case study on anxiety disorder class 12

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CBSE Class 12 Psychology Important Case Study Based Questions 2023: Read and Solve for Tomorrow's Exam

Psychology important case study questions for cbse class 12: practice important psychology case study-based questions for cbse class 12. these questions are important for the upcoming cbse class 12 psychology board exam 2023..

  CBSE Class 12 Psychology Exam 2023: Hello students! kudos to the efforts you put into tackling your 2023 board examinations. We understand that the last few weeks were tremendously tiring, both mentally and physically. Don’t worry, take a deep breath and relax as this is the final phase of your CBSE examination 2023. The class 12 Psychology exam is the last in the lane. Its paper code is 037. The exam is planned for 05th April 2023, that is, tomorrow. The exam will be for 3 hours scheduled between 10.30 AM to 01.30 PM. We believe you have already solved the sample question and previous year papers for Class 12 Psychology and must be aware of the exam pattern. If not, please refer to the links below.

• CBSE Class 12 Psychology Previous Year Question Papers: Download pdf
• CBSE Board Class 12 Psychology Sample Paper 2022-23 in PDF

CBSE Class 12 Psychology, Important Case Study-Based Questions:

Case 1: .

Read the following case study and answer the questions that follow: 

Sundar, a college-going 20-year-old male, has moved from his home town to live in a big city. He has continuous fear of insecurity and feels that enemy soldiers are following him. He gets very tense when he spots anyone in a uniform and feels that they are coming to catch him. This intense anxiety is interfering with his work and relationship, and his friends are extremely concerned as it does not make any sense to them. Sundar occasionally laughs abruptly and inappropriately and sometimes stops speaking mid-sentence, scanning off in the distance as though he sees or hears something. He expresses concern about the television and radio in the room potentially being monitored by the enemies. His beliefs are fixed and if they are challenged, his tone becomes hostile. 

Q1. Based on the symptoms being exhibited, identify the disorder. Explain the other symptoms that can be seen in this disorder.

Q2. Define delusion and inappropriate affect. Support it with the symptoms given in the above case study.

Read the case and answer the questions that follow. 

Alfred  Binet, in 1905,  was requested by the French government to devise a method by which students who experienced difficulty in school could be identified.  Binet and his colleague,  Theodore  Simon,  began developing questions that focused on areas not explicitly taught in schools those days, such as memory, and attention skills related to problem-solving.  Using these questions, Binet determined which were the ones that served as the best predictors of school success. 

Binet quickly realised that some children were able to answer more advanced questions than older children were generally able to answer and vice versa.  Based on this observation, Binet suggested the concept of mental age or a measure of intelligence based on the average abilities of children of a  certain age group.  This first intelligence test is referred to as the Binet-Simon  Scale. He insisted that intelligence is influenced by many factors, it changes over time,  and it can only be compared in children with similar backgrounds. 

Q1 . Identify the approach on which the Binet-Simon Intelligence Scale is based. Discuss its features.

Q2 . ‘Binet quickly realised that some children were able to answer more advanced questions than older children were generally able to answer and vice versa’. Why do individuals differ in intelligence? Using examples, give reasons for your answer.

Read the following case study and answer the questions that follow :

All the Indian settlers were contemptuously and without distinction dubbed “coolies” and forbidden to walk on footpaths or be out at night without permits. 

Mahatma Gandhi quickly discovered colour discrimination in South Africa and confronted the realisation that being Indian subjected him to it as well. At a particular train station, railway employees ordered him out of the carriage despite his possessing a first-class ticket. Then on the stagecoach for the next leg of his journey, the coachman, who was white, boxed his ears. A Johannesburg hotel also barred him from lodging there. Indians were commonly forbidden to own land in Natal, while ownership was more permissible for native-born people. 

In 1894, the Natal Bar Association tried to reject Gandhi on the basis of race. He was nearly lynched in 1897 upon returning from India while disembarking from a ship moored at Durban after he, his family, and 600 other Indians had been forcibly quarantined, allegedly due to medical fears that they carried plague germs. 

Q1. What is the difference between prejudice and discrimination ? On the

basis of the incidents in the above case study, identify a situation for each

which are examples of prejudice and discrimination.

Q2. What do you think could have been a source of these prejudices ? Explain

any two sources. 

Read the given case carefully and answer the questions that follow: 

Harish belonged to a family of four children, him being the eldest. Unlike any first born, he was not given the attention he should have had. His father worked as an accountant, while his mother stayed at home to look after the kids. He dropped out of school and could barely manage to get work for a little salary.

His relationship with his family played an important role in building his disposition. He felt a certain feeling of insecurity with his siblings, especially his brother Tarun, who was able to finish college because of parental support.

Due to the hopelessness Harish felt, he started engaging in drinking alcohol with his high school friends. Parental negligence caused emotional turmoil. He also had insomnia which he used as a reason for drinking every night.

Over time, Harish had to drink more to feel the effects of the alcohol. He got grouchy or shaky and had other symptoms when he was not able to drink or when he tried to quit.

In such a case, the school would be the ideal setting for early identification and intervention. In addition, his connection to school would be one of the most significant protective factors for substance abuse. His school implemented a variety of early intervention strategies which did not help him as he was irregular and soon left school. Some protective factors in school would be the ability to genuinely experience positive emotions through good communication.

(i)It has been found that certain family systems are likely to produce abnormal functioning in individual members.

In the light of the above statement, the factors underlying Harish's condition can be related to model.

(A) Humanistic

(B) Behavioural

(C) Socio-cultural 

(D) Psychodynamic

(ii) Over time, Harish needed to drink more before he could feel the effects of the alcohol. This means that he built a alcohol. towards the

(A) Withdrawal

(B) Tolerance

(C) Stress inoculation

(D) All of the above

(iii)He got grouchy or shaky and had other symptoms when he was not able to drink or when he tried to quit. This refers to

(A) Low willpower symptoms.

(B) Addiction symptoms

(C) Withdrawal symptoms

(D) Tolerance symptoms

(iv) Which of the following is not true about substance related and addictive disorders?

(A) Alcoholism unites millions of families through social interactions and get-togethers.

(B) Intoxicated drivers are responsible for many road accidents. 

(C) It also has serious effects on the children of persons with this disorder.

(D) Excessive drinking can seriously damage physical health.

Read the given case carefully and answer the questions that follow:

Monty was only 16 years when he dealt with mixed emotions for every couple of months. He shares that sometimes he felt like he was on top of the world and that nobody could stop him. He would be extremely confident. Once these feelings subsided, he would become depressed and lock himself in the room. He would neither open the door for anyone nor come out.

He shares, "My grades were dropping as I started to breathe rapidly and worry about almost everything under the sun. I felt nervous, restless and tense, with an increased heart rate. My family tried to help but I wasn't ready to accept." His father took him to the doctor, who diagnosed him. Teenage is a tough phase as teenagers face various emotional and psychological issues. How can one differentiate that from a disorder? Watch out when one is hopeless and feels helpless. Or, when one is not able to control the powerful emotions. It has to be confirmed by a medical practitioner.

During his sessions, Monty tries to clear many myths. He gives his perspective of what he experienced and the treatment challenges. "When I was going through it, I wish I had met someone with similar experiences so that I could have talked to her/him and understood why I was behaving the way I was. By talking openly, I hope to help someone to cope with it and believe that it is going to be fine one day."

Now, for the last five years Monty has been off medication and he is leading a regular life. Society is opening up to address mental health issues in a positive way, but it always helps to listen to someone who has been through it.

(i)Monty's symptoms are likely to be those of

(A) ADHD and anxiety disorder

(B) Bipolar disorder and generalised anxiety disorder 

(C) Generalised anxiety disorder and oppositional defiant disorder

(D) Schizophrenia

(ii) During his sessions, Monty tried to clear many myths. Which one of the following is a myth?

(A) Normality is the same as conformity to social norms.

(B) Adaptive behaviour is not simply maintenance and survival but also includes growth and fulfilment.

