Helen is a year-old chemistry student who sought therapy for intense anxiety concerning University Exams. She also suffered from anxiety and depressive symptoms. At the first stages of her interviewing it became apparent that Helen complained for the following:. She could not attend the lectures or enter the lecture theatre "lecture theatre phobia". She could not concentrate, study for the exams or sit an exam.
She avoided getting close to the University and she also avoided anything relevant to the University. She was not able to decide whether she wanted to get her degree or not. She was in a general state of anxiety about anything. She would think about University all the time. Thus, she was not able to enjoy herself and was always sad. She avoided being with people and finally avoided crowded places. As far as her physiological complaints are concerned, it appeared that Helen suffered from: Permanent headache, Insomnia, Stomachache, Fatigue, Loss of energy, Drowsiness, Clenching of teeth while she slept that resulted in pain.
The result of all the above was that she felt anxious, disappointed and melancholic. Helen was the second child in the family. There was an elder brother now married and a younger sister who had graduated from the law school. There seemed to be many problems in the family with her brother. He was rebellious and undisciplined — the "problem child" as Helen characterized him.
Helen could not find any means of communication with her family, and her sister was the only person she really talked to. Helen felt that as a pupil she was good at everything. However, she felt that her family shadowed her. They knew anything she did, pressurizing her. The situation at the time when Helen reached for therapy had as follows:.
Her sister and father pressed her to continue her studies. They even wanted her to pursue postgraduate studies. Her father always told her that if she did not finish University, she would end up being a cleaner. Helen felt that her father counted on her.
I always felt that I had to adhere to what he wanted" she said. Her sister always criticized her calling her irresponsible. The only sector that Helen could function at the time of therapy was foreign languages. She was good at them and she could study without anxiety.
She considered foreign languages a hobby and not "real work". Surprisingly, her parents were not interested in her performance as far as languages were concerned, so they did not pressure her. To make matters worse, their financial situation was very bad so Helen could not decide whether she should continue with her studies or find a job in order to solve her financial difficulties.
Even though Helen felt that she is suffocating because of all these problems, it seemed that there was no way out since her parents were ill and she could not leave home. She was pressed and criticized for not being able to continue her studies. Considering this in combination with the rest "difficult" family environment it comes as no surprise that Helen developed an anxiety disorder.
Dysfunctional assumptions and rules are general beliefs which individuals hold about the world and themselves which are said to make them prone to interpret specific situations in an excessively negative and dysfunctional fashion.
In anxiety most dysfunctional assumptions or beliefs revolve around issues of acceptance, competence, responsibility, control and the symptoms of anxiety themselves [8,9]. I cannot get into the lecture theatre b. I cannot control this matter c. My parents will never be happy for me d. It is too late for me to change e. I have no second chance f. Everything seems like a mountain g. I am sick of sitting exams h.
If you have a degree you do not feel inferior i. No matter what I do this degree will always bother me j. I do not believe that it is possible to sit an exam and pass k. My mind is not functioning, I am not going to make it l. I do not want to be snob like all the other students. The range of stimuli that evoked anxiety increased and anything that had to do with the University was perceived as a danger stimulus generalization.
The first thing James would need to do would be to seek professional help and see if he has this disorder, although being a medical doctor, he may have self diagnosed himself, however he should see a psychiatrist. There are no laboratory tests that can determine if a person has anxiety or a mental illness, but a doctor will perform a battery of tests to weed out other illnesses, such as an overactive thyroid gland, which can produce anxiety and its symptoms.
NA, WebMD. James' next plan of attack would be to discuss the different types of medications that are available for providing relief from this disorder. Since James has generalized anxiety disorder, which has been called a 'free-floating' disorder because of his constant worrying and nervousness, as stated earlier, he would need a medication that treats low levels of GABA.
Roberts, ch. The textbook states that the drub benzodiazepine minor tranquilizers is the most frequently prescribed. Durnad, p. The drug is used for short-term relief and can be hard to stop taking because of dependence issues. One such drug in particular is called Xanax, which is shown to enhance the function of GABA in the brain. It also slows down the central nervous system. This drug is extremely addicting; it's the drug my ex-husband did not want to give up, so we got a divorce. There is also evidence that antidepressants can be used for GAD and may be a better choice.
