**Case study clinical example: First session with a client with symptoms of social anxiety (CBT model) — Transcript & Summary | SozAI**
Source: https://sozai.app/transcript/case-study-first-session-social-anxiety-cbt/

A clinician conducts a first CBT session with Hannah, a young photographer whose social anxiety has worsened since moving out of home, affecting work and friendships.

## Key Takeaways

- Social anxiety can emerge or worsen during major life transitions such as leaving home or peers' divergent paths.
- Avoidance and safety behaviours maintain anxiety and erode work and social opportunities.
- A CBT first session focuses on gathering specific situational examples, thoughts, and physical symptoms to build a shared formulation.
- Client shame about seeking help is a common barrier that the clinician addresses through rapport-building.

## What the video covers

- Hannah is referred by her GP for anxiety difficulties that began about five or six years ago, around age 19, when friends went to university.
- Her anxiety escalated after she moved out of her parents' home for the first time, leaving her isolated in her flat.
- She is a freelance photographer who increasingly declines work involving interaction with people, such as group shoots or campaigns.
- Social situations trigger physical symptoms: feeling hot and sweaty, difficulty breathing, shaking, and a sense that others are staring and judging her.
- Her core belief is that people will think she is stupid, a weirdo, or an idiot, and that she is 'the freak who can't do normal things'.
- She uses safety behaviours such as avoiding eye contact, wearing black, holding the camera tightly, and preferring solo shots to focus attention away from people.
- Coffee outings with friends left her wanting to go home after two weeks, and she fears losing her friendships.
- The clinician uses a structured CBT-style assessment: exploring the presenting problem, concrete recent examples, thoughts and feelings in situations, and the impact on work and relationships.
- Hannah expresses hope that therapy will help, but also shame at needing help at all.
- The session establishes a formulation foundation linking situational triggers, feared evaluation, physical arousal, and avoidance.

## Chapters

1. 00:00 Introduction and rapport with Hannah
2. 01:00 Referral and how anxiety has changed since moving out
3. 04:00 Feelings about attending therapy today
4. 07:30 Impact on photography work and friendships
5. 10:20 Identifying difficult situations and fears of judgement
6. 15:00 Physical symptoms and recent example from work
7. 19:00 Safety behaviours and avoidance strategies

Answers

## Questions about this video

Why did Hannah go to her GP?

Her anxiety had escalated after she moved out of her parents' home for the first time. She felt more isolated and was avoiding work and social situations, which led her GP to refer her for help.

What specific difficulties does Hannah describe?

She avoids work that requires interacting with people, has trouble maintaining friendships, and experiences hot sweats, breathlessness, and a fear that others are staring and judging her as stupid or weird.

What safety behaviours does Hannah use?

She avoids eye contact, wears black clothing, grips her camera tightly, and prefers shooting alone so she can focus on the camera rather than on other people.

## Full Transcript — Download SRT & Markdown

00:17

Speaker A

hi Hannah, nice to meet you.

00:33

Speaker A

ago okay um it kind of it escalated a bit um I've just recently moved out um from living with my parents so it's made it a bit worse I think okay is this the first time that you've left home uh yeah

00:47

Speaker A

Hi. So I understand that you were referred to me by your GP because you've been experiencing some anxiety difficulties.

00:59

Speaker A

like that that was what led you to go to your GP yeah so how has that uh changed things for you um you know it's kind of I haven't really told anyone so I mean it's made it like better in the sense I

01:13

Speaker A

Yeah. Um, yeah. I guess it kind of started like five, six years ago.

01:23

Speaker A

actually go and like get help if that makes sense okay so how do you feel about being here today it's like scared I don't know hopefully it will help okay so you've been feeling a little bit anxious about today yeah

01:37

Speaker A

Okay. Um, it kind of escalated a bit. I've just recently moved out from living with my parents, so it's made it a bit worse, I think.

01:48

Speaker A

of home for the first time and um and that was what kind of LED you to go to the GP so how did that change things how were things after you moved out um I thought that they'd be better but

02:00

Speaker A

Okay. Is this the first time that you've left home?

02:11

Speaker A

come and visit a bit but it's not I don't know it's kind of scary because I've just been kind of literally just in the flat by myself which I always thought I'd like but I don't actually like it okay so what are the kind of

02:27

Speaker A

Uh, yeah. I, um, yeah, it is the first time, actually. Yeah. I was going to a few years ago, but I just thought it would be easier to stay home.

