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CASE STUDY
Case Study Assessment: Jane
Ashara Morrisbrown
School of Behavioral Sciences, Liberty University
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CASE STUDY
Client Concerns
Symptoms Behaviors Stressors
Difficulty concentrating Difficulty sleeping Memories of the car
accident
Irritable Intrusive memories of the
accident multiple times a
day
Driving in a car
Easily angered Thoughts about how she
could do things differently
Soon she will have to drive
herself
“snapping” Nightmares 5x/week The highway
Keyed up Jumps//screams in the car Not seeing her friends and
family
Anxious Worried about her safety in
general (past 3 days)
Not going to church
Distracted Questioning why God let
this happen to her
Cannot care for her parents
the way she used to
Tense Avoiding the highway
Overwhelmed/worried
Recurrent flashbacks
Assessment
The assessment used in this case is the Acute Stress Disorder Scale (ASDS). According to
Bryant, Moulds, and Guthrie (2000) the ASDS is 19 item, self-report inventory that indicates
acute stress disorder and can also predict posttraumatic stress disorder (PTSD). This assessment
was chosen because research asserts that it has a high degree of validity, reliability, and identifies
acutely traumatized individuals and their risk for developing PTSD (Bryant, Moulds, & Guthrie,
2000).
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Diagnostic Impression
Jane presents with intrusive memories of the accident. She reported being afraid of
driving on the highway where her accident had taken place. More recently, she has been worried
and anxious about her safety in general. Jane reports having nightmares, difficulty falling and
staying asleep, feeling tense, keyed up, and irritable.
Jane meets criteria for the following DSM-5 Diagnoses:
F43.0 Acute Stress Disorder (Primary diagnosis)
At risk for developing PTSD (F43.10)
Signs and Symptoms
DSM-5-TR Diagnostic Criteria:
Acute Stress Disorder (F43.0)
Client’s Signs/Reported Symptoms:
Criterion A:
Exposure to actual or threatened death,
serious injury, or sexual violence in one (or
more) of the following ways
1. Directly experiencing the traumatic
event(s)
2. Witnessing, in person, the event (s) as
it occurred to others
3. Learning that the event(s) occurred to
a close family member or close friend
4. Experiencing repeated or extreme
exposure to aversive details of the
traumatic event(s) (APA, 2022).
Jane was trapped in the car, upside down for
45 minutes upside down.
She could hear others scream and call for
help.
Jane added that 3 people died in the accident.
Criterion B:
Presence of nine (or more) of the following
symptoms from any of the five categories of
intrusion, negative mood, dissociation,
avoidance, and arousal, beginning or
worsening after the traumatic event(s)
occurred:
Intrusion symptoms
Jane has been having memories of the
accident multiple times per day.
Jane has reported avoiding the highway the
accident occurred on
She has not been driving on her own since the
accident and is willing to drive an additional
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CASE STUDY
1. Recurrent, involuntary, and intrusive
distressing memories of the traumatic
event(s).
2. Recurrent distressing dreams in which
the content and/or affect of the dream
are related to the event(s).
3. Dissociative reactions (e.g.
flashbacks) in which the individual
feels or acts as if the traumatic
event(s) were recurring. (Such
reactions may occur on a continuum,
with the most extreme expression
being a complete loss of awareness of
present surroundings.)
4. Intense or prolonged psychological
distress or marked physiological
reactions in response to internal or
external cues that symbolize or
resemble an aspect of the traumatic
event(s).
Negative mood
5. Persistent inability to experience
positive emotions (e.g. inability to
experience happiness, satisfaction, or
loving feelings).
Dissociative symptoms
6. An altered sense of the reality of one's
surroundings or oneself (e.g. seeing
oneself from another's perspective,
being in a daze, time slowing).
7. Inability to remember an important
aspect of the traumatic event(s)
(typically due to dissociative amnesia
and not to other factors such as head
injury, alcohol, or drugs).
Avoidance symptoms
8. Efforts to avoid distressing memories,
thoughts, or feelings about or closely
associated with the traumatic event(s).
9. Efforts to avoid external reminders
90-minutes to avoid the highway.
Jane reported feeling irritable, anger, guilt,
and fear.
Jane has reported struggling to concentrate,
difficulty sleeping, and being startle while
riding in the car.
She stated, “I will be trying to concentrate on
something completely nonrelated to the
accident, like at work, and a memory of the
crash will suddenly overwhelm me.”
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CASE STUDY
(people, places, conversations,
activities, objects, situations) that
arouse distressing memories, thoughts,
or feelings about or closely associated
with the traumatic event(s).
Arousal symptoms
10. Sleep disturbance (e.g. difficulty
falling or staying asleep, restless
sleep)
11. Irritable behavior and angry outbursts
(with little or no provocation),
typically expressed as verbal or
physical aggression toward people or
objects
12. Hypervigilance
13. Problems with concentration
14. Exaggerated startle response
(APA, 2022)
Criterion C:
Duration of the disturbance (symptoms in
Criterion B) is three days to one month after
trauma exposure (APA, 2022).
It has been 2.5 weeks since the accident
Criterion D:
The disturbance causes clinically significant
distress or impairment in social, occupational,
or other important areas of functioning (APA,
2022).
Jane stated that she has not had a social life
since the accident due to her overwhelming
fear up driving on the highway.
