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CASE STUDY: ANNA
Case Study Assignment: Anna
Sterling Nelsen
School of Clinical Mental Health Liberty University
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CASE STUDY: ANNA
Case Study Assignment: Anna
Client Concerns
Symptoms Behaviors Stressors
Anxiety Poor sleeping patterns/stress
relating to the future
Family, relationships,
finances, safety
Worry Worrying to the point of
physical ailments such as
headaches and shoulder pain
Caring for her mother but if
she chooses to stop, she will
bring shame to her family
Fear Questioning if she will end
up dying alone in a street
because no one wants to be
around her
If she does not provide for
her family will they survive?
Can she appropriately care
for everyone including
herself?
Obsession Unable to stop her consistent
worrying even to the point of
losing sleep and relationships
Continuing to worry and gain
anxiety about things she is
unable to control
Assessment
Chapa (2022) suggests that by utilizing the Beck Anxiety Inventory to monitor anxiety
and stressors within the workplace, researchers will gain a better understanding of the
differentiating symptoms regarding depression and anxiety and the triggers leading up to
experiences of these symptoms (Chapa, 2022). Beck’s Anxiety Inventory is categorized as a 21-
itemized self-reporting assessment that measures a variety of factors leading to anxiety disorders.
Anna has described herself as having symptoms of anxiety, worry, loneliness, and irritation to
others. Anna’s daughter has affirmed many of these symptoms while suggesting that her
mother’s worrying is causing a separation within their family. The beck anxiety inventory
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CASE STUDY: ANNA
assessment is relatively short and self-administering leading to a quicker understanding of the
treatment necessary. Because of these factors I believe that becks anxiety inventory is an
appropriate choice when compared to other scales such as the depression anxiety stress scale or
the Yale-brown obsessive-compulsive scale.
Diagnostic Impression
Due to Anna’s consistent worrying regarding a multitude of situations and her struggle to
alleviate feelings of anxiety and stress, I believe that the primary diagnosis is generalized anxiety
disorder (GAD) which is ICD-10 code F41.1 within the diagnostic and statistical manual of
mental disorders (APA) (2013). Secondary diagnosis’s that closely relate to Anna’s symptoms
include: separation anxiety (F93.0) and social anxiety (F40.10) (APA, 2013). Anna struggles
with anxiety regardless of the social situation that she encounters. Anna’s symptoms appeared to
begin before there was any separation of her family though that worsened her ongoing worrying.
Signs and symptoms
DSM-5-TR Diagnostic Criteria: Client’s Sign’s/Reported Symptoms:
Criterion A: Excessive anxiety and worry on
more days than not within a minimum of six
months
Anna’s anxiety and worry symptoms have
lasted well over a year and are active almost
daily.
Criterion B: It is difficult to control the
worrying
Anna reported that she struggles to not worry
to the point where it is affecting her
relationships.
Criterion C: Association with being easily
fatigued, feeling restless, struggling to
concentrate, irritability, muscle tension, or
sleep disturbances.
Anna reports that she feels restless and
fatigued. Anna has also reported that she
feels strained in her neck and shoulders and
she has been continually and increasingly
struggling to sleep.
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CASE STUDY: ANNA
Criterion D: Symptoms can cause impairment
relating to social, occupational, and other
areas where adequate functioning is required.
Though Anna is no longer employed, she
reports strained social relationships with her
family and struggling to appropriately
function within day to day situations.
Criterion E: Symptoms are not credited to
physiological effects from either substances
or an existing medical condition.
Anna reports an increase in her alcohol
consumption but neither she nor her daughter
believe that it is a concern relative to her
anxiety. Anna does not report any medical
issues other than sleeping issues for which
she is prescribed Paxil.
Criterion F: The ongoing disturbance would
not better explained by a differing mental
health issue due to symptoms aligning
appropriately.
Anna’s symptoms align well with
generalized anxiety disorder and she does
not report a knowledge of any mental
disorders within herself or family (APA,
2013).
Other DSM-5-TR Conditions Considered
Anna presents multiple symptoms synonymous with separation anxiety due to the loss of
her husband within the past few years and her children moving out of her home with two
currently residing out of state. While Anna does appear to fear separation from her family, she
does not report a fear of being alone and her daughter confirms that she has always struggled
with being “high strung.” Separation anxiety involves anxiety taking place as a result of
separation or fear of separation from loved ones. However, Anna only meets one third of
criterion A. Social anxiety disorder was under consideration due to Anna’s reference of how
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CASE STUDY: ANNA
others may judge her, however, she only meets two out of the ten criteria and her anxious
feelings are triggered by a plethora of scenarios not relating to social situations (APA, 2013).
Developmental Theories and/or Systemic Factors
Referencing Erikson’s stages of development, Anna is in stage eight, integrity and
despair. According to Gilleard (2019), The purpose of stage eight is a time to look back on all of
life’s accomplishments and regrets hoping to gain an overall sense of satisfaction from
relationships formed and goals achieved. Alongside satisfaction, unfortunately, is the
understanding of failures and concerns both of which are presently active and will engage in the
future after one is no longer physically here (Gilleard, 2019). Within this stage, Anna may be
gaining increasing anxiety as sees all that she wants to still accomplish and all that she desires to
protect. From Anna’s recollection of the shifting in her family dynamic, it is understandable that
there is an increase within her recent worries triggering her disorder. Because of the loss of her
husband, her younger children moving away, and the newfound realization that her grandchildren
choose to avoid her, Anna is forced to confront her mental health issues. Anna’s increased stress
regarding her family mixing with her view that she feels trapped taking care of her mother and
the loneliness that she feels all appear to work together to increase anxiety.
