FORMULATION Early Life Experiences Family history of mental health difficuties e.g. paternal grandmother's diagnosis of Schizophrenia and father’s diagnosis of depression when Heather was 15 Poor relationship with paternal grandmother (afraid of her) Bullying by peers at school (physical and emotional abuse) Poor relationship with food ~ binge eating to cope with bullying ‘Symptoms of MS started when she was 16 Core Beliefs am worthless, | should keep everyone happy, | must keep my feelings hidden Others are untrustworthy, the world is not a safe place, something bad is going to happen p Conditional Beliefs IF allow others to get close to me, | will get hurt If1 please everyone, | will not get rejected If avoid work and crowded places, | am safe cannot control situations, something bad will happen ub Critical incident Change of departments at work (complaints) ~ 4 NZ Coan work became more stressful ~ disciplinary ns “People should have more respect for me” "Something bad is going to happen” Behaviour Emotions Emotional outburst, irtable Anger, fear ‘and abrupt with others ’ frustration, low mood Physi Headaches / migraines, Muscle tension, NauseaPredisposing Faciors Brought up around mental health difficulties in family (paternal grandmother and father) When her father experienced depression, difficulties in the family led to family therapy Bullied by peers at school experienced physical and emotional abuse Heather began experiencing symptoms of MS when she was 16 BBinge-eating and self-harm to cope with bullying J Precipitating Factors Heather's job was moved to a complaints department which she found very stressful. She found this difficult to ‘manage, which led to a disciplinary. ar ina Factors Presenting Factors Core BelsfsSchemas Anxiety and fear of Difcuties wih anger! |.am worthless (sel) others ~ particularly in | should Keep everyone crowded places: aggression happy (self) High levels of anxiety | must keep my feelings Worrying about the past [JAP enn teem hidden (sel) ee He ‘The world is not a safe Diagnosis of MS place (the world) Angetlaggression ~ others are untrustworthy iil to express in a (others) healthy way Something basis going to happen (the future) ‘Avoiding shopping / going out Zz Lo — Protective Factors eather has maintained her ful-time job for along period of time and has a long-term partner, indicating her abilty to maintain long-term relationships Able to build a therapeutic relationship High motivation in therapy ~ has attended every session Has a supportive family and some friends at work Has some psychological insight of her dfficuties