Amara Case Study 2
Case Study Assignment- Amara
Client Concerns
Symptoms Behaviors Stressors
Anxiety Trouble sleeping Taking care of mom
Irritability Arguing with children Confrontation
Fatigue 5-6 hours of sleep with 1-2 hours
of worrying
Worrying about children and
future
Hopelessness/uselessness Worrying Kids not speaking to her.
Work tribe no longer there
Restlessness Pacing/ worry headaches
Body tension
Strained family relationships
Assessment
According to the NIH, the Anxiety Symptoms Questionnaire (ASQ) is a brief self-report
questionnaire which measures rate and strength of symptoms and was developed to improve
assessment of anxiety symptoms in a clinical setting. “This tool is used to identify and evaluate
the specific factors, situations, or circumstances that trigger or exacerbate a person's anxiety.”
(Baker et al, 2019) This assessment helps individuals understand the root causes of anxiety and
develop strategies to manage or avoid these triggers.
Diagnostic Impression
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Amara's presentation of a wide array of symptoms, encompassing both physical and
psychological aspects support General Anxiety Disorder. (GAD) According to the DSM-5 the
following criteria describes GAD: essential feature of generalized anxiety disorder is excessive
anxiety and worry (apprehensive expectation) about a number of events or activities. The
intensity, duration, or frequency of the anxiety and worry is out of proportion to the actual
likelihood or impact of the anticipated event. The individual finds it difficult to control the worry
and to keep worrisome thoughts from interfering with attention to tasks at hand. (APA, 2022).
“Adults with generalized anxiety disorder often worry about every day, routine life
circumstances, such as possible job responsibilities, health and finances, the health of family
members, misfortune to their children.” (2022) The ICD-10 code F41.1 for Generalized anxiety
disorder.2
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Generalized Anxiety
Disorder (F41.1)
Client’s Signs/Reported
Symptoms:
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).
Increased worry
Criterion B: The individual finds it difficult to control the
worry.
Intrusive thoughts
Criterion C: The anxiety and worry are associated with three Sleeping trouble,
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(or more) of the following six symptoms (with at least some
symptoms having been present for more days than not for the
past 6 months)
restlessness, and
muscle tension
Criterion D: 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).
Paxil ineffective
Criterion E: The disturbance is not better explained by another
mental disorder2
2There are no panic attacks,
feared social situations, nor
PTSD
Other DSM-5-TR Conditions Considered
A. Scared to be judged by others.
B. Embarrassing oneself.
C. Other social settings causing anxiety
These symptoms aforementioned are for Social Anxiety Disorders, similar to GAD but I
didn’t choose the latter because Amara’s symptoms more closely aligned with personal
not social settings especially since she was a teacher.
Developmental Theories and/or Systemic Factors
Amara Case Study 5
Family systems refer to the interconnected relationship dynamics that exist within a family unit.
Amara’s family system has been constantly changing for the past 4 years. Becoming a widow,
taking care of her mother, retiring, and losing her colleagues as support can all have an impact on
her well-being. The death of a spouse in later life is consistently rated as the most stressful
normative life event (Carr& Utz, 2020) The constant role changing can be affecting Amara.
Multicultural and/or Social Justice Considerations
In Asian countries, adult children are expected to provide support or care to their parents due to
the tradition of filial piety. The health outcomes of filial obligation may largely depend on
caregivers’ acceptance of their role responsibilities, their motivations for providing care, the
meanings associated with that care, or their resources to balance the stresses from caregiving
demands. (Pan et al, 2021)
Treatment Recommendations
Key Issues for Treatment
·Anxiety/Worry
·Irritability
·Restlessness/Fatigue
Recommendations for Individual Counseling
One treatment recommendation is mindfulness-based therapy is an approach to mental health and
well-being that incorporates mindfulness techniques and practices. Mindfulness is the practice of
intentionally paying attention to the present moment without judgment. It involves being fully
aware of your thoughts, feelings, bodily sensations, and the surrounding environment.
