Reason for Referral
Carol has come to the clinic seeking treatment after her boss gave her a demotion and was likely going to change her work location to an office that was out of range of public transportation, which would mean she would have to drive. The patient has struggled with anxiety over driving previously and these changes have increased the intensity of that anxiety and caused her to seek treatment on her own volition. She also did not feel she could leave her current job because of the anxiety around the hiring process at a new company would be too much to handle.
Presenting Complaints, Symptoms and Possible Diagnosis
Carol self-reported the following symptoms:
• Waking up feeling nauseous and stressed both related to driving and situations that required it
• A racing heart with entering her car
• Sweating and shaking at the thought of driving or while driving
• Overwhelming fear of causing an accident because of her nervousness
• General feeling of unease throughout the day
• Difficultly concentrating, forgetful and lack of focus at work
• Worrying about even the little things
• Less social interaction with family and friends, related to the thought of having to drive and see them
• Trouble falling asleep, resulting in exhaustion and more worried about being overtired for work
Given these complaints and symptoms, my early thoughts on diagnosis would be Specific Phobia Disorder or General Anxiety Disorder. My reasoning is included in the following table
Specific Phobia Disorder (Situational Type)
A. Marked or persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (driving in this case)
Carol Yes The patient has nausea related...
... middle of paper ...
... replace them with more realistic thoughts. For example, being shown evidence that driving is, indeed, usually not dangerous. However, cognitive therapy alone is usually not an appropriate choice for people with specific phobias, as most individuals with phobias recognize that their fears are irrational.
In addition, teaching Carol some relaxation techniques - such as breath retraining and exercise – may help her cope more effectively with the symptoms related to the anxiety she feels around having to drive
These three treatment types would be done simultaneously in order to best assist Carol to recover from this phobia
Medication is shown not to help with Specific Phobia Disorder. I would also add that if treatment improved the phobia but Carol still suffered from anxiety around other parts of her life, then she may need treatment of those symptoms separately.
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