In this proposal we will be discussing on anxiety disorder and a treatment on the client based on a case study. In current era, the most common psychiatric illnesses affecting both children and adults are anxiety disorder. Anxiety disorder is a serious mental illness. Those who are affected with this disorder are most likely to have the feelings of excessively frightened, distressed, or uneasy during situation in which most other people would not experience the same feelings. Besides, this disorder is composes of various type of disorder such as panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder, specific phobias, separation anxiety disorder and generalized anxiety disorder (Ken Duckworth, 2012). There are several causes for this disorder such as environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these (Crosta, 2009). If a person who is experiencing this disorder, they are most likely to exhibit several symptoms such as the feeling of excessive fear, obsessive thoughts, nightmares, problem sleeping, shortness of breath, nausea, muscle tension and dizziness (Katz, 2012). However, these symptoms vary depending on the type of disorder.
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In this particular case study, we will be looking in depth on separation anxiety disorder. This disorder will affect both a person in any stages of life from childhood to adolescence and even adulthood. Besides, if one is diagnosed with this disorder, they might pose several symptoms such as trouble sleeping when separated from a specific person, excessive worry about losing major attachment figures and repeated nightmares involving the theme of separation.
Client is a female, age 50. She is a retired housewife. She does not have any medical history or psychological disorder in her first degree relative. Client is also very attached to her husband. Whenever her husband would take her out for a meal or a trip out, she would become excessively distress and worry that something might happen to her husband and fear that she might lose her husband in the event of an accident or some disaster that might fall upon her husband. Besides, whenever her husband have to make business trips and will be away for a few days, she would find it very difficult to sleep. Her excessively distress and fear of losing her husband has cause the married couple housebound. In addition her extreme inactivity had also left her physically weak as well as emotionally withdrawn. The reason she came to seek help from the counselor is that she fear her current situation is jeopardizing her relationship with her husband.
Counselor’s analysis and assessment on the client’s condition
The new DSM-5 (2013) has proposed a set of official diagnostic symptoms and signs for separation anxiety disorder. In order for a client to be classify as a patient of this disorder, one must exhibit several symptom which are (a)Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death. (b) Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure. (c) Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings. (d) Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure. As for the client, her major attachment figure is her husband. She projects these symptoms while her husband is out or separated from her husband. Therefore, client is most probably experiencing separation anxiety disorder.
The Goal of this treatment is to improve the client security feelings towards her husband whereby the client separation anxiety disorder would be reduce and that she will be able to become functional again in her daily activity.
A study was conducted by Zimmermann, Wittchen, Hofler, Pfister, Kessler and Lieb (2003) to find the relationship between primary anxiety disorder and the development of subsequent alcohol use disorder. This research is done using the cross-sectional method by using a baseline and 4 years follow up data from the EDSP-study, a prospective community survey of adolescents and young adults aged 14-24 years old. Total follow-up participants are 2548. In this research, DSM-IV anxiety disorder, alcohol use and alcohol use disorders were assessed with the Munich-Composite-International-Diagnostic-Interview (M-CIDI). The outcome of this research shows that anxiety disorder such as panic attack significantly predicts the persistence of combined abuse or dependence. However, since this research is carried out using a cross-sectional method, this research does not permit distinction between cause and effect.
Another study was conducted by Sareen, Chartier, Paulus, Stein (2006)to investigate the relationship between anxiety disorder and illicit drug use. The researchers obtain and compare their data from two contemporaneous surveys which is the National Comorbidity Survey and the Ontario Health Survey-Mental Health Supplement. These surveys were design during the 1990s. From that data, the researchers came to a conclusion that all the anxiety disorder, except social phobia with fears limited to speaking situations was significantly associated to illicit drug use. However, the result of this research might be ineffective due to the surveys that the researchers used. Since the surveys are design during the 1990s, results of this research might not be accurate as the survey is antiquated.
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Another relevant study was conducted by Lipsitz, Martin, Mannuzza, Chapman, Liebowitz, Klein, Fyer (1994) to investigate the relationship between retrospectively reported childhood separation anxiety disorder and adult anxiety disorder. All the 252 outpatients in the anxiety disorder research clinic participated in this research whereby there are 104 men and 148 women and aged from 18 to 58. From this research, it is learnt that patients with retrospective reports of childhood separation anxiety disorder were positively associated with lifetime adult anxiety disorder. In other words, suggesting that childhood separation anxiety disorder could be the marker of lifetime vulnerability of multiple anxiety disorder. However, the outcome of this research is based on 252 participants. It is insufficient to cover the wide population in the society to provide a more accurate result.
Another research was conducted by Iverach, O’Brian, Jones, Block, Lincoln, Harrison, Hewat, Menzies, Packman, Onslow (2009)to explore the prevalence of anxiety disorder among adults seeking speech therapy for stuttering. There were 92 adults who were eligible for this research out of the total 10641 participants. Out of the 92 adults, 72 are males and 22 are females whom aged from 18 to 73 years old. The outcome of this research shows that the prevalence of any anxiety disorder for adults seeking speech therapy for stuttering was significantly higher than matched controls. However, the outcome of this research is limited to 92 participants and the amount of males out ratio the females which might cause a biased results.
By looking into the case of the client, the Cognitive Behavior Therapy would be the intervention model used as it will be the most appropriate and effective way of treating the client. Cognitive Behavior Therapy is known as the talk therapy, to help client to change their behavior and thinking patterns that would affect their emotional and physical health conditions among adults, young adults and children (Cherry, 2005).
The diagnostic assessment that will be used is the Adult Separation Anxiety Questionnaire(ASA). This is a self-report questionnaire developed by Manicavasgar (2003). This questionnaire is to evaluate adulthood separation anxiety symptoms (from 18 years of age) and it includes 27 items. All the questions in this questionnaire is a 4 point Likert type questions where 0 indicates “this has never happened” and 3 indicates “this happens very often”. Besides the principal components, analysis reveled a coherent construct of adult separation anxiety with high internal consistency (Cronbach’s α = 0.95) and sound test-retest reliability (r = 0.86; P < 0.001). Furthermore, a receiver operation characteristic(ROC) analyse against this semi structured interview shows a high area under the curve (AUC) index of 0.9. This with these test, it suggest that this questionnaire is an adequate alternative measure of adult separation anxiety.
Treatment will be held twice a week for the first month, and once a week for the following months with an hour per session in the counselling room. A total of six months course will be given to help client to improve from her current condition. In every treatment session, client is required to imagine of a moment with her husband no matter if it is positive or negative moment. Counsellor will need to observe and take note on what the client is trying to convey throughout the session, and try to discuss the problem with the client.
At the end of the six months counselling session, if the client shows a positive effect of decreased in the level of separation anxiety, then the treatment proposed is effective and the following treatment will be continued with the current treatment that is used. On the other hand, if the client shows a negative effect, increasing or show no changes in the level of separation anxiety, after receiving the six months treatment, the treatment would then need to be stopped and alter to another way that suits the client.
Another alternative treatment if the treatment fails is family therapy, where it includes the participation of the client’s husband and family members to support her (Ponton, 2014). By doing this, the client will feel the sense of secure provided by the family, and counsellor might also identify the contributing factor of the disorder in the client.
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