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Running head: ANNA CASE STUDY
1
Anna Case Study
Name
Institution
ANNA CASE STUDY
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Client concerns
Symptoms
Behaviors
Stressors
Biological
Long term fatigue
Difficulty sleeping
Increased headaches
Taking care of her mother
Muscle tension
Not sitting still in one
place
Neck and shoulder pain
Strained relationship with
her family.
Psychological
Sadness
Trouble sleeping
Husband Death
Strained relationship with
children and grandchildren
Irritability
Snapping
Confrontation from
daughter and mother, being
asked to stop calling
Anger
Multiple fights with
daughter
Strained relationship
Social
Hopelessness
Less contact with family
and friends
Strained relationships with
children and
grandchildren.
Lost contacts
Caring for her mother
Assessment
The client's worry and anxiety have been the greatest hindrance to her well-being, normal
functioning, and personal life. It has also affected her health psychologically, mentally, and
physically. Anna’s anxiety and worry can be assessed using the Penn State Worry Questionnaire
(PSWQ) (Crocq, 2022). PSWQ is a 16-question questionnaire that evaluates the level of worry in
a client. This assessment tool uses a 5-point Likert scale where 1 no worry at all and 5 indicate
highly probable (Schroder, Clark & Moser, 2019). PSWQ was used to conduct this assessment
because the client exhibited symptoms similar to that of generalized anxiety disorder. PSWQ was
ANNA CASE STUDY
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chosen instead of other assessments such as Hamilton Anxiety Scale and Beck Anxiety Inventory
since Anna's symptoms closely match those analyzed through PSWQ.
Diagnostic Impressions
Based on the symptoms Anna is experiencing, the diagnosis for her is the generalized
anxiety disorder that is covered by the DSM-5 ICD – 10 code 300.02, F41.1 of the American
Psychological Association (APA). This code highlights similar signs to the one Anna is
displaying. The table below shows the anxiety and worry symptoms that Anna is experiencing.
DSM-5-TR Diagnostic Criteria: Generalized
Anxiety Disorder: DSM-5 ICD – 10 code
300.02 F41.1
Client’s Signs/Reported Symptoms:
Criterion A: Restless or on Edge
Anna has been high-stung and restless since
she retired from her job.
Criterion B: Being easily fatigued
Anna has experienced fatigue for the last 12
months and she is experiencing it regularly
Criterion C: Difficulty Concentrating
Anna has not reported difficulty concentrating
Criterion D: Irritability
Anna’s irritability has increased in the past
months to the level that she has snapped at
her firstborn daughter after she confronted she
raised concern at her worry.
Criterion E: Muscle tension
Anna is experiencing increased tension in her
body, neck, and shoulders. She is also
experiencing a persistent headache.
Criterion F: Sleep disturbance
Anna is struggling to sleep for the past 18
months.
Although Anna is diagnosed with generalized anxiety disorder, there are other diagnoses
that can apply to her case. These diagnoses include agoraphobia ICD-10 code F40.0 and
separation anxiety disorder ICD – 10 code F93.0 (Haller et al. 2021). According to DSM-5,
agoraphobia symptoms include fear and anxiety that is out of proportion to real risk to a person
in the context of socio-cultural and environment (Swee, Olino & Heimberg, 2019). On the other
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hand, the symptoms of separation anxiety disorder are the fear or anxiety of separation from the
main attachment figures, complaints of physical signs, and excessive worry about facing
unpleasant situations. Despite Anna having the signs of these two diagnoses, they were not
conclusive in diagnosing her with either agoraphobia or separation anxiety disorder.
