Client Case
Presenting Issues
Client reported intense anxiety leading up to presentations at work. Symptoms included dry mouth, increased heart rate, mental blanking, and avoidance behaviours.
Background Information
The client is a 39-year-old marketing executive. The anxiety began during university presentations but worsened with job responsibilities. Despite being knowledgeable in their field, the client avoided promotion opportunities involving public speaking and reported growing frustration and self-doubt.
Assesment
Client demonstrated anticipatory anxiety days before presentations, overestimated negative outcomes (e.g., “I’ll freeze and embarrass myself”), and experienced physical symptoms consistent with performance anxiety. Cognitive distortions and past negative experiences were contributing factors.
Treatment Plan
Goals
- Reduce physiological and cognitive symptoms of anxiety before presentations
- Build confidence and self-trust in public speaking situations
- Equip the client with coping tools for high-pressure environments
Intervention Strategies
- Psychoeducation about anxiety and the fight-or-flight response
- Cognitive restructuring to challenge negative self-talk
- Hypnotherapy for confidence and calmness under pressure
- Gradual exposure to speaking tasks
- 5 sessions over 5 weeks, with two follow-up check-ins over the next month
Frequency and Duration
6 weekly sessions over 6 weeks, with ongoing email check-ins between sessions
Results
Significant reduction in anticipatory anxiety
Successfully delivered a work presentation with only mild nervousness
Reports improved self-esteem and willingness to accept future speaking opportunities
Implemented daily calming techniques and self-talk strategies
"I still get a little nervous, but it’s no longer something I dread. I feel prepared, calm, and proud of how far I’ve come."
Case Details
Symptoms Encountered
Dry mouth, racing heart, shaky hands, sweating, nausea, muscle tension, blanking or forgetting words, difficulty making eye contact, fear of being judged, negative self-talk, avoidance of speaking opportunities, trouble sleeping before an event, over-preparing or procrastinating, feeling overwhelmed or panicked in front of a group.