CNL-605 Biopsychosocial Assessment (Obj. 6.1 and 6.2)

CNL-605 Biopsychosocial Assessment (Obj. 6.1 and 6.2)


Review Josh’s recorded video of his intake interview with therapist Dr. Amy Wenzel, and complete the attached biopsychosocial assessment.




This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.




You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Course Resources if you need assistance.


This assignment is informed by the following CACREP Standards:


2.F.5.i. Development of measurable outcomes for clients.


2.F.5.n. Processes for aiding students in developing a personal model of counseling.


5.C.1.c. Principles, models, and documentation formats of biopsychosocial case conceptualization and treatment planning.


5.C.2.d. Diagnostic process, including differential diagnosis and the use of current diagnostic classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD).


5.C.3.a. Intake interview, mental status evaluation, biopsychosocial history, mental health history, and psychological assessment for treatment planning and caseload management.


5.C.3.b. Techniques and interventions for prevention and treatment of a broad range of mental health issues.




Transcript of Video

Cognitive Behavioral Therapy for Anxiety and Depression (Session 1 of 6)

1: Opening the Session

Josh, I’m so glad you were able to come in for a visit today.


JOSH: Um hmm.




5 seconds AMY WENZEL

[00:05] AMY WENZELWhat was it you were hoping to accomplish today in our visit?


JOSH: Um, I just thought it was a good opportunity


10 seconds JOSH

[00:10] JOSHto take care of some of the anxiety issues, or at least talk about it.




JOSH: So any opportunity I have, especially because I’m not fully insured to talk about it with a professional. I usually take up, pretty frugal that way.


AMY WENZEL: Yeah. No, it sounds like you’re seizing an opportunity and we’re gonna


30 seconds AMY WENZEL

[00:30] AMY WENZELmake the best use of it.


JOSH: Yeah.


AMY WENZEL: That’s terrific. That’s terrific. So I definitely wanna hear more about the anxiety and then so one of the things that I was hoping to do here today is to hear a bit more specifically what you’re experiencing in terms of anxiety and I saw in here there’s a little bit of depression as well. So we’ll kind of talk about, not only those emotional experiences that you’re having, but also some of the things going on in your life, the stressers and things that might trigger some of the depression and anxiety. And as you’re talking I will link what you’re talking about to the questionnaire here, to some of the responses that you made on here. And then I’ll also link it to this model right here. This is the cognitive behavioral model that underlies the particular type of therapy that I do, cognitive behavioral therapy.


1 minute 15 seconds AMY WENZEL

[01:15] AMY WENZELAnd this is a way of just really making sense of your emotional experiences and other experiences in your life. So as you’re telling me about this, we’ll kind of make sense of it in terms of this model so you can start to understand how the pieces get put together.


JOSH: Sure.


AMY WENZEL: How does that sound?


JOSH: Uh, yeah,


1 minute 30 seconds JOSH

[01:30] JOSHthat sounds fine. It looks a good, looks like a pretty textbook model.




1 minute 35 seconds AMY WENZEL

[01:35] AMY WENZELTextbook model, you got it. You got it.


JOSH: Very professional.


AMY WENZEL: Good. Good. You know, the other thing I was hoping to do here today was just share a little bit more about what cognitive behavioral therapy’s all about and just hear from you if you think it’s a good match or if there’s some things that you think might pose some obstacles to some of our work together in the future.


JOSH: Sure.


AMY WENZEL: Sound okay?


JOSH: Yeah.


AMY WENZEL: Okay. So tell me a little bit more about the anxiety.


JOSH: Um, my anxiety, I guess a good way


2 minutes 0 seconds JOSH

[02:00] JOSHto track my anxiety would be just like my educational experience. Since when I was 18, if you would’ve asked me what I’d be doing now I’d be taking over the world. I’m 24. I’ve been in school for six years and I get my bachelor’s degree in May. And a lot of that, I think about two years into my college education I just really developed some sort of anxiety, just like this, I wanna call it, almost like a fog in my head where certain things became harder.




2 minutes 30 seconds AMY WENZEL

[02:30] AMY WENZELHow difficult.




2 minutes 35 seconds JOSH

[02:35] JOSHThe closer to school related it is, the harder it became.




JOSH: Right before I really started getting a lot of anxiety I became involved in a business fraternity. And we actually started on campus at ISU. But over the course of two semesters, I completely fell out of the group of friends I was with. I went from being the social chair to just not showing up. I took a semester off and then never went back to the fraternity.




3 minutes 5 seconds AMY WENZEL

[03:05] AMY WENZELOkay.


JOSH: So I’ve definitely gone down since then but I’ve come back up since then too.


AMY WENZEL: Okay. Good to hear that. Good to hear that. So when you started off by saying, boy, when you were 18 you thought you were gonna take over the world, I’m taking that as that you didn’t really have problems with anxiety up until that time. Is that correct?


JOSH: No. Even up until I was maybe like 19 or 20.


AMY WENZEL: 19 or 20. Like one or two years in.


JOSH: I mean, I was always very educationally


3 minutes 30 seconds JOSH

[03:30] JOSHsound. I always had a lot of ambition. I was the young entrepreneur on the block, you know?


AMY WENZEL: Oh, really.