02:43

Speaker A

that is kind of involving me having to interact with people I just tend to just turn it down so I was kind of making things hard in that respect and um just kind of friends wise and everything I

02:55

Speaker A

So it's been quite a big step and a big change, and it sounds like that was what led you to go to your GP?

03:10

Speaker A

certain things so they're they're stopping you from taking up kind of certain types of work and as a freelance photographer I guess that that can be kind of a problem and they're also stopping you or you feel like it's

03:20

Speaker A

Yeah. So how has that changed things for you?

03:33

Speaker A

that's fine but you know they would I'd go to places with them or I'd kind of have people there but more and more I'm just finding myself just staying in a lot I mean I went like two weeks give

03:46

Speaker A

Um, you know, it's kind of... I haven't really told anyone. So I mean, it's made it, like, better in the sense that I feel hopefully this is, you know, this is it, it will help. But I don't know. I don't like thinking that I've had to do this. I never thought I'd be the kind of person you'd have to actually go and get help. If that makes sense.

03:57

Speaker A

about how where this is going to lead to yeah um yeah okay so you said that you first noticed the anxiety kicking in when about five or six years ago so you would have been about 19 yeah and what was

04:10

Speaker A

Okay. So how do you feel about being here today?

04:24

Speaker A

as much as not at all as much as it has been doing the last few years I guess it just started when it like my friends went to University and I don't know I felt like I was expected to kind of move

04:34

Speaker A

It's like scared. I don't know. Hopefully it will help.

04:48

Speaker A

I love it I really like doing photography but I'm just kind of getting less and less work as it goes on so which is my fault I keep saying no but what kind work is the most difficult for

05:01

Speaker A

Okay. So you've been feeling a little bit anxious about today.

05:15

Speaker A

there not just photographers but actual you know if I'm like taking photos of people that I don't know I just kind of find myself saying no I mean I want to do them but just it's scary so I just

05:27

Speaker A

Yeah.

05:41

Speaker A

and you're going to have to have social interaction what kind of thoughts go through your head um just I mean I get really hot and sweaty and I don't I feel like everyone's kind of looking at me and thinking that I'm just like really

05:56

Speaker A

Okay. So I guess, just going back to why you went to the GP and how you've ended up coming here today: it sounds like you've been experiencing anxiety for quite a few years, but just recently you moved out of home for the first time, and that was what kind of led you to go to the GP. So how did that change things? How were things after you moved out?

06:09

Speaker A

just kind of just try and get out of the situation or just focus on something else so that's why I like doing shots where it's just me and the camera because I then I can just put all my

06:19

Speaker A

I thought that they'd be better, because I thought I'd have to be independent. But it's actually a lot worse. I'm just kind of staying in the house a lot. I don't really have any friends or anything. I mean, my family come and visit a bit, but it's not... I don't know. It's kind of scary, because I've just been kind of literally just in the flat by myself, which I always thought I'd like, but I don't actually like it.

06:32

Speaker A

will stare people will think I'm a weirdo there's quite a lot about what you what you think are the people will think yeah um and how does that make you feel um just makes me feel like an idiot

06:44

Speaker A

Okay. So what are the kinds of difficulties that you have been experiencing?

06:56

Speaker A

and they're normal and I'm just the freak who can't like do normal things and okay can you give me an example of a recent situation maybe we can focus on that um like a work situation or just yeah time when you were maybe doing a

07:10

Speaker A

Um, I mean, I'm a photographer, so it's been stopping me a bit. My anxiety has been stopping me from being able to get work, because every time there's an opportunity that involves me having to interact with people, I just tend to turn it down. So I was kind of making things hard in that respect. And, um, just friends-wise and everything, I just feel like I'm increasingly more alone. So it's kind of stopping me from making friends and, you know, relationships and stuff.

07:20

Speaker A

to work with a lot of different people um and and when they told me about the job I thought it would be fine I thought it was just going to be a few other photographers but there actually people

07:31

Speaker A

Okay. So you said that your difficulties are getting in the way of you doing certain things. They're stopping you from taking on certain types of work, and as a freelance photographer, I guess that can be quite a problem. And they're also stopping you socially, or you feel like they're stunting you. You're not able to make new friends and meet new people.