(C) People are hesitant to consult a doctor or a psychologist because they are ashamed of their problems.

(D) Genetic and biochemical factors are involved in causing mental disorders.

(iii) With an understanding of Monty's condition, which of the following is a likely symptom he may also be experiencing?

(A) Frequent washing of hands

(B) Assuming alternate personalities

(C) Persistent body related symptoms, which may or may not be related to any serious medical condition

(D) Prolonged, vague, unexplained and intense fears that are not attached to any particular object

(iv) Teenage is a tough phase as teenagers face various emotional and psychological issues. The disorder manifested in the early stage of development is classified as,

(A) Feeding and eating disorder

(B) Trauma and stressor related disorder

(C) Neurodevelopmental disorder

(D) Somatic symptom disorder

• CBSE Class 12 Psychology Syllabus 2022-23 .
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• On what day CBSE Class 12 Psychology 2023 exam is? + As per the official schedule, the CBSE class 12 psychology exam will be conducted on 05th April 2023. It would a Wednesday.
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Module 4: Anxiety Disorders

Case studies: examining anxiety, learning objectives.

• Identify anxiety disorders in case studies

Case Study: Jameela

Jameela was a successful lawyer in her 40s who visited a psychiatrist, explaining that for almost a year she had been feeling anxious. She specifically mentioned having a hard time sleeping and concentrating and increased feelings of irritability, fatigue, and even physical symptoms like nausea and diarrhea. She was always worried about forgetting about one of her clients or getting diagnosed with cancer, and in recent months, her anxiety forced her to cut back hours at work. She has no other remarkable medical history or trauma.

For a patient like Jameela, a combination of CBT and medications is often suggested. At first, Jameela was prescribed the benzodiazepine diazepam, but she did not like the side effect of feeling dull. Next, she was prescribed the serotonin-norepinephrine reuptake inhibitor venlafaxine, but first in mild dosages as to monitor side effects. After two weeks, dosages increased from 75 mg/day to 225 mg/day for six months. Jameela’s symptoms resolved after three months, but she continued to take medication for three more months, then slowly reduced the medication amount. She showed no significant anxiety symptoms after one year. [1]

Case Study: Jane

Jane was a three-year-old girl, the youngest of three children of married parents. When Jane was born, she had a congenital heart defect that required multiple surgeries, and she continues to undergo regular follow-up procedures and tests. During her early life, Jane’s parents, especially her mother, was very worried that she would die and spent every minute with Jane. Jane’s mother was her primary caregiver as her father worked full time to support the family and the family needed flexibility to address medical issues for Jane. Jane survived the surgeries and lived a functional life where she was delayed, but met all her motor, communication, and cognitive developmental milestones.

Jane was very attached to her mother. Jane was able to attend daycare and sports classes, like gymnastics without her mother present, but Jane showed great distress if apart from her mother at home. If her mother left her sight (e.g., to use the bathroom), Jane would sob, cry, and try desperately to open the door. If her mother went out and left her with a family member, Jane would fuss, cry, and try to come along, and would continually ask to video-call her, so her mother would have to cut her outings short. Jane also was afraid of doctors’ visits, riding in the car seat, and of walking independently up and down a staircase at home. She would approach new children only with assistance from her mother, and she was too afraid to take part in her gymnastics performances.

Jane also had some mood symptoms possibly related to her medical issues. She would intermittently have days when she was much more clingy, had uncharacteristically low energy, would want to be held, and would say “ow, ow” if put down to stand. She also had difficulty staying asleep and would periodically wake up with respiratory difficulties. [2]

• Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. ↵
• Hirshfeld-Becker DR, Henin A, Rapoport SJ, et alVery early family-based intervention for anxiety: two case studies with toddlersGeneral Psychiatry 2019;32:e100156. doi: 10.1136/gpsych-2019-100156 ↵
• Modification, adaptation, and original content. Authored by : Margaret Krone for Lumen Learning. Provided by : Lumen Learning. License : CC BY: Attribution
• Treatment of anxiety disorders. Authored by : Borwin Bandelow, Sophie Michaelis, Dirk Wedekind. Provided by : Dialogues in Clinical Neuroscience. Located at : http://Treatment%20of%20anxiety%20disorders . License : CC BY: Attribution

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• Psychology /

Psychological Disorders Class 12 Notes

• Updated on  
• Jan 25, 2024

Often referred to as mental disorders or psychiatric disorders, Psychological disorders are one of the largest areas of enquiry in Psychology. All major disorders are categorized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). This volume helps in the treatment, analysis and detection of disorders in patients. Psychological disorders are covered in class 12th to help students prepare for a career in Psychology . In this blog, we present to you our detailed and insightful notes on Psychological Disorders Class 12:

This Blog Includes:

Concept of abnormality and psychological disorders, approaches to study abnormality and psychological disorders, factors underlying abnormal behaviour, major psychological disorders, anxiety disorders, separation anxiety disorders, somatic symptom and related disorder, dissociative disorders, bipolar and related disorders, schizophrenia disorders, neurodevelopmental disorders , feeding and eating disorders, substance related and addictive disorder, important questions for psychological disorders class 12, psychological disorders class 12 ncert pdf.

Also Read: 100 Psychological Facts You Must Know

Before we begin our notes on Psychological Disorders Class 12, let’s understand the concept of abnormality and psychological disorders. Meaning of Abnormality can be aptly described with the help of 4Ds :

• Deviance : Psychological disorders are characterized by Deviance, Unusual, Bizarre, Strange
• Dysfunction : Interferes with the normal functioning of an individual.
• Distress : It implies behaviour that is unpleasant and distressing to oneself and to others.
• Danger  It means behaviour that is harmful and dangerous to the person concerned and others.

Psychological Disorders Class 12 also covers the different approaches to the study of abnormality and mental disorders:

• First Approach views abnormal behaviour as deviation from social norms and those who are not able to fit in the society are viewed as deviants
• The second Approach is the maladaptive approach according to which behaviour that does not help the other person in leading a fulfilling life should be viewed as abnormal.

There are various factors underlying Abnormal Behaviour according to Psychological Disorders Class 12:

Biological Model

A wide range of biological factors like hormonal imbalances, faulty genes, and other factors may have repercussions on the normal functioning and development of individuals. As per various researches and studies, Abnormal activity by various neurotransmitters may lead to abnormal behaviour and Psychological disorders like schizophrenia may happen because of the high activity of dopamine and depression may be due to the low activity of serotonin.

Genetic Model

A lot of Psychological Disorders like Schizophrenia, Depression, Anxiety Happen because of hereditary factors and genetic mapping of individuals. These may be regressive in nature but can be triggered in an individual life to external stimuli.

Psychological Model

According to Psychological Disorders Class 12, there are several Psychological factors due to which the development of Psychological Disorders may happen and some of those factors are Maladaptive Family Structure, Faulty Parent-Child relationship, severe stress, maternal deprivation etc. Various other psychological models which provide a substantial explanation of Psychological disorders are explained as follows:

• Psychodynamic Model focus on the fact that human behaviour whether normal or Abnormal is a result of Psychological forces (Id, Ego, Superego) in the unconscious mind and the relative strength of Id, Ego and Superego determines a person’s personality.
• Behavioural Model states that human behaviour whether normal or Abnormal can be learnt and unlearnt. Abnormal behaviour is a result of learning Maladaptive ways of Behaving. There are three most eminent theories of the behavioural model are classical conditioning, operant conditioning and social learning.
• Cognitive Model states that Abnormal Behaviour is a consequence of faulty thinking and negative and irrational beliefs about one self and others and drawing broad negative conclusions on the basis of insignificant event results in abnormal behaviour.
• Humanistic-Existential Model -This model views human beings in a positive light and believes that human beings are inherently positive, cooperative and can self-actualize. Those who lack meaning in their lives tend to leave empty, depressed and dysfunctional lives.
• Socio-cultural model : Various socio-cultural factors like employment conditions, war, prejudice, discrimination, culture(collectivistic or individualistic) explain human behaviour whether normal or Abnormal in the best possible manner.
• Diathesis Stress Model : As per this model Psychological Disorders develop when a Diathesis (biological predisposition to the disorder) is set off by a stressful situation.