JOSH: So yeah, you needed something done around your house, the odds are you could find me to do it.


AMY WENZEL: Okay. Okay. So you were ambitious. You were entrepreneurial.


JOSH: Very ambitious. Yeah.




3 minutes 45 seconds AMY WENZEL

[03:45] AMY WENZELOkay. You went to a four year school. Sounds like you were gonna major in business.


JOSH: Yeah. Yeah, I actually went into


3 minutes 50 seconds JOSH

[03:50] JOSHaccounting.


AMY WENZEL: Okay. You went into accounting. And then, so tell me a little bit more


3 minutes 55 seconds AMY WENZEL

[03:55] AMY WENZELabout that period when you had the onset of that fog and the anxiety.


JOSH: Um, it was the winter time when I first noticed it.


4 minutes 0 seconds JOSH

[04:00] JOSHI guess looking back now I probably didn’t realize it then. I probably just brushed it off as a seasonal disorder, something like that. I remember telling my grandmother on the phone about it and she’s, my grandmother’s kind of a close mentor for me, and she told me to go to see somebody. And they diagnosed me with just really mild depression and anxiety. But.




4 minutes 25 seconds AMY WENZEL

[04:25] AMY WENZELOkay, okay. So it sounds like there was no specific trigger.


JOSH: There certainly were a few things in my


4 minutes 30 seconds JOSH

[04:30] JOSHlife. I’m sorry, I was trying to think what the original question was.




JOSH: I had a breakup with a high school sweetheart. I don’t wanna say that was it. I was living away from home. I had that stresser. And I had just moved out of the dormitories into an apartment. So there’s the not being cradled by the university anymore.




JOSH: And my parents started getting their divorce, which didn’t really affect me as much, I don’t know, I was away from home. But maybe affected me, I just didn’t realize it.


AMY WENZEL: Okay. Okay.


5 minutes 5 seconds AMY WENZEL

[05:05] AMY WENZELSo it sounds like you didn’t have a history of depression or anxiety prior to this period. What about anybody that your biologically related to in your family?




5 minutes 15 seconds JOSH

[05:15] JOSHUm, my mother had, I believe I remember hearing she had post baby depression, postpartum depression.


AMY WENZEL: Postpartum depression.


JOSH: And I know she’s had an anxiety attack or two in her life.




JOSH: I don’t know too much about her experiences and all. But I know she’s experienced it in the past. And then of course with the divorce, you ask which parent what’s wrong with the other one, they’ll give you a whole list of medical; she’s bipolar, she’s this, he’s that.


AMY WENZEL: Sure. Sure. Okay.


JOSH: Most people I’m with would say I’m nothing like my parents.




JOSH: Cause I work in a family business.




JOSH: So they all know my parents.


AMY WENZEL: So the reason I was asking that question about your


5 minutes 55 seconds AMY WENZEL

[05:55] AMY WENZELfamily is because I’m trying to put this together now into an understanding of the onset of your anxiety. And one of our models of depression and anxiety that we oftentimes use in our field is something called a vulnerability stress model. And a vulnerability could be like a genetic predisposition to depression or anxiety. And one of the ways we know if a person has a genetic predisposition is if they have a family history of depression or anxiety. So you know the way I’m starting to understand this is that you might have this vulnerability and when things are going well and you’re successful and entrepreneurial, you’re not experiencing any symptoms.


6 minutes 30 seconds AMY WENZEL

[06:30] AMY WENZELBut it sounds like you had a trifecta of stress there, a transition between the breakup, the moving out of the comfort of the university taking care of you into the apartment, and then your parents’ divorce. And so that was a stresser, that really sort of brought that anxiety out or brought it to the next level.


JOSH: Yeah.


AMY WENZEL: Does that resonate with you?


JOSH: Yeah, certainly,


6 minutes 50 seconds JOSH

[06:50] JOSHlike the perfect storm.


AMY WENZEL: Perfect storm. You got it. So then you experienced


6 minutes 55 seconds AMY WENZEL

[06:55] AMY WENZELit as fog, you said.


JOSH: I just didn’t wanna do anything with anyone.


7 minutes 0 seconds JOSH

[07:00] JOSHYou have those classes in college where you go every day. You have the classes where you go Tuesday and Thursday and… I mean, I would just be sitting in class saying, “Okay, after this next slide I’m gonna leave.” Cause I turned to my homework, I don’t need to be in class. And then it just got worse from there.




JOSH: It’s like oh, my friend’s in class today, I don’t need to go. And then I would still always do the homework and everything but I just fell behind.




7 minutes 25 seconds AMY WENZEL

[07:25] AMY WENZELOkay. Okay. So you fell behind and then you said it got the point where you took a semester off from Illinois State. Correct?


JOSH: Uh, not completely a semester. I just took a really


7 minutes 35 seconds JOSH

[07:35] JOSHlight load and then I took off from the fraternity. So my membership was in pause or on hold or something. And then I just never went back to that. But I was always enrolled with the university.


AMY WENZEL: Always enrolled in university. And you said since that time there’s been basically ups and downs.


7 minutes 50 seconds AMY WENZEL

[07:50] AMY WENZELIs that right?


JOSH: Yeah. One big down and hopefully one last big up.


