CASE STUDY: JANE 1
Case Study: Jane
Frank B. Hill
School of Behavioral Sciences, Liberty University
Author Note
Frank Hill
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Frank B. Hill
Email: fbhill@liberty.edu
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CASE STUDY: JANE
Client Concerns
Symptoms Behaviors Stressors
Recurrent flashbacks Snapping at people Car accident ~2 weeks ago
Inability to concentrate Irritable and angering
easily
Self-doubt of how she
handled accident
Nightmares 5X/week Decreased work
performance
Social life negatively
affected
Difficulty falling asleep
and returning to sleep
Not able to drive - panic
attack when approaching
vehicle
Church attendance
negatively affected
Anxiety Cannot participate in
normal
social/work/community
activities
Community involvement
negatively affected
Reliving trauma with
physiological symptoms
Startles easily Anger with God
Feelings of
Sadness/hopelessness
Inability to care for parents
Assessment
The assessment used to clarify diagnosis for the client was the National Stressful Events
Survey Acute Stress Disorder (NSESSS). This screening tool is comprised of seven questions
for the client to answer regarding the symptoms they are experiencing related to their traumatic
experience (Psychiatry.org, n.d.). It looks at the severity of the symptoms over the course of the
past week and is scored on a five point scale with a five being most severe and a zero meaning
that the symptom is not present. If two or more questions are not answered by the client, the
assessment cannot be scored or used as a diagnostic tool
Diagnostic Impression
Signs and Symptoms
DSM-5 Diagnostic Criteria: Acute Stress
Disorder F43.0 (American Psychological
Association, 2013)
Client’s Signs/Reported Symptoms:
Criterion A: Exposure to actual/threatened
death, injury or sexual violation in one or
more of the following ways
Directly experiencing traumatic event
Witnessing traumatic event occur to
others
Learning about the event occurring to
close family/friend
Experiencing repeat exposure to
aversive details of trauma
Client was in a traumatic car accident
18 days prior
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CASE STUDY: JANE
Presence of 9 or more of the following
symptoms
Recurrent/involuntary/intrusive
memories of the trauma
Recurrent distressing dreams related
to the trauma
Dissociative reactions (flashbacks)
Intense psychological distress or
marked physiological reactions in
response to internal/external cues that
resemble an aspect of the traumatic
event
Persistent inability to experience
positive emotions
Altered sense of reality of one’s
surrondings or self
Inability to remember important
aspects of the event
Efforts to avoid distressing memories,
thoughts, feelings associated with the
event
Efforts to avoid external reminders
that arouse distressing memories,
thoughts, feelings about the event
Sleep disturbance
Irritable behavior/angry outbursts
Hypervigilance
Problems with concentration
Exaggerated startle response
Client states that she is having
uncontrollable memories related to the
accident and thinks about how she
could have handled it better to have
avoided it
Nightmares of accident 5X/week
Physiological symptoms (increased
heartrate, sweating) when thinking
about accident or about driving again
Avoidance of driving and of highways
Inability to sleep without nightmares
Inability to fall asleep easily
Inability to return to sleep post-
nightmare
Snaps at family members/husband
Self-report of irritability
Hypervigilance when driving in car
related to finding ways to get to work
avoiding highways
Inability to concentrate
The disturbance causes clinically significant
distress or impairment in social, occupational,
or other areas of functioning
Client is unable to participate in normal
social/church/community activities. Client is
unable to drive self to work at this time.
Duration of disturbance between 3 days and
one month post-trauma
Car accident occurred 18 days prior to visit
Disturbance not attributable to the
physiological effects of substance or other
medical condition including brief psychotic
disorder
No hx of substance use. No medical
conditions
Other DSM-5 Conditions Considered
The other DSM-5 conditions that I considered were Post-Traumatic Stress Disorder, at
first glance, but because of the amount of time that has passed since the trauma, it does not yet
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CASE STUDY: JANE
meet the requirements. After one month post-trauma, we would be able to consider that
diagnosis as a possibility (APA, 2013).