Also Read: Must Watch Movies on Psychological Disorders

According to Psychological Disorders Class 12, some major psychological disorders are covered by DSM5 are:

Anxiety is defined as a vague and unpleasant feeling of fear and apprehension and some of its symptoms are rapid heart rate, fainting, dizziness, sweating etc. The main types of anxiety disorders are described as follows:

Generalised Anxiety Disorders

• Consists of vague, intense and inexplicable that is not attributed to any particular object or cause. 
• Its symptoms are frequent worry, apprehension, hypervigilance that involves continuous scanning of dangers in the environment and motor tension. A person finds it pretty difficult to stay at ease and relax.

Panic Disorder

• Comprising frequent anxiety attacks in which the person experiences intense terror and here, anxious thoughts are experienced due to a specific cause or stimuli.
• Symptoms include shortness of breath, choking, nausea, fear of going crazy or death, chest pain etc.

Phobias  

According to Psychological Disorders Class 12, Phobias are defined as irrational fears related to a particular object, person or situation. Three types of Phobias are

• Specific Phobias highly irrational fears such as fear of a specific type of animal or being enclosed into enclosed spaces
• Social Phobias is defined as a feeling of intense fear and embarrassment when dealing with others in public
• Agoraphobia is the fear of entering unfamiliar situations and people with agoraphobia have problems in leaving their home as well and thus due to which they are not able to carry out their normal activities as well.

It is defined as an intense fear of being separated from attachment figures to such an extent that it hinders their development as well. Children with Separation Anxiety Disorder show the following symptoms are reluctant to go to school alone, shadow every move of their parents and throw tantrums when they are away from their parents even for a little while.

Obsessive-Compulsive and Related Disorders

• People who suffer from OCD are preoccupied with a certain idea or a thought and they are unable to prevent themselves from carrying out a particular activity that hinders their normal day to day functioning.
• Obsessive Behaviour means the inability to stop thinking about a particular Behaviour or a thought.
• Compulsive Behaviour is the need to perform certain behaviours over and over again.

Also Read: Social Influence and Group Processes Class 12 Notes

Trauma and Stress- Related Disorder

• People who have been victims of bomb blasts, terrorist attacks often experience Post Traumatic Stress Disorder (PTSD).
• Recurrent Dreams
• Frequent flashbacks
• Emotional distress

These are defined as conditions in which the client feels some of the physical symptoms and Psychological difficulties without any biological and medical cause. Main types of somatic symptom and related disorders are explained as follows-

Somatic Symptom Disorder

• Persistent body Related symptoms are seen in this disorder which does not have a definite medical cause.
• People with this disorder are preoccupied with their Symptoms, worry about their health and thus, make frequent visits to doctors.

Illness Anxiety Disorder

As the name suggests, people with illness Anxiety Disorder are preoccupied about the thought of developing a serious illness.

Conversion Disorder

Clients with conversion Disorder report loss of a body part or bodily function like deafness, blindness, difficulty in walking etc.

Dissociation is defined as a feeling of estrangement, unreality or depersonalisation etc. Some of the major Dissociative Disorders mentioned in the psychological disorders class 12 chapter are-

Dissociative Amnesia

• Its main characteristic feature is extensive but selective memory loss where people fail to remember either a particular incident, phase of life or cannot remember anything about their past. It is associated with high stress.

Dissociative Identity Disorder

• Its main root lies in Traumatic childhood experiences and it is also known as multiple personality disorder. A person assumes alternate or different personalities which may or may not be aware of each other.

Depersonalisation

• This involves a dream-like state in which there is a sense of being separated from self and reality.
• A person’s sense of reality is temporarily lost.

Dissociative Fugue

• New identity formation happens because of an unexpected travel away from the workplace and home.
• People with Dissociative Fugue experience inability to recall the previous identity.

Depression is defined as one of the most widely recognized mental disorders and it usually indicates a range of negative emotions and behavioural changes. Depression is usually experienced either after a fallout in a relationship or our failure to attain a significant goal.

Major Depressive Disorder

It is characterised by loss of interest and enthusiasm in most of the activities in our life and along with that other symptoms include irregular sleep patterns, change in body weight, irritability, withdrawal from social relationships, etc. Factors predisposing to Depression are mentioned below-

• Age : Women are likely to get depressed in young adulthood and men are likely to get depressed during middle age either due to midlife crisis.
• Genetics : It is a crucial factor that determines an individual’s proneness to depression.
• Other factors : Significant bad phase in life or lack of desired social support can cause depression as well.

People who suffer from mania are highly euphoric, talkative and easily distractible and episodes of mania are accompanied alternatively by depression. In bipolar mood disorder, both mania and depression happen alternatively and in between, there are periods of normal mood as well.

Suicide  

Suicide is a major concern as the suicide rate has increased and some of the symptoms of suicide are mentioned below

• Difficulty in maintaining concentration.
• A drastic change in personality.
• Change in eating and sleep pattern
• Cut off from family and friends 
• Drug and alcohol abuse.

Factors leading to suicide are given below-

• The last attempt of suicide is the strongest factor.
• Significant problems in the family, peer group, work-life, and inability to deal with them may lead to suicide.
• Culture also is an important factor determining suicide.

Some measures suggested by WHO to reduce Suicide

• Care for people who attempted suicide and providing them much needed support
• Limiting access to suicide.
• Early identification, treatment and prevention of people who are at risk

It is the descriptive term for a group of psychotic disorders in which functioning in personal, social and work life deteriorates and the causes behind that can be motor abnormalities, unusual emotional states and strange perceptions. Psychological disorders class 12 states the symptoms of Schizophrenia is classified into three categories:

Positive Symptoms

They are defined as bizarre additions to a person’s behaviour and they are mentioned below and are basically excess of thought, emotion and behaviour.

It is defined as a false belief that is firmly held on inadequate grounds and they are of various types –

• Delusion Of Persecution -People believe that they are being plotted against, spied upon and threatened.
• Delusion Of Reference -People attach special and personal meaning to actions and events of others
• Delusion Of Grandeur -People believes themselves to be highly empowered.
• Delusion Of Control- People believes that their thoughts, emotions, feelings are in the hands of others.

Hallucination

Perceptions that occur in absence of stimuli are defined as hallucination and various types of Hallucination are described as follows-

• Auditory Hallucination : Patients hear sounds or voices that speak sounds, phrases, words etc.
• Tactile Hallucination -People experience tingling and burning sensation.
• Olfactory Hallucination -People experience the smell of poison or smoke.

Negative Symptoms  

They are pathological deficits and include poverty of speech, blunted and flat affect and social withdrawal.

• Alogia -People show a reduction in speech content
• Blunted Effect – People show less anger, sadness, joy etc.
• Flat effect -People at times exhibit no emotion at all.
• Avolition – Inability to start or complete a course of action.

Psychomotor Symptoms

They move less spontaneously and make odd gestures.

• Catatonic Stupor -People remain motionless and silent for long stretches of time.
• Catatonic Rigidity -People maintain rigid postures for hours.
• Catatonic Posturing -People maintain awkward and bizarre positions for long stretches of time.

Formal Thought Disorders 

In the chapter, Psychological disorders class 12, there are formal thought disorders wherein people are not able to think rationally, communicate properly, quickly switch from one topic to another and at times invent their own phrases too.

According to Psychological Disorders Class 12, there are neurodevelopmental disorders manifest during early childhood and impact academic and personal development. They are characterised as excesses or deficits in a particular behaviour. Several neurodevelopmental disorders are discussed as follows-

Attention-Deficit /Hyperactivity Disorder

Main features of ADHD are-

• Inattention is defined as the ability to sustain attention in academics or play. Children who are inattentive quickly lose interest in boring activities, are disorganized and find it difficult to follow instructions.
• Impulsivity is defined as the inability to control their immediate reaction to the stimulus in the environment and they are habitual of instant gratification and they find it difficult to delay their gratification.
• Hyperactivity Children who are hyperactive have difficulty sitting still through class and are in constant motion. Boys are four times more likely to get diagnosed with ADHD as compared to girls.

