CASE STUDY 2
Introduction
Sarah is a 35-year-old woman who has been struggling with symptoms
characteristic of both Generalized Anxiety Disorder (GAD) and Major Depressive
Disorder (MDD). She is constantly plagued by worry, restlessness, and difficulty
concentrating, which are characteristic symptoms of GAD. Concurrently, she also
exhibits symptoms of MDD, such as persistent sadness, loss of interest in activities she
once enjoyed, and sleep disturbances. In this case, Sarah's symptoms span physical,
emotional, and cognitive domains. Physically, she experiences restlessness and sleep
disturbances. These symptoms can manifest as a constant feeling of being on edge,
difficulty sitting still, and trouble falling or staying asleep. Emotionally, Sarah is
persistently sad and has lost interest in activities she once enjoyed. This means she no
longer finds pleasure in hobbies, social activities, or other sources of enjoyment that she
used to look forward to. This emotional numbness is a common symptom of MDD.
Cognitively, Sarah struggles with constant worry and difficulty concentrating. This
means she has trouble focusing on tasks, is easily distracted, or may have intrusive
thoughts of worry that interfere with her daily life. These cognitive symptoms are typical
of GAD.
Clinical History
Sarah, our patient, comes from a middle-class family background. She is the
eldest of three siblings and was raised in a suburban neighborhood. Sarah completed
her education with a Bachelor's degree in Business Administration and has worked in a
corporate setting for the past ten years. Sarah's family psychiatric history is significant,
with her mother having been diagnosed with Major Depressive Disorder. Sarah herself
CASE STUDY 3
has had a history of psychiatric issues, with intermittent episodes of anxiety and
depression throughout her adult life. She has previously sought outpatient therapy but
has never been hospitalized for her symptoms. Sarah does not have a history of drug or
alcohol abuse. However, she admits to occasional social drinking. Regarding her family
and social relationships, Sarah is unmarried and maintains a close relationship with her
family. She has a small but supportive circle of friends.
Sarah has faced significant life stressors in recent years, including a demanding
job and the loss of a close family member, which have worsened her symptoms.
Despite her struggles, Sarah has expressed future goals of advancing in her career and
starting a family. Currently, Sarah lives alone in a two-bedroom apartment in the city.
The narrative of Sarah's life history, coupled with her current symptoms, leads us to her
dual diagnosis of Generalized Anxiety Disorder and Major Depressive Disorder.
Diagnosis
Sarah has been diagnosed with Generalized Anxiety Disorder (GAD) and Major
Depressive Disorder (MDD) based on the DSM-V criteria. For GAD, the DSM-V criteria
include excessive anxiety and worry about various events or activities for more days
than not for at least six months, difficulty controlling the worry, and anxiety associated
with three or more of the following symptoms: restlessness, being easily fatigued,
difficulty concentrating, irritability, muscle tension, and sleep disturbance. Sarah's
constant worry, restlessness, and difficulty concentrating meet these criteria. For MDD,
the DSM-V criteria include five or more of the following symptoms present during the
same two-week period and represent a change from previous functioning: depressed
mood, markedly diminished interest or pleasure in all or almost all activities, significant
CASE STUDY 4
weight loss or gain or decrease or increase in appetite, insomnia or hypersomnia,
psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness
or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of
death. Sarah's persistent sadness, loss of interest in activities, and trouble sleeping
meet these criteria.
Rationale
The theoretical framework guiding the treatment plan for Sarah is Cognitive
Behavioral Therapy (CBT). This modality has been empirically validated for treating
both Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD). CBT
operates on the premise that maladaptive thought patterns contribute to emotional
distress and behavioral issues. By helping Sarah identify and challenge these negative
thought patterns, we aim to alleviate her symptoms of both GAD and MDD.
Overlapping symptoms between GAD and MDD, such as difficulty concentrating
and sleep disturbances, will be addressed within the CBT framework. Cognitive
restructuring and behavioral activation can help Sarah manage these symptoms.
The number of sessions proposed in the treatment plan is based on
recommendations from the research literature. According to the American Psychological
Association, a typical course of CBT for depression is often 10-20 sessions and a
similar range is suggested for GAD. Therefore, we propose weekly sessions for a period
of 20 weeks to address both disorders.
Treatment Protocol
CASE STUDY 5
Treatment Protocol for Sarah who is suffering with symptoms of Generalized Anxiety
Disorder (GAD) and Major Depressive Disorder (MDD) would include the following.
Session 1:
Objective: Establish rapport and gather information about Sarah's symptoms and
background.
Behavioral Intervention: Conduct a thorough intake assessment to understand
Sarah's presenting concerns and history.
Session 2:
Objective: Educate Sarah about the nature of GAD and MDD.
Behavioral Intervention: Provide psychoeducation about the symptoms, causes,
and treatment options for GAD and MDD.
Session 3:
Objective: Teach Sarah relaxation techniques to manage anxiety symptoms.
Behavioral Intervention: Instruct Sarah in deep breathing exercises and
progressive muscle relaxation to help her cope with anxiety.
Session 4:
Objective: Address negative thought patterns related to depression.
Behavioral Intervention: Introduce cognitive restructuring techniques to challenge
and change negative thoughts that contribute to Sarah's depression.
CASE STUDY 6
Session 5:
Objective: Develop a personalized self-care plan for Sarah.
Behavioral Intervention: Collaborate with Sarah to create a plan that includes
activities she enjoys, healthy coping strategies, and social support.
Session 6:
Objective: Practice exposure therapy for anxiety.
Behavioral Intervention: Gradually expose Sarah to anxiety-provoking situations
to help her confront and overcome her fears.
Session 7:
Objective: Implement behavioral activation for depression.
Behavioral Intervention: Encourage Sarah to engage in pleasurable activities and
set achievable goals to increase her motivation and improve her mood.
Session 8:
Objective: Monitor progress and adjust treatment plan as needed.
Behavioral Intervention: Review Sarah's symptoms and progress, discuss any
challenges or improvements, and modify the treatment plan as needed.
Overall, the treatment protocol for Sarah will involve a combination of
psychoeducation, relaxation techniques, cognitive restructuring, exposure therapy,
behavioral activation, and ongoing monitoring to address her symptoms of GAD and
CASE STUDY 7
MDD. The goal is to help Sarah develop coping skills and strategies to manage her
anxiety and depression effectively.
Discussion
In the case of Sarah, a 35-year-old woman presenting symptoms of both
Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD), a
comprehensive treatment protocol was developed to address both disorders effectively.
To address GAD, Cognitive Behavioral Therapy (CBT) was utilized to help Sarah
identify and challenge negative thought patterns contributing to her anxiety. Through
weekly CBT sessions, Sarah worked on restructuring her cognitive distortions and
developing coping strategies to manage her symptoms of worry, restlessness, and
difficulty concentrating.
For MDD, medication management was incorporated into the treatment plan. An
antidepressant, such as a selective serotonin reuptake inhibitor (SSRI), was prescribed
to regulate Sarah's mood and alleviate symptoms of persistent sadness, loss of interest,
and sleep disturbances. Close monitoring by a psychiatrist was emphasized to optimize
treatment outcomes.
The treatment protocol also addressed overlapping symptoms between GAD and
MDD, such as difficulty concentrating and sleep disturbances, within the framework of
CBT. Techniques like cognitive restructuring and behavioral activation were employed
to help Sarah manage these shared symptoms effectively.
By integrating evidence-based interventions for both GAD and MDD, the
treatment plan aimed to provide Sarah with a holistic approach to addressing her mental
