CASE STUDY ASSIGNMENT 1
Amara Case Study
Lauren Nesmith
School of Behavioral Sciences, Liberty University
Amara Case Study
Amara is a 68-year-old widowed Asian American woman who is suffering from extreme
anxiety and daily worry. She is a retired elementary teacher, and her daughter referred her to
counseling after family conflict. Amara also sought medication from her primary care physician
and has been taking Paxil for the past four weeks without any noticeable results.
Client Concerns
Biological factors
Psychological
Social/cultural
Spiritual
Physical symptoms, for
example: neurological,
past present impact
Ideas, thoughts
feelings, beliefs,
values about self,
Family systems,
Relationships with
others,
Religious and spiritual
aspects of self/family
Past present
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Past and present others the world
Past and present
Cultural elements
Past, present
Current intense anxiety It would bring her shame to
have her
mother enter a nursing
home
Husband died four years ago Holds to South Asian traditions
Trouble sleeping Very sad when thinking of
husband’s death
Currently has 3 children Practices Hinduism
Increased irritability Doesn’t think she has an
alcohol problem
Has 90-year-old mother Wants to incorporate her
spirituality into sessions
Very fatigued Is afraid of her family not
liking her
Only in touch with two friends Believes she should be the
primary caretaker of
her mother
Has been taking Paxil for four
weeks
Performs reassuranceseeking
calls to family
Deeply values her
relationships with her family
Assessment
Amara is clearly struggling with anxiety, and has been for some time. Her symptoms
seem to be pointing to the diagnosis for the Generalized Anxiety Disorder. To help determine
whether or not she has GAD, the Generalized Anxiety Disorder scale-7 can be used. This
diagnostic tool is very quick and easy to use, it contains seven questions where an individual can
record an answer of zero to three. It asks questions pertaining to how often the patient has
been bothered by different symptoms of anxiety in the past few weeks, and has the client
answer numerically (0-3) representing “not at all,” “several days,” more than half the days,” and
“nearly daily.” The GAD-7 scale has also been proven to have superb test rate reliability with an
interclass correlation of .83, and remarkable internal consistency with a Cronbach alpha of .92
(Sapra et al., 2022). Due to its high reliability and validity, I believe it would be perfect for
Amara’s case. I chose it over the GAD-2 scale as I felt that one was not quite thorough enough,
and that the GAD-7 would do a better job portraying the severity of her anxiety. According to an
article in Cureus by Sapra et al. (2020), the GAD-7 questionnaire maintains good specificity and
sensitivity for the diagnosis of the most common anxiety disorders encountered in primary care.
Diagnostic Impression
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Generalized Client’s Signs/Reported Symptoms from case
CASE STUDY ASSIGNMENT 3
Anxiety Disorder (F41.1) study:
Criterion A: Excessive anxiety and worry
(apprehensive expectation), occurring more
days than not for at least 6 months, about a
number of events or activities (such as work or
school performance).
Amara has constantly worried since being a
mom, but it has increased in the past 18
months. She worries about her finances,
health, other’s opinions of her, her family, and
more.
Criterion B: The individual finds it difficult to
control the worry.
Amara says that she has told her self to “just
stop worrying” but it never works, she can’t
control it so much so that it keeps her up at
night.
Criterion C: The anxiety and worry are
associated with three (or more) of the
following six symptoms: Restlessness, easily
fatigued, difficulty concentrating, irritability,
muscle tension, and sleep disturbance.
Amara has reported feeling easily fatigued and
not wanting to do anything around the house
other than what needs to be done. She is very
restless and will often get up and walk around,
and is only getting 5 to 6 hours of sleep due to
her worry.
Criterion D: The anxiety, worry, or physical
symptoms cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
Her worry has strained her relationship with
her grandchildren, with some of them not
wanting to be around her or attend social
gatherings with her. She now only has two
close
friends who say they enjoyed spending time
with her more before she worried so much.
Criterion E: The disturbance is not attributable
to the physiological effects of a substance (e.g.,
a drug of abuse, a medication) or another
medical condition (e.g., hyperthyroidism).
While Amara does drink a couple glasses of
wine per day, she has said that this doesn’t
affect her physiologically. She has reported
taking Paxil to help with her anxiety but hasn’t
noticed it helping.
Criterion F: The disturbance is not better
explained by another mental disorder.
It is not better explained by another MD
because all the evidence and symptoms point
to her having Generalized Anxiety Disorder
Other DSM-5-TR Conditions Considered
While reading over Amara’s case, it was apparent that she also exhibited some
depressive symptoms. I looked at Persistent Depressive Disorder because she exhibited a few of
the symptoms, including insomnia, low energy, and feelings of hopelessness. However, she
didn’t meet all the criteria and she hasn’t had those symptoms for two years or more, so this
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option was ruled out. Additionally, she has some of the symptoms that fall into Separation
Anxiety Disorder, including persistent worry of experiencing an untoward event (she worries
about falling into a sink hole). Amara also has excessive worry about losing major attachment
figures (her family members) or possible harm to them. While these are both symptoms of SAD,
she only exhibits three of the eight diagnostic criteria (American Psychiatric Association, 2022).
Developmental Theories and/or Systemic Factors
Considering the stage of development that Amara is in according to Erikson’s Stages of
Psychosocial Development, we can gain a better understanding of her behavior. Because she is
68-years-old, she is in Stage 8, where she is dealing with Integrity vs. Despair. The individual can
undergo increased challenges during this time if they have lost a spouse, which Amara has.
