Depression Case Study Colchester, Essex

Diagnosis: Depression (patient lives in Colchester, Essex)

Thomas (not his real name) is 35 years old, married with three children, all under seven years of age. He works in a large engineering firm.

About three months before he came to see me for assessment, Thomas had made an important career changing decision, which he had come to see as an error of judgment - "I made a terrible mistake", which was to remove himself from a comfort zone where he had commanded a high level of respect from work colleagues, and moving to a job where he was an unproven, unknown quantity.

Struggling in  his new role, his loss of 'validation' and respect from his new colleagues led to a loss of confidence, an increase in self-doubt and a self-perception as a "failure".

He believed that others, including his new boss, and even his wife, shared the perception that he was in some way "defective" and flawed - in his words, "useless" and "unloveable", respectively. He believed very strongly that he would lose both his job, and his wife, as they came to confirm their belief in him as a failure and a "loser".

At the beginning of therapy we drew up on a flip-chart a CBT formulation of the problem.  Thomas learned from this that he had set incredibly high standards for himself, which didn't seem to apply to others. He was conditioned to be very hard on himself from a very early age; his parents were very demanding in the standards they set for him.

From the formulation he could see also that he had an intense dislike of change, or the unexpected, and recognised this as learned behaviour, first encountered as a child. Thomas had wanted to be a Doctor but his father had insisted that he take a 'steady' nine-to-five job, repeatedly told not to take risks and to "play it safe". And so, like his Dad, Thomas became an engineer.

The 'trigger' for Thomas' depression was the job change, a risky strategy compared to his play-it-safe disposition.

At this new job Thomas developed perfectionist tendencies, combined with a fear of failure in whatever task was set by his manager, and this anxiety would so paralyse him that he would procrastinate. Putting off task after task, his work would pile up, to be followed by comments from his boss, all conspiring to confirm Thomas' self-perception as a "failure" - his vicious cycle.

In treatment, we began to use Activity Scheduling and Thomas soon discovered that he was spending more than 80% of his time working, often unproductively.  He had stopped many of his pleasurable activities, including exercise and socialising. The Activity Schedule was to be used as a planning tool to modify and implement more helpful activities, such as spending time with his family, going to the gym, etc.

We also used Thought Records to find a less rigid thought pattern of insisting on high standards and perfectionism, and he began to develop a more balanced view about the implications of tasks that would not be 100 percent perfectly completed, either in work or other settings.

Within about six weeks, Thomas' depression had reduced to normal levels, and he felt that he could cope better, and was enjoying life a lot more, particularly as he was spending less time at work. His perfectionism reduced so his time spent at work, was actually more productive.