Autism Spectrum Disorder

This disorder is characterised by difficulty in social communication, interaction and restricted categories of interests. Children with autism are unresponsive to others in social situations, face problems in communication and are intellectually deficient as well.

Specific Learning Disorder

The individual experiences problems in processing information accurately and efficiently and in reading, writing. In the early years of childhood, academic performance is usually below average but with efforts and inputs, it can be improved.

Disruptive, Impulse-Control and Conduct Disorders

Various disorders under this category according to the chapter on Psychological Disorders Class 12-

• People exhibit an age-inappropriate amount of stubbornness and are defiant.
• People behave in a hostile manner.
• Verbal Aggression includes actions like name-calling, swearing etc.
• Physical Aggression includes hitting, fighting with others.
• Proactive Aggression includes bullying and dominating others without being provoked.
• Hostile Aggression is aimed at inflicting injury to others.

According to Psychological Disorders Class 12 chapter, there are various eating disorders:

Anorexia Nervosa

People with Anorexia Nervosa see themselves as overweight and thus due to their self-image, they exercise extensively and refuse to eat. They can starve themselves to death as well at times.

Bulimia Nervosa

People with Bulimia Nervosa may over-eat and then purge their body by vomiting or using laxatives and thus, feel relieved.

Binge Eating

Binge Eating is characterized by frequent episodes of out-of-control eating. The erratic eating patterns can be harmful to the health and well-being of the individual.

Disorders which are related to maladaptive Behaviours resulting from regular and consistent use of substance involved are included under substance-related and Addictive disorders and some of the frequently used substances are explained below-

• People who abuse alcohol and rely on it to handle severe situations and this addiction interfere with their ability to function well in their social, personal, and work lives.
• Due to excessive consumption of alcohol, the body of alcoholics develops a tolerance for alcohol which means that they have to consume it to feel normal.
• Withdrawal of alcohol results in a huge range of Psychological problems like anxiety, depression and other health problems as well.

Heroin  

• It impacts our social and occupational functioning.
• People develop a tolerance for it and experience withdrawal when they stop consuming Heroin
• It paralyzes breath and may lead to death as well.
• May cause problems in short term memory and attention.
• People develop a tolerance for it and experience withdrawal when they stop consuming Cocaine
• People who are Cocaine addicts may function poorly in their work-life and social life.
• It has serious repercussions on Psychological and physical well-being.

Also Read: Class 12 Psychology Sample Papers

Important question and answers for Psychological Disorders Class 12-

Q. Identify the symptoms associated with depression and mania. Ans . Symptoms of Mania are highly euphoric, talkative and easily distractible and symptoms of depression are loss of interest in all the activities which they like, change in eating and sleeping patterns, cut off from family and friends etc.

Q. Describe the characteristics of hyperactive children. Ans. Children who are hyperactive have difficulty sitting still through class and are in constant motion.

Q. Distinguish between obsessions and compulsions . Ans. Obsessive Behaviour means the inability to stop thinking about a particular Behaviour or a thought. Compulsive Behaviour is the need to perform certain behaviours over and over again.

Must Read: Entrance Exams for Psychology after 12th

A lot of Psychological Disorders like Schizophrenia, Depression, Anxiety Happen because of hereditary factors and genetic mapping of individuals.

Anxiety is defined as a vague and unpleasant feeling of fear and apprehension and some of its symptoms are rapid heart rate, fainting, dizziness, sweating etc.

Perceptions that occur in absence of stimuli are defined as hallucination.

This was all about Psychological Disorders class 12 notes. Worried about how to revise at the last moment for exams? Don’t worry! We, at Leverage Edu , are here for you to provide all the required notes to help you revise faster and ace your examinations. Follow us on Facebook , Youtube , Instagram and LinkedIn . 

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Class 12 Psychology Case Study Questions

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Are you having trouble preparing for the CBSE Class 12 Psychology Case Study Questions? Are you looking for a wide range of Class 12 Psychology Case Study Questions? Then you’ve landed in the right place. Students can explore Class 12 Psychology Case Study Questions to assist them in answering a range of questions concerning the case study.

Other ed-tech sites may provide limited study material for Class 12 Psychology students, but myCBSEguide has a variety of questions that cover all aspects of Class 12 Psychology including case study questions. Class 12 Psychology questions are designed to help students understand and retain the material covered. In addition, myCBSEguide also offers practice tests and sample papers to help students prepare for Class 12 Psychology exams.

All About Class 12 Psychology Case Study

What is a case study.

A case study is a scenario in a specific professional environment that students must analyze and answer based on specific questions provided about the circumstance. In many cases, the scenario or case study includes a variety of concerns or problems that must be addressed in a professional setting.

Case Study Questions in Class 12 Psychology

Class 12 Psychology Case-Based Questions are a new feature to the exam. Class 12 Psychology Case Study Questions are easy to comprehend and will help you get good grades. You may also get free access to the most recent NCERT textbooks for Class 12 Psychology and all other subjects on myCBSEguide, which had been designed in accordance with the most recent Class 12 CBSE/NCERT Psychology curriculum and examination pattern.

Sample Case Study Questions in Class 12 Psychology

Below are some examples of Class 12 Psychology Case Study Questions. These Class 12 Psychology Case Study Questions will be extremely beneficial in preparing for the upcoming Class 12 Psychology exams. Class 12 Psychology Case Study Questions are created by qualified teachers using the most recent CBSE/NCERT syllabus and books for the current academic year. If you revise your Class 12 Psychology exams and class tests on a regular basis, you will be able to achieve higher marks.

Class 12 Psychology Case Study Question 1

Read the case given below and answer the questions by choosing the most appropriate option: This is a story of three students Ruby, Radhika and Shankar who were enrolled in an Undergraduate Psychology Program in a University. Ruby was the admission officer’s dream. She was selected for the program as she had perfect entrance test scores, outstanding grades and excellent letters of recommendation. But when it was time for Ruby to start coming up with ideas of her own, she disappointed her professors. On the other hand, Radhika did not meet the admission officer’s expectations. She had good grades but low entrance exam scores. However, her letters of recommendation described her as a creative young woman. She could design and implement research work with minimal guidance at college. Shankar ranked somewhere in between the two students. He was satisfactory on almost every traditional measure of success. But rather than falling somewhere in the middle of his class at college, Shankar proved to be an outstanding student. His strength lay in the ability to not only adapt well to the demands of his new environment but also to modify the environment to suit his needs.

Identify the theory of intelligence which best explains the intelligence of all the three students in the story:

• One Factor Theory
• Theory of Primary Mental Abilities
• Hierarchical Model of Intelligence
• Triarchic Theory of Intelligence

Identify the type of intelligence Ruby possesses.

• Componential
• Experiential

Which of the following statement is NOT TRUE about Radhika’s intelligence?

• People high on this quickly find out which information is crucial in a given situation.
• It is also called experiential intelligence.
• It involves modifying the environment to suit the needs.
• It reflects in creative performances.

Two statements are given in the question below as Assertion (A) and Reasoning (R). Read the statements and choose the appropriate option. Assertion (A):  Shankar is not high in contextual intelligence. Reason (R):  Shankar was good at adapting well to the demands of his new environment and modifying the environment to suit his needs. Options:

• Both A and R are true and R is the correct explanation of A.
• Both A and R are true, but R is not the correct explanation of A.
• A is true, but R is false.
• A is false, but R is true.

Out of the three students mentioned in the story, who are/is more likely to be a successful entrepreneur?

