Question

Imagine that you have been seeing a client for 4 months. During treatment, you learn that he has been 5 years sober but lately has felt an intense sense of anxiety and has requested a referral to a psychiatrist. Upon returning to his counseling sessions, you learn that the psychiatrist has prescribed diazepam, a benzodiazepine. You are aware of the fact that the benzodiazepine functions similarly to alcohol in the body. You are concerned about a relapse because of this newly prescribed medication for the anxiety disorder.

Sometimes the medication a doctor chooses to treat a client's symptoms is ineffective or inappropriate, or it may not create the desired effect without intolerable side effects.

For this explanation, view "Anxiety Disorder Case Study: Mary."Assume the role of a mental health professional to respond to the client call.

"Anxiety Disorder Case Study: Mary."

Mary is nervous at all times. She worries about turning in her homework on time or forgetting about an assignment entirely. She stresses out what to make for dinner when her parents visit her in her apartment. She feels others scrutinise the way she talks and walks. She wonders if they are being critical about her as she is with herself. She recently found out that her suspicion and fears about high blood pressure were true. Her doctor said her blood pressure was high and that diet and exercise will be the trick to correct the problem. She was afraid she will not be able to exercise enough or eat right which will cause her to have a heart attack. She could literally feel her blood pressure rising and it describes more things to add to her list of worries. She thinks her level of constant anxiety has kept her from having a voice. She wants to try out for the women's across team, but she worries she won't be of any good. She wonders if she can function as a normal person and be happy instead of being scared. She finds herself even worrying about being worried these days. It is a good thing she does not drink because she probably will drink all the time and the worry about the effects it will have on her.

Question

• Explain any concerns, ethical or otherwise, that may be regarding the Mary's generalized anxiety disorder treatment
• Explain the factors that would be taken into consideration in developing a strategy to treat the Mary's generalized anxiety disorder
• Explain a treatment strategy for Mary's generalized anxiety disorder along with a justification for the strategy
• Explain how as a mental health professional you would advocate for the selected treatment strategy

Answer 1

Generalized anxiety disorder

1. Explain any concerns, ethical or otherwise, that may be regarding the Mary's generalized anxiety disorder treatment

Answer: In Mary's case ethical concerns regarding her treatment for Generalzed anxiety disorder can be as follows:

When striving to be an ethical clinician, individuals must avoid causing harm and seek to maximize the success achieved in therapy. To facilitate ethical practice through treatment choices, attempts have been made to provide recommendations for treatment approaches by identifying empirically supported treatments (ESTs) for specific disorders. In their efforts to compose a comprehensive list of current empirically validated therapies, Chambless et al. (1998) provide a list of treatments, termed “well-established treatments” and “probably efficacious treatments” used to treat numerous psychological disorders.

The specific “well-established treatments” identified for anxiety primarily fall in the cognitive behavioral therapy (CBT) realm, although treatments may vary on their emphasis on either cognitive or behavioral components.

CBT is listed as a well-established treatment for panic disorder (with and without agoraphobia) and Generallized Anxiety Disorder.

The treatments for anxiety deemed as “probably efficacious” include applied relaxation for panic disorder and GAD; exposure therapy for post-traumatic stress disorder (PTSD) and social phobia; eye movement desensitization and reprocessing (EMDR) therapy for PTSD; stress inoculation training for PTSD; and systematic desensitization for specific phobia and social exposure / social phobia (Chambless et al. 1998).

As all of these treatments either are variants or include tenets of CBT , CBT is often deemed the gold standard for treatment of anxiety disorders (Rauch et al. 2012). Additionally, CBT has been identified as the most empirically supported treatment for child and adolescent anxiety (James et al. 2012; Sburlati et al. 2011).

CBT utilizes techniques to identify and modify maladaptive thoughts and behaviors (Beck 2011). A key CBT behavioral treatment for anxiety is exposure . Exposure approaches are based on classical conditioning theory. Exposure includes taking a feared, although not actually dangerous, stimulus and providing the individual with opportunities to experience the stimulus without associated negative consequences. The rationale is that repeated exposures without negative experiences other than the fear and anxiety will result in a reduction of fear. Exposure techniques may also include pairing feared stimuli with a positive experience, such as a relaxation exercise. The goal of Exposure is for the client to reach a point of habituation, which is achieved by first igniting the client’s fears. The anxiety and fear experienced during an exposure typically increases, reaches a plateau, and then decreases over time (Muller and Schultz 2012). Exposure exercises can take different forms, including either imaginal, in which one imagines the feared stimulus, or in vivo, when one confronts the stimulus directly. Exposure techniques can also vary in the progression of intensity. Systematic desensitization, for example, involves the creation of a hierarchy of feared stimuli and exposes the client gradually. Flooding, on the other hand, is an exposure that starts with the primary feared object. Exposure are a major behavioral technique utilized in CBT for anxiety and are often used to combat avoidance strategies (Beck 2011). Additional behavioral techniques that can be used include skills training and relaxation.

