Counseling Consultation

Current Presentation

• Persistent generalized anxiety and occupational burnout following a recent corporate restructuring.
• Moderate severity (GAD-7: 12); manifests as initial insomnia (2–3 hours sleep latency), daytime fatigue, and reduced concentration at work, though basic ADLs remain intact.

Session Content

• Reviewed recent workplace stressors, specifically managing an increased workload after team downsizing. Discussed current adherence to sertraline (Zoloft®) 50 mg PO OD and reviewed sleep hygiene protocols.
• Expressed feelings of guilt when logging off on time and fear of redundancy. Reported persistent cognitive distortions, primarily catastrophizing about performance reviews.
• Recognised a core link between people-pleasing behaviours at work and childhood schemas of conditional self-worth, noting that overworking serves as a maladaptive safety behaviour to mitigate anxiety.

Obstacles, Setbacks and Progress

• Difficulty setting firm boundaries with senior management and disconnecting from work emails after hours.
• Experienced a mild panic attack on Tuesday evening after receiving critical feedback on a project draft, resulting in working until 23:00 and subsequent sleep disruption.
• Successfully implemented a 30-minute daily walk four times this week and completed three thought records, demonstrating improved ability to identify cognitive distortions in real time.

Session Summary

• Productive 50-minute CBT session focusing on boundary setting, cognitive restructuring of perfectionistic standards, and behavioural experiments to reduce safety behaviours.
• Central themes included tolerance of uncertainty in the workplace and decoupling professional output from personal self-worth.
• Patient was engaged, insightful, and euthymic with congruent affect; demonstrated readiness to move from cognitive awareness to behavioural change, though anticipatory anxiety remains elevated regarding upcoming conversations with management.

Next Steps

• Conduct a behavioural experiment by logging off strictly at 17:30 on at least three days over the coming fortnight, and continue daily thought records when anxious urges to check emails arise.
• 28/05/2025 at 14:00 AEST.