Treating Those With Mental Disorders A Comprehensive Approach To Case Conceptualization And Treatment 1st Edition by Victoria E. Kress – Test Bank

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Chapter 5: Anxiety Disorders

Discussion Questions and Activities

1. Consider a time in your life when you felt exceptionally anxious. Reflect on how long you felt like this: were there any precipitating events?; how intense were your feelings/emotions?; what kinds of thoughts

did you have during this time?; did you have sleep and/or appetite changes?; how did you interact and relate to others?; and, what aided or helped you in feeling better? Using these reflections, ponder how this may aid you in working with someone who is feeling anxious.

2. Reflect on some of the fears you have had over the course of your life. How do/did they impact your thoughts, feelings, and behaviors? Did they impact your level of functioning? Discuss the similarities and differences between fears and

3. Discuss when and how you may utilize exposure therapy (in vivo) in clinical practice. Construct a step- by-step approach to using this treatment with a specific

4. Compare and contrast the three outlined approaches (i.e., cognitive-behavioral therapy [Borkovec’s cognitive avoidance model], cognitive-behavioral therapy- [intolerance of uncertainty model], and acceptance and commitment therapy) for treating those who have generalized anxiety disorder. Be sure to pay attention to the similarities and differences of each of these

5. Review the case study of Ka-Sean (at the beginning of the chapter) and briefly summarize the following components of the I CAN START model:
   • Reflect on your own (I) personal reactions to Ka-Sean including her lived experiences, her problems/ difficulties, and her actions/behaviors
   • Describe her (C) contextual assessment
   • Describe her (A) assessment and diagnosis
   • Describe her (N) necessary level of care
   • Describe her (S) strengths, capacities, and resources (at the individual, family, and community levels)
   • List what (T) treatment approach seems most appropriate and outline three (A) aims/objects with the corresponding (R) research-based interventions
   • List any additional (T) therapeutic support services for Ka-Sean

Compare and contrast your answers with the I CAN START model application at the end of the chapter.

6. Construct a creative toolbox activity based on a treatment approach outlined in the chapter. The activity should be tailored for clinical practice and address a specific clinical population. In constructing this activity, identify the following: (a) general activity overview; (b) treatment goals of the creative activity; (c) directions on how to implement the activity in clinical practice; and (d) process questions. Use the two creative toolbox activities within the chapter as a

7. Review the case vignette provided in the instructor’s manual. Using the I CAN START model, construct a comprehensive treatment plan addressing every aspect of the model (Use the treatment plan application at the end of each chapter as a guide). Two considerations worth noting: (1) make sure your (A) aims/objectives are specific, measurable, attainable, results-oriented, and timely; and (2) make sure your (T) treatment approach aligns with the (A) aims/objectives and the (R) research-based interventions.

Chapter 5 Case Study: Joseph

Joseph is a 65-year-old, Native American (of Cherokee decent) who recently retired after 30 years working in higher education as an anthropology professor. He has a strong cultural identity and is married with two adult daughters. Joseph’s daughters are married and live in different parts of the country, yet they remain extremely close with Joseph and he regularly speaks with them both. During his time in academia, he was confident, motivated and dedicated to his work. He was hard-working, punctual, and rarely missed work.

Throughout his career and until retirement, he wrote and made presentations across the United States. Joseph reports that he has been looking forward to “slowing down a bit” during his retirement and “doing all the things he did not have time for” with his wife Nancy to whom he has been married for 46 years.

Upon retirement, and with a new routine, Joseph feels “disoriented.” He reports feeling anxious about his “open schedule” and about going and “meeting new people” in the community. The new feelings of anxiety started to gradually escalate in the first few months after he retired. Joseph states he feels this anxiety when he is around other people. As a professor, he was often anxious to be in front of a class, but he focused on teaching the material and this enabled him to deal with his anxiety. Currently, without this type of distraction, his focus is more so on himself. Due to a recent decline in his vision and hearing, Joseph reports persistent and pervasive thoughts that others are judging and evaluating him as being disabled.

