CASE STUDY ASSIGNMENT 1
Case Study Assignment: Amara
Megan Grubbs
School of Behavioral Sciences, Liberty University
Case Study Assignment Amara
Amara is a 68-year-old Asian American female who observes the Hinu religion and is
recently widowed, retired, and is now her mother’s caretaker. She is struggling with many racing
thoughts of anxiety relating to her family’s safety, her life decisions, and her loss of
interpersonal relationships. She has decided to pursue counseling and has recently been put on
Paxil by her primary care physician.
Client Concerns
Biological factors
Psychological
Social/cultural
Spiritual
Physical symptoms, for Ideas, thoughts Family systems, Religious and spiritual
CASE STUDY ASSIGNMENT 2
example: neurological,
past present impact
Past and present
feelings, beliefs,
values about self,
others the world
Past and present
Relationships with
others,
Cultural elements
Past, present
aspects of self/family
Past present
Irritability Lack of sleep Lack of sleep because of life
changes
Muscle tension in shoulder/ neck
and headaches
Constant stress Taking care of her mother Hindu religion prioritizes taking
care of the elder
Paranoia Constant fear of the unknown
or worst-case scenario
Death of husband, major life
changes, separation from
family
Would like to integrate her
religious views into her
counseling
Lack of sleep Mind racing at night Loss of job, no contact with
kids/ grandchildren
Assessment
After accessing my clients’ needs, I would use the Generalized Anxiety Disorder 7-item
(GAD-7) to better measure the severity of Amara’s symptoms of anxiety. This assessment has
seven questions in which the client would reflect on how often they are experiencing anxiety
symptoms within the last two weeks. The scale ranges from 0 (never) to 3 (every day) and the
total score one could receive is from 0 to 22, the higher the number means the higher the
anxiety. I went with GAD-7 over other assessments because of the strength of its research
bases, ease of administration, quickness, scoring, and its ability to show standardized
measurements of anxiety severity (Kai-Shuen et al., 2023). This is considered a reliable tool to
use because of its popular use in clinical and research compacities.
Diagnostic Impression
When reviewing Amara’s case, I was able to gain knowledge on the severity of anxiety
she has, my primary diagnostic is listed in DSM-5-TR as Generalized Anxiety Disorder (GAD)
which is ICD-10 diagnostic code F41.1. This was my initial thought due to her extensive
worrying, difficulty sleeping, muscle tension in her shoulders/ neck, tension headaches, and
paranoia. My secondary diagnostic would be Major Depressive Disorder (MDD) which is code
F32.9. This was indicated by her overall sadness, feelings of hopelessness, sleep deprivation, and
loss of motivation. She has recently lost her job, husband, contact with most friends, regular
contact with her children, and her independence because she is now having to be her mother’s
caretaker.
CASE STUDY ASSIGNMENT 3
Signs and Symptoms
DSM-5-TR Diagnostic Criteria: Generalized
Anxiety Disorder- ICD-10 Code: F41.1
Client’s Signs/Reported Symptoms from case
study:
Criterion A: Persisting and excessive worry that
occurs for than one day over the last 6-month
period
Causing hardships within her friedships and
family system
Criterion B: The client is unable to control the
worry and/or concern they feel from happening
Racing thoughts
Criterion C: Worries about potential harm or
danger
Concerned for children, grandchildren and her
mother’s safety in an excessive amount
Criterion D: Fatigue Cannot sleep due to racing thoughts
Criterion E: Muscle Tension Weekly/ daily headaches and body aches
Criterion F: Sleep Disturbance Struggles falling or staying asleep
Other DSM-5-TR Conditions Considered
While reading this case I noticed other DSM-5-TR symptoms but as I read deeper into
Amara’s story my thought process changed, and I was able to rule them out. I first noted Panic
Disorder because of her constant need to panic, fear of dying or others dying, neck soreness,
headaches, and a constant need to analyze interactions. However, I ruled this out because
Amara never mentioned experiencing panic attacks, shaking, or chest pain; so, the overall
criteria does not fit her case.
Developmental Theories and/or Systemic Factors
Amare best identifies in the Erin Erikson’s 8th stage, “Integrity vs. Despair”. She is
constantly stressing, becoming anxious, and struggles to find a certain level of integrity about
her life decisions in the present and past. At this last stage in life people struggle to find peace in
their past decisions, which in our client’s case has led to major anxiety issues. As her counselor, I
would take this into consideration when forming a plan of action for our session. She has had a
multitude of large life events happen in the last 5 years; losing her husband, retiring, losing most
friends, creating a strained family relationship, being the caretaker for her mother, and losing
CASE STUDY ASSIGNMENT 4
herself amid it all. Researching this stage of development would be vital in her case to better
understand how to guide her.