Jane reported that the fear of driving, the
recurring memories, the lack of sleep, and the
overwhelming anxiety have kept her from her
normal activities which she highly enjoyed
Criterion E:
The disturbance is not attributable to the
physiological effects of a substance (e.g.
medication or alcohol) or another medical
condition (e.g. mild traumatic brain injury)
and is not better explained by brief psychotic
disorder (APA, 2022).
Jane reported no history of health problems, is
on no medication, no past mental health
diagnosis, and has no history of alcohol use or
other substance use.
Other DSM-5-TR Conditions Considered
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The other DSM-5-TR conditions considered were posttraumatic stress disorder (PTSD)
and adjustment disorder with anxiety. The client reported the accident being 2.5 weeks ago, but
for a PTSD diagnosis the symptoms need to last for at least a month after the event, so the
disorder was ruled out. Acute adjustment disorder was considered based on her symptoms,
however since more than 3 days had passed and she qualified for a diagnosis of acute stress
disorder, acute adjustment disorder was ruled out.
Developmental Theories and/or Systemic Factors
There are systemic factors in play that impact Jane’s likelihood of her acute stress
disorder becoming posttraumatic stress disorder (PTSD). One of the key contributing factors is
her ethnicity. According to extant research, people of color have a higher likelihood of
developing PTSD after experiencing a traumatic event (Sibrava et. al., 2019). Another
contributing factor to the likelihood of Jane developing PTSD is her personal responsibilities.
Jane has several responsibilities that she is unable to keep up with and feels guilty about. Jane
not only works full time, but she also cares for her parents. These responsibilities, and the guilt,
keeps her from being able to focus on and overcome the trauma of the accident.
Multicultural and/or Social Justice Considerations
According to the DSM-5-TR, both the onset and severity of PTSD from one cultural
group to the next is impacted by the type of trauma, the continued sociocultural context,
exposure to discrimination, and other cultural factors (American Psychiatric Association, 2022).
Sibrava et. al. (2019) notes that African Americans are one of the groups of people that are more
likely to develop chronic PTSD following a traumatic event. PTSD following a traumatic event
may vary from one culture, ethnic, and racial group to the next. Therefore, it is imperative to take
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her ethnicity into consideration when treating her. It is important to consider any possible
discrimination she may face or negative emotions she may have regarding her diagnoses.
Treatment Recommendations
Key Issues for Treatment
Avoiding external reminders
Intrusive distressing memories
Sleep disturbance
Exaggerated startle response
Recommendations for Individual Counseling
Recommendations for individual counseling for acute stress disorder are cognitive-
behavioral therapy, hypnosis, and narrative exposure therapy. Narrative exposure therapy would
be used to address Jane’s avoidance of external reminders. Narrative exposure therapy (NET) is
used to treat trauma disorders. In NET the counselor would assist the client in reconstructing or
retelling the memory of the event, identifying and integrating upsetting events (Kaltenbach et.
al., 2021). Utilizing NET versus exposure therapy will allow us to alleviate the burden of driving
to the office for session by meeting for virtual sessions. We would work our way to exposure
therapy at Jane’s speed. According to Bryant, Moulds, Guthrie, and Nixon (2005) hypnotherapy
has been said to be one of the most beneficial techniques for treating acute stress disorder (p.
334). Studies show that combining CBT with hypnosis may reduce reexperience of symptoms in
individuals following traumatic events (Bryant et. al., 2005).
Specific Considerations
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CASE STUDY
A triggering event may affect how you prioritize treatment interventions. Jane has
experienced a traumatic car accident that has resulted in her having acute stress disorder. She has
been avoiding driving a vehicle since the accident and because she must drive to work, it is
important to prioritize this in treatment. It is equally important to collaborate with the client
when treatment planning. Jane has openly stated that her faith is important to her. During
treatment planning it is important to find out if Jane wants to incorporate her faith into her
treatment plan. Some barriers that may be encountered during treatment planning with this client
may be her reluctance to expose herself to the trauma-inducing factor. To address this barrier I
may incorporate spirituality.
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References
Bryant, R. A., Moulds, M. L., & Guthrie, R. M. (2000). Acute stress disorder scale: A self-report
measure of acute stress disorder. Psychological Assessment, 12(1), 61–68.
https://doi.org/10.1037/1040-3590.12.1.61
Bryant, R. A., Moulds, M. L., Guthrie, R. M., & Nixon, R. D. (2005). The additive benefit of
hypnosis and cognitive-behavioral therapy in treating acute stress disorder. Journal of
Consulting and Clinical Psychology, 73(2), 334–340. https://doi.org/10.1037/0022-
006x.73.2.334
Kaltenbach, E., McGrath, P. J., Schauer, M., Kaiser, E., Crombach, A., & Robjant, K. (2021).
Practical guidelines for online narrative exposure therapy (e-NET) – a short-term treatment
for posttraumatic stress disorder adapted for remote delivery. European Journal of
Psychotraumatology 12, (1). https://doi.org/10.1080/20008198.2021.1881728
Sibrava, N. J., Bjornsson, A. S., Pérez Benítez, A. Carlos I, Moitra, E., Weisberg, R. B., &Keller,
M. B. (2019). Posttraumatic stress disorder in African American and Latinx adults:
Clinical course and the role of racial and ethnic discrimination. The American
Psychologist, 74(1), 101-116. https://doi.org/10.1037/amp0000339
Trauma- and stressor-related disorders. (2022). Diagnostic and Statistical Manual of Mental
Disorders.
https://doi.org/10.1176/appi.books.9780890425787.x07_trauma_and_stressor_related_diso
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