Joseph feels trapped because he doesn’t want to leave his home or be around others, yet his wife wants them to engage in more extracurricular leisure activities such as attending concerts, painting and sculpture classes, and catching up with family and old friends across the country. A week after his retirement, Joseph and his wife made a trip to Yellow Stone National Park and he felt relief when they arrived at the park and were secluded away from other people.

Joseph reports that he is unsure “what is going on with him” and because of his wife’s advisement he is willing to see if counseling could be helpful. He reports not only declining physical symptoms, but also feelings of hopelessness that he will never fully enjoy the retirement he dreamed of for so many years. He reports feeling trapped. He says that he only feels safe in his home and that even when he is in his yard, in a crowd, or in line at the grocery store he feels overwhelmed by this intense anxiety that he is being judged or evaluated by others.

Treatment Plan for Joseph

The following I CAN START conceptual framework outlines treatment considerations that may be helpful in working with Joseph.

C = Contextual Assessment

Joseph is a 65-year-old Native American with a strong sense of family and cultural heritage. He has been married to his wife for 46 years and recently retired as a college anthropology professor.

Secondary to retirement, he is transitioning into a new phase of life. During this transition, Joseph started to struggle with feelings of hopelessness stemming from thoughts that others were/are evaluating and judging him. Physically, he began to experience a decline in his vision and hearing and this may be exacerbating his social anxiety.

A = Assessment and Diagnosis

Diagnosis = Social Anxiety Disorder 300.23 (F40.10)

N = Necessary Level of Care

Outpatient, individual counseling (once per week)

S = Strength-Based Lens

Self: Joseph is an intelligent, insightful, and thoughtful individual. He is reliable, devoted, driven, and hard working. He possesses multiple educational degrees and has been gainfully employed for over 30 years in higher education. He is passionate about his culture, his family and desires to enjoy his retirement.

Family: Joseph enjoys a close relationship with his wife of 46 years. She is a loving, dedicated, and invested in his well-being. Additionally, he is extremely close with his daughters and speaks with them regularly.

Community: Joseph has a strong cultural identity and feels connected to his family, his community, and his ancestors. He has long-standing relationships with colleagues, yet secondary to his current isolating behaviors he has not connected with these individuals recently.

T = Treatment Approach

Cognitive Behavioral Therapy (CBT) with Relaxation Training and Exposure-Based Interventions

A = Aim and Objectives of Treatment (90-day objectives)

Joseph will increase his ability to tolerate his social anxiety and discomfort  Joseph will utilize at least one relaxation technique (e.g., deep breathing, progressive muscle relaxation) when he begins to feel overwhelmed by his intense social anxiety. He will utilize this learned relaxation skill 100% of the time.

Joseph will learn to identify and challenge cognitive distortions related to his social anxiety  Joseph will utilize cognitive restructuring to examine his thoughts/beliefs (e.g., “people are judging me and think I’m disabled”), evidence-review of the accuracy of those thoughts/beliefs, and engage in behavioral experimentation of an alternative and more accurate thoughts/beliefs 80% of the time.

Joseph will increase his ability to tolerate situations which evoke social anxiety  Joseph will create a hierarchy of stimuli that cause anxiety and discomfort (e.g., being in his yard, going to the grocery store, standing in a line). He will gradually be exposed to these situations and resist avoiding them at least 75% of the time. He will learn how to tolerate these situations and the thoughts that he associates with them. He will realize that they do not produce the horrible outcomes which dominate his thoughts.

R = Research-Based Interventions (based on CBT)

Counselor will help Joseph develop and apply the following skills:

• Challenging cognitive distortions
• Accepting and tolerating anxiety
• Applying relaxation skills

Counselor will help Joseph with effective utilization of cognitive restructuring techniques. This restructuring will focus on his thoughts and his anxiety and any misconceptions of how he thinks others view him.

T = Therapeutic Support Services

• Medication evaluation with a psychiatrist
• Weekly individual counseling

Social anxiety support group