• Radhika and Shankar
• Ruby and Radhika

Identify the three components of intelligence that Ruby is high on

• Knowledge acquisition, Meta, creativity
• Knowledge acquisition, Meta, performance
• Knowledge acquisition, Meta, planning
• Planning, performance, adaptability

Class 12 Psychology Case Study Question 2

Refer to the picture given below and answer the questions by choosing the most appropriate option:

Which type of personality assessment is being depicted in the above picture?

• Projective Technique
• Psychometric Tests
• Behavioural Analysis
• Self-report Measures

Which of the following is NOT a characteristic of this test?

• It reveals the unconscious mind.
• It can be conducted only on an individual basis.
• Its interpretation is objective.
• The stimuli are unstructured.

Identify the name of the test from the options given below.

• Thematic Appreciation Test
• Thematic Apperception Test
• Theatre Apperception Test
• Theatre Appreciation Test

Which of the following statements are NOT true of this test? i. In the first phase, called performance proper, the subjects are shown the cards and are asked to tell what they see in each of them. ii. The second phase is called inquiry. iii. Each picture card depicts one or more people in a variety of situations. iv. The subject is asked to tell a story describing the situation presented in the picture. ​​​​​​​ Choose the correct option:

Which of the following is NOT a drawback of this test?

• It requires sophisticated skills and specialised training
• It has problems associated with reliability of scoring
• It has problems associated with validity of interpretations
• It is an indirect measure of assessment.

Identify the stimuli that are used in such kinds of tests as given in the above picture.

• Picture cards

NOTE- The following questions are for the Visually Impaired Candidates in lieu of questions 55 to 60. Answer the questions by choosing the most appropriate option.

Nafisa feels that she is liked by her peers in class. This reflects that she ________.

• is high on self-efficacy
• is high on social self-esteem
• possesses a high IQ
• is an introvert

Discrepancy between the real self and ideal self often results in ________.

• self-actualisation
• self-regulation
• unhappiness and dissatisfaction
• intrapsychic conflicts

If an individual is fat, soft and round along with a temperament that is relaxed and sociable, then he/she is said to have the characteristics of an:

Gurmeet was given a personality test to assess how he expresses aggression in the face of a frustrating situation. Identify the test most suitable for this.

• Rosenzweig Picture Frustration test
• Eysenck Personality questionnaire
• 16 Personality Factors Test

According to Karen Horney the origin of maladjustment can be traced to ________.

•  the inferiority feelings of childhood.
• basic anxiety resulting from disturbed interpersonal relations.
• overindulgence of the child at early stages of development.
• failure to deal with intrapsychic conflicts.

An individual’s sole concern with the satisfaction of ________ needs would reduce him/her to the level of animals.

• belongingness

Class 12 Psychology Case Study Question 3

Read the case given below and answer the questions

Mental health professionals have attempted to understand psychological disorders using different approaches through the ages. Today, we have sophisticated facilities and hospitals dedicated to the treatment of the mentally ill. While studying the history of psychological disorders it is interesting to note that some practices from ancient times are still in use. Take the case of Lakshmi and her daughter, Maya. Maya exhibits abnormal behaviours and Lakshmi believes that this is because of evil spirits that have possessed her. She has been taking her daughter to a self-proclaimed healer, who uses counter-magic and prayer to cure her. Stigma and lack of awareness prevents Lakshmi from using the modern facilities and hospitals that provide quality mental health care. On the other hand, when young Rita reported seeing people and hearing voices, mental health professionals at a modern facility were able to understand her hallucinations using a convergence of three approaches. Psychologists use official manuals like the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5) and International Classification of Diseases (ICD-10) to indicate presence or absence of disorders. Today there is increased compassion for people who suffer from disorders and a lot of emphasis is placed on providing community care.

• Identify the method used by the healer to cure Maya’s illness. How does this theory from ancient times explain Maya’s treatment?
• Which approach do you think would best explain Rita’s treatment? How do you think DSM – 5 and ICD -10 help mental health professionals in indicating the presence or absence of disorders?

Class 12 Psychology syllabus at a glance

Class 12 Psychology students must have a better comprehension of Class 12 Psychology New curriculum in order to have a positive impression of the exam pattern and marking scheme. By studying the CBSE Class 12 Syllabus, students will learn the unit names, chapters within each unit, and sub-topics. Let’s have a look at the Class 12 Psychology Syllabus, which contains the topics that will be covered in the CBSE test framework.

CBSE Class – 12 Psychology (Code No. 037) Syllabus

Course Structure

Benefits of Solving Class 12 Psychology Case Study Question

• You will be able to locate significant case study problems in your class quizzes and examinations because we offer the best collection of Class 12 Psychology case study questions 2. You’ll be able to go over all of the crucial and challenging themes from your CBSE Class 12 Psychology textbooks again.
• Answers to all Class 12 Psychology case study questions have been supplied.
• Class 12 Psychology Students in Class will be able to download all Psychology chapter-by-chapter assignments and worksheets in PDF format.
• Class 12 Psychology Case Study Questions will aid in the enhancement and improvement of topic understanding, resulting in higher exam scores.

myCBSEguide: The best platform for Class 12 Psychology

myCBSEguide is the best platform for Class 12 Psychology students. It offers a wide range of resources that are not only helpful for academic purposes but also for personal development. The platform provides access to a variety of online courses, mock tests, and practice materials that can help Class 12 Psychology students ace their exams. Additionally, the forum on the website is a great place to interact with other students and get insights into different aspects of the subject. Overall, myCBSEguide is an invaluable resource for anyone pursuing Class 12 Psychology.

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where are the answers? atleast give answers with the questions so we can know our mistakes

No answers ?.

teri behen ko naman

Dude what about the answers?

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Due to current covid19 situation and as a measure of abundant precaution, our member services centre are operating with minimum staff, eissn: 2373-6445, psychology & clinical psychiatry.

Case Report Volume 1 Issue 4

Exams Anxiety: Case Study

Theodoratou maria, 1 function clickbutton(){ var name=document.getelementbyid('name').value; var descr=document.getelementbyid('descr').value; var uncopyslno=document.getelementbyid('uncopyslno').value; document.getelementbyid("mydiv").style.display = "none"; $.ajax({ type:"post", url:"https://medcraveonline.com/captchacode/server_action", data: { 'name' :name, 'descr' :descr, 'uncopyslno': uncopyslno }, cache:false, success: function (html) { //alert('data send'); $('#msg').html(html); } }); return false; } verify captcha.

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1 Clinical Psychologist, Technological Institute of Patras, Greece 2 Health Psychologist - Psychotherapist, New York College, Greece 3 Counselor, Greece

Correspondence: Maria Theodoratou, Clinical Psychologist, Technological Institute of Patras, School of Health and Welfare Professions, Patras, Greece

Received: May 05, 2014 | Published: July 12, 2014

Citation: Theodoratou M, Andriopoulou P, Manousaki M (2014) Exams Anxiety: Case Study. J Psychol Clin Psychiatry 1(4): 00021. DOI: 10.15406/jpcpy.2014.01.00021

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The case we are going to present concerns a 28-year-old woman, suffering from intense anxiety about University Examinations. We consider this case as extremely interesting, because even though she had interrupted her studies in chemistry for four years, she managed to overcome her anxiety, graduate successfully and pursue further postgraduate studies in Great Britain, after undergoing cognitive therapy. The purpose of this article is to present the cognitive map of the patient and the procedures that led to the achievement of the therapeutic goals.

