In this work, a case study of a patient who needs to be prescribed treatment is carried out. Cognitive-behavioral therapy (or CBT) is a technique that highlights the unconscious motivations of a person, brings them to a conscious level, helps to change beliefs and behavior that cause unstable and other pathological conditions. The use of this technique can be auspicious in the case of a 28-year-old female patient with no medical history who needs help due to anxiety and anxiety (Heinig et al., 2017). Anxiety leads to panic attacks, but other symptoms in other body parts are entirely denied or absent. Since the problem is psychiatric, the use of such a technique can be fruitful.
A 28-year-old woman complains of anxiety, increased anxiety, turning into panic attacks. As a result, symptoms of hyperventilation and shaking are highlighted. The problem began in adolescence but has intensified relatively recently and significantly interferes with the patient’s adult life.
The patient is 28 years old, has a bachelor’s degree, works part-time, and lives with a girlfriend. She is 5 feet 3 inches tall, which at 200 pounds indicates signs of obesity. The absence of abnormal movements, grooming, support of visual and speech contacts, and a willingness to cooperate shows the absence of serious problems. Even in the process of discussing issues that bothered her, she did not betray her anxiety. The patient’s current situation began about six months ago and interfered with her healthy long sleep, concentration at work, and, consequently, an everyday life, including her companion. She feels guilty about holding back her partner, but no other adverse disorders have been found. There is no medical history, although these problems began at the age of 10. The previous therapist prescribed Paxil, but after a short-term admission, the patient refused due to poor health. At the moment, the patient is not sick; she does not have any other symptoms and past illnesses at all, the experience of taking medications and treatments. The only possibly influencing fact is that the patient daily drinks 2-3 cups of coffee, 1-2 cups of tea, and 2-3 cans of cola.
A short scale for assessing mental status showed the maximum score. The patient enjoys working at TraderJoes; she is focused on a promising future, has many vital plans to work on herself, worries about her companion, and has remorse that worsens due to the symptoms. Socialization has suffered in the last six months due to the indicated symptoms, due to which the patient missed work shifts and avoided social situations and contacts. In her family, her parents also had psychiatric anxiety and OCD. The patient has the highest level of education, lives with a girlfriend, clearly formulates her speech, and answers questions directly without evasion. She has never taken psychoactive substances, has had no problems with the law, and denies having any severe history.
- (F43.22) Adjustment Disorder with Anxiety.
- (F32.9) Major Depression Disorder – may develop against the background.
- (F41.1) Generalized Anxiety Disorder.
- (F41.0) Panic Disorder.
- (F51.01) Primary Insomnia – a symptom of an underlying problem.
Therapist’s Conceptualization of the Problem
My guideline, in this case, is cognitive-behavioral therapy, which will reveal the most significant events in the patient’s life, the most important experience that has consequences now and prevents her from living a whole life. Beliefs form interpretations in the patient’s thought processes, and my task is to get to these sources. My role is to give the patient an opportunity to look at her beliefs and the meaning given to them from a different perspective to understand the true nature of their origin and the observed symptoms. Most often, as practice shows, it is not the events themselves that are the cause of concern but their interpretation in people’s thought processes.
From a cognitive theoretical point of view, I would conceptualize the patient’s struggle as self-doubt turning into a fear of great responsibility. As it turned out, this fact was caused by a move to her girlfriend, which just took place about six months ago, and since then has been a source of debilitating anxiety, reaching panic attacks. It can also be concluded that the patient is concerned about safety for her gender. The problem dates back to childhood, and most likely, this behavior was a consequence of parents’ behavior, each of whom suffered from a psychiatric disorder, which prevented them from living in harmony (Maric et al., 2018). This problem began to become a habit and formed a template for the interpretation of any setbacks or problems that arise along the patient’s path. It is not for nothing that her plans include losing weight and taking care of herself, which implies the presence of a problem in herself, but guilt and symptoms of anxiety do not allow starting acting, which ultimately leads to the above diagnoses.
Cognitive patterns have a reasonably strong connection with the behavior of patients. Therefore, the goal of this treatment is to try to break these patterns or “adapt” to them. In this case, any situation for the patient, in which her successor the quality of her efforts is questioned, should be interpreted by herself with a different meaning, for example, as a challenge or the interpretation of difficulty as confirmation of being on the right path. Particular attention should be paid to changing behavioral patterns in social situations to avoid aggravating the fear of symptoms in crowded places.
What is more, CBT works great when combined with pharmacological effects. The patient is prescribed Sertraline (Zoloft), Hydroxyzine (Vistaril), the first of which is an antidepressant from the group of selective inhibitors, and the second is a weak tranquilizer with sedative and antihistamine effects. These drugs will improve the patient’s condition for a more effective result of modeling various situations. Finally, these medications can help relieve several symptoms of anxiety, such as insomnia.
The therapist’s goal, in this case, is to create a particular set of situations that will contribute to changing these patterns. As an example, a patient can be led into a cognitive conflict in which she will either see the actual cause of her anxiety or find a new solution to the problem that runs counter to negatively influencing patterns (Hayes & Hofmann, 2018). Various methods and therapeutic techniques will be introduced gradually, acquainting the patient with the theoretical foundations in this area, further allowing her to be involved in any situation. Finally, there have been cases where CBT has been shown to provide short-term relief from insomnia symptoms (van der Zweerde et al., 2019). In the patient’s case, it is necessary to introduce situations that make it possible to clarify the influence of parents on her behavior and identify her strengths, and be guided by common sense and personal experience, not by complexes or anxiety.
We need to show her that when faced with such a burden of responsibility, she is strong enough to pull it, constantly emphasizing its advantages. Modeling such situations can change the patient’s pattern of behavior and return her to everyday life, adequate perception of difficulties, and opportunities for development at work and in personal life. Of course, these problems are likely laid down at the deepest level of knowledge, but with the proper application of the methodology, recovery is only a matter of time.
Hayes, S. C., & Hofmann, S. G. (Eds.). (2018). Process-based CBT: The science and core clinical competencies of cognitive-behavioral therapy. New Harbinger Publications.
Heinig, I., Pittig, A., Richter, J., Hummel, K., Alt, I., Dickhöver, K. & Wittchen, H. U. (2017). Optimizing exposure‐based CBT for anxiety disorders via enhanced extinction: Design and methods of a multicentre randomized clinical trial. International Journal of Methods in Psychiatric Research, 26(2), e1560.
Maric, M., van Steensel, F. J., & Bögels, S. M. (2018). Parental involvement in CBT for anxiety-disordered youth revisited: family CBT outperforms child CBT in the long term for children with comorbid ADHD symptoms. Journal of Attention Disorders, 22(5), 506-514.
van der Zweerde, T., Bisdounis, L., Kyle, S. D., Lancee, J., & van Straten, A. (2019). Cognitive-behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies. Sleep Medicine Reviews, 48, 101208.