Case Study: Anxiety

Instructions

Read the following case study about a woman, Allison, who is suffering from anxiety. After you have read the case study, diagnose Allison and present some methods of treatment by answering the questions.

Presenting Complaint

Allison, a 33-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 was going to result in her being fired from her job.

Allison worked as a flight attendant for a major airline and loved interacting with the passengers. She was particularly proud of her extensive knowledge of aircraft safety regulations and had confidence in her ability to properly manage a crisis situation 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. She 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 was going to remember to pay her bills on time, or if the bus she was riding would break down and leave her stranded. Allison recalled that she noticed a change in her thinking after the terrorist attacks of September 11, 2001. She repeatedly thought, “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. Allison 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 worried that she will have a panic attack on the airplane and the pilots will have to make an emergency landing. She also worries about the hotel that she is scheduled to stay in and whether or not they will still have her reservation when she arrives. Furthermore, Allison worries about the danger of being out at night in a strange town.

She explains, “It’s just not safe for a single woman to be out at night. Some cities have a high rate of crime and are extremely dangerous. ” Allison finds that she worries about all of these things simultaneously, which leaves her exhausted and overwhelmed. However, when she tries to sleep, she cannot shut her mind off. She lays awake for hours thinking about all of the things that could happen. Therefore, Allison is often sleep deprived which leaves her stressed, tense, and irritable. Allison has experienced a few panic attacks in her life, but has not had a panic attack in more than two years.

But she still carries Xanax with her everywhere she goes, just in case she needs it. Ever since she was 7 years old, she has worried about random issues. Allison remembers walking through her house at 7 years old, checking on all of the appliances to make sure that they were all unplugged before everyone fell asleep in fear that a fire would break out and burn the house down. Allison was also worried as a 3rd grader about her mother dying any day from cancer, since her mother was a smoker. When Allison was 16, she had great difficulty with learning how to drive in fear that she would be involved in a car accident.

Indeed, Allison was involved in 2 car accidents, none of which were her fault. Regardless, Allison quit driving and has taken public transportation ever since. Allison has had difficulty with seeking treatment because she is afraid to give up her worrying. She believes that some of her anxiety has been helpful because it has kept her safe. And by worrying, Allison believes that is able to help prevent the negative event from occurring. For example, because of Allison’s worrying, her mother quit smoking and is cancer-free today.

In fact, Allison is considering removing herself from treatment because she is afraid that the psychologist will tell her that she has a serious problem that is beyond help. If she cannot get help, then what will she do? Social and Family History Allison is the youngest of 6 children, 4 of which are boys. She was raised by both parents and considers herself the “black sheep” of the family. Allison felt very different from her brothers because of gender and the way that they treated her with a paternalistic manner. Allison felt inadequate around her sister, who seemed to be successful in everything she did.

Allison feels like her sister looks down on Allison because of the anxiety. Allison’s father never understood her, either. He was very distant and did not seem to want much to do with the children. He worked long hours and spent much time taking Allison’s mother on long errands since Allison’s mother was afraid to go out alone. Allison tried really hard to do well in school to get her father’s attention, but it never seemed to be quite enough. Allison often had to rely on her older siblings to take care of her since their mother was always “sick”. Her mother rarely left the house and would spend hours locked in her room.

Allison thought that her mother suffered from agoraphobia and remembers conversations with her mother about how dangerous the world is. Because of her mother’s beliefs about the dangerousness of the world, Allison was not allowed to play outside with friends unless a parent was supervising at all times. Therefore, Allison did not make many friends. Instead, she played in the neighbor’s garden since her mother could see Allison from the window. One day, Allison’s neighbor, Jack, was helping Allison in the garden and offered her some cookies and milk.

Allison had to go inside with Jack to get the cookies and milk, but she thought that it would not be a problem since mom was right next door. Once inside Jack’s home, he sexually abused Allison. She never told anyone since she believed it was her fault for going inside and not staying in her mother’s line of sight. Allison has been unable to stay in a long-term relationship. Just after Allison moved away from her home town for the first time in her life, her boyfriend broke up with her. He was supposed to move in with Allison, but a week after Allison bought a home and moved her belongings in, he ended the relationship.

That was the last time Allison had a severe panic attack. She was hospitalized and has been terrified of living alone ever since.

Diagnosis

Refer to the DSM-IV-TR checklist for generalized anxiety disorder.

• Which of Allison’s symptoms meet the diagnostic criteria? Be sure to match specific symptoms with specific criteria.
• Based on your review of Allison’s symptoms and the diagnostic criteria, could Allison be diagnosed with generalized anxiety disorder or would she be better diagnosed with a phobia or obsessive –compulsive disorder?
• Does Allison appear to have a comorbid panic disorder? Refer to the diagnostic criteria for panic disorder with agoraphobia and determine if she warrants this diagnosis, too.
• How would the sociocultural perspective explain Allison’s generalized anxiety disorder?
• How would the current psychodynamic perspective explain Allison’s generalized anxiety disorder?
• How would the cognitive perspective explain Allison’s generalized anxiety disorder?
• What are the second-generation cognitive explanations for generalized anxiety disorder and how do the activities associated with each theory serve to maintain the worry?
• Describe a biological explanation for why Allison developed generalized anxiety disorder.

Treatment

• Which theoretical perspectives offer treatments for generalized anxiety disorder that have been more than modestly supported by the research literature?
• Discuss the cognitive therapy technique of focusing on worry.
• What are some of the nondrug biological treatments used to treat generalized anxiety disorder?