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ANA CASE STUDY #1
Anna Case Study
Rocio Vega Arriaga
CEFS 546-Psychopathology, Liberty University
Author Note
Rocio Arriaga
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Rocio
Arriaga. Email: rvega[email protected]
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ANA CASE STUDY #1
Symptoms
Anxiety
Client Concerns
Behaviors
uncontrollably anxious,
having a hard time sitting
still, irregular sleeping
patterns
Worries all day, headaches,
shoulder, and neck ache.
Diagnostic Impression
Stressors
Retirement, loss of friends
and family relationships.
WorrisomeAre the kids safe? Do I have
enough money for the rest of
my life? Etc. Anna has never
experienced any of the events
she is worried about.
FearLoss of friends, grandchildrenFears that no one will want to
no longer want to be around be around her again and that I
her. will die alone in the streets,
forgotten and rejected by my
friends and family
FatigueTired all the time, no energyNo motivation
Assessment
The Beck Anxiety Inventory (BAI) consists of 21 self-reported items (four-point scale) used to
assess the intensity of physical and cognitive anxiety symptoms during the past week. The scale
ranges from Not All (0), Mildly (1), Moderately (2), Severely (3). The average time to complete
is about 10 minutes. The BAI is the logical choice for Anna because The BAI is a 21-item state
anxiety scale measuring the intensity of cognitive, affective, and somatic anxious symptoms
experienced during the last 7 days (Goldbloom, 2006). In my research I also found that the
measure has been validated in other countries, with studies suggesting that the measure is
reliable and valid in numerous cultures (Beck Anxiety Inventory, 2018).
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Criterion B: Separation Anxiety Disorder
309.21 (F93.0)
DSM-5-TR Diagnostic Criteria: disorder
name and code number
Criterion A: Generalized Anxiety Disorder
300.02 (F41.1)
Developmental Theories and/or Systemic Factors
Client’s Signs/Reported Symptoms:
excessive worrying, increasing anxiety,
uncontrollably anxious about everything, pain
in neck and shoulders, wound up and tense,
difficulty sitting still and experiencing
headaches 3-4 times a week.
Felt very sad and cried a lot the year after her
husband died. Reported that leaving her job
was hard because of leaving friends.Lost
every friend (coworker) except two. Retired
from job and felt like her usefulness might be
over. It makes her sad that her grandchildren
do not want to be around her. She is worried
that no one would ever want to be around her
again and that she will die alone in the streets,
forgotten and rejected by my friends and
family. She is experiencing headaches 3-4
times a week.
Other DSM-5-TR Conditions Considered
Major Depressive Disorder symptoms were shown from the client but I couldn’t diagnose
her with it because there were only 4 of the 9 symptoms that she had. The client expressed
feeling tired all the time and having a really hard time motivating herself to do anything around
the house. She reported her fatigue has been present for at least 12 months. Client also reported
in the past 12 months she has struggled to get to sleep nightly. Retired from job and felt like her
usefulness might be over. A person must meet five or more symptoms to be diagnosed as having
MPD, but this is something to keep in mind.
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Key Issues for Treatment
●
Uncontrollable Anxiety
●
Excessive Worrying
●
Body tensions and headaches
●
Inability to sleep or sit still
Multicultural and/or Social Justice Considerations
Anna is an Asian-American born in the United States to parents who immigrated two
years before she was born. Based on Kring and Johnson, culture and settings may impact and
influence anxiety disorders, this must be considered while analyzing symptoms for a diagnosis
(Kring & Johnson, 2021). Anna holds many of her parent’s Asian traditions, including the need
to prevent her mother from entering a nursing home. She reported that it would be such a shame
in the family if she allows her mother to go to a nursing home and she would not be able to face
her family in Hindu. Anna deeply values her relationships including my children, grandchildren,
extended family, and friends. Her traditions, beliefs, and values play a big role in Anna's life as
she wants to integrate the teachings of her religion into counseling.
Anna is presently in Erickson's Psychosocial Development Theory's eighth stage, ego
integrity vs. despair. At this stage, individuals review their lives, either with satisfaction or regret
(Chen & Yeh, 2021). She had already lost her husband, experienced retirement, loss of friends
and family, and now caring for her elderly mother. Anna is now worried that no one would ever
want to be around her again and that she will die alone in the streets, forgotten and rejected by
my friends and family.
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ANA CASE STUDY #1
Specific Considerations
Anna’s cultural background plays an important role in her treatment. Anna is Hindu and
she wants to integrate the teachings of her religion into counseling. Her traditions, beliefs, and
values play a pivotal role in Anna's life. Any treatment that may require Anna to put her mother
in a nursing home to reduce her anxiety will go against her cultural beliefs and values. The
counselor would have to educate herself in the Hindu religion and avoid imposing any personal
values or beliefs during the process of the treatment (ACA, 2014). The counselor will need to
respect and incorporate Anna’s beliefs, values, and traditions into the treatment process.
Recommendations for Individual Counseling
Treatment for Anna would begin with cognitive behavior therapy. Cognitive behavioral
therapy (CBT) appears to be a therapeutic strategy that is as effective for adults and young
people with anxiety disorders. Many studies show that Cognitive Behavioral Therapy (CBT) is
an effective therapeutic strategy for a wide variety of mental disorders, as it is a preferential
treatment for anxiety disorders (Salza, etc., 2020). This would help equip Anna with specific
skills to manage her uncontrollable anxiety and excessive worries. Mindfulness training is
increasingly being incorporated into traditional cognitive behavioral therapy (CBT) approaches
(Webb, etc., 2019). Mindfulness methods like breathing, meditation, walking, or even exercising
will allow her to calm her mind and body and just focus on the present moment rather than
creating unfounded worries.
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ANA CASE STUDY #1
Goldbloom, D. S. (2006b). Psychiatric Clinical Skills. Elsevier Gezondheidszorg.
Salza, A., Giusti, L., Ussorio, D., Casacchia, M., & Roncone, R. (2020). Cognitive behavioral
therapy (CBT) anxiety management and reasoning bias modification in young adults with
anxiety disorders: A real-world study of a therapist-assisted computerized (TACCBT)
program vs. “person-to-person” group CBT. Internet Interventions : The Application of
Information Technology in Mental and Behavioural Health, 19, 100305-100305.
https://doi.org/10.1016/j.invent.2020.100305
Webb, C. A., Beard, C., Forgeard, M., & Björgvinsson, T. (2019). Facets of mindfulness predict
References
ACA Code of Ethics. (2014). Retrieved from
https://www.ncblpc.org/Assets/LawsAndCodes/ACA_Code_of_Ethics(2014).pdf
Beck Anxiety Inventory. (2018, March 30). The National Child Traumatic Stress Network.
https://www.nctsn.org/measures/beck-anxiety-inventory
Chen, P., Ho, W., Lo, C., & Yeh, T. (2021). Predicting ego integrity using prior ego development
stages for older adults in the community. International Journal of Environmental
Research and Public Health, 18(18), 9490. https://doi.org/10.3390/ijerph18189490
Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Arlington, VA:
American
Psychiatric Association.
Kring, A. M., & Johnson, S. L. (2021). Abnormal psychology: The science and
treatment of
psychological disorders (15th ed.). John Wiley & Sons, Inc. ISBN:
9781119933489.
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depressive and anxiety symptom improvement above CBT skills. Mindfulness, 10(3),
559-570. https://doi.org/10.1007/s12671-018-1005-1
