What can we learn from the case study of Philip?

  Although Philip’s problem of performance anxiety did lead to him experiencing high levels of anxiety on occasions, he was able to successfully overcome his problem by confronting his fears directly. However, many people get into a vicious circle in which things can deteriorate quite rapidly. This is because becoming anxious about one’s performance can actually reduce the quality of one’s performance. This deterioration in performance can draw the individual to the attention of their line manager, supervisor or colleagues, who may notice for example that they have little to say, appear withdrawn, contribute little to meetings, volunteer infrequently or appear to have few ideas. This in turn is likely to lead to increased scrutiny and criticism of their observed poorer performance. This scrutiny and criticism then leads to even greater anxiety and further impairs their performance. This invites even more criticism and a downward spiral of decreasing performance, negative feedback and increasing anxiety is created. If this downward cycle continues unabated, the employee’s anxiety can become increasingly disabling and they may begin to experience panic attacks.

Panic attacks

  A panic attack is defined as a ‘sudden onset of intense fear or terror, often associated with feelings of impending doom’. In the most extreme cases the symptoms experienced can be so powerful that the individual suffering them can actually believe that they are dying. Physical symptoms of panic include increased breathing, dizziness, blurred vision, shaking, hot flushes, sweating, tingling in the hands and feet, chest pains and palpitations. The increased rate of breathing disrupts the balance of oxygen and carbon dioxide in the bloodstream and this causes the individual to experience further ‘odd’ bodily sensations associated with hyperventilation, such as feelings of light-headedness, dizziness and feeling faint (see Figure 10.1).

Figure 10.1 The panic cycle

 

Case study: Andrew

  This case study of Andrew illustrates the treatment of panic attacks based on the conceptualization outlined in Figure 10.1.

Andrew was a 32-year-old school teacher with no previous history of mental health problems. He had ten years’ experience of teaching at the local secondary school and had always been proud of his ability to cope with the demands of the job. However, in the few months prior to experiencing panic attacks, he had been experiencing a lot of pressure at work. There had been a visit to the school by an Ofsted official (Ofsted inspects schools in the UK and assesses their quality and performance against national standards). The Ofsted inspector had made some damning criticisms of the quality of teaching in the school. In addition, one of the parents had made a complaint about Andrew’s treatment of their son, who was a pupil in his class, which was being investigated formally. Andrew took both of these events very much to heart since he had always been proud of both the quality of his teaching and his positive attitude towards his pupils. He began to feel very tense generally and one day while teaching, he experienced a full-blown panic attack in front of his pupils. Physically, he experienced his heart pounding, felt very weak, a tight chest, dizziness and difficulty getting enough air (suffocation). He described it as the worst feeling he had ever experienced and had really believed that he was going to collapse or even die. He felt so bad that he was unable to complete the lesson. The experience eroded his self-confidence and he began to worry about having another attack. He went on sick leave and began to wonder if he would ever be able to return to the job.