ANXIETY DISORDER CASE STUDY 2
Amara – Case Study
Client Concerns
Symptoms Behaviors Stressors
Sleep disturbance Worry Loss of husband
Anxiety Outbursts of anger Caring for elder mother
Headaches Alcohol consumption Loss of job
Fatigue Trouble sleeping Cultural responsibility (Care
for parents)
Sadness Mind racing Interpersonal relationships
Hypervigilance Restlessness
Body tension
Assessment
Amara presents with excessive, unrealistic worry that has increased for the last 18
months. Based on the intensity and frequency of the fear and worry and its relation to life’s
circumstances, generalized anxiety disorder (300.02/F41.1) is the presenting concern. To further
explore this, the generalized anxiety disorder 7 (GAD7) assessment tool will be administered.
Anxiety is prevalent in all aspects of Amara’s life and presents itself through cognitive and
somatic symptoms, so the Beck assessment would not provide further clarity. The GAD7 will aid
in understanding the severity of anxiety symptoms (Hinz et al., 2017).
Diagnostic Impressions
Signs and Symptoms
DSM-5-TR: General 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 many events or activities
Amara reports daily increased worry over the
past 18 months.
Criterion B: Difficulty controlling the worry Amara reports mind racing and various
worries 2-3 days per week.
Criterion C: 3 or more symptoms present:
1. Irritability
2. Muscle tension
3. Sleep disturbance
4. Restlessness
Amara reports an outburst toward her
daughter and mother, tension in her shoulders
and neck, difficulty getting to sleep due to
worrying, and feeling like she may "jump out
of the skin."
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Criterion D: Anxiety causes clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.
Amara's family has withdrawn due to physical
symptoms related to worry. Adversely, the
withdrawal causes more anxiety and
impairment in functioning.
Criterion E: The disturbance is not
attributable to a substance.
Amara has no history of substance abuse or
medical concerns. Recently, she was
prescribed Paxil to assist with anxiety
management. Alcohol consumption has
increased since the death of her husband and
retirement, yet it is of no concern to Amara or
her family.
Criterion F: The disturbance is not better
explained by another mental disorder.
No other mental disorder explains the
presenting symptoms and behaviors.
Other DSM-5-TR Conditions Considered
Amara reported purchasing a condominium before her husband's passing; before this, she
became the primary caretaker for her 90-year-old mother. Additionally, Amara was forced to
retire due to her school district's age limit. Given all these transitions, adjustment disorder was
strongly considered. There are multiple stressor events, i.e., death of spouse, retirement, and
burden of caring for mother. However, Amara's symptoms have persisted beyond six months,
which has ruled out adjustment disorder even with specifiers of anxiety and depression being
considered as the stressor is not persistent with enduring consequences (American Psychiatric
Association, 2022).
Developmental Theories and Systemic Factors
As an Asian American daughter, mother, and recent widow, Amara's cultural history and
interactions have been pivotal in her development. Having immigrated to America at two, Amara
has been deeply educated in her ethnic traditions. Given these interactions, Vygotskian Theory
would argue that Amara’s development has been influenced by her interactions with people and
her social environment (Burns et al., 2012). Amara reported that her mother was very anxious.
Therefore, Amara learned coping and regulation skills from seeing her parents cope with life
ANXIETY DISORDER CASE STUDY 4
stressors. Burns et al. (2012) noted that Vygotsky's development theory emphasizes developing
coping and regulation skills in specific interactions within culture and family. Ultimately,
learning can lead to development, and development can lead to learning.
Multicultural and Social Justice Considerations
Hays and Erford (2023) state that filial piety is a substantial value deeply rooted in Asian
families. The collectivistic and interdependent emphasis makes family extremely important in the
culture. There is no notion of individual space, and often, the family needs to override the
individual needs. Amara is pushing her trauma and threats to her well-being aside for the sake of
familial needs and concerns. While hypervigilant behaviors are causing a familial strain, the
family is withdrawing to promote discipline and maintain family cohesion (Hays & Erford,
2023).
Life has put Amara in stressful situations within the past four years. The cultural
considerations of enduring in silence and putting family needs above one's own need to be
considered when counseling Amara, as her ability to cope with the stress on top of stress is
beyond her capacity. Asian Americans view mental health problems as one's ability to control
oneself. This leads to reluctance, hiding, and denial. There needs to be respect for the system of
care and feelings of stigmatization. Additionally, as the clinician continually learning the cultural
system and ensuring confidentiality will go far (Yang et al., 2016)
Treatment Recommendations
Key Issues for Treatment
Identify the core conflict that is the source of excessive worry.
Stabilize anxiety level while increasing the ability to function daily.
Explore how cultural childhood experiences and interactions affect adult choices and
behavior.
Repair and enhance familial relationships to increase interpersonal communication.
