Cognitive Restructuring

Mr. Brian was an 82-year-old widowed Caucasian male with 12 years of education, who presented with generalized anxiety symptoms. He had a history of chronic obstructive pulmonary disease (COPD), prostate cancer, and coronary artery disease.

He did not have any history of a psychiatric diagnosis or treatment, although his children reported that he had always been an "anxious" person.

A few months before this intervention, he was living independently when he experienced a series of medical problems, including a worsening of his COPD that required hospitalization.

After the hospitalization, his son and daughter noticed a dramatic decline in Mr. Brian’s cognitive function. He was seen by the neurology department and diagnosed with possible Alzheimer’s disease (AD), which may have been worsened by sleep apnea related to COPD.

After his hospitalization, Mr. Brian was no longer able to live independently and moved to a rehabilitation/assisted-living facility. Mr. Brian has now been diagnosed with generalized anxiety disorder and specific phobia (fear of falling).

The initial assessment revealed that Mr. Brian worried frequently about financial problems and being left alone. He would constantly check his wallet to ensure he had enough money.

He was also fearful of falling and stayed in his wheelchair, even though his physical condition would have allowed him to walk short distances. If he went on a trip he would not walk for fear of falling, this leading to the fear of not having money to pay his hospital bills. His physical symptoms included trembling, heart palpitations, poor sleep, and low energy.

His baseline assessment scores suggested clinically significant anxiety. Mr. Brian’s son reported minimal caregiver distress over his anxiety difficulties. How will you develop a case formulation and treatment plan, using CBT?