Client R
Details: Male, Married with 2 children, employed in marketing
Presenting concerns: Sudden anxiety with palpitations, sweating, tremors, and restlessness
Other details: chronic smoker with occasional alcohol consumption, found allergic to Nexito
Day 1
We began the session by taking baseline records. We found R’s (skin conductance level) to rise gradually before reaching a stable value of 2μS after five minutes, while his BVP (blood volume pulse) remained uniform. For the next twenty minutes, we spoke about the client’s childhood, recent past, habits, among other aspects, in an attempt to understand his triggers for anxiety. His parameters revealed nothing.
Throughout the rest of the conversation, I found that R had a mostly positive outlook and was in general goal-oriented. He seemed happy and content with his family, work, and most other aspects of his life. For a few moments, I was stumped. Educating the client through biofeedback required a response to triggering thoughts, and there did not seem to be one.
For a few moments, I was stumped. Educating the client through biofeedback required a response to triggering thoughts, and there did not seem to be one.
That changed when I looked at the post-session graph. During our discussion, R’s SCL had severe fluctuations and rose to a peak of 10μS. His temperature and BVP were equally irregular.
What stood out to me was a stark contrast between R’s body language and his parameters. I asked if there was something he might be hiding from me, or something he might be hesitant to share. His answer was no, and it appeared genuine.
This led to my working hypothesis: the cause for the client’s anxiety may have been our conversation itself. In his daily life, the regular recurrence of anxiety may have stemmed from the many new faces he meets in his line of work. I requested a second appointment on the next day to test this idea.
Day 2
We began the session with a five-minute baseline record. We found the SCL to be high, at 30μS, but it quickly fell during the next five minutes. We spoke on various topics for around twenty minutes, at the end of which I brought up “hiding something in private life”.
Viewing the graphs post our discussion showed that the last point I brought up did not cause the client any disturbance. In fact, the SCL by that point was lower than the initial baseline value! This further reinforced my belief that meeting a new person was the cause for R’s anxiety. On day two, I was no longer a stranger to him and hence, meeting me did not cause much anxiety.
Day 3
We began the session by taking baseline values, before jumping into JPMR (Jacobson’s Progressive Muscle Relaxation – a simple mind-body relaxation technique) and some projection work using TAT (thematic apperception test). Post-session analysis was revealing.
During JPMR, the client experienced higher than usual SCL, which was maintained. While narrating his interpretations of the images in TAT, his SCL was around 10-11μS, which though elevated, was well within the normal range and much lower than in previous sessions.
This confirmed to me that since R had now become comfortable with me and his new environment, his baseline anxiety was lower. The rises during JPMR and TAT could be due to a new activity in which he did not feel comfortable.
I advised R to continue with JPMR as it would be beneficial for regulating his BVP and heart rate. Later that day, he dropped into my room to let me know he was feeling better due to the rTMS (a neuromodulation technique) going on in parallel. I assured both him and his spouse that regular practice in therapeutic methods (like JPMR), medication, and familial support would help him lead a fulfilling life.
Image Credit: Towfiqu Barbhuiya (Pexels)