38-year old client with sudden panic attacks and fears of medical illnesses – ranging from heart arrhythmias to autoimmune diseases, – despite doctors denying any medical condition.

It begins with a racing heart, pounding so hard client can feel it in the throat, shortness of breathe, becomes short and quick, as if he can’t get enough air, a wave of dizziness, cold sweat breaks out across his forehead, and tingling sensations in the finger and toes.

Thoughts include, “Am I having a heart attack? Am I going to pass out? What if I can’t breathe?” These fears loop endlessly in her mind, each one feeding into the next.

Triggers included a “heart palpitation”, chest pain, and abdominal pain out of the normal. 

Monitoring of treatment
Panic Disorder Severity Scale

29-year old client struggling with obsessions related to death, telling the truth, contamination and superstitious thinking.

Compulsions included using gloves, doing things three times, opening door with foot or elbow, typing in a certain way to avoid contaminating laptop.

Mental compulsions included mentally figuring it out – did it touch part of my body/face that is contaminated ?, ruminating about death.

Monitoring of treatment
Yale-Brown Obsessive Compulsive Scale

14-year old client struggling with social anxiety.

Client reported experiencing fear and avoiding the following situations: telephoning in public, eating in public, giving a talk in front of an office, writing while being observed, calling someone they don’t know, talking with people they don’t know, meeting strangers, using a public bathroom, entering a room where others are seated, expressing disagreement, eye contact, returning goods to a store, and throwing a party.

Monitoring of treatment
Liebowitz Social Anxiety Scale

41-year old client suffering from chronic worry

Client’s mind raced with an endless stream of “what-if” scenarios as she lay awake at night, her heart pounding. Financial worries consumed her thoughts: “What if I lose my job? What if I can’t pay my rent next month? What if I never save enough for retirement?”

Client’s relationship with partner was another source of constant anxiety. “What if he’s losing interest in me? What if we argue and can’t resolve it? What if he meets someone else?”

Health concerns were also present. Every twinge or ache sent her spiraling: “What if this headache is actually a brain tumor? What if that mole is cancerous? What if I have an undiagnosed heart condition?” Client found herself constantly checking her body for signs of illness.

At work, client struggled with worry thoughts such as “What if I make a mistake on this important project? What if my presentation goes terribly? What if my boss is secretly dissatisfied with my work?”

Measurement
Penn Scale Worry Questionnaire

37-year old client suffering with social anxiety.

Client endorsed the following fears: telephoning in public, eating in public, working while being observed, writing while being observed, talking with people I don’t know very well, meeting strangers, urinating in a public bathroom, talking to people in authority, entering a room where others are already seated, speaking up in a meeting, taking a test, and expressing disagreement.

Monitoring of treatment
Liebowitz Social Anxiety Scale

51-year-old client suffering from Post-Traumatic Stress Disorder.

Client often finds himself reliving the traumatic event through vivid, unwanted memories that intrude on his thoughts during the day.

His body seemed to be in a constant state of high alert; he startled easily at unexpected noises and felt tense and on edge most of the time. He had difficulty concentrating on tasks at work and home, and his mind often felt foggy.

To cope with these overwhelming feelings, client stopped going to places or engaging in activities he once enjoyed because they triggered painful memories. Client has also withdrawn from friends and family, finding it difficult to connect emotionally or talk about his experiences. Client often felt numb and disconnected from his surroundings, as if he was watching his life from a distance.

Client felt stuck and unsure how to move forward.

Monitoring of treatment
Post-Traumatic Stress Disorder Checklist 5