Anxiety, cognitive behavioral therapy
I. General information
1, demographic data
Help-seeker Zhang, an only son, is 20 years old and a freshman in a university. He was born in Zhangdian District, Zibo City, Shandong Province, and his parents work in this university. The family has good material conditions and the helper grows smoothly. His mother is reasonable, gentle and concerned about him. His father is quick-tempered and prominent, and doesn't want to talk much.
2. Growth history
The parents of the helpers are both senior intellectuals, both graduated from universities and have good family conditions. The helper speaks late after birth, but responds quickly. They are regarded as the apple of their eyes by their grandparents and parents, and they have been respected since childhood. People who seek help grow up well, and their parents provide them with the best life and education. As I grew up, when I was in kindergarten, I competed with my children and occasionally got rough with my friends. After going to primary school, I was grumpy and caused a lot of trouble. My classmates were scared and my teacher criticized me. After graduating from primary school, I went to junior high school nearby. Due to the development of adolescence, I became silent and didn't interact with my classmates very much. However, I have a strong self-esteem and attach great importance to my appearance. The pimples on my face make me very unhappy. I went to the hospital and prescribed medicine, but it didn't work and my mood became bad. When I was in junior high school, I studied hard in the first year, but after the second day of junior high school, I slacked off and didn't study hard. Until I graduated from junior high school, I couldn't adjust my status and my grades were average. Due to the abnormal performance, the grade of the third grade graduation exam is not ideal, which is not enough for the scores of key high schools. His parents went through a lot of trouble to give him a place to pay his tuition. For this reason, my father was very unhappy. There is a lack of communication between father and son, and he is under psychological pressure. In high school, most of them are closed, do not take the initiative to speak, introverted and willing to go it alone. Although I don't work hard, I feel that I have tried my best, and my grades are relatively low in the class. Due to the increase of study pressure, students will feel tired of learning in the second semester of senior two, have a bad temper, have great opinions on their parents, and react obviously in adolescence. In the end, I got poor grades in the college entrance examination, and finally, at the suggestion of my parents, I was barely admitted to three majors in my parents' university. However, he is unwilling and always feels very sorry. He wanted to drop out of school, but he was afraid that his parents wouldn't agree, and he was afraid that he was under pressure and didn't do well in the exam, so he was hesitant and painful. Although I went to college, I always ran home because I was close at hand. When you come back, lock yourself in your room, watch the computer, or go to an Internet cafe to kill time. In the past two months, I have been conscious of loss of appetite, lack of sleep, irritability, chest tightness, headache, fatigue, inability to study at ease and don't want to go to school. I have serious sleep problems and feel as if I am on the verge of mental breakdown.
3. Physical state, mental state and social function
Physical state: loss of appetite, lack of sleep, irritability, chest tightness, headache and fatigue.
Mental state: anxious, nervous, introverted, sensitive, unable to study with peace of mind, want to drop out of school.
Social function: Learning efficiency declines, and people have the idea of giving up their studies.
4, psychological test results
SCL-90 Somatization 2.4 Depression 2.2 Anxiety 3. 1 Hostility 0.6
The demarcation value of SDS 46 for depression is 53.
SAS 65 is moderate anxiety.
Second, the chief complaint and personal statement
1. Narration: During these two months, I felt loss of appetite, lack of sleep, irritability, chest tightness, headache and fatigue, and I was unable to study and stay in the university campus with peace of mind. I want to drop out of school and go home, and I am particularly sad at the thought of losing the college entrance examination. I have always felt very sorry, unwilling to make my own mistakes, regretting that I didn't study hard, but I didn't have the courage to repeat the same mistakes, so my heart was very contradictory.
Third, observation and reflection of others.
1, counselor's observation: the help-seekers are well dressed, especially the hairstyle is very personal. But he is shy, his eyes dare not look at people, and his eyes are always evasive. He didn't take the initiative to speak, and the answer to the question was extremely simple. But the language expression is logical, the thinking is normal, and I can make clear what I have encountered and my own thoughts. Basically, I can cooperate with the counselor's questions and have complete self-knowledge. I hope the counselor can help me solve my psychological confusion. It is not difficult to find in the speech that the help-seekers are introverted, self-abased, lack of self-confidence, strict with themselves, and excessively worried that their relatives and friends will have a bad opinion of their universities. Therefore, the inner tension and anxiety are relatively strong, and I feel overwhelmed with heavy psychological pressure.