07:43

Speaker A

was for some kind of I'm not sure if it was a campaign or something but it was yeah it was really cool but I find it found it really hard to try and focus on that cuz I was so I was kind of feeling

07:56

Speaker A

Yeah, yeah. Um, it was kind of easier when I was at home, because I was obviously with me and my parents, and so that was fine. But they would... I'd go to places with them, or I'd have people there. But more and more, I'm just finding myself staying in a lot. I mean, I went for coffee with my friends for like two weeks, and the whole time I was just wanting to go home again. So I just don't want that to happen. I don't want to lose everyone.

08:07

Speaker A

in your head when you were in that situation I just felt really just really kind of hot I couldn't really breathe and just felt like I wanted to just get out and I was kind of trying really really hard to just focus and just you

08:21

Speaker A

So you're worried about where this is going to lead.

08:33

Speaker A

was just thinking I was really stupid and I shouldn't have been there and I can tell you getting kind of anxious even just thinking about that day yeah okay so you're describing quite a lot there to me so you're saying that you

08:44

Speaker A

Yeah. Um, yeah.

08:55

Speaker A

just hold it really tightly it would just I don't know I'd kind of just be able to just get through it and just focus so you're holding the camera very tightly and why was that why was that helpful cuz I felt like I was getting

09:07

Speaker A

Okay. So you said that you first noticed the anxiety kicking in about five or six years ago, so you would have been about 19?

09:17

Speaker A

shaking like loads like and I could just tell everyone was looking and they could see and I just thought if I just managed to hold on to it it wouldn't be as noticeable but okay so okay so it sounds

09:28

Speaker A

Yeah. And what was happening around that time?

09:44

Speaker A

like kind of like everyone was just going to be staring and just thinking that like I just felt like everyone was looking at me and just they could tell and just thinking what what she doing and they could tell what I was just

09:59

Speaker A

Uh, I guess I'd finished school about a year before that. And I've always been a bit shy at school, but it was never... it didn't really affect things as much as it has been doing the last few years. I guess it just started when my friends went to university, and I don't know, I felt like I was expected to move out or do something, and then it just kind of escalated from there. I'd just stop going to parties, or I'd say no to invitations, or... I don't know. I thought my job would help, because I love it. I really like doing photography. But I'm just getting less and less work as it goes on, which is my fault. I keep saying no.

10:10

Speaker A

can't tell but I mean my hands like they was so shaking I was really red and just just just wishing that I just wasn't there so I mean you've already described it to me a little bit but if you think

10:22

Speaker A

But what kind of work is the most difficult for you in your job?

10:34

Speaker A

probably sweating and shaking like my hands were definitely really really shaking um and every it was like definitely really noticeable everyone could definitely see okay and what what did you do about how did you try and conceal that or hide that um well again

10:51

Speaker A

I guess when I have to be working with other people. I don't like that. When I'm trying to do an event or something where there are a lot of people there, not just photographers but actual... if I'm taking photos of people that I don't know, I just find myself saying no. I want to do them, but it's scary, so I just don't do it.

11:05

Speaker A

not look at anyone else and just yeah just kind of try and get on with it as best as I could but so you avoided looking at people it sounds like you wore black as well in kind of

11:16

Speaker A

So tell me a bit more about what happens then. Let's focus on maybe an invitation to do a job that's going to involve photography with a group of people, and you're going to have to have social interaction. What kind of thoughts go through your head?

11:30

Speaker A

end um well it kind of went on for like an hour or so and then um people were going um just after every shoot people go out for drinks after just to kind of celebrate like that we've done it but I

11:44

Speaker A

Um, I just... I get really hot and sweaty, and I feel like everyone's kind of looking at me and thinking that I'm really stupid. I feel like they're all going to be staring and thinking I just can't do my job, and I'm just an idiot. I mean, they'll think I just look like a weirdo. And I just try and... I just kind of try and get out of the situation, or just focus on something else. That's why I like doing shots where it's just me and the camera, because then I can put all my attention on that instead of having to be with other people.

11:54

Speaker A

away okay

Topics: social anxiety CBT clinical case study first session assessment safety behaviours avoidance freelance photographer therapy clinical psychology

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