CASE STUDY ASSIGNMENT 1
Case Study Assignment: Amara
LaShay Timmons
School of Behavioral Science, Liberty University
CASE STUDY ASSIGNMENT 2
Case Study Assignment: Amara
Client Concerns
Symptoms Behaviors Stressors
Anxiety Excessive worry Primary caretaker for elderly
mother
Tension Irritability Death of husband
Headaches Difficult sleeping Retirement
Fatigue Frequent checking on family Financial worries
Racing thoughts Snapping at family members Strained relationships with
children and grandchildren
Difficult sleeping Increased alcohol
consumption
Loss of social network after
retirement
Increased Worry Difficult sitting still Cultural expectations
(avoiding nursing home for
mother)
Sadness Loss of motivation Fear of being alone and
forgotten
Feeling overwhelmed Crying Guilt over potential family
shame
Fear of making mistakes Isolation from former
coworkers
Managing care
responsibilities without a
husband
Physical tension Difficult maintaining
relationships
Hopelessness
CASE STUDY ASSIGNMENT 3
Assessment
The best choice for measuring Amara's anxiety and how it interferes with her day-to-
day existence is the Generalized Anxiety Disorder 7-item (GAD-7) scale. The GAD-7 is a short,
self-administered screening tool designed to diagnose GAD and also assess the severity of the
condition (Sun et al.,2021). The assessment includes seven questions that reflect respondents'
estimations of how often they have experienced anxiety symptoms during the past two weeks;
the response scale ranges from 0 (never) through 3 (almost every day). The total potential score
is from 0 to 21, and the higher value corresponds to the higher severity of anxiety symptoms.
The GAD-7 was chosen due to its strong research base, brevity, ease of administration and
scoring, and ability to provide a standardized measure of anxiety severity. It is also widely used
in both research and settings, making it a reliable tool for evaluating Amara's anxiety.
Diagnostic Impression
From the information provided regarding Amara, including her symptoms and stressors,
the primary diagnosis is GAD according to DSM-5-TR, which is coded as F41. 1 in ICD-10.
Amara exhibits excessive worry, tension, fatigue, difficulty sleeping, and physical symptoms
such as headaches and muscle tension. Additionally, she experiences secondary symptoms of
Major Depressive Disorder, coded as F32.9, indicated by sadness, loss of motivation, and
feelings of hopelessness. These disorders are likely exacerbated by significant life stressors,
including being a primary caretaker, the death of her husband, retirement, financial worries, and
strained familial relationships. Comprehensive treatment should address both anxiety and
depressive symptoms.
CASE STUDY ASSIGNMENT 4
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Generalized
Anxiety Disorder name. ICD-10 Code: F41.1
Client's Signs/Reported Symptoms:
Criterion A: Persisting anxiety and worry for
six months or more, which is manifested on
most days with concerns about several events
or activities.
Excessive worry, Increased worry, Racing
thoughts
Criterion B: The patient is unable to prevent
the worry from happening
Difficult sitting still, Frequent checking on
family
Criterion C: The anxiety and worry are
present or observed for at least 6 months, and
at least one of the following indications:
Impatience, difficulty falling or staying
asleep, restless or unproductive sleep, being
effortlessly fatigued, challenges in
concentrating or mind going blank, irritability
as well as muscle tension
Restlessness (Difficult sitting still), Fatigue,
Difficulty concentrating (Racing thoughts),
Muscle tension (Physical tension), Irritability,
Sleep disturbance (Difficult sleeping)
Criterion D: The physical symptoms or
anxiety must cause clinically noteworthy
distress or weakening in social, occupational
or other important life activities. (APA,2022).
Snapping at family members, Increased
alcohol consumption, isolation from former
coworkers
CASE STUDY ASSIGNMENT 5
Criterion E: The disturbance is not
consequent of a pharmacological action of a
substance like drug abuse, a medication or
any other medical condition such as
hyperthyroidism
No evidence of a medical condition causing
the symptoms.
Criterion F: The disturbance is not better
enlightened by another mental illness, fear of
having additional panic attacks in panic
disorder, negative assessment in Social
Anxiety Disorder, contamination or other
obsessions in obsessive compulsive disorder.
It does not explain separation from an
attachment figure in Separation Anxiety
Disorder, and experiences linked to the
traumatic event in posttraumatic stress
disorder.
No evidence of manic or hypomanic episodes.
Other DSM-5-TR Conditions Considered
CASE STUDY ASSIGNMENT 6
1. Major Depressive Disorder was considered, given Amara's reported sadness, loss of
motivation, and crying spells. However, her main symptoms appear to be extreme worry
and physical symptoms of anxiety rather than a depressed mood most of the day, nearly
every day. Her sadness seems situational, related to missing her late husband rather than a
pervasive depressed mood.