2. Mother Zhang: Children depend on their mothers since childhood, and they are self-reliant and self-rational. They seldom take the initiative to do anything without urging. Not very talkative, introverted, but demanding self-esteem, strong sense of self-protection, very serious about offending children, obvious counterattack. This feature becomes more and more obvious with age, so we can't tolerate other people's negative views. When I was in primary school, I didn't get along well with my classmates, especially the opposite sex, and I was often called to education by my teacher. In junior high school, I didn't take the initiative to say hello to my teachers and classmates. After the education of my parents and teachers, I corrected this problem. Usually I like watching TV, falling in love with the Internet, and I don't study hard, but I pay special attention to my grades when I take exams. If I don't do well in the exam, I will be in a bad mood. In high school, adolescence was obviously slow and unwilling to listen to parents' opinions. Relations with relatives and friends are average. The unsatisfactory results of the college entrance examination hit him hard, and he was unwilling, which made it difficult for him to adapt to the new life on campus when he went to college. In the past two months, he has suffered from lack of sleep, headache, chest tightness, depression, anxiety, nervousness and dreaminess. Occasionally lose your temper, have obvious weariness of learning, escape from campus life, be mentally confused and suffer mentally. Sometimes I cry and don't eat. Parents understand that he has accumulated many years of psychological release, especially the potential contradictions and inner conflicts in the past three years. His parents' persuasion failed, and his emotional reaction was very strong. Parents feel that he is unbearable and are willing to find a psychological counselor to help him solve it. He finally agreed to cooperate with the negotiation.
3. Uncle's reaction: The children are generally good. Although they are not so outstanding in study and life, they have reached the upper-middle level, yes! Although the child is somewhat introverted, he never causes trouble and is not annoying. He knows how to treat his elders politely. Children are good at handicrafts and painting, especially basketball. They play basketball seriously and single-mindedly, especially like a professional basketball player. As the last boy of our junior generation, everyone regards him as a treasure and takes good care of him. Besides, his family conditions are quite good, and we have great expectations for him, hoping that he will have greater prospects. I feel that my child's self-esteem is very strong, and I will be unhappy if I criticize it wrong. Children often play at home under the leadership of her mother, especially with my child, his cousin, who is about the same age. Two children can play together, and I watched him grow up little by little. Over the years, his mother nagged him a lot, which made the children rebellious, and his father was more serious. I think these are minor problems! I didn't expect children who went to college to be so uncomfortable, irritable, anxious and painful. I feel distressed when I look at them. This is so wrong. This may have something to do with his mother's nagging and his parents' lack of communication and understanding, I think.
The classmate said: I haven't seen him at school since I went to college. When I met him, I was the first person to say hello. He treats his classmates warmly. Zhang is introverted and shy, like a shy girl, not annoying. There are not many classmates and good friends in the class, but everyone has a good impression and feeling of him. He never takes the initiative to answer questions in class, and he rarely participates in club activities in his freshman year. It seems that he is neither very happy nor very happy. It is said that he runs to Internet cafes and homes more often. Recently, he seems to have disappeared out of thin air, and he can't be seen in the classroom on campus.
Four. Evaluation and diagnosis
1, mental state evaluation
The counselor comprehensively analyzed the collected clinical data, made a comprehensive judgment and analysis, and combined with the psychological test results, made the following assessments: the client's appetite decreased, sleep was less, headache, chest tightness, depression, anxiety, dreaminess, impatience, reluctance to see more people and reluctance to communicate with others. His overall mental health is very poor, and there are many problems, some of which are still difficult, but he has feelings, thoughts and communication with people.
2. Cause analysis
(1) Biological reasons: The client is male, aged 20 years. Although adolescence is over, the personality and mentality of the parties mature late, and the reaction after adolescence is still there.
(2) Psychological reasons:
① Personality factors: the help-seekers are introverted and have strong self-esteem. Less communication with people, more fragile and sensitive psychology; Help-seekers have strong achievement motivation, high self-demand and pursuit of perfection, but the degree and method of efforts in the process of striving for it are wrong.
2 misconception: you must be admitted to a key university to gain face, otherwise you will be looked down upon by relatives and friends, and feel that there is no future and life is meaningless. I am sorry for my parents and family.