Multicultural and/or Social Justice Considerations
Kring (2021) encourages counselors to take time to understand the importance of various
cultural differences within clientele in order to not only avoid offense but to target areas of
importance and best assist them (Kring, 2021). Anna is an Asian American, the role she feels the
need to take on is directly correlated with her cultural heritage and the respect that she holds for
her elders and her children. Anna believes that it is her duty to take care of her mother placing
her needs above her own to the point where if she does not she fears she will be able to return to
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CASE STUDY: ANNA
her extended family. Anna is also a widowed mother living in America, there is an assumed lack
of support which places pressure on her. Goetter (2020) references the importance of
understanding the barriers set aside for minorities such as stigmatic and logical struggles among
an overall lack of access to affordable and appropriate treatment (Goetter, 2020). Because of both
Anna’s socioeconomic, ethnic, and cultural status, she is at a higher risk for barriers regarding
her care. Final consideration relates to Anna’s religious beliefs, as a Hindu woman, there are
certain regulations that she must uphold within the counseling process, however, as long as these
are met, she should find encouragement and guidance through her spirituality.
Treatment Recommendations
Key Issues for Treatment
-Anna’s constant worrying
-Anna’s physical symptoms as a result of her anxiety
Recommendations for Individual Counseling
Because Anna’s struggles are based around her anxiety, I believe that integrating
cognitive behavioral therapy (CBT) into her treatment will allow her to redirect her anxious
thoughts and formulate a calmer attitude through redirection and neuroplasticity. According to
Robichaud (2019), the use of CBT within GAD encourages clients to shift focus from the
impending problems taking precedent over their daily actions to a scaled understanding of the
realistic severity of these problems mixed with a positive outlook on other aspects of life
(Robichaud, 2019). A second treatment recommendation is the implementation of a mindfulness
practice specifically when correlated with Acceptance and Commitment Therapy (ACT). Morgan
(2014) suggests that continued mindfulness practices integrated into acceptance therapy provided
positive effects regarding symptoms triggered by GAD (Morgan, 2014). At this time, I do not
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CASE STUDY: ANNA
believe medication is necessary because Anna presents as motivated to worth through her
struggles and an integration of therapeutic techniques hopefully will appropriately aid her but
this should be revisited after several weeks of continued therapy.
Specific Considerations
Anna’s cultural background plays an imperative role in this specific case study. It would
be beneficial to gain greater detail regarding the specific sect of Hinduism she adheres to and
how that integrates into her daily life. Because the majority of Asian culture prioritizes success
from a collectivistic standpoint, seeking aid would be looked down upon as bringing shame and
placing selfish needs before that of an elder. Encouraging Anna to prioritize her recovery and
treatment may challenge the entirety of her culture proving to give us many obstacles from her
family and close friend. As a white male who has a background in a westernized individualistic
culture, there I will need to humble myself focusing on developing an authentic relationship
where I can compartmentalize my personal values and autonomously encourage Anna to do what
is best for her mental wellbeing (Kring, 2021). As a Christian, I believe that we are called to
allow the Lord to guide us to aid others, my personal values include a love of others viewing
them as the Lord does, therefore managing my values include partnering with Anna to help her
autonomously make positive choices regarding the future of her relationship with her feelings.
References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders:
DSM-5 (5th ed.). American Psychiatric Association Publishing.
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CASE STUDY: ANNA
Chapa, O. (2022). An examination of the beck anxiety inventory structure and psychometric
properties: A study of American employees. International Journal of Human Resource
Management, 33(12), 2420-2441.
Gilleard. (2019). The final stage of human development? Erikson’s view of integrity and old age.
International Journal of Ageing and Later Life: IJAL, 14(2), 1–24.
Goetter, E. M., Frumkin, M. R., Palitz, S. A., Swee, M. B., Baker, A. W., Bui, E., & Simon, N.
M. (2020). Barriers to mental health treatment among individuals with social anxiety
disorder and generalized anxiety disorder. Psychological Services, 17(1), 5-12.
Kring, A. M., & Johnson, S. L. (2021). Abnormal psychology: The science and treatment of
psychological disorders (15th ed.). John Wiley & Sons, Inc.
Morgan, L. P. K., Graham, J. R., Hayes-Skelton, S. A., Orsillo, S. M., & Roemer, L. (2014).
Relationships between amount of post-intervention mindfulness practice and follow-up
outcome variables in an acceptance-based behavior therapy for generalized anxiety
disorder: The importance of informal practice. Journal of Contextual Behavioral Science,
3(3), 173-178.
Robichaud, Koerner, N., Dugas, M. J., & Dugas, M. J. (Michel J. (2019). Cognitive-behavioral
treatment for generalized anxiety disorder from science to practice (Second edition.).
Routledge.
