brief chat he was sent home with instructions to contact the company’s employee support line for a confidential chat.
The result of that chat was that he took a four week break from work and got a referral to me via a medical insurer.
At our first Skype session he talked about his agitation and being tense, unable to concentrate and feeling emotional. After a short explanation about stress, anxiety and depression he began to see how bad things were, and also that he had nothing pleasurable in this life.
The starting point for the treatment was psycho education about anxiety and depression and the physical effects it has on people. He was surprised to discover that thousands of other people probably felt the same as him at this moment due to the pressures of the pandemic on their lives.
He was asked to keep a daily record of good things that happened, take regular exercise and keep himself disengaged from his work. After three sessions the scores for his anxiety and depression had reduced from the severe zone to mild, and he was doing proscribed self-help work between sessions.
His boss was sympathetic and supported reducing his hours of work for a temporary period when he did return to work in June on a part time basis. He was given a new role, which was clearly a reward for the difficult work he had been doing prior to the lockdown, and he felt played more to his strengths. He found keeping clear boundaries between hours of work and home very therapeutic and felt more relaxed and in control of himself and his thinking.
In July he increased his hours at work, and the organisation were encouraging those that wished to, to return to the office on a part time basis. He decided to return one a day a week and found it helpful to meet colleagues face to face. He also enjoyed the easier drive to work. He had been developing new slogans to use when before he would be anxious and began to realise how much this was second nature. He also reported that he had not felt seriously anxious since his return to work, and if he noticed the physical effects he could manage them easily.
The final appointment in October showed that he was still continuing with daily exercise, keeping a daily record of good things, managing his occasional anxious thoughts, and keeping to sensible working hours. He was going into work two days a week as he found it helpful to have direct contact with people and be out of the house.
He felt that part of him had been "missing" well before the Covid crisis, but the lockdown had exacerbated his anxieties out of control. Until then he had not realised how worry and anxiety had affected him and how it could be dealt with using CBT.
One of useful tips was reading "Feel the Fear and do it anyway" by Susan Jeffers and using some of her slogans on his home office wall so he could see them as he worked.
In most cases of anxiety and depression during these stressful times, Covid has not caused it, but made it harder to manage without help. His organisation has trained staff to acknowledge mental health issues alongside physical issues equally and this played a part in him seeking help and then returning with batteries recharged to his demanding role.
Stress-related anxiety in the work place is one of the biggest contributing factors for people signing-off sick or looking for alternative employment. When I first met my patient, he was suffering from very high levels of stress and anxiety, triggered by a fear of giving highly-scrutinised presentations at work.
His anxiety was affecting his ability to concentrate and he often experienced palpitations, sweating and stomach pains on the day (and days) prior to the presentation.
Although he was able to deliver the presentation, he felt his productivity and happiness at work was being affected and his anxiety was also impacting on his personal life.
His natural reaction was to resign, however the nature of his work meant that presentations would continue to be a significant part of his work, so he really needed a way to control his anxiety and move forward.
The first step in his treatment plan was to understand and recognise the symptoms of anxiety and to learn effective ways to self-manage his own symptoms.
CBT encouraged him to reflect on how he felt about delivering presentations and to document any thoughts, emotions and behaviours he experienced. The process helped to rewire his thinking and develop more a productive and positive mindset towards presentation day.
As a keen cyclist, increasing the amount of exercise he was doing on a weekly basis was advised, and he gradually started to create a new routine at work, with a fresh perspective towards the people he worked with.
Becoming more aware of his symptoms and implementing self-help measures at home, in- between sessions, helped my patient stay on track.
After 8 CBT sessions my patient reported significantly lower feelings of anxiety in build up to, and on presentation day. And, although he still experiences a level of anxiousness, he now understands this is normal for the situation and he is able to better control his thoughts and prevent any escalation in his anxiety levels.
His annual appraisal was very positive and is now considering promotion rather than resigning. He continues to practice CBT and mindfulness techniques and has kept up with the cycling.