Some of these drugs that I have researched for GAD, are also used for treating migraines, because I was prescribed some for headaches. No wonder I was always in a good mood, even though it felt like my head was about to explode. Because the drugs prescribed for this disorder are recommended to be taken for short periods of time, therapy should be initialized as well.
The side effects of these drugs are: Xanax benzodiazepines : drowsiness, fatigue, decreased concentration, confusion, blurred vision, pounding or irregular heartbeat, impaired coordination, short term memory problems, dizziness. Smith et al, Smith et al, These medications offer so many side effects, it's a wonder anyone wants to take them at all. But I guess for the person who is suffering from anxiety attacks or generalized anxiety disorder, the side effects may be a welcomed relief There are also natural remedies to help with GAD such as valerian root and kava kava, which has been treating anxiety for years, but the results are not well documented.
Smith et al, Some natural remedies can actually make anxiety worse and taking supplements may interact with the prescription anxiety medications, so it's a good idea to discuss this with a doctor. Another approach to treatment is to help James with therapy sessions to try to figure out why he is experiencing all this anxiety and worry. One session may include showing James pictures of things that may make him anxious and then teaching him how to relax deeply to fight his tension.
It's called cognitive behavioral treatment, developed in the early s, and is quite successful; however we need both medications and therapy to treat GAD. Acupuncture, which is one medical treatment that does no harm to the body, only releases energy and gets it moving in the system; NA, biofeedback, which is the ability to allow the patient hear or see feedback of their body's physiological state while relaxing; Grohol, and hypnotherapy shown as an appropriate treatment modality for those individuals who are highly suggestible, have also been used to treat anxiety.
Grohol, So which treatments work the best? That is hard to say because everyone is different and will react differently to each treatment. As stated in the textbook, a combined treatment of therapy and medications suggested there were no advantages for both, and that people did better in the long run when having psychological treatments only.
So it's suggested to start with psychological treatment first and then followed by drug treatments for the patients who are not responding to therapy. How does environment influence our behavior? Do we imitate what we see around us? Are we simply looking for acceptance, thereby, acting or saying what we think society expects? Who decides what acceptable behavior is? Although the environment may affect a person's behavior, there are many other elements to explore that influence the way we are.
James is coping with generalized anxiety disorder, as was stated earlier. At 31, he is allowing this disorder to control his life which is leading to being emotionally and physically drained. Although he realizes that he is an intelligent and capable person, he knows to avoid any situation that may exacerbate the anxieties that he is experiencing.
With minimal support from his family and friends, James feels that he is dealing with this all alone and just wants to lead a normal life. Perhaps the stress and strain of becoming a doctor led to James' anxiety disorder as it may have been dormant within his genetic makeup, and is now just surfacing.
Many people develop generalized anxiety disorder GAD during adolescence, but do not seek professional help until they are adults. When they do finally get help, they claim they have been anxious and nervous all their lives. These people cannot just 'get over it' but society seems to not grasp that concept. This would affect James immensely because his whole life has been based around his becoming a doctor. Even his father wanted him to follow in his footsteps and have a prestigious career.
Although James did not experience anxieties until after he graduated from medical school, I'm sure he still felt anxious with tests and schoolwork. This would be dealing with James' parents as they are somewhat supportive but disappointed that his career has not been progressing. He also lost his relationship with his girlfriend of three years because of the stress. Because James is dealing with this disorder, his health is rapidly declining.
He is having headaches, body aches and pains and is always tired. His emotional health is affected as well with feelings of laziness and worthlessness. James is realizing that if he cannot work, he cannot earn a paycheck. He is living off a small trust fund set up for him by his great uncle, but that won't last forever. All of these things are considered threats and can cause James to worry excessively which is interfering with his life.
Is the environment to blame for James' anxiety or is it more biological? I think that genetics and the environment work together to produce this disorder. The environment has to play a role in the mobility of this disorder. If James were to isolate himself from the world, he would still have anxiety; however he would not be able to face his fears, thus restricting his life.
