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CASE STUDY
Case Study: Anna
Lara Compton
School of Behavioral Sciences, Liberty University
Author Note
Lara Compton
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Lara Compton
Email: lcompton1@liberty.edu
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Client Concerns
Symptoms Behaviors Stressors
Anxiety Strain on relationships Uncontrollable worrying,
feeling hopeless/useless
Fatigue Lack of motivation Being restless, feeling on
edge
Headaches Constant worrying Irritational thoughts
Shame Worried about others’
opinions
Maintaining her Asian
traditions
Assessment
I will assess Anna for generalized anxiety disorder using Beck’s anxiety inventory scale
(BAI). The BAI scale has 21 items, and it is a four-point scale, with 1 being no symptoms and 4
being severe. The BAI has shown to have less measurement errors and it measures a wide range
of symptoms, making it easy to administer and score as a pretest for a clinical diagnosis (Pang et
al., 2019).
Diagnostic Impression
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Generalized
Anxiety Disorder: F41.1
Client’s Signs/Reported Symptoms:
Criterion A: Excessive anxiety and worry Anna reports that her anxiety and worry has
increased in the past 18 months
Criterion B: Difficult to control the worry She knows her worries are irritational, but she
states that she is unable to stop them
Criterion C: Anxiety and worry are associated
with 3 or more other symptoms
Anna experiences all six of the additional
symptoms: she is “high strung”, she has sleep
disturbances, she is fatigued, she has felt
increasing tension, she has become irritable,
she has trouble concentrating on anything
other than her worries
Criterion D: Symptoms cause significant Anna’s children have reduced communication
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distress or impairment with her to minimum, her grandchildren do
not want to visit her, her friends have
questioned her increasing anxiety
Criterion E: Not caused by another medical
condition or use of a substance
Anna has just started taking Paxil for her
anxiety, there are no other known medications
or medical conditions that would account for
her symptoms
Criterion F: Not caused by a different mental
disorder
Anna’s symptoms do not align with another
mental disorder
Other DSM-5-TR Conditions Considered
Panic disorder was considered, but the client has persistent anxiety and worry rather than
sudden panic attacks. Major depressive disorder was considered, but the client only reported four
out of five required symptoms, so it was ruled out.
Developmental Theories and/or Systemic Factors
Erikson’s stages of development hold that an individual faces a conflict at each
developmental stage they go through, which they may or may not resolve successfully. The client
is in the last stage, integrity versus despair, which is the stage when an individual reflects on
everything that has happened throughout their life span. Individuals who experience despair are
normally lacking acceptance of themselves or events, and they are likely to be diagnosed with
depression or anxiety (Goodcase & Love, 2017). The psychosocial crisis of despair correlate
with the client’s symptoms.
Multicultural and/or Social Justice Considerations
The client’s daughter stated that due to her mother’s cultural background, seeking help
for mental health and counseling was not an option. She was raised to leave family problems
within the family and not obtain outside help. The client has struggled with anxiety and worry for
as long as she can remember, but she just dealt with it in hopes that it would go away on its own.
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Treatment Recommendations
Key Issues for Treatment
Uncontrollable anxiety and worry
Trouble sleeping and fatigue
Feeling hopeless and alone
Recommendations for Individual Counseling
The first treatment that I would recommend to my client is cognitive behavioral therapy
(CBT). A study conducted by Borza (2017) states that “CBT is an effective treatment for
generalized anxiety disorder, typically leading to reductions in worry, and a study has shown that
such therapy is equal to pharmaceutical treatment and more effective 6 months after study
completion”. CBT aims to help clients become aware of their current thinking and behaviors and
shift it from negative to positive. The goal is to restructure the neural pathways in the client’s
brain so that their thought patterns are no longer skewed. Another treatment that I would
recommend to my client is psychotherapy, also known as talk therapy. According to Bandelow et
al., (2017) says that all anxiety disorders require talks that are supportive and to give attention to
the emotional problems that are associated to the anxiety disorder.
Specific Considerations
Anna’s cultural background plays a big role in her treatment plan. She is unable to put her
mother in a nursing home to relieve some of her stress because it would be shameful for her to
do. The client would also like to incorporate some of her Hindu beliefs and teachings into her
treatment plan. As her counselor, I would need to educate myself on the Hindu religion. Some
conflicts that could occur would be because we hold different religious beliefs and cultural
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values, but I would avoid imposing my own beliefs and opinions onto the client and I would
promote her mental health and wellbeing.
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References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental
disorders: DSM-5 TR (5th ed. Text Revision). American Psychiatric Press, Inc.
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues
in clinical neuroscience, 19(2), 93–107.
https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
Borza L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical
neuroscience 19, (2), 203–208. https://doi.org/10.31887/DCNS.2017.19.2/lborza
Goodcase, E. T., & Love, H. A. (2016;2017;). From despair to integrity: Using narrative therapy
for older individuals in Erikson’s last stage of identity development. Clinical Social Work
Journal, 45(4), 354-363. https://doi.org/10.1007/s10615-016-0601-6
Pang, Z., Tu, D., & Cai, Y. (2019). Psychometric properties of the SAS, BAI, and S-AI in chinese
university students. Frontiers in Psychology, 10, 93-
93. https://doi.org/10.3389/fpsyg.2019.00093
