CASE STUDY: AMARA
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Case Study: Amara
Destinee Chavis
School of Behavioral Science, Liberty University
Author Note
Destinee Chavis
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Destinee Chavis
Email: dmchavis1@liberty.edu
CASE STUDY: AMARA
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Client Concerns
Symptoms Behaviors Stressors
Anxiety Trouble sleeping Caring for her elderly mother
and grandchildren
Irritability/Anger Racing Thoughts Her family distancing from
her due to her anxiety
Increased headaches and body
tension
Excessive worrying Death of her husband four
years ago due to cancer
Sadness Increased alcohol
consumption
Retirement/ Loss of social
relationships
Fatigue Inability to sit still due to
worry
The urge to move
Lack of motivation
Assessment
Amara appears to be present with severe anxiety symptoms. She has been experiencing
these symptoms for several years, however in the last 18 months they have worsened. Based on
the self-report from Amara and collateral information provided by her daughter, I would use the
DASS-42 to assess her case. The Depression, Anxiety and Stress Scale was developed by Peter
F. Lovibond and Susan H. Lovibond in 1995. The scale is a 42 item self-reported assessment that
is used to measure the psychopathological symptoms of depression, anxiety, and stress
(Holzapfel, 2025). I believe that this assessment would be beneficial because it separates
depression, anxiety, and stress into subscales that can help differentiate anxiety symptoms from
depression. Some of the symptoms that Amara reported could be classified as depression. The
DASS-42 would help provide the proper diagnosis for Amara.
Diagnostic Impression
Amara is presenting with symptoms and behaviors that are consistent with a DSM-5
diagnosis of Generalized Anxiety Disorder 300.02 (F41.1). The DSM-5 states that clients that are
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diagnosed with GAD must have at least three of the six related symptoms for the past six months
(APA, 2022). Amara reported that she has been experiencing uncontrollable anxiety and worry
for about 18 months. The symptoms that she reported are in direct correlation with the six
symptoms listed in the DSM-5. Although Amara has reported increased alcohol consumption, it
would not be appropriate to diagnose her with Alcohol Use Disorder.
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Generalized
Anxiety Disorder 300.02 (F41.1)
Client’s Signs/Reported Symptoms:
Criterion A: Excessive anxiety and worry
more days than not for at least 6 months,
The client reports uncontrollable anxiety for
the past 18 months.
Criterion B: The individual finds it difficult to
control the worry.
The client reports the inability to stop
worrying although she acknowledges the
worries are unfounded.
Criterion C: The anxiety and worry are related
to three out six symptoms:
1. Restlessness or feeling keyed up or on edge
2. Easily fatigued
3. Difficulty concentrating or mind going
blank.
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or
staying asleep, or restless, unsatisfying sleep.
The client reports that she “snaps” at her
daughter and mother when they confront her
about her worries. The client reports
increasing tension in her body, specifically
her shoulders and neck. The client reports that
she has difficulty sitting still. She reports
feeling tired all the time. She has difficulty
falling and staying asleep. The client reports
laying in bed for one to two hours then
waking up after five to six hours of sleep with
worry.
Criterion D: The anxiety or worry, or physical
symptoms cause clinically significant distress
or impairment.
Amara has a strained relationship with her
children due to her worries that are now
affecting the relationship with her
grandchildren as well. Her son ignores her
phone calls. Her grandchildren opt out of
family gatherings to avoid her behavior.
Criterion E: The disturbance cannot be
attributed to the physiological effect of a
substance (drug abuse or medication) or
another medical condition.
The client does report an increase in alcohol
consumption; however, it does not appear as a
dependency nor as a cause of her worries.
Criterion F: The disturbance is not better
explained by another mental disorder.
The client does not report any symptoms that
relate to any psychological disorders. (i.e.,
Bipolar I or schizoaffective disorder)
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Other DSM-5-TR Conditions Considered
Amara reported being sad about the passing of her husband. She reported that she often
cried the year after his passing. She even reported currently feeling sad about the death but tries
to think about the good memories they have. Amara also reported being sad when she retired for
approximately six months. When Amara found out that her grandchildren no longer wanted to
attend family gatherings with her present, she stated that she cried for several days. Amara fears
being alone and turns to drinking alcohol to relax. These symptoms could be related to Major
Depressive Disorder as outlined in the DSM-5. After reviewing the criteria for that diagnosis, I
realized that it would not be appropriate to diagnose Amara with depression. The DSM-5
requires that the client presents with five or more symptoms within a two-week time span.
During the initial interview Amara did not report that she experienced sadness or crying spells
recently. These symptoms appear to be situational for her. Generalized Anxiety Disorder was a
better diagnosis because it covered all the symptoms she has been experiencing.
Developmental Theories and/or Systemic Factors
If the clinician applied a developmental theory to Amara’s case, they may consider Piaget’s
Cognitive Developmental Theory. Piaget’s framework focuses on how thinking and reasoning
evolve over time. Amara is a 68-year-old woman. Evidence shows that older adults tend to use
more emotion-focused coping strategies versus problem focused strategies. Although Amara has
been experiencing signs of extreme anxiety for a long time it can be noted that the most recent
episodes are due to her age. Aging is a process where many changes occur, not only physical but
psychological and social as well (Galiana et al., 2020). In the initial interview, Amara has
acknowledged that she does not have much of social life due to retirement, her family has begun
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to pull away from her, and her worrying has become uncontrollable. These are changes that can
be attributed to the increase in her symptoms. Amara also appears to be having racing thoughts
which could cause her to overestimate what she feels is a threat to herself or her family.
