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AMARA CASE STUDY
Amara Case Study
School of Behavioral Sciences, Liberty University
Author Note
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Dorothy Michelle Fyfe.
Email: dmfyfe@liberty.edu
Amara Case Study
The client Amara is 68-year-old who is Asian American woman. Amara has three grown
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AMARA CASE STUDY
children, her husband is deceased, and she is the caretaker for her 90-year-old mother. Amara
repots to experience worry and anxiety. Amara is known to be high-strung, and her symptoms
have gotten worse over the past two years. The increase in Amara’s anxiety has caused issues
mentally, physically, and emotionally and is directly affecting her relationships. The family
physician referred Amara for assessment.
Client Concerns
Symptoms Behaviors Stressors
Body Tension Discomfort in neck and
shoulders, headaches
Worry
Restlessness Difficulty sitting still Worry and anxiety
Fatigue Feels tired and has a hard time
motivating to do anything
Lack of sleep
Inability to sleep Only sleeping 5-6 hours Inability to stop overthinking
Sad/ Hopelessness Loss of husband and
friends/retirement
Death of husband and retiring
for social job
Increased Drinking Alcohol consumption daily Anxiety and worry
Increased worry She cannot control her
thoughts, constant worrying,
and anxiety
Being alone and taking care of
her mother
Shame She feels like she will dishonor
family
Taking care of mother and will
not put mother in nursing home
Anxiety Worries, lost contact with
family and friends
Being alone, caregiver, and
reality of getting older
Assessment
According to Rose and Devine (2014), the Beck’s Anxiety Inventory (BAI) (2) is used to
assess anxiety levels in patients and consist of a four-point scale of 21 self-reported items. BAI
can inventory the anxiety levels for severity for both cognitive and physical symptoms. The BAI
can distinguish depression form anxiety (Rose & Devine, 2014). The 21 items consist of a rating
scale to evaluate the anxiety symptoms severity on scale of 0 to 63 and can be utilized to track
progress through administrating it in subsequent sessions for improvements.
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Diagnostic Impressions
Amara presents a wide variety of symptoms, that are both attributed to psychological
and physical factors. Based on Amara’s symptoms, the primary diagnosis is Generalized Anxiety
Disorder (GAD), F41.1 (DSM-5 TR, 2022). The second diagnosis is Major Depressive Disorder,
moderate recurrent episodes, F33.1, with anxious distress, severe (DSM-5 TR, 2022). Amara
meets the criteria for both disorders. For Generalized Anxiety Disorder, Amara meets all six of
the diagnostic criteria and had the symptoms for longer than six months (DSM-5 TR, 2022)..
Amara reflects six of the nine required in criterion A and presents A-C criterion for major
depressive disorder, presenting the same within a two-week period (DSM-5 TR, 2022).
Exhibiting five of the five symptoms for specifier, severe anxious distress most of the days
(DSM-5 TR, 2022). It is worth consideration that Persistent Depressive Disorder was reviewed,
but most symptoms were relevant eighteen months, not two years.
Signs and Symptoms
DSM-5-TR Generalized Anxiety Disorder,
F41.1
Client’s signs/reported symptoms:
Criterion A: Excessive anxiety and worry,
occurring more days than not for at least six
months, about a number of events or activities
Amara reported increasing levels of worry
and constant anxiety over several different
issues, events, our activities.
Criterion B: the individual finds it difficult to
control worry
Amara reports that she knows the worries are
unfounded, but she still constantly worries.
Criterion C: the anxiety and worry are
associated with three or more of the following
six symptoms:
1. Restlessness or feeling keyed up or on
edge
2. Being fatigued
3. Difficulty concentrating our mind
going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance
Amara reports restlessness, being tired all the
time, snapping at people, irritability, elevated
body tension, headaches, and inability to
sleep.
Criterion D: The anxiety, worry, or physical
symptoms cause clinically significant distress
Amara reports her relationships have been
strained due to her excessive worry, she is no
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or impairment in social, occupational, or other
important areas of functioning
longer working and has retired, and she finds
herself only talking about worries in her
social relationship.
Criterion E: The disturbance is not attributed
to psychosocial effects of substance drug
abuse or another medical condition
Amara discontinued drinking on social status
and the worrying continued.
Criterion F: The disturbance is not better
explained by another mental disorder.
The disturbance is best described as GAD.
DSM-5-TR Major Depressive Disorder,
moderate, F33.1
Client’s signs/reported symptoms:
Criterion A: Five (or more) of the following
symptoms have been present during the same
2-week period and represent a change from
previous functioning; at least one of the
symptoms is either (1) depressed mood or (2)
loss of interest or pleasure.
