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Introduction

To determine that client has a psychiatric diagnosis of mental illness due to the symptoms the client is presenting is crucial to determine what the problem Is and how to intervene medically. Psychotherapy has proven to be a very vital intervention in the management of multiple psychiatric disorders. This paper discusses the diagnostic and statistical manual of mental disorders (DSM-5) stipulations a client must meet before diagnosing the client with anxiety disorders, and the efficacy of cognitive-behavioral therapy.

Client and Situation

The process group session at PHP was a 14-year-old Mexican American girl who lives with her parents and other siblings. The client presents to therapy because she has a gift of vision, and her dreams are visions of the future because they materialize. The client is anxious and afraid the dreams will become a reality. The client reports her premonition warns her she owes it to her family to warn them about her dreams that usually come true. The client has a history of anxiety attacks that flared up and out of control after reporting her dream to mom that something mysterious beyond their control will happen to the family. The client reports intense anger when parents and other family members do not take her premonitions seriously, causing her to lash out to others. The client reports a history of sexual abuse by a cousin at age 12 in the bathroom. The client reports anxiety attacks sometimes with a specific visual flashback that reminds her about the sexual assault. The patient reports no medical diagnosis and no previous surgical experience. Patient reports taking medication for anxiety as needed. The patient dresses decently. Her speech is well articulated. The patient denies suicidal ideation, homicidal ideation, visual or auditory hallucinations. 

Prescription: 

• Vistaril 25 mg capsule. Take two by mouth 3 (three) times daily as needed for anxiety.                              

DSM DIAGNOSIS:

Other Specified Anxiety Disorder 

Post-Traumatic Stress Disorder

Other Specified Anxiety Disorder: Anxiety disorder, according to American Psychiatric Association (2013), is an emotional or mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one’s daily activities. Individuals with anxiety disorders tend to elaborate on the danger in situations they fear. In this scenario, the client’s anxiety became out of control due to her dream. Therefore, the client’s anxiety will not meet the requirement to call generalized anxiety disorder. According to APA (2013), this category applies when symptoms the client presents do not meet the stipulation requirements for any of the disorders in the anxiety disorders diagnostic class. 

Post-Traumatic Stress Disorder (PTSD). The client’s s specific visual flashback that reminds her about the sexual assault also qualify for a diagnosis of Post-Traumatic Stress Disorder PTSD). According to the APA (2013), a terrifying event triggers PTSD; symptoms include frequent repetition of vivid flashbacks, nightmares, severe anxiety, and frequent, persistent thinking out of control about the event. In PTSD, there is a trigger that stirs the mental/emotional response. Whereas Anxiety attacks, on the other hand, do not require a trigger. 

Efficacy of Cognitive Behavioral Therapy

Clients with an anxiety disorder have worries that can build up to tension as part of everyday routine. Some of these anxieties may be reflection or projection of inner struggles and how they express it. The therapist needs to determine if the client acknowledges that she has an anxiety disorder. The client accepting that she has anxiety will help her changeover as a collaborative approach to work together with the therapist to achieve a goal. There are many circumstances in which the presence of anxiety is maladaptive and constitutes a psychiatric disorder (Stahl, 2013). Emotional factors like anxiety disorder and PTSD can lead to onset, exacerbation, or relapse of psychiatric conditions leading to maladaptation, impairment, or dysfunctions that may or not respond to medications. 

According to Hofmann et al. (2012), the essence of CBT is to help the client repossess control of the maladaptive cognitions that contribute to the maintenance of emotional distress and behavioral problems. CBT is structured to disclose and dispute dysfunctional beliefs and help the client in self-discovery of misconceptions that drive the emotions and beliefs by asking questions that will make them understand why they engage in the behavior. 

CBT helps the client to understand the interactions of his thoughts, feelings, and behaviors. The client will benefit from CBT because the client will find irrational thoughts that trigger/provoke her emotions and change the thought to rational thoughts that are more realistic. (example client believing her dream can cause a dome or disaster to the family versus the number of times the manifestation of her dreams has come to reality). 

Expected outcomes for this client will include, 1) The client will develop strategies to reduce symptoms. 2) The client will learn strategies or interventions to avoid triggers. 3) The client will develop strategies to distract thoughts. 4) The client will learn two positive interventions for anger management strategies. 5) Recognize and acknowledge that she cannot change the future or control the outcomes of her dreams. 

Legal and Ethical Implications

The client is a minor. Consents from the parents are vital before initiating treatment. Maintaining the confidentiality of this client is also vital. The client discloses some of these vivid dreams to mom only and the client’s anxiety that is out of control to avoid the social stigma that comes with mental illness, which is worse in some cultures due to cultural misunderstandings (Simos & Hofmann, 2013).  

It is vital to establish therapeutic communication with clients that promotes effective communications. Excellent communication between the patient and the practitioner is imperative to ensure actual clinical practice and proper assessment of adherence behavior to ensure a positive change in the individual’s health and treatment outcome. 

Another fundamental process in ensuring accurate diagnosis and treatment is an accurate assessment by the practitioner. Diagnostic tests and appropriate physical exams are appropriate tools to help identify underlying factors that lead to a disease process

It is vital to respect the values and practices of the client’s cultures, using approaches that reflect awareness and sensitivity. 

Conclusion

In anxiety disorder, there is excessive fear and worry that incapacitates the individual, thereby interfering with activities of daily functions. Cognitive-behavioral therapy is a widely accepted form of effective treatments and interventions that reduces anxiety in children and adolescents (Hudson, 2005).

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