2. Generalized Anxiety Disorder appears to better account for her array of symptoms,
including excessive anxiety/worry, irritability, sleep disturbance, fatigue, muscle tension,
and difficulty controlling worry. While she experiences some sad mood, it does not
appear to meet the criteria for a persistent depressed mood required for Major Depressive
Disorder.
3. Adjustment Disorder with Anxiety was considered given her recent life stressors
(husband's death, retirement, caretaking responsibilities), but her symptoms have
persisted for over six months, which would preclude this diagnosis.
4. Substance/Medication-Induced Anxiety Disorder was ruled out as her anxiety predated
her recent alcohol use and medication trial. There is no evidence her symptoms were
precipitated by a substance or medication. While she reports some obsessional thoughts,
there is no indication she experiences true obsessions or compulsions required for
obsessive-compulsive disorder. Her thought patterns appear to be excessive worries
versus obsessions.
Developmental Theories and/or Systemic Factors
CASE STUDY ASSIGNMENT 7
Amara is in Erik Erikson's 8th stage of psychosocial development, "Integrity vs.
Despair." At this later stage of life, individuals reflect on their accomplishments and try to find
meaning (Gilleard, 2020). Amara's excessive worry and anxiety may stem from struggling to
achieve a sense of integrity about her life choices. She expresses guilt over potentially placing
her mother in a nursing home, which goes against her cultural values. Her strained family
relationships and loss of social connections after retirement may contribute to feelings of despair
or emptiness. Moreover, the case of Amara illustrates the effectiveness of the cultural norms and
gender roles as a system. She, as an Asian American woman, may feel compelled to be the
caregiver of the family as well as the confined role of a daughter. Based on her ethnic
background, age and sex, she undergoes various stressors that are unique to that group. Thus, in
the case of ethnic groups, particularly Asian American women, Misra et al. (2021) identified
caregiver burden and cultural conflicts as predictors of depression and anxiety disorders. Amara's
concern for the preservation of honor of her family is a perfect representation of cultural
practices that is part of her primary self. It is crucial for understanding how various types of
oppression relating to Amara's multiple positions on the margins affect her health.
Multicultural and/or Social Justice Considerations
Asian American ethnicity/race might dictate Amara's experience in some way as an Asian
American woman. The studies indicate that Asian Americans rarely seek professional help for
mental issues because of the stigma and cultural values surrounding mental health (Yang et
al.,2020). It is possible that due to internalization of these values, Amara waited until her anxiety
was beyond her control to seek help. Her role as the daughter and caregiver is associated with
Confucianism principles of obeying parents and family responsibilities. In her culture, admitting
such difficulties or having to place her mother in a nursing home may be humiliating and cause a
CASE STUDY ASSIGNMENT 8
loss of face. This fear of being alone if abandoned by her children resonates with anxiety over
defying feminine ideals. Her identity is linked to age, making her vulnerable to various "isms"
such as sexism, ageism, and racism that may increase her distress. Culturally sensitive care that
affirms Amara's cultural perspective must be provided to her.
Treatment Recommendations
Key Issues for Treatment
The top 3 symptoms/issues I believe are involved in Amara's case, in order of importance, are:
1. Excessive and uncontrollable worry/anxiety
2. Strained family relationships and social isolation
3. Physical symptoms (fatigue, tension, sleep disturbance) related to anxiety
Individual Counseling Recommendations
Since Amara's symptoms include excessive worrying, Cognitive Behavioral Therapy
would be an ideal first-line treatment to offer the client. CBT is centred on the modification of
negative patterns of thinking and behavior that contribute to anxiety (Van Dis et al.,2020). It
would be useful for Amara to engage in cognitive restructuring in order to address her patterns of
unrealistic pessimism about aspects of life such as money, family, and mothering. CBT methods
such as worry exposure could assist in facilitating Amara's cognitive change and become more
accepting of the uncertain future. CBT has been found efficacious for treating Generalized
Anxiety Disorder across ethnic groups. MBCT could be used as an addition to CBT because it
will help Amara learn how to distance herself from the unhelpful cycle of worrying.
Mindfulness-Based Cognitive Therapy combines mindfulness meditation with cognitive
techniques to develop metacognitive awareness and decentering (Burgess et al.,2021). Through
breathing exercises and body scans, Amara could cultivate present-focused, nonjudgmental
CASE STUDY ASSIGNMENT 9
attention to counter her anxious rumination. MBCT has been adapted for older adult populations
and has shown promise in reducing worry, anxiety, and depressive symptoms. Its emphasis on
self-compassion could resonate with Amara's cultural values around caring for the family.