3. Misevaluation of reality: I think I could have done better in the college entrance examination, and I could have gone to a key university in a foreign city, which was caused by my bad luck in the exam. I think my relatives and friends are not satisfied with their college entrance examination results, and they all look down on themselves. Even university teachers and classmates feel that they really shouldn't study in the university where their parents work.
(3) Social reasons:
① Life events: High school students suddenly enter the university, and their hearts are relatively immature. Suddenly they face a completely unfamiliar environment, which is a blow to their psychological endurance. In particular, his dissatisfaction with the university he attended aggravated his inadaptability to the new university environment. Therefore, he feels anxious, fidgety, lack of sleep, headache, chest tightness, depression, anxiety, dreaminess, nervousness and inability to study at ease. He feels that he can't bear this psychological pressure and wants to stop going to school, otherwise his spirit will collapse.
② Social support: Help-seekers are introverted and have little communication with classmates and teachers at all stages of their studies, especially since they entered the university. My father seldom communicates with Zhang because of his personality and busy work. He also has a lot of prejudice against his father and is unwilling to take the initiative to talk to him. His mother's nagging for many years caused him a greater psychological burden, which made him choose to escape implicitly, lonely and helpless, and could not find an effective outlet for psychological irritability.
3. Diagnosis and diagnosis basis:
The anxiety and irritability caused by the difficulty of adapting to the new environment for the first time, as well as the serious psychological problems caused by many misconceptions in cognition.
Diagnostic basis:
First of all, the reason for the "serious psychological problems" of help seekers is a relatively strong realistic stimulus, which poses a threat to individuals. Freshmen are unwilling because their college entrance examination results are not satisfactory and the institutions they attend are not recognized. In addition, suddenly facing a brand-new environment, the pressure suddenly increased sharply, and the psychological state was far from being adjusted, which was obviously unbearable. Therefore, the feeling of helplessness, doubt, pain, loss, injustice, etc. for help seekers is becoming more and more serious.
Second, from the perspective of duration, the painful mood lasts for more than two months;
Third, the learning efficiency of the help-seekers is obviously reduced, and they are tired of learning and difficult to get rid of;
Fourth, if you want to drop out of school at home, there will be some generalization and avoidance, and your social function will be damaged.
Based on the above symptoms, severity, course of disease and psychological test results, the psychological counselor comprehensively evaluated and diagnosed the helper as a serious psychological problem.
3, differential diagnosis:
(1) Differentiation from psychosis: According to the three principles of disease and non-disease, the client has the unity of subjective and objective world, knowledge and insight, takes the initiative to seek medical treatment, and has no abnormal feelings, hallucinations and delusions, so the psychotic disorder can be ruled out.
(2) Differentiate from depression: Although the help-seekers have obvious symptoms such as anxiety and irritability, they have no thoughts or behaviors such as slow thinking, decreased interest, pessimism and suicide, and have complete self-knowledge and strong desire for treatment. If the severity of symptoms does not meet the standard of depression, depression can be ruled out.
(3) Differentiate from neurosis: Although the help-seekers have obvious symptoms such as depression, anxiety and irritability, the duration is short. The content is not completely summarized, which does not seriously affect social function and logical thinking. The psychological conflict of the helper has obvious moral color, which is different from the deformation of the psychological conflict of neurosis, and neurosis can be ruled out.
(4) Differentiate from general psychological problems: General psychological problems refer to recent emotional problems, the content has not been summarized, and the reaction intensity is not too strong. In this case, the customer's pain was intense and lasted for more than two months. The content has been generalized. So rule out general psychological problems.
Determination of consulting goal of verb (abbreviation of verb)
Based on the above assessment and diagnosis, the following consultation objectives are determined through consultation with the clients:
Long-term goal and ultimate goal: to help people who seek help realize themselves and grow up.
Specific goals and near-term goals: correctly evaluate the significance of the college entrance examination, don't care too much about scores, accept your own college entrance examination results anyway, reduce anxiety and distress in coping with the new environment, adjust self-cognition, establish good trust and communication relations with parents, classmates and teachers, develop a sound self, and be able to study, live and communicate normally. Gradually adapt to the new environment of the university, cope with it freely and happily start the study and life in the university era.
Formulation of consulting scheme for intransitive verbs