Reference no: EM133668020
Presenting Complaint-Case study
Annabeth, a 37-year-old white woman, knew that it was finally time for her to seek psychological services. She had always been an anxious person and, for years, had managed to keep it under control. But this time, she felt as though she was fighting a losing battle and worried that it would result in her being fired from her job. Annabeth worked as a flight attendant for a major airline and loved traveling all over the world and interacting with the passengers. She was particularly proud of her extensive knowledge of aircraft safety regulations and had confidence in her ability to manage a crisis properly should it arise. However, over the past year, she had missed a significant amount of work because of her extreme anxiety about flying and staying in hotels in different cities. Annabeth had wanted to believe that her worry about her career was justified, but she knew deep down that she worried about everything, not just work. She worried about other things that most people would see as trivial: whether she would be caught in the rain without an umbrella, if she would remember to pay her bills on time, or if the bus she was riding would break down and leave her stranded.
Annabeth recalled that she noticed a change in her thinking beginning with the disappearance and loss of a Malaysian plane repeatedly reported by the media. Then, after the terrorist attack that brought down a Russian aircraft - which triggered memories of the September 11th attacks from over a decade prior - she began to repeatedly think, "That could have been me in that plane. What would I have done? This is just one more sign that the world has become a very dangerous place." Annabeth finds that she can't relax on her days off because she spends the entire time worrying about taking her next flight. "I worry all the time--about everything." She worries that she will miss the bus to the airport and be late for work. She worries that she will have a panic attack on the airplane, and the pilots will have to make an emergency landing. Annabeth has experienced two or three panic attacks in her life but has not had a panic attack in more than three years. However, she carries with her everywhere a dose of Xanax a friend gave to her "just in case she needs it." In the past, once Annabeth made it to work, she could relax somewhat. But now, she worries about being the target of a terrorist attack or dying in a plane crash. She also worries about where she will stay once she reaches her destination. "We always arrive so late and must take an Uber to our hotel. Some of those cities have very high crime rates and are extremely dangerous. It's just not safe to be a single woman out at that time of night." Annabeth finds that she can worry about all of these different issues almost simultaneously, which leaves her feeling exhausted and overwhelmed. This is usually when she calls in sick to work and goes back to bed.
Although she always hopes just to sleep away her problems, Annabeth inevitably finds that a good night's rest is elusive. It is always the same: When she goes to bed, she can't shut her mind off, and her thoughts keep racing. Many nights, she spends hours trying to fall asleep, which only causes her to worry that she will be less able to function adequately in her job when she is sleep-deprived. Furthermore, she notices that she has a much shorter fuse with people around her when she is stressed and tired. Annabeth worries about this, too, because she doesn't want to lash out at one of her co-workers and create tension among the staff.
From as far back as she can remember, Annabeth has always been called a "worry wart." She recalls that when she was seven years old, she would walk around the house making sure all the appliances were unplugged before she went to bed for fear that a fire would break out and burn the house down while everyone was sleeping. In the 3rd grade, after hearing doctors talking about the relationship between cancer and smoking, she became convinced that her mother was going to die of lung cancer because she had been a smoker for many years. Furthermore, she began to worry that everyone else in the family would also become ill from the second-hand smoke. Many years later, even after her mother quit smoking, Annabeth still worried about her dying from cancer.
She also often worried about someone in her family getting killed in a motor vehicle accident. Annabeth was not a typical 16-year-old adolescent because she had no desire to learn how to drive. Driving was a terrifying and dangerous activity. One day, her father told her that she absolutely needed to know how to drive and signed her up for driving lessons. She eventually received her driver's license and, within the first six months of driving, was involved in two accidents, neither of which were her fault. After the second accident, Annabeth concluded that driving simply was unsafe and that she had used up her good luck in the first two accidents. She has never driven since and instead rides the bus.
One of the reasons it has been difficult for Annabeth to seek treatment is that, although she knows her anxiety is starting to interfere with her life, there is a part of her that feels afraid to give it up. She also believes that some of her anxiety has been helpful. For example, she believes that worrying about safety and being vigilant has been a good thing because it has kept her safe until now. She feels that people, in general, aren't concerned enough about personal safety, and that is why they end up in dangerous situations. In addition, years of experience have taught her that if she worries, it seems to help prevent the adverse event from occurring. Although some people call her superstitious, Annabeth points to the fact that one of the reasons her mother quit smoking was because she didn't want to add to Annabeth's stress and as a result of Annabeth's continued worrying, her mother never started smoking again and is healthy and cancer-free today.
Even so, Annabeth found herself in the psychologist's waiting room, doubting whether she had made the right decision. "After all, "she thought, "everyone has some anxiety, right? What if the doctor thinks I'm really crazy for thinking this is such a problem? Even worse, what if she tells me that I'm so messed up that I'm beyond help? Then what will I do?"
Social and Family History
Annabeth was born the youngest of six children. Both biological parents raised her and her siblings in a mid-sized town in Ohio. She always considered herself the "black sheep of the family." Her four eldest siblings were boys, and although she got along with them fine, the age and gender difference made her feel that their relationships were more paternalistic than anything else. She had one sister who was three years older; however, she described their relationship as "superficial" because they had such different personalities and views of the world. Annabeth's sister never seemed to worry about anything. She took every day as it came and couldn't understand why Annabeth was always thinking about the future and not living in the present. Annabeth felt inadequate around her sister, who seemed to be successful in everything she did, and she believed that her sister looked down on her for having problems with anxiety.