Medication Considerations
I would recommend referring Amara for a medication evaluation to augment
psychotherapy for her generalized anxiety disorder. Pharmacological interventions can help
provide relief from her severe and impairing anxiety symptoms like excessive worry,
restlessness, muscle tension and sleep disturbance. Research supports the use of anti-anxiety
medications, particularly selective serotonin reuptake inhibitors (SSRIs), as first-line
pharmacotherapy for GAD (Gosmann et al.,2021). While Amara has already tried Paxil (an
SSRI) for 4 weeks without improvement, guidelines suggest allowing 8-12 weeks at an optimal
dosage before considering it ineffective. If Paxil remains inadequate, switching to another SSRI
like escitalopram or an SNRI like duloxetine or venlafaxine could provide greater symptom
relief. Benzodiazepines like clonazepam may also be considered as an adjunct for short-term
management of severe anxiety, though their use should be limited due to risks of dependence
(Gupta et al.,2020). Buspirone, an azapirone anxiolytic, is another option.
Specific Considerations
The cultural perspective of Amara can help explain some of her experiences and
actions. Her cultural beliefs influence how she perceives the world, how she deals with stress,
and how she feels about seeking help for her mental health. The cultural practices, beliefs, and
expectations of the society she comes from need to be analyzed to understand her position fully.
Cultural variation is likely to cause some conflicts of values, for instance, mental health, male or
female supremacy or function of family members. Culturally appropriate care enhances the
CASE STUDY ASSIGNMENT 10
effectiveness of treatment since it is in harmony with the cultural background of the client,
according to Flynn et al. (2020). Thus, when dealing with personal values as well as working
with Amara and addressing her cultural needs, culturally appropriate behavior, such as
maintaining cultural humility and embracing a non-biased conversational approach, is important.
CASE STUDY ASSIGNMENT 11
References
American Psychiatric Association. (2022). Diagnostic & Statistic Manual of Mental Disorders--
Text Revision.: DSM-5 (Vol. 5, No. 5). Washington, DC: American Psychiatric
Association.https://www.mredscircleoftrust.com/storage/app/media/DSM
%205%20TR.pdf
Burgess, E. E., Selchen, S., Diplock, B. D., & Rector, N. A. (2021). A brief mindfulness-based
cognitive therapy (MBCT) intervention as a population-level strategy for anxiety and
depression. International Journal of Cognitive Therapy, 14(2), 380-398.
https://doi.org/10.1007/s41811-021-00105-x
Flynn, P. M., Betancourt, H., Emerson, N. D., Nunez, E. I., & Nance, C. M. (2020). Health
professional cultural competence reduces the psychological and behavioral impact of
negative healthcare encounters. Cultural Diversity and Ethnic Minority Psychology,
26(3), 271–279. https://doi.org/10.1037/cdp0000295
Gilleard, C. (2020). The final stage of human development? Erikson's view of integrity and old
age. International Journal of Ageing and Later Life, 14(2), 139-162.
https://doi.org/10.3384/ijal.1652-8670.1471
Gosmann, N. P., Costa, M. D. A., Jaeger, M. D. B., Motta, L. S., Frozi, J., Spanemberg, L., ... &
Salum, G. A. (2021). Selective serotonin reuptake inhibitors, and serotonin and
norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress
disorders: A 3-level network meta-analysis. PLoS Medicine, 18(6), e1003664.
https://doi.org/10.1371/journal.pmed.1003664
CASE STUDY ASSIGNMENT 12
Gupta, A., Bhattacharya, G., Farheen, S. A., Funaro, M., Balasubramaniam, M., Young, J., ... &
Tampi, R. R. (2020). Systematic review of benzodiazepines for anxiety disorders in late
life. Ann Clin Psychiatry, 32(2), 114-27.
Misra, S., Jackson, V. W., Chong, J., Choe, K., Tay, C., Wong, J., & Yang, L. H. (2021).
Systematic review of cultural aspects of stigma and mental illness among racial and
ethnic minority groups in the United States: Implications for interventions. American
journal of community psychology, 68(3-4), 486-512. https://doi.org/10.1002/ajcp.12516
Sun, J., Liang, K., Chi, X., & Chen, S. (2021). Psychometric properties of the generalized
anxiety disorder scale-7 item (GAD-7) in a large sample of Chinese adolescents. In
Healthcare (Vol. 9, No. 12, p. 1709). MDPI. https://doi.org/10.3390/healthcare9121709
Van Dis, E. A., Van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L., Van Den
Heuvel, R. M., ... & Engelhard, I. M. (2020). Long-term outcomes of cognitive
behavioral therapy for anxiety-related disorders: a systematic review and meta-analysis.
JAMA psychiatry, 77(3), 265-273.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902232/
Yang, K. G., Rodgers, C. R., Lee, E., & Lê Cook, B. (2020). Disparities in mental health care
utilization and perceived need among Asian Americans: 2012–2016. Psychiatric
Services, 71(1), 21-27.
https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201900126