One of my youngest patients was referred to me by her distraught mother after desperately trying to manage her daughter’s depression, refusal to go to school and suicidal thoughts.
She had been referred to the local CAMHS service and placed on a 4-month waiting list, however it was clear that she required immediate intervention to prevent her mental health condition from deteriorating further.
At the first appointment she was very miserable and withdrawn but after taking the time to get to know her and share interests, she relaxed. By the end of the session we had talked about a very difficult few months when she felt lonely and judged by others on social media.
She had good family support, and was encouraged to do things she enjoyed like baking, taking the dog for a walk and spending time with her family, instead of being alone in her bedroom.
She was also given information about social anxiety and depression, and advised to keep a daily diary of her mood. She was also encouraged to take some fresh air and exercise (not an easy ask of a teenager).
This was the easy bit. She found doing these things helped her feel more positive, and then she worked with me on changing her perception about how she thought and valued other people’s opinions. This involved reducing her use of social media and trying to be more face to face with her friends, and then not critically judging herself.
She returned to school, found things easier with some coping strategies developed in session with Joy and made the decision to continue with her University applications which she had put on hold over the summer. The negative thoughts were much reduced and her confidence began to rise. Her family felt they had their daughter back.
Delighted to say she has since been accepted at the two universities she wants to study at. She is better equipped to manage the stress of her mock exams and is now having bi-monthly sessions to maintain her progress until she has sat her A levels. Friendships are a source of support, rather than sorrow now and the future looks very different from 7 months ago.
My patient was referred to me after a break-down at work. She had been signed-off from work by her GP and was suffering with symptoms of social anxiety and depression.
Despite doing well in her job for over 10 years, she described feeling overcome with tiredness and very little willingness to do much, except the school run and basic errands.
She had been feeling low for a while prior to her break-down and was worried that she would never be able to return to work.
As part of her treatment, I recommended she went for regular walks after the school run, ideally with a friend, and encouraged her to keep a journal of all her positive feelings and experiences.
With time, she felt more confident talking to friends and family about her feelings and gradually increased her daily exercise, until she began enjoying her life and spending time her family again.
Once her depression started to subside, she could reflect on her social anxiety and low self-esteem, and realised she had been suffering with the symptoms for a long time.
The focus of her CBT treatment was to gradually build up her confidence and self-esteem. She followed a tailored programme designed to challenge her social anxiety and she started to plan her return to work with her employer.
She returned to work on reduced hours and her manager changed her attitude towards mental health, restoring trust in my patient.
Developing assertiveness was a key part of her recovery, enabling her to manage the demands of work and feel confident saying ‘no’ whenever she felt overwhelmed with the volume of work. After her initial 15 BCT sessions, BUPA agreed an extension of treatment, enabling her to maintain her progress. She continued to exercise regularly, and developed new social contacts and interests.
GJ is now back at work on her original hours. Despite some organisation hiccups she has coped well, and says “saying no” (politely) when necessary is part of her new persona. She maintains her daily journal, and regularly reviews the material and notes from Joy to keep her focus on the present and the future. She has become the mental health ambassador at her organisation and promotes mental health issues to the managers and employees.
My patient’s anxiety about contamination and cleanliness was affecting both her home and work life. So much so, that when we first met, she had been signed-off from work.
Keen to return to work and gain control over her OCD, we started to examine her intrusive thoughts and over the course of her 10 sessions, she was able to identify the triggers for her anxiety.
CBT helped her understand how her anxiety had developed into OCD. Her road to recovery started when she began to test out her ‘false’ predictions that “something awful would happen” if she did not clean and do her rituals and discovered that despite her misgivings nothing happened.
She created a pyramid of her anxieties and began to challenge the lowest ones first and gradually working up to the hardest. She used CBT to help challenge her thinking and her behaviour, and found that over time her anxious feelings diminished.
She returned to work and received the support she needed from her employers with a ‘return to work’ programme and did not resume her cleaning rituals in the workplace.
Within 6 months she has been promoted to a more senior role.
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