7 minutes 55 seconds JOSH

[07:55] JOSHBut I mean there were times where I would just lay in bed and not be able to go to class. Not because I wasn’t smart enough or I didn’t have the material or anything but I was sure that if I did the homework I would get good grades, no doubt about it. But…




8 minutes 10 seconds AMY WENZEL

[08:10] AMY WENZELOkay, okay. Why don’t we fast forward and tell me about the past month then, in terms of some of the depression and anxiety. What’s been going on now?


JOSH: The past month,


8 minutes 20 seconds JOSH

[08:20] JOSHI think if I look back next year, this’ll be the hardest couple, the hardest six months in the past five years of my life. I’ve really just grabbed the bull by the horns, I think. And if I don’t succeed this semester it’s just gonna be game over for college for me. I’m graduating in May.




8 minutes 35 seconds AMY WENZEL

[08:35] AMY WENZELGood for you.


JOSH: I have a full load of classes. And I’m trying to study for the


8 minutes 40 seconds JOSH

[08:40] JOSHenrollment exam for the IRS.


AMY WENZEL: Oh, terrific.


JOSH: So I feel good about it. And I’ve been dieting and exercising. And I think that really helps with my mood and just being really positive.




8 minutes 55 seconds AMY WENZEL

[08:55] AMY WENZELSo you described it as the hardest six months but it sounds like hardest in terms of working hard and accomplishing. Okay.


JOSH: But I mean there’s just,


9 minutes 5 seconds JOSH

[09:05] JOSHI had a quiz the other day I just didn’t do. You know so every once in a while I slip up like that and I have to really, for me it’s more about getting into the habit of doing it.




JOSH: You’ve heard of the power of the habit, the book.




9 minutes 20 seconds AMY WENZEL

[09:20] AMY WENZELhave. I sure have. Yeah, so this is interesting because both in your paperwork as well as a couple things you said here suggest that the anxiety and depression are mainly now related to academic issues or academic stressers.




9 minutes 35 seconds JOSH

[09:35] JOSHAcademic stressers and just like succeeding and like what I feel I’m supposed to be doing in


2: Patterns of Thoughts, Feelings, and Behaviors

9 minutes 40 seconds JOSH

[09:40] JOSHlife at this point.


AMY WENZEL: Okay. Okay. So let’s take this specific example


9 minutes 45 seconds AMY WENZEL

[09:45] AMY WENZELof the quiz that you didn’t do very well on. When was that?


JOSH: That was


9 minutes 50 seconds JOSH

[09:50] JOSHtwo weeks ago over the weekend. I didn’t do well on it, I just didn’t do it. I read the chapter of the book. I couldn’t do it. Between Friday, Saturday and Sunday night and I found a reason not to do it every single night until Monday morning. I’m just kicking myself cause I didn’t do it.


AMY WENZEL: You didn’t do the reading? Or you didn’t take


10 minutes 10 seconds AMY WENZEL

[10:10] AMY WENZELthe…


JOSH: I did the reading. I did the work. I didn’t log onto blackboard our website and I didn’t


10 minutes 15 seconds JOSH

[10:15] JOSHhit begin quiz.




JOSH: And then go through the ten questions.


AMY WENZEL: That’s what I was missing. It was an online quiz.


JOSH: And it’s like three points for the class. I understand how every point in the class works. Four points I had to do to get an A. You can take the quiz three times without any penalty, write down the answer every time, you get an A on the quiz. I usually do that.




JOSH: I just, sometimes I just freeze up.


AMY WENZEL: Okay. Let’s talk about hat freezing a little bit more. So when you’re


10 minutes 40 seconds AMY WENZEL

[10:40] AMY WENZELover the weekend, you’ve read the book or you’ve read the chapter, you’re contemplating taking the quiz, tell me what runs through your mind?


JOSH: I just, I try to keep things from running through my mind. I try not to think about em.


10 minutes 50 seconds JOSH

[10:50] JOSHI’ll get busy with something else. You know there’ll be, I’ll start looking at condos for my girlfriend on Craig’s List and spend an hour doing that. I’ll do laundry, I’ll clean everything. My room’ll be spotless. Everything, my car’ll be clean.


AMY WENZEL: Lots of avoidance, huh?


JOSH: Yeah, avoidance. I put everything else on the way that needs to be done. You got something that needs to be done, when I have something that needs to be done it’s probably the best time to ask me to do it. Cause I don’t wanna do what I have to do.


AMY WENZEL: Okay. Okay. So if


11 minutes 20 seconds AMY WENZEL

[11:20] AMY WENZELyou are forced to direct your attention to what you have to do, what would jump into your mind?


JOSH: I mean, usually when I think of forced I think,


11 minutes 30 seconds JOSH

[11:30] JOSH”Oh God, it’s the last minute to apply to graduate” forced. And then I just do it. Just bite the bullet and do it. It’s a really hard zone for me to get in. But certainly I can get into it.


AMY WENZEL: Okay. So do you ever have any


11 minutes 45 seconds AMY WENZEL

[11:45] AMY WENZELthoughts like, “I’m not gonna do well. I’m gonna fail.”


JOSH: Yeah, certainly. Yeah.