Anna's behavior, functioning, and development have been greatly influenced by cultural
and environmental factors. As an Asian American woman, Anna has adopted the Asian culture in
the American environment. The cultural and environmental background should be carefully
evaluated when diagnosing her with general anxiety disorder. According to Crocq (2022),
distress and anxiety can be greatly predisposed by sociocultural factors that can lead to anxiety
disorder. As an Asian American, Anna’s anxiety is fuelled by Asian cultural experiences which
are highlighted by her somatic symptoms. For instance, she is worried about fulfilling her
family’s obligation of caring for her 90-year-old mother. She is also worried about the strained
relationship with her children and grandchildren. The Asian culture put a lot of emphasis on the
importance of family which explains why she has a lot of anxiety about having strained
relationships with her family.
Treatment Recommendations
The main issues affecting Anna are difficulty in controlling her worry and physical
symptoms associated with her anxiety. Anna should also be re-introduced to her social circle in
order to get support from a wider network. There are several treatment approaches that be
applied to Anna to help her control her worry and reduce physical symptoms.
The first treatment recommendation is cognitive behavioral therapy (CBT). This
treatment is very effective in minimizing the recurrence of anxiety symptoms. The counselor
ANNA CASE STUDY
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should use this treatment in clinical settings to treat Anna’s psychological symptoms. CBT will
help Anna face the issues that are causing her anxiety and worry to find a lasting solution to
them. Cognitive behavioral therapy can be done together with other treatment exercises such as
mindfulness and meditation to relieve both psychological and physical symptoms (Otte, 2022).
Anna should be taken through relaxation therapy to help her deal with anxious thoughts.
Relaxation therapy will offer techniques she can use to counter anxiety thoughts. She should be
taught to tolerate uncertainty through mindfulness and meditation. Mindfulness and meditation
exercises assist in relieving muscle tension and enable her to sleep well at night. Anna is likely to
receive this mindfulness meditation therapy since it originated Asian religions of Hinduism and
Buddhism which resonate well with her cultural background.
Specific Considerations
There are several issues that need special consideration to understand the root causes of
Anna's anxiety and ways of treating the problem once and for all. While it is easy to understand
Anna's symptoms, it is essential to consider other factors such as her family history and cultural
background when tracing the root cause for her worry. The Asian culture, for instance, places a
lot of priority on family values, cohesion, morals, and the well-being of every member. It is
therefore essential to consider the factors that have caused strain between Anna, her children, and
her grandchildren in the context of culture and environmental background. A clear understanding
of her culture is essential to successful treatment as it allows the counselor to comprehend factors
that influence her worldview and how cultural differences are contributing to her symptoms. It is
also important to evaluate why Anna doesn't like the idea of sending her mother to a nursing
home since this seems to be a cultural belief that is affecting her mentally. The conflict may arise
from cultural and religious differences. Issues such as religious behavior and lifestyle such as the
ANNA CASE STUDY
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care of the elderly in nursing homes are likely to arise. The counselor needs to have a clear
understanding of her background to avoid personal, cultural, or religious prejudice. The
counselor needs to manage personal or conflicting views that may offend the client or erode her
trust in the treatment. The counselor should give information or views from a professional point
rather than trying to force the client to change her cultural or religious views.
References
1.
Crocq, M. A. (2022). The history of generalized anxiety disorder as a diagnostic category.
Dialogues in clinical neuroscience
.
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2.
Haller, H. et al. (2021). A systematic review and meta-analysis of acceptance-and
mindfulness-based interventions for DSM-5 anxiety disorders.
Scientific reports
,
11
(1), 1-
13.
3.
Otte, C. (2022). Cognitive behavioral therapy in anxiety disorders: current state of the
evidence.
Dialogues in clinical neuroscience
.
4.
Swee, M. B., Olino, T. M., & Heimberg, R. G. (2019). Worry and anxiety account for
unique variance in the relationship between intolerance of uncertainty and depression.
Cognitive Behaviour Therapy
,
48
(3), 253-264.
5.
Schroder, H. S., Clark, D. A., & Moser, J. S. (2019). Screening for problematic worry in
adults with a single item from the Penn State Worry Questionnaire.
Assessment
,
26
(2),
336-346.