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Michelle: A Case Study of Generalized Anxiety Disorder
Transcript of Michelle: A Case Study of Generalized Anxiety Disorder
Generalized Anxiety Disorder
An anxiety disorder characterized by general feelings of dread and foreboding and heightened states of bodily arousal.
DSM-IV Dx Criteria
she has excessive anxiety and worry occurring more days than not for at least 6 months
she has difficulty controlling her worry
she is experiencing more than one of these six symptoms: Restlessness, fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance.
Her focus of worry is not confined to features of an AXIS I disorder
Her anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social and educational areas.
her disturbance is not due to the direct physiological effects of a substance or a general medication
Mental Status Exam
The client was dressed casual in jeans, a tank top, and flip flops. She was in good physical shape and did not seem to have any problems seeing or hearing. Her thinking was coherent and she was orientated to date, time, and person. She had a fatigued look on her face and seemed very anxious. Her cognitive level was fine and so was her memory. She has a good insight on her anxiety and knows that she needs help in dealing with it.
14 year old 9th grader
lives with mom, dad, older problematic brother, and younger sister who looks up to Michelle
Exceptional student who wants to be an English teacher when she grows up
She spends most of her time cheering, reading, studying, and playing with her two dogs.
Michelle has always been a "worry wart" . Recently it has been hard for Michelle to control her worrying. She worries about her peers, letting down her parents, ending up like her problematic brother, not being a good role model for her sister, getting good grades, and getting into college
She is always exhausted and experiences muscle tension and body aches.
DSM-IV Multiaxial Classification
AXIS I: Generalized Anxiety Disorder
AXIS II: NO personality disorder or mental retardation
AXIS III: Broken arm and leg a year ago from cheerleading accident
AXIS IV: Adjusting transferring to high school
AXIS V: GAF 65
Developmental, Psychiatric, and Medical History
Developmental History: Normal
Psychiatric History: None
Medical: Broken arm and leg after falling of cheerleading pyramid.
Cognitive Behavioral Therapy
CBT is a short-term goal oriented psychotherapy treatment that takes a hands-on practical approach to problem solving. Its goal is to change patterns of thinking or behavior that are behind peoples difficulties.
Therapy session 1
Goal: To figure out what was causing Michelle's recurrent worry
Actions: Make a list of worries and rank them from fearful to most fearful. We then discussed how to determine whether her worries were "real problems" or "just a worry"
Therapy Session 2
Goal: To introduce guided imagery to michelle as a relaxation technique to cope with her anxiety
Actions: practice guided imagery and for homework she is to keep practicing the guided imagery technigue.
Purpose: to evaluate the effect of a GAD-specific cognitive treatment in a sample of adolescents with GAD
Participants: 10 girls and 6 boys aged 7-17
Treatment:There were 6 Stages of treatment and each stage consisted of these components: detailed discussion of current worries, to identify common elements, to identify common elements of uncertainty and cognitive avoidance, critical discussion to distinguish real-life problems from worries, behavioral experiments to test the validity of any worry related beliefs and imaginal and in vivo exposure to feared situations.
Results: Out of 16 participants, 13 lost their GAD Dx, 2 were improved but still had GAD and only 1 participant did not show any improvement.
A pilot investigation of cognitive Therapy for GAD in children aged 7-17 years
By: Susanna Payne, Derek Bolton, And Sean Perrin