11 minutes 50 seconds JOSH

[11:50] JOSHDefinitely a fear of success type thing going on. You know.




JOSH: I switched majors twice in college.


AMY WENZEL: Oh did you? Okay.


12 minutes 0 seconds AMY WENZEL

[12:00] AMY WENZELOkay.


JOSH: From accounting to finance and from finance to information systems.






12 minutes 5 seconds JOSH

[12:05] JOSHSo I have all those credits and GSU put me into the interdisciplinaries program because I had so many upper division credits but not one clear focus. So the last year in college I just spent focusing on accounting.


AMY WENZEL: Okay. Do you think the jumping


12 minutes 20 seconds AMY WENZEL

[12:20] AMY WENZELfrom major to major, was that another indication of this avoidance pattern?




12 minutes 25 seconds JOSH

[12:25] JOSHYeah. I don’t know what I’m gonna do when I graduate college. I’ve been, it’s the education, your entire life. I didn’t feel like I was ready when I was an information systems major. And then I switched back to accounting. But…


AMY WENZEL: Okay, okay. So let’s say you graduate and


12 minutes 45 seconds AMY WENZEL

[12:45] AMY WENZELyou’re still a bit unsure here. Tell me about some of the things that you worry about.




12 minutes 50 seconds JOSH

[12:50] JOSHright now in my life I’m trying to move up to the city, Chicago, to live with a girlfriend. And the girlfriend’s becoming a main motivator to do anything anymore cause you can’t live at Mom and Dad’s house the rest of your life. Especially when they’re getting divorced.




13 minutes 5 seconds AMY WENZEL

[13:05] AMY WENZELRight.




AMY WENZEL: Hence looking for a condo.


JOSH: Yeah. So I’m just trying to move,


13 minutes 10 seconds JOSH

[13:10] JOSHtrying to get a job. I’ll take any job that you have to have a four year degree to take. So, the true requirement is to have a job for me.


AMY WENZEL: Is it safe


13 minutes 20 seconds AMY WENZEL

[13:20] AMY WENZELto say that you worry about things?


JOSH: Oh yeah.


AMY WENZEL: Okay. Tell me some more about your worries.


JOSH: Money is always a big worrier. I live from paycheck to paycheck.


13 minutes 30 seconds JOSH

[13:30] JOSHUm, buying books. I just got done buying books for the semester. The semester started like three weeks ago.




13 minutes 35 seconds AMY WENZEL

[13:35] AMY WENZELOkay.


JOSH: So I kinda pay for things as they come.


13 minutes 40 seconds JOSH

[13:40] JOSHAnd then this past month or two I felt really good about myself cause I’ve been taking care of things. And my credit report that I didn’t pay for, that I issued into normal. I paid off a thousand dollars for the past two months. Yeah. But now I don’t have much of a tax return left.




14 minutes 0 seconds AMY WENZEL

[14:00] AMY WENZELOkay.


JOSH: I don’t know. I’m just trying to watch myself out there right now.


AMY WENZEL: Okay. Okay. So you’re worrying about money. What else are you worrying about?


JOSH: Moving.


AMY WENZEL: Moving. Okay.


JOSH: And do you


14 minutes 15 seconds JOSH

[14:15] JOSHfundamentally do you focus on bad things that might happen, like things not working out?




14 minutes 20 seconds AMY WENZEL

[14:20] AMY WENZELFocus on like the worst case scenarios of what could happen. Like, “Oh my God Josh, if you don’t get back on the computer, type that email to that person and tell them this that you were supposed to tell em this morning, you’re gonna be…”




14 minutes 35 seconds JOSH

[14:35] JOSHAnd when you focus on those worst case scenarios, what does that do to your mood?




14 minutes 40 seconds AMY WENZEL

[14:40] AMY WENZELI get into this mood sometimes and my girlfriend notices it, where it’s just like all of a sudden we’re in a hurry, I’m in a hurry cause I’m thinking about something that I can’t get done where I’m at. And I don’t wanna tell anybody else I didn’t do it. I have to go somewhere to get it done. But I just like, I have to rush through things. And then I lose attention to detail.


JOSH: And so you lose attention to detail and you’re rushing.


15 minutes 5 seconds JOSH

[15:05] JOSHWhat does it do to your anxiety level?


AMY WENZEL: Um, if I get on


15 minutes 10 seconds AMY WENZEL

[15:10] AMY WENZELthe track where I know I’m gonna get it done, my anxiety level goes down. But until there’s that moment of relief, it’s gonna be okay. Like, I couldn’t, the 50 dollars was due for the graduation fee on a Thursday and I got paid on a Friday. I didn’t know if I was gonna be able to have the gas to get here and then. Cause I’m only working part time right now. I didn’t know if I had the gas to get back and everything.


JOSH: Okay.


AMY WENZEL: And I was just like freaking out. And I went and I was just gonna pay for it and they’re like, “Oh, the graduation application fee is due in March.” It was January, I think, late January.


JOSH: Okay.


AMY WENZEL: And then I felt good.


JOSH: Okay. When you were freaking out,


15 minutes 55 seconds JOSH

[15:55] JOSHwhat were some of the things that you said to yourself?


AMY WENZEL: Oh like you’re not gonna graduate college.