His thought process would be 'what if this happened, or what if that happened? Alloy, p. Our textbook states that GAD generally runs in families, which I mentioned earlier. With all the research and studies that are performed, it will show that generalized anxiety disorder is inherited.
So genetics and biology has to be the most important because people who aren't suffering from anxiety will react more favorable to a stressful situation, than someone who is suffering from GAD. It seems that we all have to face the same environmental influences, but the threat of each situation interacts with the biological aspect of a person, thus bringing on the symptoms of the disorder.
James needs to be treated by a psychiatrist, not a family physician. He needs to be seen by someone who deals with psychological disorders daily and is educated with the treatments available. Psychological treatments work better in the long run and work just as well as prescription medication. Our textbook states that, 'as we learn more about generalized anxiety, we may find that helping people with this disorder to focus on what is actually threatening is useful.
Research has indicated that psychological treatments work very well for children who suffer from GAD. But I feel that unless a child is diagnosed early in life, the treatments won't be as effective. I'm sure that James was experiencing some form of anxiety as a child, but children are difficult to diagnose, and if the parents don't know what to look for, they won't know the child needs help. But children respond to cognitive-behavioral treatments along with family therapy.
I feel that psychosocial treatments would be the best way to start with a patient. In James' case, I think he should start with therapy for at least three months. He needs to confront the fear, phobias and anxieties head on to figure out what's making him feel emotionally and physically drained.
I would also suggest to James that he should educate and read everything he can on this disorder. Having this knowledge will benefit him so he may get the most out of his treatments. If I had a disorder, I would want to know everything about it. And I would be asking a million questions. Sometimes I feel that everyone in society could use some form of therapy to deal with the stressors of life. Next, I would try medications in addition to therapy to help James with possible other symptoms of GAD, such as depression.
The medication, however, would only be used on a temporary basis, as addiction can occur. My ex-husband was on medication for his GAD, but he was not seeing anyone for therapy. I think that was the biggest problem. He was increasing his dosage without telling his doctor, thus becoming extremely dependent on the drugs. As a doctor, James should know that some of the medications used for GAD are very addictive and hopefully would only be used as directed.
There are certain beliefs about thoughts and thought processes that are included in cognitive forms. Papageorgiou, p. Type 1 worries deal with external daily events such as the welfare of a partner, and non-cognitive internal events such as concerns about bodily sensations. Type 2 worries are focused on the nature and occurrence of thoughts themselves such as worrying that worry will lead to insanity.
Emma and her family were also supported to have meals together on the unit and the dietitian advised her family on how to manage her meal plan when she went home. When Emma was ready for weekend leave, she related much better to her family. They all believed that the family therapy had helped, as well as the carer support group and education sessions. Emma was pleased that she was supported by the unit and her school to continue studying for her AS levels during her stay at Priory, and held on to her dream of going to university.
Her family were more relaxed as they knew how to help Emma, and no longer felt helpless or fearful for the future. For more information about the eating disorder services that Priory offer, download our brochure. Eating Disorder Case Study. Eating Disorders Case Study. Additional Information. Find a Treatment Location.
Search by town, region or postcode. Condition Autism. Contact Us. Call our Enquiry Line Eating Disorders Information. Download Our Brochure. Get our brochure. You are much more of an observer than an experimenter and you must remember that, even in a multi-subject case, each case must be treated individually and then cross case conclusions can be drawn. Analyzing results for a case study tends to be more opinion based than statistical methods. The usual idea is to try and collate your data into a manageable form and construct a narrative around it.
Use examples in your narrative whilst keeping things concise and interesting. It is useful to show some numerical data but remember that you are only trying to judge trends and not analyze every last piece of data. Constantly refer back to your bullet points so that you do not lose focus. It is always a good idea to assume that a person reading your research may not possess a lot of knowledge of the subject so try to write accordingly.
In addition, unlike a scientific study which deals with facts, a case study is based on opinion and is very much designed to provoke reasoned debate. There really is no right or wrong answer in a case study. Check out our quiz-page with tests about:. Martyn Shuttleworth Apr 1, Case Study Research Design.
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