John was advised to seek psychotherapy by an occupational health nurse at work. He went to her at the instigation of his manager, following an appraisal. The manager had told him that his subordinates had complained that John was irritable, colleagues felt that he was not pulling his weight, and, to top it all, his performance was also deteriorating.

John was unable to account for these changes at first, but as the assessment interview continued, he admitted that he found travel more and more difficult. As a result, although he did more than his fair share in the office, he often tried to avoid work that required travelling. He knew that this was not good, and he had begun to worry constantly about it. The travel problem increasingly became the focus of the assessment interview. John said that he would worry for days if he had to make a long rail trip and that he would hardly sleep at all if he had to fly. He had taken to having one or two stiff drinks before travelling, too. When actually on a train, he would be OK if he could bury himself in something, but as soon as he started to think about not being able to get out in the event of an accident, his anxiety mounted.