Her father never seemed to understand her either. Annabeth always felt as though her father was very distant and difficult to impress. He wasn't just like this with her. He seemed to have little to do with any of the children. Her father worked long hours as an attorney, and when he was not working, he had to take his wife out to run errands since she was afraid to go out alone. Annabeth tried so hard to do well in school to impress her father, but it seemed as though whatever she did wasn't quite good enough to get his sustained attention.
Annabeth often had to rely on her older siblings to take care of her as her mother was always "sick." Her mother rarely left the house unless she was with her husband and would spend hours locked in her room.
It seemed as though the whole family just accepted the way her mother was and never questioned if she needed treatment of some sort. As an adult, Annabeth came to believe that her mother suffered from agoraphobia. She remembers from a very young age how her mother would talk to her about how dangerous the world is. They would often watch the news together, and her mother would point out all the terrible things that could happen to people if they were not highly cautious at all times. She remembers never being allowed to play out on the street with the other neighbors or spend time at a friend's house unless a parent was directly supervising. As a result, she did not have many friends growing up, which added to her feelings of being different from everyone around her.
When she was eight years old, the only person Annabeth was allowed to spend unsupervised time with was their neighbor, Mr. Jack. Mr. Jack was 45 years old, never married, and loved to work in his garden. Annabeth was permitted to help Mr. Jack in his garden while her mother was either in the kitchen or on their deck. This way, she could still see Annabeth but did not have to be right by her side.
Annabeth was well aware of the rules but started accepting Mr. Jack's invitation to come into the house for a quick drink of iced tea and candy as a thank-you for her hard work. One day, while her mother was gathering laundry downstairs, Mr. Jack invited Annabeth over to his house for cookies and milk. She figured she could be back home before her mother found out and rushed over to Mr. Jack's house. That day, Annabeth was sexually molested by Mr. Jack. She never told anyone in her family about what happened and never went over to his house again. Annabeth still experiences an extreme amount of guilt related to the molestation because she didn't listen to her mother and believes that the abuse was her fault because she trusted someone she didn't know very well.
Annabeth struggled with romantic relationships while she was growing up. She knew she had problems with trust, but given her past experiences, she didn't know when it was safe to trust someone. When she was 26 years old, she began dating someone with whom she felt a genuine connection. He was an airline pilot and, therefore, understood some of her anxieties about flying and spending so much time away from home. After they had been dating for two years, Annabeth discovered that she would be required by her job to move to Seattle, Washington. Initially, she was very wary of such an abrupt change; she had lived in Ohio her entire life. However, when her boyfriend told her he would move with her, she became excited about their future and agreed to the transfer. Because of different flying schedules, Annabeth needed to move to Seattle a week before her boyfriend. While she was there, setting up their new apartment, her boyfriend called and informed her that he was not going to move and "wanted some time apart." Annabeth was utterly crushed, had a severe panic attack, and spent her first night in Seattle in the emergency room. Since that time, she has not dated anyone seriously, lives alone, and she is terrified of being burglarized. Annabeth even keeps a large pair of men's shoes and a dog bowl outside her front door despite being single, not owning any pets, and being nervous around dogs.
1. Refer to the DSM-5-TR checklist of generalized anxiety disorder (provided in your textbook and corresponding Chapter 4 PowerPoint). First, list the GAD DSM-5-TR criteria for which Annabeth qualifies, then match and describe the specific symptoms Annabeth presented in the case study.
2. Based on a description of Annabeth's thought and behavioral patterns, does she meet the criteria for the DSM-5-TR diagnosis of an additional comorbid anxiety disorder discussed in Chapter 4? If so, which?
Refer to the diagnostic checklists in Chapter 4 (and the corresponding PowerPoint) and support your reasoning for or against an additional DSM-5-TR diagnosis.
3. Discuss the sociocultural perspective's explanation for Generalized Anxiety Disorder (GAD) Then apply it to Annabeth.
4. First, discuss and apply today's modern psychodynamic perspective to explain Annabeth's GAD. Then, explain the goal of the modern-day psychodynamic therapist for treating GAD, including at least three techniques a clinician might use
5. Discuss Carl Roger's Humanistic perspective on GAD, and describe his Client Centered therapeutic approach and how it might be used to treat Annabeth.
6. How would the cognitive dimension explain Annabeth's GAD? Provide examples from the case study.
7. Compare and contrast the goals and approaches of the cognitive-behavioral therapies Rational-Emotive Therapy and Breaking Down Worry.
8. According to your textbook what are three possible biological factors that might have contributed to Annabeth's GAD?
9. Identify three different classifications of medications (NOT the brands or generic names of specific drugs) that are most commonly used to treat Generalized Anxiety Disorder, and briefly explain which neurotransmitters they affect.
10. Based upon what you have learned about the possible causes and therapies for GAD, which do you believe best applies to Annabeth? Explain your rationale, being sure to support your reasoning.
11. Identify and explain two non-drug-related biological therapies used to treat GAD?