16 minutes 0 seconds AMY WENZEL

[16:00] AMY WENZELYour girlfriend’s gonna break up with you. You’re gonna be stuck living…


JOSH: If I don’t graduate


16 minutes 5 seconds JOSH

[16:05] JOSHfrom college this semester, I just can’t push it off for another semester. She graduated last year and I’m a year older than her.




16 minutes 10 seconds AMY WENZEL

[16:10] AMY WENZELOkay. Okay.


JOSH: And she’s got a great job and everything.




3: Applying the Cognitive Behavioral Model

16 minutes 15 seconds AMY WENZEL

[16:15] AMY WENZELOkay. Okay. Can I share with you this model a little bit in light of what you’re saying here?


JOSH: Certainly.


AMY WENZEL: I’m gonna actually call your attention to this bottom rectangle right here. In cognitive behavioral therapy, cognitive means how we think about things or how we make meaning of things. I oftentimes find that when people struggle a bit with depression and anxiety, they tend to go to that worst case scenario, as you’re saying. Or they tend to really focus on things that are excessively negative or excessively unhelpful at the expense of some other pieces of information that might soften out the interpretation a little bit. And I wonder if, and we call these automatic thoughts because they come up just so quickly that we don’t even necessarily know that we’re thinking them. We just know that we’re anxious or we just know that we’re upset. But a lot of time it can help us to slow down, recognize what we’re thinking and then really take a good hard look at it to make sure that we’re not forgetting about some other pieces that suggest that things aren’t quite so catastrophic. I’m wondering what you think about that? I mean, do you think that’s relevant to you?


JOSH: Certainly.


17 minutes 20 seconds JOSH

[17:20] JOSHI mean an automatic thought, just the worst case scenario that I would have. Yeah, I mean. It pops in my head. Sometimes where I have a big failure or I think I have a big failure, I go, “Oh, stuck in this town for another year.” And so I’m unable to overcome it.




JOSH: But I mean, I see the rules and assumptions, I just assume I have to live in Joliet the rest of my life if I don’t graduate college.




17 minutes 45 seconds AMY WENZEL

[17:45] AMY WENZELThat’s so important there. Let’s talk a little bit more about the other pieces of the model. So these automatic thoughts, we kinda start at this level because they come up in particular situations and they’re the easiest types of thoughts or cognitions to identify. But there are all these layers that kinda of are underneath the automatic thoughts. And you’re absolutely right that people then hold these rules and assumptions like a number of patients I’ve worked with have had assumptions like, “I should get all As or else I’m a failure.” Or, “I should graduate in a certain amount of time.” And it just puts so much pressure on them that then it’s very easy to jump to these worst case scenarios when they’re faced with some sort of stresser.


18 minutes 25 seconds AMY WENZEL

[18:25] AMY WENZELDoes that seem like that resonates with you?


JOSH: Yeah. Certainly. I think it’s pretty in line with what happens to me.


AMY WENZEL: Okay. Okay.


JOSH: I don’t really understand. What’s the,


18 minutes 35 seconds JOSH

[18:35] JOSHcan you tell me what the formative experience is?


AMY WENZEL: Absolutely. Absolutely. So


18 minutes 40 seconds AMY WENZEL

[18:40] AMY WENZELaccording to this model, oftentimes people have experiences, formative experiences just means a key experience from your life that really shaped the way that you view the world or you approach life. And so oftentimes we have these experiences, perhaps with our parents, perhaps with our peers.


JOSH: Adolescence.


AMY WENZEL: Yeah. It could be adolescence. Although it doesn’t always have to be limited to childhood like I actually wonder if the experience that you had at ISU when you started to have all the stressers and have difficulties with the transition, might have been another formative experience that sort of stuck with you and affects the way that you view the world. Is there any truth to that hypothesis?


JOSH: Yeah. Definitely. I mean,


19 minutes 20 seconds JOSH

[19:20] JOSHI have a different view towards university in general now.




JOSH: Towards any educational institution, I have a different view towards.




JOSH: At this point.


AMY WENZEL: Exactly.


19 minutes 30 seconds AMY WENZEL

[19:30] AMY WENZELSo that really kind of rocked your world a bit because up to that point you had a very different outlook about school.


JOSH: Yeah, I was much more optimistic.


AMY WENZEL: Okay. Okay, okay. And oftentimes these formative experiences lead to what we call these core beliefs. And these are kind of, this is the most fundamental level of cognition. It’s a belief that you have about yourself or about the way the world works or other people that oftentimes just serves as a lens or filter by which you view the world. And I wonder with you, especially because of this experience that you had at ISU, if there’s a bit of a fear of failure or this belief that you are a failure or that you won’t be successful.




20 minutes 10 seconds JOSH

[20:10] JOSHYeah, I mean I have a big fear of failure. But a lot of it comes from just comparing myself, cause I was in league with a lot of really successful people. And going on Facebook now can be really anxiety causing.


AMY WENZEL: Facebook is dangerous for that.


JOSH: You just go through, oh that’s a really nice house you bought. First job out of college. I wish I had stuck in school longer like you did or done what you did while I was there.