1. Depressed mood most of the day, nearly
every day, as indicated by either
subjective report (e.g., feels sad, empty,
hopeless) or observation made by others
(e.g., appears tearful).
2. Markedly diminished interest or
pleasure in all, or almost all, activities
most of the day, nearly every day (as
indicated by either subjective account
or observation).
3. Significant weight loss when not
dieting or weight gain (e.g., a change
of more than 5% of body weight in a
month) or decrease or increase in
appetite nearly every day.
4. Insomnia or hypersomnia nearly every
day.
5. Psychomotor agitation or retardation
nearly every day (observable by
others, not merely subjective feelings
of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every
day.
1. Amara feels sad, hopeless, and others
notice it.
2. Amara only feels like doing what has
to be done daily.
3. N/A
4. Amara cannot sleep.
5. Amara is restless and others see it as
well.
6. Amara is tired every day.
7. Amara feels a guilt to take care of her
mother and feels like she has done
something to make everyone mad or
not like her.
8. N/A
9. N/A
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7. Feelings of worthlessness or excessive
or inappropriate guilt (which may be
delusional) nearly every day (not
merely self-reproach or guilt about
being sick).
8. Diminished ability to think or
concentrate, or indecisiveness, nearly
every day (either by subjective
account or as observed by others).
9. Recurrent thoughts of death (not just
fear of dying); recurrent suicidal
ideation without a specific plan; a
specific suicide plan; or a suicide
attempt.
Criterion B: the symptoms cause clinically
significant distress or impairment in social,
occupational, and other important areas of
functioning.
Amara has reported that she is having strains
in her family relationships, friendships, and
other areas are functioning period
Criterion C: The episode is not attributed to
psychological effects of substance or other
medical condition
Amara is not using substances and does not
have a current medical condition.
Specifier: With anxious distress, moderate -
severe
Four or five symptoms.
1. Feeling keyed up our tense.
2. Feeling unusually restless.
3. Difficulty concentrating because of
worry.
4. Fear that something awful may happen.
5. Feeling that the individual might lose
control of himself or herself.
Amara feels high strung, tense, restless,
worries all the time, believes something awful
will happen, and sometimes feels she will
jump out of her own skin.
Other DSM-5 TR Conditions Considered
The client reported several of the symptoms for Persistent Depressive Disorder (F34.1),
but most symptoms were not present for at least two years. Social Anxiety Disorder (F40.10) was
considered based on Amara reporting anxiety, the fear of she shows anxiety, and avoiding
socialization, but Amara does avoid social engagement due to fear or anxiety.
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Developmental Theories and/or Systematic Factors
There are several things that are occurring and have happened in Amara’s life that could
be influencing her functioning and behaviors. To start, the death of Amara’s husband and the
retirement from her job were two events that brought dramatic changes to her life. Both could be
attributed to traumatic changes in normalcy and occurred within a short period of each other.
Additionally, Amara exhibits stress and anxiety of caring for her aging mother and feels the guilt
to due to her cultural beliefs. Amara does not see her constant worrying as the issue in her
relationships, but others see it and are discontinuing the relationships. Amara experienced
sadness of losing her husband and work-related friends. She was forced to retire due to age and
feels restless and hopelessness. Amara worries about losing her children, finances, and her health
due to the loss of her husband and career. Amara is in stage 8 or Erikson’s theory of psychosocial
development that reflects integrity vs despair. The loss of a spouse, friends, retirement, and other
changes can result in despair (Orenstein & Lewis, 2022). Amara exhibits maldevelopment due to
these turning points in this stage.
Multicultural and/ or Social Justice Consideration
The DSM-5 TR states women with Depressive Disorder are at higher risk for developing
sleep disturbances and interpersonal sensitivity (DSM-5 TR, 2022). Generalized Anxiety
Disorder is exhibited more frequently in women (DSM-5 TR, 2022). Amara appears to view
taking of an older parent as a responsibility due to her Asian cultural values, beliefs, and her
gender placement role. According to Fajkowska et al. (2017), the typology of depression and
anxiety can be formulated within systemic approach of personality. Amara reported her mother
had similar symptoms, but they dissipated as she aged. Amara reflected her symptoms did not
calm with menopause and there is conformity of anxiety/ depression that can be exhibited by
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emotional changes such as loss of a spouse or other components (Fajkowska et al. (2017). The
symptoms could be attributed to cultural, and gender deemed responsibilities.