Multicultural Competencies and Considerations
Amara race/ethnicity consist of being Asian American and her religious beliefs are Hindu.
After reviewing her case, I can see how these traditions and expectations from her race,
ethnicity, and religion have led to certain decisions she has made and in return brought her
more anxiety. Amara chose to be her mother’s caretaker instead of putting her into a nursing
home which reflects the cultural values within the South Asian roots. South Asian culture has a
deep belief that you should respect and honor your family through the entirety of their life
(CITE). This decision created a domino effect on her life when deciding to become her mother’s
caretaker. After retiring she wanted to go back to work, the stress of doing right by her mother
has created more stress on herself and her daughter who helps her, and she has a constant
sense of concern for her mother’s wellbeing; these are all examples of the impact this one
decision from her cultural views has had on her life. Being able to understand and integrate
these cultural and religious views into her diagnostic and counseling will help recognize ways
this worldview has shaped Amara and her decisions in the future.
Treatment Recommendations
Key Issues for Treatment
After reviewing and understanding Amaras case I have found three symptoms that need
to be addressed first and below I will list them by importance:
•Extreme excess and uncontrollable anxiety with symptoms such as constant worry of her
family’s safety and constant worry about her decision making.
•Repairing and strengthening the interpersonal relationships within her life.
•Physical symptoms from anxiety with symptoms such as muscle tension and tension
headaches that occur more than once a week.
CASE STUDY ASSIGNMENT 5
Recommendations for Counseling
With the consideration of Amaras excess worrying and signs of anxiety, my first
recommendation would be Cognitive Behavior Therapy (CBT). CBT is ideally a perfect fit as it
focuses on modifying negative patterns of thinking and behavior that could contribute to the
client’s anxiety (Öst et al., 2023). This treatment would help Amara reroute her mindset from
continuous worrying to new coping skills that would train her to use focused thinking.
The second recommendation for Amara would be Mindfulness-Based Stress Reduction
(MBSR). MBSR helps clients experiencing body tensions and tension headaches, similar to
Amara, with a specific set of skills to help them find a sense of relaxation and mindfulness,
giving her the ability to manage these symptoms of anxiety. This treatment plan is one of the
most widely researched and used internationally within different races, ethnicities, and religions
(Hoge et al., 2023). MBSR would equip the client with many tools such as meditation, body
scanning, and mindful movement to help when she is feeling these physical signs of anxiety.
In regard to medication, it is noted that Amara is already taking Paxil and has only been
on it for a short period of time. A combination of medication and counseling would be a starting
point and then I would have her consult with her primary physician. After she is diagnosed with
GAD this may change her medication route, however I feel it is necessary to begin counseling
first and allow her to see the combined effect of the two before making in medication changes.
Specific Considerations
Cultural background always plays a key role in every client’s experience in counseling. As
Amaras counselor I would want to learn more about the background, traditions, and cultural
beliefs to better serve her. It is also vital that I understand how Amara views her religious beliefs
in regard to her anxiety management. After evaluating what treatment routes would best fit her
cultural and religious needs, we would then be able to work together in incorporating these
beliefs into her growth with GAD. Amara is of Hindu beliefs and comes from a Asian American
ethnicity, conflict wise, it is imperative that as her counselor I put my beliefs aside to better
CASE STUDY ASSIGNMENT 6
assist her. This means that I will need to research what her cultural practices are so that I don’t
impose my personal beliefs on her. If I was Amaras counselor, I would work to build a strong
counselor relationship because I truly feel that she needs someone to confide in these issues
within. As we do observe two different religions, I would not impose my views on her, but I
would surely pray for her on my own time. I would pray for Amara to begin this journey with an
open heart and mind, ready to be vulnerable and grow so that she may find some peace within
her situation.
CASE STUDY ASSIGNMENT 7
References
Hoge, E. A., Bui, E., Mete, M., Dutton, M. A., Baker, A. W., & Simon, N. M. (2023).
Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With
Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry, 80(1), 13–21.
https://doi.org/10.1001/jamapsychiatry.2022.3679
Kai-Shuen Pheh, Chee-Seng, T., Kai, W. L., Kok-Wai Tay, Ong, H. T., & Sook, F. Y. (2023).
Factorial structure, reliability, and construct validity of the Generalized Anxiety Disorder
7-item (GAD-7): Evidence from Malaysia. PLoS
One, 18(5)https://doi.org/10.1371/journal.pone.0285435
Öst, L.-G., Enebrink, P., Finnes, A., Ghaderi, A., Havnen, A., Kvale, G., Salomonsson, S., &
Wergeland, G. J. (2023). Cognitive behavior therapy for adult anxiety disorders in routine
clinical care: A systematic review and meta-analysis. Clinical Psychology: Science and
Practice, 30(3), 272–290. https://doi.org/10.1037/cps0000144
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