Psychology Session Note

Update

• Practised progressive muscle relaxation (PMR) and daily thought records over the past fortnight.
• Completed PMR 4x/week prior to sleep; reported moderate reduction in somatic tension and improved sleep onset latency. Thought records completed 2x following acute workplace stressors, reducing subjective distress from 8/10 to 5/10.
• Encountered difficulty initiating cognitive restructuring when fatigued after late shifts, defaulting to rumination.

Background Information

• Hx of mild asthma; Nil other significant medical history.
• Diagnosed with GAD and MDD by GP in 11/2023. Current pharmacotherapy: sertraline (Zoloft®) 100 mg PO OD.
• EtOH: 2-3 standard drinks on weekends. Denies illicit substance or tobacco use.
• Supportive partner (Sarah, 32yo); strained relationship with mother due to perceived high expectations.
• Employed FT as a project manager; reports chronic high workload and understaffing.
• Resides in a rented apartment in Marrickville with partner.

Current Presentation

• Presents neatly groomed, cooperative, euthymic to mildly anxious affect. Reports anticipatory anxiety regarding upcoming quarterly performance review. Ongoing middle insomnia (waking 03:00, taking > 1 hr to return to sleep).
• Somatic symptoms (chest tightness, GI upset) have decreased in frequency since last session. Mood slightly improved; less pervasive anhedonia on weekends.

Session Content

• Raised concerns about potential redundancy or negative feedback at upcoming performance review, alongside guilt regarding taking leave.
• Explored cognitive distortions underlying workplace anxiety, specifically catastrophising and mind-reading regarding manager's silence.
• Reviewed treatment goals: 1) Reduce work-related rumination outside of business hours; 2) Improve boundary setting with management.
• Making steady progress on Goal 1 via scheduled worry time; Goal 2 remains challenging due to fear of conflict.
• Discussed the link between perfectionism, over-functioning at work, and subsequent burnout. Patient demonstrated good insight, recognising that working unpaid overtime reinforces the belief that she is solely responsible for team outcomes. Responded receptively to Socratic questioning.

Intervention

• Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT).
• Conducted cognitive restructuring on the automatic thought "If I don't finish the project early, I will be fired." Introduced ACT cognitive defusion techniques ("I am having the thought that...") to manage repetitive worry thoughts during the workday. Patient engaged well and generated balanced alternative thoughts independently.

Out of Session Tasks

• Practice ACT defusion exercises daily when noticing perfectionistic thoughts, to reduce cognitive fusion. Complete one behavioural experiment: leave work at 17:30 on two occasions this week without checking emails in the evening, to test catastrophic beliefs regarding boundary setting.

Plan for Next Session

• Next Session: 28/05/2024 at 14:00
• Review outcome of the behavioural experiment (leaving work on time) and debrief following the performance review. Introduce assertive communication strategies (DEAR MAN) to assist with boundary setting.

Risk Assessment and Management

Nil suicidal ideation, intent, or plan. Nil self-harm or harm to others. Risk remains low. Current safety plan remains in place (contact partner, GP, or Lifeline 13 11 14 if distress escalates).

Session Summary

34yo female attended session 5/10 under Better Access MHTP for GAD and MDD. Good engagement with CBT/ACT interventions targeting occupational perfectionism and anticipatory anxiety. Demonstrated insight into maladaptive safety behaviours (overworking). Focus moving forward will shift towards behavioural experiments and assertiveness training to prevent relapse.