Treatment Recommendations
Key Issues for Treatment
Extreme worry
Restlessness, fatigue, inability to sleep
Decline in social relationships
Recommendations for Individual Counseling
The first symptom that should be treated in Amara’s case is the extremity of the constant
worrying. I recommend cognitive behavior therapy to treat the anxiety disorder. According to
Curtiss et al. (2021), cognitive-behavioral therapy is the first line of intervention for anxiety and
can target the distortions of interpretation of circumstances and events. Cognitive behavior
therapy utilizes techniques that focus on the unwarranted thoughts, behaviors, and feelings to
reduce anxiety symptoms. I recommend that Amara see a counselor once a week while also
working through CBT workbook for extra support due the severity. The use of cognitive
behavior therapy will help Amara understand her thoughts and emotions that trigger the anxiety
(Curtiss et al., 2021). Identifying these behaviors and thoughts can assist in transforming them
into a rational and realistic view. Through CBT Amara can work to strengthen her social
relationships that have declined due to anxiety and habitual behaviors associated with constant
worry.
The second treatment recommendation for Amara is Interpersonal and Social Rhythm
Therapy (IPSRT) to address the decline in social relationships and regulation of daily routines. It
is often used in mood disorders and could be utilized for depressive and anxiety disorders. It has
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been seen to minimize the impact of losing a job, role-changing life events, sleep irregularities,
and stress/ worry (Gupta, 2022). It focuses on improving daily routines, social relationships,
stability, and improving mood stability. It can be utilized with cognitive-behavioral therapy and
has shown to be beneficial in depression and anxiety disorder (Gupta, 2022). This approach can
help to with the avoidance Amara expressed experiencing and cultivate an awareness of
unwanted internal reactivity through thoughtful response modification.
Specific Considerations
Medication Considerations
I would consider referring Amara for a medication evaluation due to severity of her
generalized anxiety disorder and major depressive disorder with anxious distress, severe.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors
(SNRIs) are antidepressants that will also treat anxiety symptoms (Strawn et al., 2018). The
medication could alleviate the symptoms of anxiety, hopelessness, inability to relax and sleep,
and the jumpiness. The final decision to medication should be collaborative with Amara, the
therapist, and her physician. Consideration of the side effects and risk should be evaluated and a
specific plan for comprehensive treatment should be addressed to minimize adverse effects.
Unique Client Considerations
Cultural background was an essential aspect that was considered in Amara’s case. Amara
is of Asian descent and of Hindu faith, she was raised by immigrants and still has family in Asia
that she corresponds with. Additional information was needed in reference to Amara’s faith and
traditions to establish to what extent Amara adheres to the beliefs and traditions of her culture.
This could be established through dialogue within the consent process to gain clarity and offer
self-disclosure. 21:01 a8/p8here are several beliefs and cultural content that could be conflicting
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due to different and unfamiliar backgrounds and religious beliefs. It is imperative that there is a
comprehensive understanding of the unfamiliar to collaborate with Amara for effective
counseling. Cognitive behavior therapy relies on rationality and what the therapist perceives as
rational my not be viewed the same way by Amara due to religious and cultural aspects.
Managing my personal bias during therapy with Amara would require understanding, empathy,
and providing culturally sensitive therapeutic support to provide effective counseling (Tanaka-
Matsumi, 2022). I would need self-aware of my beliefs and understand cultural context to fully
gain Amara’s perspective.
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References
Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral treatments
for anxiety and stress-related disorders. FOCUS, 19(2), 184–189.
https://doi.org/10.1176/appi.focus.20200045
Diagnostic and statistical manual of mental disorders DSM-5-TR. (2022). American Psychiatric
Association.
Fajkowska, M., Domaradzka, E., & Wytykowska, A. (2018). Types of anxiety and depression:
Theoretical assumptions and development of the anxiety and depression questionnaire.
Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.02376
Gupta, S. (2022, September 15). What is interpersonal and Social Rhythm therapy (IPSRT)?
Very well Mind. https://www.verywellmind.com/interpersonal-and-social-rhythm-therapy-
ipsrt-techniques-and-benefits-6665996
Orenstein, G.A., Lewis L. (2022) Eriksons stages of psychosocial development. StatPearls
Publishing,7. https://www.ncbi.nlm.nih.gov/books/NBK556096
Rose, M., & Devine, J. (2014). Assessment of patient-reported symptoms of anxiety. Dialogues
in Clinical Neuroscience, 16(2), 197–211. https://doi.org/10.31887/dcns.2014.16.2/mrose
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy
for generalized anxiety disorder in adult and pediatric patients: An evidence-based
treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070.
https://doi.org/10.1080/14656566.2018.1491966