Literature review

Standard Beckian CBT, also called cognitive therapy (CT), is based on the cognitive model, which links cognitions, emotions, and behaviors such that cognitions shape behaviors and emotions, and unrealistic cognitions can lead to inappropriate emotions and behaviors. 1 CT is a structured or semi-structured, directive, active and short-term approach. Its clinical use is applied to several psychiatric disorders i.e., anxiety-, personality- and eating-disorders, several situations of crises and disorders related to the use of psychoactive substances. 2

Most approaches to CI agree to its basic principles which include that people develop adaptable and non-adaptable behaviors and affective patterns through cognitive processes, the functions of these cognitive processes can be activated by the same procedures that are commonly used in the human learning laboratory, and the task for a therapist is that of a diagnostician and pedagogue who evaluates dysfunctional cognitive processes and arranges such learning experiences that transform the existing cognitive patterns, and correlate them with behaviors and patterns of experiencing things. 3 , 4

CT’s goals are to restructure the dysfunctional cognitions and give cognitive flexibility when assessing specific situations and to solve focal problems and mainly to provide patients with cognitive strategies to perceive and respond in a functional way to the real world. 5 CT is considered to have results with issues related to depression and panic disorders, i.e. verbal and non-verbal communication skills, assertiveness, criticizing and receiving criticism, refusing alcohol, and in general saying no. 6

Description of problem behavior

Helen is a 28-year-old chemistry student who sought therapy for intense anxiety concerning University Exams. The diagnostic interview indicated that she suffered from Specific Phobia (Exams Phobia) according to DSM-IV- TR. 7 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 wanted to be perfect in everything and she worried about other people’s criticism. 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.

Personal and family history

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. Her family was a low-income one putting an extra burden on Helen’s shoulders. 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. "If you do not have a degree, you are a zero" he said. Helen felt that her father counted on her. "He has put me in the place of his son. I always felt that I had to adhere to what he wanted" she said. Her sister always criticized her calling her irresponsible. She was also interfering trying to contact Helen’s lecturers to ask them to be more lenient with her, something that made Helen furious.

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.

As it becomes apparent from the above short account of Helen’s family history, her parents and sister put too much pressure on her in relation to her studies. 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

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

Helen’s assumptions-beliefs:

• "I am nothing unless I have a degree"
• "I always have to please my family"
• "I cannot cope with the exams"
• "If I cannot cope with this, I cannot cope with anything"
• "I always have to do everything perfectly well; otherwise others will look down on me"
• "I always have to do what my father wants"
• "Students are snob and I do not want to be like them"
• "I have to be in control all the time"
• "If you are used to something, you cannot change"

Helen’s above-mentioned beliefs gave rise to a number of automatic thoughts such as:

• I cannot get into the lecture theatre
• I cannot control this matter
• My parents will never be happy for me
• It is too late for me to change
• I have no second chance
• Everything seems like a mountain
• I am sick of sitting exams
• If you have a degree you do not feel inferior
• No matter what I do this degree will always bother me
• I do not believe that it is possible to sit an exam and pass
• My mind is not functioning, I am not going to make it
• I do not want to be snob like all the other students.

Cognitive distortions

Helen’s main cognitive distortions were stimulus generalization, catastrophizing and selective abstraction. 10 The range of stimuli that evoked anxiety increased and anything that had to do with the University was perceived as a danger (stimulus generalization). As many anxious people, 11 Helen tended to dwell on the worst possible outcome. For example, she thought: "If I fail the exam, I will not be able to finish University and as a consequence I will end up as a cleaner" (catastrophizing).

Finally, it seemed that Helen was aware of her difficulties in handling the exams situation but not of her assets. Thus, she had a biased view of the degree both of the danger she was in and of her own vulnerability (selective abstraction).

Figure 1 shows how the reactions to symptoms maintain the phobia by creating vicious circles that perpetuate fear. Avoidance maintains anxiety because it makes it difficult to learn that the feared situation (e.g. exams) is not in fact dangerous, or is not dangerous in the way, or to the extent that Helen thinks it is. Other important maintaining factors include thoughts, for example about the meaning of the symptoms of anxiety (e.g. "My brains don’t function properly"), or about the anticipated consequences of entering the phobic situation (e.g. "I will fail", "I will never be able to finish University"), and loss of confidence. 12

Figure 1 Helen’s vicious circle Adapted from Butler. 12

Goals of treatment

• Explaining the cognitive model, using Helen’s individual symptoms to illustrate how vicious circles maintain symptoms
• Teaching her how to identify automatic thoughts and find alternatives
• Problem solving concerning studying and sitting exams
• Becoming able to differentiate from her family

Behavioral and cognitive techniques used

"TIC-TOC" technique:  Helen could not study because of the negative cognitions she had concerning studying and University. The therapist focused on these "Task Inhibited Cognitions" and educated Helen to be able to monitor and challenge these dysfunctional cognitions and substitute them with "Task Oriented Cognitions" 13 . Thus, Helen’s automatic thought "I am not going to make it" was substituted with "If I do not try I have no possibility of succeeding, if I do try though I have at least some possibilities".

"Graded task assignment":  The aim of this technique was to maximize the chances of success by breaking tasks into small, manageable steps. 14 Hence, Helen was given small tasks to carry out. For example, she would study a few pages each time in order to become able to face this anxiety-provoking situation (studying).

"Graded exposure":  Exposure is defined as facing something that has been avoided because it provokes anxiety. 12 Helen was encouraged to talk about University and try to visit University. She thus managed to be able to visit University and even write down the timetable of the exams. Finally, she managed to go to the lecture theatre to sit an exam with the presence of the therapist at first and then by herself.

"Daily record of dysfunctional thoughts":  Situations that precede unpleasant emotions were recorded along with the emotions and the automatic thoughts. At a later stage, Helen learned how to challenge these thoughts (a sample of Helen’s Daily record of Dysfunctional thoughts is given in Table 1 . It should be noted at this point that Helen was not willing to do any homework. This was considered to be part of her problem since she could not concentrate properly. Thus, the record forms were completed in the therapeutic session.

Table 1 Helen’s daily record of dysfunctional thoughts

Therapeutic achievements

Despite the difficulties in treatment (Helen would not do any homework) the therapeutic results were quite impressive. After five months of therapy including follow-ups:

• She managed to decide whether she wanted to finish University or not
• She graduated successfully
• Her physical symptoms disappeared
• She pursued postgraduate studies in Great Britain

This case study presented the main tools treating anxiety disorders and provided specific conceptual frameworks of cognitive therapy that were used effectively in therapy of this patient and affected her whole life so that she could lead a well adjusted life. Last, but not least in a follow-up session she mentioned that she has worked in a company in Great Britain for the last ten years after having completed her postgraduate studies.

Acknowledgments

Conflicts of interest.

Author declares there are no conflicts of interest.

• Beck JS, Liese BS. Cognitive Therapy. In: Frances RJ, Miller SI & Mack AM (Eds.), Clinical text book of Addictive Disorders. (2nd edn), Guilford Press, New York, USA,. 1993. p.547‒573.
• Blackburn IM, Cottreaux J. Psychotherapie Cognitive de la Depression. (3rd Edn.), Elsevier Masson , Paris. 2011.
• Mahoney MJ. Cognition and behavior modification. Ballinger , Cambridge. 1974. p.351.
• Wright JH, Thase ME, Clark MD. Cognitive Therapy. American Psychiatric Press , New York, USA. 1997. p.174.
• Beck AT, Wright FD, Newman CF, et al. Cognitive Therapy of Substance Abuse. Guilford Press, New York, USA. 1993.
• Monti PM, Rohsenow DJ. Coping-skills training and cue-exposure therapy in the treatment of alcoholism. Alcohol Res Health . 1999;23(2):107‒115.
• American Psychiatric Association. Diagnostic and statistical manual of mental disorder . Washington, DC, USA.d. 2000.
• Clark D. Anxiety states: Panic and generalized anxiety. In: K Hawton, PM Salkovskis, J Kirk, DM Clark (Eds.), Cognitive Behaviour Therapy for Psychiatric Problems. Oxford University Press , Oxford, England. 1989. p.472.
• Clark DA, Beck AT. Cognitive Therapy of Anxiety Disorders. Science & Practice. The Guilford Press, New York, USA. 2010.
• Beck AT, Emery G, Greenberg RL. Anxiety Disorders and Phobias: A Cognitive Perspective . Basic Books. 1985.
• Beck AT. Cognitive Therapy and the emotional Disorders. Penguin Books , New York, USA. 1989.
• Butler G. Phobic disorders. In: K Hawton, PM Salkovskis, J Kirk, DM Clark (Eds.), Cognitive Behaviour Therapy for Psychiatric Problems. Oxford University Press , Oxford, England. 1989.
• Burns DD. Feeling good: The new mood therapy. Ney American Library , New York, USA. 1980.
• Fennel MJV. Depression. In: K Hawton, PM Salkovskis, J Kirk, DM Clark (Eds.), Cognitive Behaviour Therapy for Psychiatric Problems. Oxford University Press , Oxford, England. 1989.

