CASE STUDY ANNA 1
Anna: A Case Study
Jamileh Fard
Liberty University
Author Note
"A cheerful heart is a good medicine, but a crushed spirit dries up the bones."
Proverbs 17:22
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Abstract
Anna, an Asian-American widow, is 68 years old. This case study aims to assess critical issues in
Anna's daily life. Based on the information available, I will provide diagnostic impressions and
discuss and suggest treatment options. I will also take special considerations into account.
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Anna: A Case Study
Symptoms Behavior Stressor
Fatigue She is not motivated to
accomplish her task around
the house
Aching muscles, the feeling of
muscle weakness, headache,
irritability, easily agitated
Anxiety Withdraw from friends and
family, wound-up, easily
fatigued, irritable, and having
difficulty controlling feelings
of worry. Difficulty falling or
staying asleep, consuming
alcohol
Unfounded worry about her
life, her kid's life, her
grandchildren's life, baseless
finical issues worrying about
other people's feelings and
thoughts about herself,
concern about her family
culture, concern about taking
care of her mother
Muscle Tension Frequent headaches, feeling
pain in her body overall, poor
or low energy, low
concentration
Increasing her anxiety,
exhaustion
Social Isolation She is losing contact with her
friends and family, which are
very important to her
Drinking more alcohol.
Increasing fear, anxiety
Fear Racing thoughts Taking care of her mother is
difficult for Anna, loneliness
Irritable Becoming sad and angry, "I
couldn't stop worrying."
Too much sensitivity to other
people's opinions, culture-
sensitive, uncritical thoughts
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Biological
Anna stated that she is experiencing increasing physical anxiety symptoms. Recently, her
doctor prescribed Paxil. She has been prescribed this medicine for four weeks and is currently
taking it. Her physical symptoms include difficulty falling asleep, increased body tension,
fatigue, frequent headaches per week, and exhaustion. In addition, she claims to drink two
glasses of wine daily, five days a week, because it helps her to calm down temporarily.
Unfortunately, this may lead to an unwanted reaction to Paxil.
Psychological
Anna has a history of mild anxiety and has struggled with anxiety all her life, as her
children claim. However, it has gotten worse in recent years. Her pressure increased after her
husband died, after her retirement, and after losing contact with her collogues. After taking in her
mom, she is dealing with worrying thoughts that race through her mind. She becomes irritable
and angry when her family complains about her anxiety.
Social
Anna appears to have been affected significantly by her recent job retirement. Anna
stated that her social network consisted primarily of coworkers. However, due to her increasing
anxiety, she lost connection with her prior colleagues in the last 18 months. Also, her anxiety and
unfounded worry have significantly affected her relationships with her children and
grandchildren, which hurts her emotionally.
Spiritual
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Anna is Hindu and sensitive to her culture and beliefs. While this counselor does not
believe in or practice Hinduism, she has an ethical obligation to assist the patient in incorporating
the beliefs and values she desires. In this case study, Anna's Hindu beliefs could be used to help
reduce her anxiety.
Assessment
In this paper, as a counselor, I assess Anna and develop appropriate behavior to help her
reduce her anxiety. Since her family is immigrants and she is culturally sensitive, I need to
research her culture. I hope to learn about her Hindu culture to help her feel more comfortable
with me. Reading Anna's case, I believe she is struggling with Generalized Anxiety Disorder
(GAD). I used the Beck Anxiety Inventory (BAI) assessment for Anna. This scale is a self-
reported anxiety scale to assess Anna's severity of physical and cognitive anxiety symptoms.
Diagnostic Impression
After checking Anna's symptoms and studying Anna's details, I found out that Anna has
an anxiety disorder. The DSM-5 coding for her categorizes as generalized anxiety disorder
300.02 (F41.1). Anna now drinks alcohol frequently and must take medication to deal with her
anxiety, but she still struggles with increasing unwanted anxiety. In addition, Anna suffers from
separation anxiety disorder 309.21 (F93.0). Her husband's death worried her. As a result of her
husband's death, she worries about her children.
Signs and Symptoms
DSM-5 Diagnostic Criteria: disorder
name and code number
Client's Signs/Reported Symptoms:
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Criterion A: Generalized Anxiety Disorder
300.02 (F41.1)
Being easily fatigued
Irritability
Muscle tension
Sleep disturbance
Restlessness
Criterion B: Separation anxiety disorder
309.21 (F93.0)
Unusual distress at the discussion or
experience of being parted from their
attachment figure.