JOSH: But I mean…


AMY WENZEL: So it sounds like and


20 minutes 40 seconds AMY WENZEL

[20:40] AMY WENZELactually interestingly Facebook could almost be like another formative experience, not exactly like one thing that happened to you like what happened at ISU. But it’s like kind of a continual ambush, where you’re getting this message of it sounds like maybe what you’re making out of that that is that you’re not good enough or as good as other people.


JOSH: Yeah. I mean that might be why I go


21 minutes 0 seconds JOSH

[21:00] JOSHto Governor State University. Because I wanted to be a bigger fish in a smaller


4: Discussing Avoidance

21 minutes 5 seconds JOSH

[21:05] JOSHpond.


AMY WENZEL: Okay. Okay. Yeah, and what you’re actually identifying


21 minutes 10 seconds AMY WENZEL

[21:10] AMY WENZELthere is not even actually something that’s on our model but that’s still important. We call that a compensatory strategy. Where you’re doing something that compensates for a core belief that’s painful to face.


JOSH: I have a lot of compensatory…


AMY WENZEL: Yeah? What are some of the other compensatory strategies?




21 minutes 25 seconds JOSH

[21:25] JOSHI mean just like I have to make habits to do things. Even going into classes now. Last semester, I show up to school like a half hour, 45 minutes ahead of time.


AMY WENZEL: Okay, okay.


JOSH: And I’ll sit in my car and I’ll eat. I’ll listen to the radio. Some podcast or something. I just have to relax myself on campus before I go into class. I need to be in like that state of mind.


AMY WENZEL: And what if you don’t relax yourself and


21 minutes 55 seconds AMY WENZEL

[21:55] AMY WENZELcenter yourself like that?


JOSH: If I am running 20 minutes on the highway and I’m not gonna make it to class on time,


22 minutes 0 seconds JOSH

[22:00] JOSHwhy even go to class now?




22 minutes 5 seconds AMY WENZEL

[22:05] AMY WENZELokay.


JOSH: If you turn on the highway now you could be home in how long? What


22 minutes 10 seconds JOSH

[22:10] JOSHwould your mom say? What would your girlfriend say if she found out you’re missing class?




22 minutes 15 seconds AMY WENZEL

[22:15] AMY WENZELsure.


JOSH: And then anxiety just hits.


AMY WENZEL: Right. And oftentimes avoidance can be a compensatory strategy as well because if you avoid say, going to class then it might actually avoid activating some of these beliefs that you have about not being good enough or not being successful. Okay.


JOSH: Yeah. Because then the worst thing I could do


22 minutes 35 seconds JOSH

[22:35] JOSHthat I know for myself in academics with classes is miss a class. Cause that class, after that class you missed, is twice as hard to go to.




22 minutes 45 seconds AMY WENZEL

[22:45] AMY WENZELYeah. Yeah.


JOSH: Because you get all this anxiety, “Oh my God, I’m gonna walk in and everybody’s gonna look at me and


22 minutes 50 seconds JOSH

[22:50] JOSHknow oh he wasn’t here last week.” Especially at GSU because you only meet once a week.




22 minutes 55 seconds AMY WENZEL

[22:55] AMY WENZELAnd you know what you’re doing right, that’s actually another automatic thought. Everyone’s gonna know that I wasn’t here. Right? And it sounds like there’s some truth to that at a smaller university like this. I wonder what the implications with that would be. So what if everybody knows that you didn’t…




23 minutes 10 seconds JOSH

[23:10] JOSHI thought that in a 50 person class but not every day in a 200 person class at some of the bigger universities, you know.


AMY WENZEL: I see. And even so that


23 minutes 20 seconds AMY WENZEL

[23:20] AMY WENZELthought kinda got you into trouble there.


JOSH: Yeah. Certainly.


AMY WENZEL: Okay. Okay. What do you think of how we’re making sense of your whole experience so far? Is that resonating with you?


JOSH: I mean, yeah,


23 minutes 30 seconds JOSH

[23:30] JOSHit’s true. It’s definitely a formative way to put it.


AMY WENZEL: Okay. Okay. Am I sensing a hesitation or is there a piece that we’re missing?


JOSH: I mean, no, I mean I don’t know, I don’t really like looking back at experiences I guess. Cause they make me anxious. So I mean, I look at a chart like that it’s like thinking I’d rather have the arrows go the other way, like what I could be doing.




23 minutes 55 seconds AMY WENZEL

[23:55] AMY WENZELSure. Sure.


JOSH: To get around my problems.


AMY WENZEL: But you know we can conceptualize. I think that’s actually quite creative. I mean, we can make the arrows go in the other direction because you’ve mentioned habits a couple of times now. And I honestly view some of this negative thinking as a cognitive habit and then of course avoidance is a behavioral habit as well as some of the other habits that we had talked about. And so unhelpful habits can get ingrained in our mind and in our repertoire. But then more helpful ways of thinking and behaving can also get ingrained in our mind and our repertoire and that’s where the arrows would go in the other direction.


5: Navigating Resistance

24 minutes 30 seconds AMY WENZEL

[24:30] AMY WENZELAnd that’s what you and I can do together.


JOSH: Sure.


