Mental health case study

Our in-house team of fully-qualified rehabilitation experts are always on hand to support employees as they return to work. We were able to help Ben – who was experiencing presenteeism and displaying signs of distress and anxiety at work – using a cognitive behavioural approach.

Ben, in his 50s, had worked for his company for over 20 years. His manager referred him to our rehabilitation team because of concerns that there had been a noticeable change in his behaviour. Ben’s manager had observed that he was no longer engaging with the rest of the team and would disappear for long periods of time during the working day. Ben seemed to be struggling with his work so his manager contacted our rehabilitation team to see what advice they might offer to help him help Ben.

How Zurich was able to help

One of our rehab team spoke to Ben and he explained that there was conflict with two people in the office, which he felt had been escalating over the past few weeks.

Ben admitted that he dreaded coming into work, was not sleeping very well, and was very tearful as he shared how he was feeling. He described feelings of low mood and not wanting to get out of bed in the mornings. Ben also described feeling anxious as he walked into the office and symptoms of sweating, “butterflies” and chest tightness.

Ben continued to describe how if he heard laughter in the office, he felt people were laughing at him, and it made him feel angry and he wanted to shout at them to stop. Ben stopped using the shared breakout room and would go off for short walks or sit in his car to avoid others in the office. He was also refusing to go to staff meetings.

Ben was asked if he would be happy to complete a GAD-7 questionnaire, a measurement for anxiety disorders, and a PHQ-9 questionnaire, a measurement for depression. These are the national standard measures routinely used by GPs, therapists and psychiatrists as screening tools. The scoring for both helps people to understand how severe the issue is. The general rule is that the higher the number, the more severe the case is (Efficacy, 2020).

Ben scored 25 on the PHQ-9 and 20 on the GAD-7, which indicated the issues were severe (see table below). He was advised to see his GP to discuss if medication would be appropriate. Ben said he didn’t want to go off work sick but agreed to see his GP. Ben’s manager agreed to talk to the team about office etiquette and team-working, and supported Ben by agreeing that when he needed to get out of the office for a break, he could do so, but that he should notify his manager first.

Ben’s manager contacted our rehab team to speak in confidence about Ben’s behaviour in the office, as it was becoming apparent it was affecting the rest of the team. Ben was refusing to engage with his colleagues, was shouting at them and would disappear for long periods without notice, which was having a detrimental effect on his productivity and the overall morale of the office.

Ben had been to see his GP, who prescribed medication and advised him to self-refer for counselling support via the NHS website. Ben also had an ECG due to his symptoms of chest pain – the result was normal. He was taking several walks a day out of the workplace as he felt he couldn’t cope being in the office for prolonged periods.

Research (Wilday and Dovey, 2005) suggests that feelings of anxiety are an emotional response activated by fear-based cognition. The “flight or fight” response means that people cope with physical danger by fighting or fleeing.

Ben was clearly engaging in avoidant behaviour by not having his breaks in the communal break room, missing team meetings, and taking several walks a day during work time. Ben’s cognitive perception of “bullying” resulted in him experiencing “high threat”, and led to symptoms associated with anxiety, such as chest pain, sweating and a disturbed sleep pattern.

Ben’s perception of the situation was having a negative effect on his physical and mental health, but even if we can’t control or influence how others treat us, we can control and influence how we react to those individuals. It was important for Ben to understand more about the cause and effect of his dysfunctional thinking. He agreed to try the following interventions to challenge his beliefs and develop new coping strategies going forward.

• Keep a mood diary. In cognitive behavioural therapy, a “mood record” guides you through the steps of identifying, challenging, and reinterpreting negative thinking patterns. With a mood diary, Ben could document his negative emotions, analyse flaws in his thinking, and re-evaluate his negative thoughts into more balanced ones. Mood diaries also promote autonomy, responsibility and control.
• Start to attend the team meetings he had been avoiding but to stay within easy reach of the exit so he could get up and leave whenever he felt he was not coping. Ben’s manager was happy to support this approach.
• Challenge the individuals that he felt were bullying him. This could be done in a positive way, for example, “when I hear you laughing and talking, I feel that you are talking and laughing at me, this makes me feel angry and sad, so please stop”, or to simply ask them “are you laughing and talking about me, as that is not a very nice thing to do?”.
• Access an online six-week CBT course with the company’s employee assistance programme.

A turning point in Ben’s thought processes and behaviour

Our rehab team contacted Ben weekly for six weeks. During this time, we also spoke with Ben and his line manager together. At each of the meetings, Ben shared his mood diary and some of the activities that he had been doing online to identify when his mood took a big dip. As the weeks passed, Ben was encouraged by his manager to join in with short work updates which Ben could prepare for in advance and deliver. Ben was nervous about doing this, but he also recognised that it was helping with his confidence and engagement within the team environment.

A big turning point for Ben was in week four, when he emailed the individuals that he felt were laughing and talking about him, telling them how it made him feel. They in turn were shocked and very apologetic that he felt that way, and assured him they would be mindful of his feelings in future. Ben was elated by this response and shared that he felt so much better for taking control.

Ben continued with his online CBT course and mood diary and through the cognitive behavioural approach, learnt to challenge his thought processes, which in turn had a positive effect on his behaviour. Ben’s symptoms of anxiety began to reduce, and he started to sleep better. Ben said he still felt apprehensive during team meetings and when he went into the shared break area, he noticed he would still sweat and experience “butterflies” but not to the level previously.

At the last meeting, Ben said that some days were still tough and when he was having one of these days, he relied on the coping strategies he had developed.

Ben’s manager noticed that Ben’s engagement and performance had significantly improved with the support and guidance he had received, and the manager described the support available to him as a “tremendous help in a difficult situation”.