©2014 Theodoratou, et al. This is an open access article distributed under the terms of the, Creative Commons Attribution License ,--> which permits unrestricted use, distribution, and build upon your work non-commercially.

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Interpretational Processing Biases in Emotional Psychopathology pp 301–321 Cite as

“I Don’t Want to Bother You” – A Case Study in Social Anxiety Disorder

• Katharine E. Daniel 3 &
• Bethany A. Teachman 3  
• First Online: 29 March 2023

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Part of the book series: CBT: Science Into Practice ((CBT))

Gi, a 34-year-old second-generation Korean American man, presented to treatment with pronounced and longstanding anxiety in many social situations, which significantly impaired his functioning (e.g., his perceived ability to run errands in crowded stores and care for his ill father). Gi engaged in cognitive behavior therapy (CBT) via telehealth during the COVID-19 pandemic. Key cognitions and biased cognitive processes that were maintaining his anxiety included a judgment that others frequently reject him, an assumption that if he expressed his own needs, then he would be unreasonably burdening others, and a core belief that he was incompetent, along with a pervasive tendency to make negative interpretations about his abilities in most social situations. He experienced marked functional improvements and reduced anxiety throughout his 17-session course of treatment. Gi’s case and treatment are detailed throughout this chapter to illustrate how individual CBT for social anxiety disorder can be implemented. Special discussion of how the clinician continuously and collaboratively modified her case conceptualization and intervention approaches with reference to aspects of Gi’s identities and in response to her own missteps are offered throughout.

• Social anxiety disorder
• Culturally informed treatment

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Anxiety & Depression Association of America. (1.12.2022). Social anxiety disorder. https://adaa.org/understanding-anxiety/social-anxiety-disorder .

Beck, J. S. (2020). Cognitive behavior therapy: Basics and beyond (3rd ed.). Guilford Press.

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Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58 , 10–23. https://doi.org/10.1016/j.brat.2014.04.006

Article   PubMed   PubMed Central   Google Scholar  

Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99 , 20–35. https://doi.org/10.1037/0033-2909.99.1.20

Article   PubMed   Google Scholar  

Gover, A. R., Harper, S. B., & Langton, L. (2020). Anti-Asian hate crime during the COVID-19 pandemic: Exploring the reproduction of inequality. American Journal of Criminal Justice , 1–21. https://doi.org/10.1007/s12103-020-09545-1

Harpole, J. K., Levinson, C. A., Woods, C. M., Rodebaugh, T. L., Weeks, J. W., Brown, P. J., Heimberg, R. G., Menatti, A. R., Blanco, C., Schneier, F., & Liebowitz, M. (2015). Assessing the straightforwardly-worded Brief Fear of Negative Evaluation scale for differential item functioning across gender and ethnicity. Journal of Psychopathology and Behavioral Assessment, 37 (2), 306–317. https://doi.org/10.1007/s10862-014-9455-9

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). The Guilford Press.

Leahy, R. L., Holland, S. J. F., & McGinn, L. K. (2012). Treatment plans and interventions for depression and anxiety disorders (2nd ed.). Guilford Press.

Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping patients change behavior (3rd ed.). Guilford Press.

Norton, P. J., & Weeks, J. W. (2019). A multi-ethnic examination of social evaluative fears. Journal of Anxiety Disorders, 23 , 904–908. https://doi.org/10.1016/j.janxdis.2009.05.008

Article   Google Scholar  

Piccirillo, M. L., Taylor Dryman, M., & Heimberg, R. G. (2016). Safety behaviors in adults with social anxiety: Review and future directions. Behavior Therapy, 47 (5), 675–687. https://doi.org/10.1016/j.beth.2015.11.00

Turner, S. M., Johnson, M. R., Beidel, D. C., Heiser, N. A., & Lydiard, R. B. (2003). The social thoughts and beliefs scale: A new inventory for assessing cognitions in social phobia. Psychological Assessment, 15 (3), 384–391. https://doi.org/10.1037/1040-3590.15.3.384

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Daniel, K.E., Teachman, B.A. (2023). “I Don’t Want to Bother You” – A Case Study in Social Anxiety Disorder. In: Woud, M.L. (eds) Interpretational Processing Biases in Emotional Psychopathology . CBT: Science Into Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-23650-1_16

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Case-based learning: anxiety disorders

There are many types of anxiety disorders with varying levels of severity. Pharmacists should know the treatment options that are available and how to support patients. 

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Anxiety is a common mental health condition that affects approximately 6.6% of the population in England each week, along with one in six adults experiencing or being identified as having a common mental health condition per week [1] , [2] . Data suggest that women are almost twice as likely to be diagnosed with anxiety compared with men; however, the reason for this is unclear [3] , [4] . Although a large number of people are affected by mental health conditions (e.g. anxiety or depression), only 39% of adults aged 16–74 years are accessing treatment for them [5] .

Mental health conditions typically worsen over time and can negatively impact on social activities, relationships, career performance, academic work and general quality of life [6] . As such, patients that present with conditions, such as generalised anxiety disorder (GAD), are frequently seen in the community, with pharmacists having the opportunity to significantly impact on the patient’s quality of life by providing information on the treatment options that are available [7] . While occasional anxiety is a normal aspect of day-to-day life, persistent symptoms can indicate the possible presence of an anxiety disorder, which can often be debilitating. Anxiety has also been known to precipitate physiological responses, such as tachycardia and hyperhidrosis [8] . ’Functional impairment’ is a term that is often used to describe the degree to which an illness can limit a person’s ability to carry out some of their normal daily tasks; anxiety can affect this to differing degrees [9] .

There are multiple factors that could predispose or potentially encourage the manifestation of anxiety, which are often attributable to a combination of genetic and environmental factors [10] . In addition, studies suggest that alcohol and illicit drug use, particularly the use of stimulants and hallucinogens, are associated with higher rates of incidence [11] , [12] . Instances of childhood abuse and sexual abuse are also identified as potential causative factors for anxiety and depression [13] . However, there is a broad range of patients affected by anxiety, for whom there is often an unknown cause.

Types of anxiety

Anxiety disorder is an inclusive term for several disorders, including:

• Panic disorder;
• Selective mutism;
• Separation anxiety;
• Social anxiety disorder [14] .

The most common types of anxiety disorder include:

• Social anxiety disorder — this is considered to be the most common form of anxiety; in up to 50% of cases, it is present in individuals by age 11 years [15] . Symptoms include a persistent fear of social performance, panic attacks and a large fear of humiliating oneself in public [15] ;
• Phobic disorder — this broadly refers to a fear of places, situations, objects and animals. For example, agoraphobia is often considered to be simply a fear of open spaces, but it is far more serious and can include a fear of being in a place that individuals will find difficult to escape from or receive aid if things go wrong [16] .

Avoidance behaviour is common to both social anxiety disorder and phobic disorder, with patients actively trying not to encounter the feared stimulus (e.g. avoiding going outside, such as in cases of agoraphobia) [17] , [18] , [19] . This behaviour can hugely impact on a patient’s ability to maintain functional capacity.

Symptoms and diagnosis

Symptoms may involve feelings of restlessness, palpitations, problems with concentrating, uncontrollable worry, sleep disturbances and general irritability [6] .

Diagnosis of anxiety would initially be made by a GP following a comprehensive review of the following:

• Symptomatic presentation of the patient;
• Frequency of symptoms;
• Degree of severity of distress;
• Functional impairment.