AMY WENZEL: Yeah. So already as I’m thinking about this, part of what we can do is we can start with working with automatic thoughts that are certainly linked to these beliefs and assumptions. And I can give you some tools to really take a look at when these thinking patterns come up, take a step back, really evaluate everything that goes into them. And then, if necessary, modify them on the basis of the result of that evaluation. If you’re realizing that you’re forgetting to look at a whole bunch of pieces of the situation that would make it easier to tolerate, we need to make sure that you are incorporating that in to your thinking.


JOSH: Yeah.


AMY WENZEL: Does that make sense?


JOSH: Yeah,


25 minutes 10 seconds JOSH

[25:10] JOSHit makes perfect sense. It’s just gonna be hard, you know, when I go to work tomorrow and you have to put it into practice then.


AMY WENZEL: Sure, sure. Tell me what you envision would be so difficult.


JOSH: I mean I just have I guess a certain personality at work where I have to be respected and get things done a certain way. I don’t know, I just feel like I couldn’t stop and hesitate the way I do something.


AMY WENZEL: Because, so complete the


25 minutes 35 seconds AMY WENZEL

[25:35] AMY WENZELsentence; if I stop and think for a second, if I hesitate, then;


JOSH: I guess


25 minutes 40 seconds JOSH

[25:40] JOSHthere’s nothing really that bad about it. Maybe I’m just making excuses for myself.


AMY WENZEL: You know I don’t actually view


25 minutes 45 seconds AMY WENZEL

[25:45] AMY WENZELit as an excuse, I actually view it as another automatic thought that I wonder if somehow others won’t view you as respectful or others might think something’s going on.


JOSH: Yeah.


25 minutes 55 seconds JOSH

[25:55] JOSHCertainly. Um, I don’t know. I just have a lot of, things are going well at work how they are and changing them might be problematic because it’s a family business and things are fragile.


AMY WENZEL: Oh sure. So there’s a lot of dynamics there. Right?


JOSH: Yeah. I’m like the only person who works in the office every day that’s related to the family. And I get a lot of…




26 minutes 20 seconds AMY WENZEL

[26:20] AMY WENZELLet me tell you something about cognitive behavioral therapy. It’s a very collaborative therapy. So I certainly have expertise about psychotherapy in general and cognitive behavioral therapy. But you are absolutely the expert on your own situation and those dynamics. And so you and I are, we’re both in the front of the car, we’re both in, one of us is in the driver’s seat, you’re in the driver’s seat, I’m in the passenger seat. Okay? So what that means is I will never force you or tell you that you have to do nay of the stuff in any one setting.


JOSH: Yeah.


AMY WENZEL: So, it’ll be up to you to kind of take what we’re doing and we can figure out how to make that apply and how to really mold it for your situation.


6: Assigning the Thought Record

27 minutes 0 seconds AMY WENZEL

[27:00] AMY WENZELEverybody’s different.


JOSH: So if you had to say like one particular exercise


27 minutes 5 seconds JOSH

[27:05] JOSHI could do like until I see you next week, what would it be?


AMY WENZEL: Oh my gosh. You are a


27 minutes 10 seconds AMY WENZEL

[27:10] AMY WENZELgreat candidate for cognitive behavioral therapy. Because that’s actually something that we do.


JOSH: I just wanna understand how…


AMY WENZEL: Yeah. Let me actually, I’ll go ahead and give you some here. And as I’m finding the sheet I wanna give you, let me also finish my thought here and that is that while of course I’ll never just tell you what to do or never force you to do something, I might actually ask you to see if you’d consider testing out a hypothesis. That if you were to do something somewhat differently that the outcome would be catastrophic. You know we actually can experiment with that and we can actually collect information as it’s happening in order to verify whether some of these worst case scenarios or catastrophes are actually true.


JOSH: Okay.


AMY WENZEL: What do you think of that?


JOSH: I could do that.


AMY WENZEL: Okay. So here’s something I often start off with with my clients.


28 minutes 0 seconds AMY WENZEL

[28:00] AMY WENZELThat first sheet it’s an informational sheet about automatic thoughts so some of it describes exactly what I’ve already been talking about here. Some questions to prompt the automatic thoughts. Yeah, go ahead and flip over to that second page. Because this is one way for you to start to recognize those automatic thoughts. And we call this a thought record. And so you’ll notice there’s three columns there. So when you experience a situation where you notice anxiety, trepidation, maybe some depression or even dread, you haven’t used the word dread but I’m kind of sensing at times there’s a little dread there.


28 minutes 35 seconds AMY WENZEL

[28:35] AMY WENZELJot a few words about what the situation was that prompted that. Mind you sometimes it’s not always a situation. Sometimes it just kind of comes up like when you wake up in the morning or what not. So it doesn’t always have to be external. Write down what the automatic thought was or maybe there’s more than one thought. What was running through your mind. And then write down what emotion you were experiencing. You can rate the intensity of the emotion on a zero to 100 scale.


JOSH: Does the situation have to


29 minutes 0 seconds JOSH

[29:00] JOSHbe like a realizable event of something that happens? Or can it just be…


AMY WENZEL: It’s sort of like a worst case


29 minutes 5 seconds AMY WENZEL

[29:05] AMY WENZELscenario again.


JOSH: Okay.