Excessive fear of being alone
Excessive fears that harm will occur to their
attachment person
Criterion C:
Criterion D:
Other DSM-5-TR Conditions Considered
The client has shown three symptoms of Major Depressive Disorder. For this diagnosis,
the client must present five of nine DSM-5 symptoms. The lack of symptoms rules out this
diagnosis. Considering she reported she drinks wine frequently during the week and that her
drinking developed more after the current symptoms, I think Substance/Medication-Induced
Anxiety Disorder DSM-5 292.8 (F19.18). She does not believe self-treatment and drinking help
her to calm down. For this diagnosis, the symptoms must coincide with or follow the use of the
substance for the disorder to identify and distinguish it from other anxiety states. Once again, the
lack of coincidence rules out the diagnosis.
Developmental Theories and/or Systemic Factors
Erik's developmental theories play a role in Anna's case. She points to Stage 7,
Generativity vs. Stagnation, and Step 8, Integrity vs. Despair. Anna desires to give to family,
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friends, and the community. She wants to feel valued, respected, and succeed at her job. Anna
must remember what she has achieved, which will lead to her satisfaction.
Multicultural and/or Social Justice Considerations
Anna appears to have integrated into American society and maintained some family
traditions. Regarding social justice, I am considering whether the government can help him help
his mother.
Treatment Recommendations
Key Issues for Treatment
Priority should be given to learning:
ocoping skills to reduce her anxiety symptoms
oreducing Anna's anxiety and worry
odeveloping Anna's social interaction
ochanging Anna's thoughts and creating a positive attitude
Recommendations for Individual Counseling
Relaxation training and cognitive behavioral therapy are two treatment recommendations
for individual counseling based on the key issues (Cuijpers, Sijbrandij, Koole, Huibers, Berking
& Andersson, 2014). Relaxation training will assist Anna in learning calmness by relaxing one
muscle group at a time and visualizing calming images when she feels apprehensive (Kring &
Johnson, 2021). Cognitive-behavioral therapy techniques that would benefit Anna include
assisting her in developing coping mechanisms to allow her to tolerate uncertainty. Other
methods include asking Anna to keep journaling about her worries and the outcomes of these
worries; asking Anna to have scheduled times during the day when she feels worried; assisting
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Anna in learning grounding techniques to help her remain in the present rather than worrying;
and assisting Anna in addressing any core fears she may have (Kring & Johnson, 2021).
Regarding Anna's desire to incorporate her spirituality and religion into counseling, Hindu-based
principles and practices must be combined with cognitive behavioral therapy (Koszucki,
Bilodeau, Raab-Mayo, & Bradwejn, 2014).
Specific Considerations
In Anna's case, cultural history is essential. Many of Anna's worries and anxieties appear
unfounded, but one primary source of stress contributing to this anxiety and fear is Anna's
responsibility to care for her mother. Anna seeks counseling because she cannot physically attend
to and care for her mother; sending her mother to a nursing home would embarrass her in front of
the family. Anna's family is Asian and Hindu, which is shameful to send your Parent out to
nursery home. Learning more about Anna's culture is helpful for understanding cultural
perspectives on mental illness and treatment. Anna also complains she does not have much ftime
to attend another school because she is caring for her mother and needs her daughter's assistance
to continue working. Working with Anna may result in value conflicts, such as practicing
Christianity rather than Hinduism or Islam. While multicultural counseling is vital, Anna may be
opposed to receiving help from a Christian counselor. To manage Christian's values while
working with Anna, the counselor must set aside personal values and focus on what Anna
requires.
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References
American Psychiatric Association (2022). Diagnostic and statistical manual of mental
disorders: DSM-5 TR (5th ed. Text Revision). American Psychiatric Association
Publishing.
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014).
Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical
Psychology Review, 34 (2), 130-140. https://doi.org/10.1016/j.cpr.2014.01.002
Holy Bible: New International Version. (2011). Grand Rapids, MI: Biblica
Koszycki, D., Bilodeau, C., Raab-Mayo, K., & Bradwejn, J. (2013;2013;). A multifaith
spiritually based intervention versus supportive therapy for a generalized anxiety
disorder: A pilot randomized controlled trial. Journal of Clinical Psychology, 70(6), 489-
509. https://doi.org/10.1002/jclp.22052
Kring, A. M., & Johnson, S. L. (2021). Abnormal psychology: The science and treatment of
psychological disorders (15th ed). John Wiley & Sons, Inc.
