CBT for Health Anxiety: Jack's Third Session

Jane Morgan

Jack is a 29-year-old graphic designer who has been attending CBT for three weeks for health anxiety. He has a longstanding pattern of becoming highly anxious when he notices physical sensations in his body and interpreting these as signs of serious illness. The following exchange takes place in his third session. When listening to the conversation, think about CBT principles, how the practitioner (Alys) responds to Jack, and the situation at hand.

Alys Davies

Good morning Jack, I hope you’re ok. How has your week been?

Jack Scott

Mostly good. I had a wobble on Sunday but I settled down by Monday morning.

Alys Davies

You mentioned Sunday was difficult. Can you take me back and describe what happened?

Jack Scott

I’d been for a run around 5 pm, which was fine. And then when I got back and sat down, I noticed this tightness in my chest. And I just couldn’t let it go.

Alys Davies

And when you noticed that tightness, what went through your mind?

Jack Scott

Something like. What if something’s actually wrong with my heart?

Alys Davies

That thought, when it arrived, what happened next in your body, and in terms of what you did and how you felt?

Jack Scott

I started feeling more aware of my chest. Monitoring it. And then the tightness felt worse. And then I looked it up online.

Alys Davies

What happened when you searched it?

Jack Scott

I felt a bit better for about five minutes. And then I found something about heart conditions, and then I was worse than before. I kept searching on and off for most of the evening.

Alys Davies

Did searching give you a moment of relief, or mainly give you anxiety?

Jack Scott

Yes, a little relief. But the longer I’d wait between searching it again, the more anxious I felt.

Alys Davies

You’ve noticed a really important thing there. Let's talk through the whole situation and see if we can unpick why you continued to search and feel anxious. You finish a run, notice chest tightness, and think about your heart, since you can feel it quicken after your run. Then, you search your symptoms. Would you agree with that?

Jack Scott

Yes. I thought looking it up could help.

Alys Davies

And in the moment, it did, briefly. But after you run, your pulse is already higher than normal, and the thoughts, coupled with looking up your symptoms online, sent a signal to your brain, which responded as if the threat was real. This makes your chest feel tighter, and your heart rate rise. So your brain is thinking, he’s looking this up, this threat must be real. It confirmed the danger rather than settling it.

Jack Scott

So looking it up online made it worse?

Alys Davies

In the long run, yes. It's not your fault, it’s the most natural thing in the world when you’re frightened. But we’ve identified the cycle, so now we can begin to work with it....

Jane Morgan

Now that you’ve listened to the scenario, please complete one of the following tasks. The tasks and transcript for this scenario will be posted in the Academic Forum alongside the link to this podcast, so please take a look and provide quotations in your response if needed. Question 1, What core philosophical principles of CBT are visible in this exchange? Please identify them and give a brief explanation. Question 2, The practitioner clarifies the situation before offering explanations, advice, or reassurance. What is this approach called, what are its theoretical roots, and why is it considered a therapeutic mechanism in its own right, not simply a style of communication? Question 3, Please write a brief patient plan for Jack using the scenario to base your ideas. Also, please explain what mechanisms and physiological principles you have used in the creation of your plan. Question 4, Using Jack’s account as your data, map what he describes onto the components of the CBT cognitive model. What does this exercise reveal about the model’s clinical utility, and what is notable about the physical symptom loop visible in this particular presentation?