clinical case formulation

2732 Words11 Pages
All ¬anxiety disorders show distinct expressions of behavioural, subjective, and physiological symptoms of anxiety (Andrews, Creamer, Crino, Hunt, Lampe, & Page, 2004; Franklin & Foa, 2002). Research consistently showed that although basic anxiety symptoms are present in most if not all disorders, they are indeed manifesting differently in each (Caprara, Steca, Cervone, & Artistico, 2003). Therefore, the exact nature of feared stimuli cannot be predicted and is generally distinctive from individual to individual. Presenting issue Vivien is a 26-year-old woman referred by her general practitioner due to feelings of dread and discomfort that seem to result from persistent persecutory beliefs, avoidant behaviour related to her social phobic anxiety, and potential depression. She is described as experiencing a wide range of problems including a variety of specific and general anxiety. The avoidant behaviour assists her to manage the stress related to an unfair incident that happened at work. However, when Vivien faces social situations, these are endured with high levels of anxiety or even fear. Stress symptoms experienced include a constant panic sensation, embarrassment, hand tremors, irrational thoughts, tears, and general feelings of discomfort. These symptoms cause her to regularly rely on colleagues to perform tasks involving human interaction, symptoms that are underlying threats for her relationship with Paul too. Her overall mood and affect seemed depressed. There was no indication of a formal thought disorder. Although she seldom feels out of control, Vivien is aware that the feelings are rather irrational yet cannot alleviate the anxiety induced symptoms. Performance seems to be restricted under social environments; no fur... ... middle of paper ... ...scence and sexual abstinence. Vivien’s specific and generalized anxiety disorder can be treated using CBT (i.e. controlled outcome) or pharmacologically (benzodiazepines such as Xanax). Closer attention should be paid if benzodiazepine treatment is recommended due to the high risk of patients becoming dependent on the drug. Regardless of what pharmacological treatment is prescribed, psychological treatment aimed at reducing Vivien’s depression symptoms (sadness, crying, and embarrassment), avoidance behaviour, negative feelings (resentment towards boss and certain co-workers), soothing somatic cues, and reducing the patient’s expectation of future panic episodes. Psychological treatment could be a mixture of supportive and behavioural in nature to ensure that Vivien will initiate contact with threatening and anxiety provoking situations in the social environment.
Open Document