Developmental Theories and/or Systemic Factors
When looking at the possible systemic factors present, the only one that speaks to the
client being more likely to develop Acute Stress Disorder would be the present stress levels in
her life. She is responsible for visiting her elderly parents and also works full time. This could
contribute to the likelihood of developing this disorder post traumatic event. However, I do think
that the support that she has from her family, friends, and church should have made it less likely
for this to occur. Developmentally, her age does not predict a likelihood of developing a trauma
response disorder (Ditlevsen and Elklit, 2010). It is more likely for someone in their mid-
twenties to have this type of response. Her ethnicity may predict the likelihood of developing
Postraumatic Stress Disorder once a month passes. Those that are African American and Latino
are more likely to develop PTSD after a traumatic event and the course be chronic (Sibrava et al.,
2019).
Multicultural and/or Social Justice Considerations
Jane is an African American female who is willing to participate in treatment. She has a
strong spiritual background and belief. The major concern related to her ethnicity is that African
American people are more likely to develop PTSD after a traumatic event and the course is likely
to be chronic (Sibrava et al., 2019).
Treatment Recommendations
Key Issues for Treatment
Managing symptoms related to flashbacks/nightmares
Reconnecting client with social/occupational/spiritual supports by helping her to drive
R/O Medication management
Recommendations for Individual Counseling
Trauma-focused Cognitive Behavioral Therapy (TF-CBT) (Bryant, 2022).
oPatient education to normalize stress response and understand that there is an
expectation of recovery
oCognitive restructuring to address the client’s unrealistic ideas related to the trauma
and their response to the trauma
oAccording to Simon et al. (2021), Trauma-focused Cognitive Behavioral Therapy is
an effective way of approaching Acute Stress Disorder and Posttraumatic Stress
Disorder and can have positive results when completed over the internet. This would
aid Jane in at least beginning therapy in a way that is comfortable and appropriate to
her current condition.
Exposure Therapy
oBehavioral treatment to slowly allow for the client to overcome learned avoidance to
triggers related to trauma
oReduction in fear and anxiety with the goal of eliminating avoidance
oFor Jane, this would be related to driving, cars, and highways.
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CASE STUDY: JANE
oAccording to Bryant et. al (2008), when compared to other therapies, such as
cognitive restructuring, exposure therapy has the greatest reduction in symptoms
related to Acute Stress Disorder.
Cultural Considerations
As a Caucasian male counselor working with an African American female client, I would
be concerned with her ability to relate well to me in treatment and development of rapport may
be slower than normal. However, because of our shared spiritual beliefs and practices, I think
that might serve as a mediator with the previously mentioned possible issue. I believe that if she
is open to using prayer in session and if we relate it to the therapies that we are utilizing, that I
could be effective in helping her meet her goals of symptom reduction, returning to a normal life,
and avoiding the diagnosis of PTSD.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.).
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CASE STUDY: JANE
Bryant R., Mastrodomenico J., Felmingham K., (2008). Treatment of acute stress disorder: A
randomized controlled trial. Archive of General Psychiatry, 65(6):659–667.
doi:10.1001/archpsyc.65.6.659
Ditlevsen DN, Elklit A. (2008). The combined effect of gender and age on post traumatic stress
disorder: Do men and women show differences in the lifespan distribution of the
disorder? Annual General Psychiatry, 9(32). doi: 10.1186/1744-859X-9-32. PMID:
20663164; PMCID: PMC2917414.
Psychiatry.org (n.d.). Severity of acute stress symptoms adult: National stressful events survey
acute stress disorder. Retreived from:
https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Se
verity-of-Acute-Stress-Symptoms-Adult.pdf
Sibrava N., Bjornsson A., Pérez Benítez A., Moitra E., Weisberg R., Keller M.. (2019).
Posttraumatic stress disorder in African American and Latinx adults: Clinical course and
the role of racial and ethnic discrimination. American Psychology, 74(1). doi:
10.1037/amp0000339.
Simon, N., Robertson, L., Lewis, C., Roberts, N., Bethell, A., Dawson, S., Bisson, J. (221).
Internet-based cognitive and behavioral therapies for post-traumatic stress disorder in
adults. Retrieved from: Cochrane Database of Systematic Reviews.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011710.pub3/abstract