Mindfulness meditation is a central component of the therapy. Individuals are guided to engage
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in meditation practices that encourage awareness and presence in the moment. Common
practices include focused breathing, body scans, and mindfulness of thoughts and emotions.
Mindfulness encourages observing your experiences without labeling them as good or bad. This
non-judgmental stance can help reduce reactivity to difficult emotions and thoughts. Emotional
Regulation in mindfulness can help individuals regulate their emotions by fostering self-
awareness and promoting healthier responses to challenging emotions. Mindfulness-based
therapy often includes practices that promote self-acceptance and self-compassion. The
principles of mindfulness can be applied to daily life, helping individuals make more conscious
choices and develop a greater sense of presence and meaning in their activities. (Hoffman &
Gomez, 2018)
I would also recommend family therapy. Family therapy in Asian cultures may have unique
considerations and approaches due to cultural values, norms, and family dynamics. Many Asian
cultures emphasize collectivism and the importance of the family unit over individual needs.
Family therapy often respects and acknowledges these values. (Lee, 2017) Many Asian families
live in multigenerational households, which can lead to complex relationships. Family therapy
may involve addressing the dynamics between different generations.
I would not recommend medication for this client. I think all her symptoms could be treated with
effective counseling.
Specific Considerations
Culture plays a big role in this case. Respecting and deferring to elders are a common cultural
value in Asian families. Therapists need to be sensitive to this and find ways to promote open
communication and mutual respect within the family. There is also a stigma around Mental
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Health. Some Asian cultures have stigmas around mental health issues. Therapists should
address these concerns and work to reduce the stigma, making it more acceptable for clients to
seek help. There are also some communication patterns within Asian families that can vary, with
indirect communication and non-verbal cues being significant. Therapists need to be aware of
these communication styles and help clients express themselves effectively. Filial piety is a
significant cultural value in many Asian cultures, emphasizing respect and care for one's parents.
(Lee, 2017) Family therapy may involve discussions about how to balance individual needs with
these responsibilities. Immigration and Acculturation for Asian families living in Western
countries, issues related to acculturation and generational gaps may arise. Therapists should be
aware of the challenges associated with these transitions. Culturally aware family therapists
should take these cultural factors into account while tailoring their approaches to address the
specific needs of Asian families. It's essential to collaborate with the family and involve them in
the therapeutic process to ensure that cultural considerations are respected and integrated
effectively. Mindfulness-based therapy is an approach to mental health and well-being that
incorporates mindfulness techniques and practices. Mindfulness is the practice of intentionally
paying attention to the present moment without judgment. It involves being fully aware of your
thoughts, feelings, bodily sensations, and the surrounding environment.
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References
American Psychiatric Association. (2022).2Diagnostic and statistical manual of mental
disorders2(5th ed., text rev.).2https://doi.org/10.1176/appi.books.9780890425787.
Baker, A., Simon, N., Keshaviah, A., Farabaugh, A., Deckersbach, T., Worthington, J. J., Hoge,
E., Fava, M., & Pollack, M. P. (2019). Anxiety symptoms questionnaire (ASQ):
Development and validation. General Psychiatry, 32(6). https://doi.org/10.1136/gpsych-
2019-100144
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Carr, D., & Utz, R. L. (2020). Families in later life: A decade in Review. Journal of Marriage
and Family, 82(1), 346–363. https://doi.org/10.1111/jomf.12609
Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-based interventions for anxiety and
depression. Psychiatric Clinics of North America, 40(4), 739–749.
https://doi.org/10.1016/j.psc.2017.08.008
Lee, J. (2017). Asian American adult children as caregivers for their aging parents: A public
health perspective. Innovation in Aging, 1(suppl_1), 915–915.
https://doi.org/10.1093/geroni/igx004.3277
Pan, Y., Chen, R., & Yang, D. (2022). The Relationship between Filial Piety and Caregiver
Burden among Adult Children: A Systematic Review and Meta-Analysis, 43, 113–123.
https://doi.org/10.1016/j.gerinurse.2021.10.024
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