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Gladys's story

Gladys is an 82-year-old woman who had been married to Bert for over 60 years when he died suddenly of a heart attack. Following the death, her two sons arrived and stayed nearby, helping her with the funeral arrangements and sorting through his effects. Gladys lived in Leeds, her eldest son lived in London and her younger son lived in Glasgow. Immediately following the death, they were amazed at how well she seemed to be coping, noting that she was still smiling and very pleased to see them. Indeed, they were so encouraged with her apparent coping ability that they all returned to their homes after 3 weeks with no concerns about her. As before, they telephoned her once a week.

Three months after Bert's death, George received a telephone call from one of his mother's friends. She had become increasingly concerned that she had not seen Gladys since the funeral. Previously, Gladys had been a sociable lady who took part in various church activities, but she had not attended any social events or been seen in church since the funeral. Most of her friends had assumed she was staying with one of her sons. George was shocked to hear this and decided to travel to visit his mother the following week.

When he arrived, he could immediately see how overgrown the garden had become. His parents had always been keen gardeners, but now there was a mass of weeds and the grass was uncut. His mother was slow to answer the door and when she did, George was appalled to see how thin and unkempt she appeared, and how dirty and untidy the house was. Gladys had always been house proud and taken pride in her appearance. She was surprised to see George but welcomed him indoors and started general ‘small talk’ as she would do in her weekly telephone calls. It was clear that there was little food in the house and that Gladys had been mostly existing on bread and butter. George told his mother he would spend some time with her looking after some of the practical issues: going shopping, helping clean the house, going through unopened mail, cutting the lawn and arranging for help with the garden.

Marina's story

Marina is a 30-year-old married woman with two young children. A few years ago, her youngest son, George, became seriously ill with meningitis. Although George recovered well, Marina started to worry about her children catching serious illnesses and dying. She began to clean the house meticulously, scrubbing the entire kitchen and bathroom with bleach every day. If she touched anything touched by non-family members, she would wash her hands, and she constantly used antiseptic hand gel. Her hand-washing increased until she was doing it almost 100 times a day. Bathing or showering could take up to 3 h, as she felt the urge to wash until she felt certain she was completely clean. As a result, her hands became chapped and she developed bodily eczema. The children were discouraged from mixing with friends apart from at school, and Marina told them to use antiseptic hand gel at all times. When they returned from school, they had to take off all their clothes in the hallway; Marina washed the clothes immediately, while the children had a bath. Marina's husband had become so concerned about her vigorous washing of the children that he had started returning home at the end of the school day to supervise more ‘normal’ washing of the children, before he then returned to his work as an electrician.

Every attempt by her husband and mother to encourage Marina to seek help had failed. She felt too embarrassed to own up to the problem and felt she was doing her best to keep the children well and happy. After a discussion with her mother, Marina began to realise that her children were living a very restricted life and that they should have more freedom. She also worried that Social Services might become involved in the family and so, reluctantly, went to her general practitioner (GP).

Marina's GP talked to her about treatments for obsessive– compulsive disorder (OCD). Initially, she had the choice of starting on a medication and psychological treatment involving graded exposure. Marina felt she would prefer to try a psychological approach first, and her GP referred her to the local psychological therapy service.

Linda's story

Linda is a 30-year-old nurse who works part-time and has two young children. Although always an anxious person, she began noticing that she was becoming more anxious about 3 years ago. At this time her eldest child started school and she had to take her baby to nursery, drop the oldest boy at school, and then go to work at a local health centre where she worked from 10 am to 2.30 pm. She found this rushing to several places stressful and noticed she was finding it hard to concentrate because of her increasing anxiety: she was constantly worrying that she would not make it to either work or school on time.

Her husband noticed she was stressed and suggested she talk to her general practitioner (GP). Linda was reluctant at first as she felt she should be able to ‘snap out of it’, but eventually agreed. The GP thought that she seemed very stressed and discussed treatment options with her. Linda did not want to take medication but agreed to a referral to the local psychological well-being service for a course of cognitive– behavioural therapy (CBT). Linda's GP also encouraged her to eat regular meals, avoid excessive caffeine drinks and alcohol and stop smoking, to help reduce her symptoms. The GP told her that regular exercise also helps some women overcome some of the symptoms of anxiety.

Linda started taking good care of her general health by eating well-balanced meals, reducing her alcohol consumption to no more than a small glass of wine on a maximum of 5 days a week, reducing her coffee drinking and joining a fitness club. She went on a quit-smoking course and hasn't smoked for 6 months. Linda also attended five CBT sessions, in which the therapist helped her identify some of her ‘trigger’ thoughts – the ones that caused feelings of anxiety – and helped her deal with these thoughts, as well as exploring her ways of coping.

Linda now feels well and able to enjoy life. She admits that she does become stressed and anxious at times but, instead of entering into a vicious circle of anxiety, worry and guilt, she knows she can examine the reasons she feels stressed and try to work out the best possible solutions.