2.Explain the factors that would be taken into consideration in developing a strategy to treat the Mary's generalized anxiety disorder

1. Correct diagnosis with the help of physical reports, psychological questionnaires, including detail question about her medical history and symptoms.  

2, Blood and urine test reports

3. Explain a treatment strategy for Mary's generalized anxiety disorder along with a justification for the strategy.

Answer: Initially to help diagnose generalized anxiety disorder, doctor or mental health professional may:

• Do a physical reports to look for signs that your anxiety might be linked to medications or an underlying medical condition
• Order blood or urine tests or other tests, if a medical condition is suspected
• Ask detailed questions about your symptoms and medical history
• Use psychological questionnaires to help determine a diagnosis
• Use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment

Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications. You may benefit most from a combination of the two. It may take some trial and error to discover which treatments work best for client.

Available treatment options:

Psychotherapy

Also known as talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you've avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

Cognitive behavioral therapy is a very common method of psychotherapy that has shown great results for people living with Generalized Anxiety Disorder. This form of therapy is geared toward helping you recognize and understand your thoughts and the pattern of any negative thoughts you may experience. Cognitive behavioral therapy focuses on teaching you coping skills or mechanisms you can use to help you return to normal functioning and ease your feelings of anxiety. It is normally a short-term therapy and people who undergo this type of psychotherapy have found great results.

Medications are also a common form of treatment for Generalized Anxiety Disorder. The most common types of medications prescribed to individuals living with this form of anxiety include anti-depressants, anti-anxiety drugs, and in some cases, sedatives. Antidepressants are used to treat depression but have been found effective in the treatment of anxiety as well. They commonly take a couple of weeks to start taking effect and may cause some mild side effects, including headache, nausea, or difficulty sleeping. Most of the side effects are mild and tend to subside within a few weeks. Anti-anxiety medication is also often prescribed to help individuals cope with Generalized Anxiety Disorder. These types of drugs are powerful in their treatment of this type of anxiety; one of the most commonly prescribed types is a drug called buspirone often under the brand name Buspar.

During acute attacks of anxiety, doctor may prescribe a sedative to ease individual's anxiety symptoms – though these should be used as needed and on a short-term basis.

Some people find that medication alone can be helpful in the treatment of Generalized Anxiety Disorder, while others are more likely to benefit from psychotherapy. Some find that the combination of psychotherapy and medication is the best course of action. Engaging in certain behaviors may also ease your anxiety and promote a healthier lifestyle. These include:

• Daily exercise
• Limiting or stopping the use of caffeine
• Eating a healthy, well-balanced diet
• Stress management techniques – such as yoga or meditation

To decrease the occurrence of your anxiety in general, don’t miss your medication or any counseling sessions – even if person don’t feel like talking or feel “fine” and make sure person attends regularly scheduled doctor’s appointments.

4. Explain how as a mental health professional you would advocate for the selected treatment strategy

Mental helth professionals advocate medication and therapeutic treatment based on nature of symptoms, medical history etc

Medication is useful for alleviating the symptoms of generalized anxiety disorder and is often prescribed in conjunction with other therapies. Some types of anxiety drugs can be habit-forming and are usually prescribed on a short-term or as-needed basis.

In case of therapeutic treatment, Psychotherapy, Several specific forms of psychotherapy have been described in research studies as helpful for alleviating the symptoms of GAD. Two -- psychodynamic psychotherapy and supportive-expressive therapy -- focus on anxiety as an outgrowth of feelings about important relationships. Another form of psychotherapy, called cognitive-behavioral therapy, involves learning behavioral relaxation techniques as well as restructuring patterns of thinking that foster anxiety.

Biofeedback is another helpful tool. In a series of sessions with a therapist, individual client watch own brain-wave patterns on an electroencephalograph and gradually learns to control the waves. This teaches him/her to achieve a more relaxed state at will. Practitioners estimate that after about a dozen sessions, client will be able to exert control over mental activity without the help of the therapist or monitoring instrument.