AMY WENZEL: Yeah, no it absolutely doesn’t have to be something external. You know I actually wanna do, you wanna grab the clipboard and the pen and maybe we can do one together so you have that to take home?




29 minutes 15 seconds JOSH

[29:15] JOSHSure. What situation would you like to do?


AMY WENZEL: Well what situation would you like?


29 minutes 20 seconds AMY WENZEL

[29:20] AMY WENZELJust over the past few days, where were you the most anxious?




29 minutes 25 seconds JOSH

[29:25] JOSHUm, Monday I wanted to leave work early for no reason.




29 minutes 35 seconds AMY WENZEL

[29:35] AMY WENZELOkay.


JOSH: And I guess I didn’t know why.


AMY WENZEL: Okay. So kind of the situation was an urge to leave work.


JOSH: Yeah.




JOSH: I get those a lot.


AMY WENZEL: Urge to leave work. Okay.




29 minutes 50 seconds JOSH

[29:50] JOSHOkay. Thought.


AMY WENZEL: What thought was running through your mind?


JOSH: Um that if I did have my exam Monday, that I would need to be there early cause the weather was bad.




30 minutes 5 seconds AMY WENZEL

[30:05] AMY WENZELSo kind of like I’m gonna miss the exam.


JOSH: Yeah.


AMY WENZEL: Okay. That’s sort of representative of those worst case scenarios?




30 minutes 15 seconds JOSH

[30:15] JOSHYeah, I was gonna miss the exam at 7:30, even though I got off at work at 5:30. Takes me 45 minutes to get here.




JOSH: Only had two hours to do it.




30 minutes 25 seconds AMY WENZEL

[30:25] AMY WENZELOkay.


JOSH: Still worried.


AMY WENZEL: But you thought you were gonna miss the exam.


JOSH: Well it was snowing really bad.


AMY WENZEL: Okay. Okay.


JOSH: And they did end up canceling the exam.


AMY WENZEL: Interesting. You know what? And this is a great example because you know oftentimes in these automatic thoughts, there is a grain of truth. I mean we’re not, I would hate for you to get the message that we think that you’re thinking totally abnormally or dysfunctionally. But it sounds like there were a number of factors in that statement that you probably weren’t accounting for. The fact that you still had adequate time. That kind of thing. So is anxiety the emotion there?


JOSH: Oh, certainly.




31 minutes 0 seconds AMY WENZEL

[31:00] AMY WENZELAnd on the scale of zero to 100, how intense was the anxiety?




31 minutes 10 seconds JOSH

[31:10] JOSHmaybe like a four or a five, so 40 or 50.


AMY WENZEL: 40/50. Okay. Go ahead and write that down.


JOSH: Um, I always wanna leave work early, I hate staying till 5:30.


AMY WENZEL: Okay. Okay.


JOSH: I even left earlier that I was supposed to today.




31 minutes 25 seconds AMY WENZEL

[31:25] AMY WENZELhmm. One other question about this particular automatic thought before I follow up in the work issue. Were there any, was there even more meaning associated with I’m gonna miss the exam? You know like some sort of this is gonna…


JOSH: Just the domino effect of missing an exam.


AMY WENZEL: Which would be what?




31 minutes 45 seconds JOSH

[31:45] JOSHFailure.


AMY WENZEL: There you go. I wonder if you should writ that underneath that, or next to that, like, “I’m gonna


31 minutes 50 seconds AMY WENZEL

[31:50] AMY WENZELfail.” Okay.


JOSH: I didn’t want my professor to think


31 minutes 55 seconds JOSH

[31:55] JOSHless of me.


AMY WENZEL: Oh. My professor’s going to think less of me. There you go.


32 minutes 0 seconds AMY WENZEL

[32:00] AMY WENZELOkay. So when you look at the totality of those thoughts, like I’m gonna miss the exam, my professor’s gonna think poorly of me, and I’m gonna fail, are you still at a 40 or a 50 or does your anxiety go up then even more?


JOSH: I mean


32 minutes 20 seconds JOSH

[32:20] JOSHmaybe. When I think about just the urge to leave work at any given day it’s 40 to 50. But I guess it would be higher when you account for the exam thing.


AMY WENZEL: Right. And you know this is a perfect illustration of why we do this with folks because remember


32 minutes 35 seconds AMY WENZEL

[32:35] AMY WENZELI said these come up so automatically that sometimes you don’t even realize they’re there? So yeah, you have a baseline level of 40 or 50 of an urge to leave work and some discomfort there. But in this case, the anxiety was probably even higher because you were what we call catastrophizing, right? About the implications.


JOSH: Certainly. Yeah. It’s a good word.




JOSH: I don’t know how to spell it.


AMY WENZEL: Catastrophizing, we’ll figure it out after to make sure you have that written down. So.


JOSH: Should I raise the number?


AMY WENZEL: If you think that raising the number is in order, you know, after looking at those other thoughts that you had.


33 minutes 10 seconds AMY WENZEL

[33:10] AMY WENZELOkay. Okay.


JOSH: Probably much higher.


AMY WENZEL: There you go. So when you stop to think about it, there are actually quite a few catastrophic thoughts there that were really elevating your anxiety. Correct?


JOSH: Yeah.




JOSH: Certainly.


AMY WENZEL: Yeah, yeah. In between


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