During this stage, some of the symptoms of despair include feeling unproductive, depression,
regret, and ruminating over mistakes (Orenstein, 2022). These are all symptoms Amara has
demonstrated, which may point to the fact that she is on the brink of the despair stage. In
Amara’s family system, she is currently experiencing the health decline of her mother and has
become her mother’s primary caregiver. The burden of taking care of her mother as well as
having fewer friends and less social support has most likely increased her anxiety and worry.
Furthermore, she is not as close to her daughter, son, and daughter-in-law due to increased
arguments and worry.
Multicultural Competencies and Considerations
Amara carries South Asian cultural beliefs, so this would be very important to take into
consideration as her counselor. Asian Americans are almost twice as likely to assume caregiving
roles for their family members, and many of the caregivers lack an extensive support network
(JiWon et al., 2023). Furthermore, in the Asian American culture, placing a loved one in a
longterm care facility is commonly viewed as a last resort (JiWon et al., 2023). Furthermore,
another part of Amara’s cultural identity is her religion, and she subscribes to Hindu beliefs. She
mentioned in her case study that she would be interested integrating her beliefs into
CASE STUDY ASSIGNMENT 5
counseling, so it would be important for me to educate myself in Hinduism and find practical
ways to incorporate it into our counseling sessions.
Treatment Recommendations
Key Issues for Treatment
•Uncontrolled/ Excessive Anxiety
•Insomnia, only being able to sleep between 5-6 hours a night
•Interpersonal relationship strain with daughter, daughter-in-law, and son
Recommendations for Counseling
To assist Amara in overcoming her anxiety, there are a few different modalities that can
be used. First of all, I believe that Cognitive Behavioral Therapy could be a great option for
Amara. By helping Amara learn to evaluate her thoughts, ideas, and patterns, she can find ways
to correct her cognitive distortions. Furthermore, research supports the effectiveness of CBT on
GAD, and there have been multiple studies done that show it can be extremely effective at
reducing anxiety. Because generalized anxiety is a disorder that arises from the interaction of
cognitive, behavioral, and physiological components, comprehensive CBT is very effective at
treating it (Salartash, 2022). If Amara can learn to successfully manage her thoughts, she can
learn to successfully manager her anxiety.
Moreover, another evidence-based treatment model that could be applied to Amara’s
case is Acceptance and Commitment Therapy (ACT). The aim of this approach is to develop
greater psychosocial flexibility, using a six step process: acceptance, cognitive diffusion, being
present, observing self, values, and committed action (Han & Kim, 2022). I believe that ACT
could be a successful treatment modality for Amara because it could help her become more
present in the moment, accept her anxious thoughts, and realign her actions with her core
values. ACT has been shown through studies by Han & Kim to promote mindfulness, acceptance,
and committed action to living in alignment with values (2022). Amara is currently taking Paxil,
she started taking it four weeks ago, and the doctor told her it could take multiple weeks to
CASE STUDY ASSIGNMENT 6
work. Since her dosage is going to be increased in the next two weeks, I think she should wait to
see if the medication takes effect before receiving a medical referral. Paroxetine has been
proven through multiple clinical trails to be an efficacious and well-tolerated treatment for
generalized anxiety disorder (Mitton, 2022).
Specific Considerations
Amara’s South Asian culture shapes her beliefs and who she is as a person. To
understand her better, I would seek more information about her specific beliefs about filial
duties with her mother and the meaning of “shame” to her around nursing home placement.
Additionally, I would want to hear more about how she has practices Hinduism in the past and
what ways she wants to incorporate it into future sessions. Being a Christian, I could have
potential value conflicts related to her faith in Hinduism, because I don’t believe in Hinduism,
and believe there is only the one true triune God. I could manage my own personal values
through cultural humility, as well as explicitly inviting Amara’s perspective, using reflective
questions, and creating plans that align with her values.
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References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders
(5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Cherry, K. (2025, February 7). How people develop a sense of integrity vs. despair. Verywell
Mind. https://www.verywellmind.com/integrity-versus-despair-2795738
Han, A., & Kim, T. H. (2022). Efficacy of internet-based acceptance and commitment therapy for
depressive symptoms, anxiety, stress, psychological distress, and quality of life: Systematic
Review and meta-analysis. Journal of Medical Internet Research, 24(12).
https://doi.org/10.2196/39727
JiWon, C., Ta Park, V., Nguyen, E., Jung, A., & Tsoh , J. (2023). Understanding the caregiving
experiences of Asian Indian, Chinese, Korean, and Vietnamese American Family Care
Partners of Persons Living With Dementia. Aging & mental health.
https://pubmed.ncbi.nlm.nih.gov/37655598/
Orenstein, G. A. (2022, November 7). Erikson’s stages of Psychosocial Development. StatPearls
[Internet]. https://www.ncbi.nlm.nih.gov/books/NBK556096/
Mitton, A. (2022, September 12). Paxil for anxiety: Everything you need to know. K Health.
https://khealth.com/learn/antidepressants/paxil-for-anxiety/
Sapra, A., Bhandari, P., Sharma, S., Chanpura, T., & Lopp, L. (2020). Using generalized anxiety
disorder-2 (GAD-2) and gad-7 in a primary care setting. Cureus.
https://doi.org/10.7759/cureus.8224
Salartash, V., Yekta, M. A., & Zabihi, R. (2022). The effectiveness of cognitive behavior therapy on
anxiety, physical symptoms, worry, and attention deficit in women with generalized
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anxiety disorder. The Open Public Health Journal, 15(1).
https://doi.org/10.2174/18749445-v15-e2209080
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