Amara’s support system should be considered as contributing factor to her anxiety.
Although she has a family that cares for her, it appears that her family would prefer to isolate
from her instead of making the effort to help her. She is the primary caregiver for her elderly
mother which could also influence anxiety symptoms. Amara is grieving the death of her
husband and recently retired. These life changes can be considered as well.
Multicultural and/or Social Justice Considerations
Amara identifies as Asian American. In the interview she makes clear that she takes pride
in her culture and their norms. She spoke about not allowing her mother to go to a nursing home
as it would be shameful to her family. Her daughter mentions that counseling was not something
that would be considered for Amara growing up. She stated that family problems were to remain
within the family. This is a cultural norm that is seen across several cultures. In the Asian
American community mental health struggles are viewed as a weakness and can be seen as an
offense to their strength and resilience (Schlossberg, 2023). For Amara’s treatment to be
successful she will have to be willing to be open about her experiences and history, which can
present as a challenge for her and the clinician. During her treatment, Amara could benefit from
a support group that includes other individuals from her community that have experienced
mental health challenges.
Treatment Recommendations
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Key Issues for Treatment
Amara has severe anxiety that affects her quality of life.
Amara’s relationship with her family is estranged due to her worrying.
Amara’s physical health is affected by the increase in anxiety.
Recommendations for Individual Counseling
It is recommended that Amara participate in Cognitive Behavioral Therapy (CBT). CBT
is a known form of treatment that will challenge Amara to change her way of thinking and
irrational thought process. Anxiety causes Amara to have negatively biased cognitive distortions
(Curtiss et al., 2021). Individuals with Generalized Anxiety Disorder and participate in CBT
often participate in mindfulness exercises. Mindfulness exercises target the worry by promoting
the opposite of repetitive negative thinking (Curtiss et al., 2021). Another recommendation
would be for Amara to participate in individual therapy. Individual therapy can help Amara
address the estrangement with her family. Participating in therapy can provide the validation and
safety she has been missing from her family (Fairbank, 2024). She will learn ways to cope with
anxiety and strategies to establish strong relationships with her family. Amara being a part of the
Asian community contributes to the importance of her fixing those relationships. Asian
communities take pride in having close knit families.
Amara’s primary care physician has already prescribed her with a medication to aid in
subsiding her anxiety symptoms. She has noted that the medication she is taking may not work
for her or may require a dosage increase. One of the biggest benefits of Paxil is that it helps
decrease fear and lower obsessions (Paxil | Usage | Side Effects & Dosage - a Mission for
Michael, 2022)
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Paxil can also increase Amara’s desire to complete task as she mentioned having a lack
of motivation.
Special Considerations
Amara’s cultural background plays a pivotal role in her case. Her culture has a negative
stigma surrounding mental health and therapy. It is often frowned upon to participate in therapy
because it would require individuals to report details of their lives that are typically kept private.
To provide adequate treatment for Amara, the clinician would need to know what her limitations
are, what types of things would be going against her values, etc. She has mentioned being of the
Hindu religion and her acceptance to including those principles into her treatment plan. There
may be several value conflicts when providing treatment to someone of the Asian community.
One value is the mental health stigma. There is a possibility that Amara could minimize her
symptoms to avoid shame from her community (Derald et al., 2016). As a counselor, I would
make the effort to respect Amara’s culture norms and include her Hindu religion.
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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
Derald, W., Sue, D., Sue, H., Neville, L., & Smith. (n.d.). Title: Counseling the Culturally
Diverse : Theory and Practice.
https://amberton.edu/wp-content/uploads/2024/07/CSL6832_E1_Fall2024.pdf
Fairbank, R. (2024). Estrangement is never easy or straightforward. Psychologists can help.
Apa.org. https://www.apa.org/monitor/2024/04/healing-pain-estrangement
Galiana, L., Tomás, J. M., Fernández, I., & Oliver, A. (2020). Predicting Well-Being Among the
Elderly: The Role of Coping Strategies. Frontiers in Psychology, 11.
https://doi.org/10.3389/fpsyg.2020.00616
Holzapfel, N. (2025). A Depression, Anxiety, and Stress Scale (DASS‐42) Study on the Mental
Health Conditions of Japanese Employees. Japanese Psychological Research.
https://doi.org/10.1111/jpr.12587
Paxil | Usage | Side effects & Dosage - A Mission For Michael. (2022, March 17). AMFM
Mental Health Treatment. https://amfmtreatment.com/paxil-for-anxiety/#elavilresources
Schlossberg, J. (2023, May 9). Confronting mental health barriers in the Asian American and
Pacific Islander community. Www.uclahealth.org; UCLA Health.
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https://www.uclahealth.org/news/article/confronting-mental-health-barriers-asian-
american-and-2