ANXIETY DISORDER CASE STUDY 5
Recommendations for Individual Counseling
Cognitive-behavioral therapy (CBT) aims to modify specific thinking and behavior
patterns to alleviate the presenting symptoms. I recommend individual counseling using Amara's
CBT approach. CBT with prescribed medication has been found to aid in decreasing symptoms
related to anxiety in Asian Americans (Yang et al., 2016). In Amara's cultural context and recent
prescription of Paxil, this approach would assist in decreasing anxiety. It is important to note that
with this approach, the therapist is aiding the client in becoming their therapist by changing their
thinking, emotions, and behavior (American Psychiatric Association, 2017).
Another recommendation is psychoanalytic therapy. Freud highlighted the role themes
from childhood experiences and interactions play in adults as they journey through the lifespan
(Wong et al., 2015). Amara mentioned her mother dealing with anxiety, the family immigrating
to the U.S. when she was young, and the solid Asian traditions in her family. All these factors
could affect how she interacts with her children, responds to stress, and copes with life
transitions (Wong et al., 2015).
Medication Considerations
Amara falls right into the statistical category related to those experiencing anxiety. She
has visited her family doctor, who prescribed medication. Kring and Johnson (2022) note that it
is common for most to be offered a benzodiazepine to relieve anxiety symptoms. However, I
would have delayed the consideration of medication until after individual therapy began and
progressed. Medication can sometimes be an escapist strategy for anxiety, and adults over 65 are
typically prescribed medications for anxiety before a proper evaluation is given (Clinton &
Hawkins, 2015). Additionally, the brain in and of itself can make its anxiety-relieving
substances, and when coupled with some therapeutic approach, this can lead to relief.
ANXIETY DISORDER CASE STUDY 6
Nevertheless, as mentioned above, research with medication and CBT has shown successful
outcomes in lower anxiety.
Specific Considerations
Cultural background and context play a significant role in this case study. Gascon (2024),
in his lecture, essential for counseling people of Asian descent, noted that Asians are the fastest-
growing group in the U.S. With this statistic in mind, counselors must educate themselves in the
cultural intricacies of their heritage. As a therapist, additional information about the hierarchical
structure and collectivism versus individualism mindset would be helpful. Asian traditions place
a heavy responsibility on children to care for their elder parents. Exploring Amara's childhood
experiences and the family system would uncover how deeply rooted this tradition is. With the
reluctance and sense of shame that comes with mental health issues in the Asian culture, being
aware of the patience needed to speak on deep emotional issues could cause conflict. My values
are in line with more confrontation, and this style could cause Amara and the family to withdraw
(Gascon, 2024).
I would align my values with the client's and focus on creating an environment where
Amara can view her thinking and emotions and how they affect her behavior and negative
thoughts. Although Amara's religion, Hinduism, is incompatible with Christianity, In Matthew
chapter six, Jesus instructed us to look to the birds in the air, that they do not sow, nor reap nor
gather into barns, and yet your heavenly Father feeds them. Are you not worth much more than
they are (New International Version Bible, 2011)? This message can be communicated through
grace and compassion to anyone suffering from anxiety, regardless of religion. Fear and worry
are a direct reflection of the direction of the heart, and if the heart is not directed upward, then
the anxiety of tomorrow will affect one’s peace today.
ANXIETY DISORDER CASE STUDY 7
References
American Psychological Association. (2017). What is cognitive behavioral therapy? Society of
Clinical Psychology. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-
behavioral.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders
(5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Burns, S., Bodrova, E., & Leong, D. (2012). Development theory—Vygotskian theory. Retrieved
from http://education.stateuniversity.com/pages/1912/Developmenta-Theory
Clinton, T., & Hawkins, R. (2015). The New Christian Counselor: A fresh biblical and
transformational approach. Harvest House publishers.
Garzon, F. (2024). COUN 504, Week seven, lecture two: Essentials for counseling people of
Asian descent. Liberty University. https://canvas.liberty.edu
Hays, D. G., & Erford, B. T. (2023). Developing multicultural counseling competence (4th
Edition). Pearson Education (U.S.). https://online.vitalsource.com/books/9780134523736
Hinz, A., Klein, A. M., Brähler, E., Glaesmer, H., Luck, T., Riedel-Heller, S. G., Wirkner, K., &
Hilbert, A. (2017). Psychometric evaluation of the generalized anxiety disorder screener
GAD-7, based on a large German general population sample. Journal of Affective
Disorders, 210, 338-344. https://doi.org/10.1016/j.jad.2016.12.012
Kring, A. M., & Johnson, S. L. (2022). Abnormal psychology: The science and treatment of
psychological disorders (15th ed., DSM-5-TR Update). John Wiley & Sons.
New International Version Bible. (2011). Zondervan. (Original work published 1973).
Wong, D. W., Hall, K. R., Justice, C. A., Hernandez, L. W. (2015). Counseling individuals
through the lifespan. Thousand Oaks, CA: Sage Publications.
ANXIETY DISORDER CASE STUDY 8
Yang, J.Y., Chieh, L., Rodgers, R.F., & Ballou, M. (2016). Ethnic differences in the
effectiveness of cognitive behavioral therapy combined with medication: Comparing
Asian American and white psychiatric patients. Asian Journal of Psychiatry, 2, 46–50.
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