History of substance misuse, comorbidities and past medical history should be considered as part of a holistic approach to diagnosis [20] .

In addition, differential diagnoses must be considered before a formal diagnosis is made. Anaemia and hyperthyroidism are two conditions that must be ruled out and/or treated as they can both manifest symptoms of anxiety disorders [21] , [22] . Blood analysis and further tests may be necessary to ensure a correct diagnosis is made [22] , [23] . As stated by the National Institute for Health and Care Excellence (NICE), diagnostic tools, such as the Diagnostic and Statistical Manual of Mental Disorders , can be utilised for anxiety disorders [21] . The criteria include a minimum of six months of incessant and uncontrollable worries, disproportionate to actual risk, and three of the following symptoms:

• Being easily fatigued;
• Irritability;
• Muscle tension;
• Poor concentration;
• Restlessness/nervousness;
• Sleep disturbance [21] .

The ‘International Classification of Diseases, 10th revision’, a disease classification tool, offers a similar criteria [21] . There are also other resources available to healthcare professionals to work through with patients, such as the GAD-7 questionnaire for anxiety and the personal health questionnaire-9 (PHQ-9) for depression [21] . Questions typically ask how frequently certain symptoms have occurred in the preceding two weeks. Both GAD-7 and PHQ-9 allow assessors to distinguish between anxiety and depression, and provide an indication as to the severity of presentation, which can guide therapy. These are typically asked by a GP during an initial consultation with the patient and may include questions such as: ‘Over the past two weeks, how often have you been bothered by feeling nervous, anxious or on edge?’ [24]

The GAD-7 questionnaire can also be used as a tool to determine the severity of its presentation, with scores of 5 and above, 10 and above, and 15 and above (out of a possible 21) referring to mild, moderate and severe anxiety, respectively [25] . Higher scores are strongly associated with functional impairment, although individual characteristics of presentation will affect how the patient is treated.

Pharmacological treatment

For patients with mild anxiety, pharmacotherapy is not recommended. However, as per NICE guidelines, pharmacological treatment is recommended where significant functional impairment exists [26] . First-line drug treatment involves selective serotonin reuptake inhibitors (SSRIs; e.g. sertraline or fluoxetine) [26] .

SSRIs are widely used for GAD and are often well tolerated. In addition, they are considered to be safer in overdose than most other similarly indicated medicines, because they carry a lower risk of cardiac conduction abnormalities and seizures [27] , [28] , [29] . Selective serotonin–noradrenaline reuptake inhibitors (SNRIs; e.g. duloxetine and mirtazapine) are a suitable alternative; pregabalin is a tertiary option if the others are unsuitable or poorly tolerated [26] .

It is important to manage the patients’ expectations with pharmacological therapies. Providing a clear message that it could take between four and six weeks before the patient notices a benefit from their medicine is essential, as this will help ensure that they take their medication as directed. Patients should also be made aware of side effects and the withdrawal process (e.g. associated side effects) prior to commencing therapy [26] .

Common side effects of SSRIs include abnormal appetite, arrhythmias, impaired concentration, confusion, gastrointestinal discomfort and sleep disorders [27] . The incidence of side effects is reported to be highest within the first two weeks of starting treatment [30] . Although most common side effects tend to improve over time, sexual dysfunction can persist [31] . There is an increased risk with SSRIs in certain patient groups (e.g. young adults, children and patients with a previous history of suicidal behaviour) of suicidal ideation and self-harm; therefore, initiation of SSRIs must be reviewed weekly in those under aged under 30 years for the first four weeks of treatment. If the risk of recurrent suicidal behaviour is a concern, the healthcare professional may want to seek advice from the local crisis or home-based treatment team; SSRIs generally have a better safety profile than other drugs used for anxiety, but may require frequent monitoring in this case [32] , [26] .

SSRIs are one of several classes of medicines that pose a risk for long QT syndrome, which occurs as a result of a prolonged QT interval on the electrocardiogram measurements of the heart. This can lead to torsades de pointes (a specific type of abnormal heart rhythm) and possible sudden cardiac death [33] [34] , [35] .

It is important that SSRIs are withdrawn slowly to minimise the occurrence of SSRI discontinuation syndrome — an abrupt cessation of treatment that can cause a combination of psychological and physiological symptoms; the most common including nausea, dizziness, headache and lethargy [36] . Tapering drug doses slowly over several weeks will mitigate the effects of the withdrawal and minimise unnecessary re-initiation of the SSRI [37] .

Considerations for selective serotonin reuptake inhibitors and selective serotonin–noradrenaline reuptake inhibitors

Serotonin syndrome is a serious side effect that can occur with the use of SSRIs and SNRIs. It occurs as a result of overactivation of the 5-HT1A and 5-HT2A receptors, precipitated by serotonergic drug use [38] . Symptoms typically range from confusion and agitation to more serious symptoms, such as seizures, arrhythmias and loss of consciousness [31] . The risk of the syndrome is higher if patients are taking other medicines that can increase serotonin levels in the brain, such as tramadol and metoclopramide. Taking 5-HT1F agonists, which include sumatriptan, or a combination of medicines with the same effect, can also increase risk [39] .

If a decision is made to initiate an SSRI, despite the associated risk, patients should be provided with suitable information concerning the syndrome, which can be found on or printed from the NHS website [31] . If a patient experiences symptoms of serotonin sydrome, they should be advised to contact their GP surgery immediately. If this is unavailable, they should call NHS 111 for advice.

Alongside serotonin syndrome, SSRIs have been known to contribute to inappropriate antidiuretic hormone secretion, which is related to hyponatremia and has symptoms including headache, insomnia, nervousness and agitation [40] . 

Patients with anxiety disorders should be monitored as frequently as the severity of the disorder demands, which is essential to protect patients and improve their quality of life. Guidance from the British National Formulary states that patients being initiated on an SSRI should be reviewed every one to two weeks after initiation, with response being assessed at four weeks to determine whether continuation of the drug is suitable [27] . NICE guidelines expand on this by encouraging three-monthly reviews of drug therapy to assess clinical effectiveness [20] .

Non-pharmacological treatment

Patients should be advised to minimise alcohol intake and make time for activities they find relaxing. They should also be encouraged to exercise every day, aiming to do 150 minutes of moderate-intensity exercise (e.g. walking or cycling) per week as exercising has been shown to improve mental health [41] , [42] . A study has demonstrated that those who exercise had 43.2% fewer days of poor mental health, with team sports having the largest association with reduction in mental health burden [43] .

Psychological treatment

Cognitive behavioural therapy (CBT) is a common psychological treatment used for those with anxiety. This therapy aims to transform negative thinking into more structured thought patterns, which then assist the patient in making changes to their thought processes to encourage positive thinking. CBT is suitable for patients that present with ongoing anxiety and does not look at patient history [34] . This type of treatment may be useful for patients with mild anxiety, as an addition to medicine or for those who do not wish to take medicine. It can be conducted individually or as part of a group.

Guided self-help — a process by which a patient is able to work through a course with the support of a trained therapist — and counselling are other treatments available through the NHS that may benefit patients with mild anxiety or as an adjunct to prescription medicines [44] .

Specialist referral and suicide risk

Specialist referral should be considered if patients:

• Have not responded to initial therapy;
• Have comorbidities, such as alcohol or substance misuse;
• Are at significant suicide risk.

Healthcare professionals should always assess suicide risk by discussing the patients’ feelings about self-harm openly and considering other contributing factors, such as the use of prescribed or illicit drugs. Healthcare professionals must take opportunities to make interventions — for example, referring patients for urgent mental health assessment or in the case of serious concerns, calling emergency services [23] .

In the UK, area-specific community programmes and the charity  Anxiety UK  can provide patients with further advice on managing their anxiety. However, many primary care networks are now recruiting social prescribers, who will have the ability to direct patients to attend local groups that are more suited to individual needs. Community pharmacists are also likely to be aware of local support networks.

Case studies

Case study 1: a woman taking interacting medicines

Joanne*, a woman aged 65 years, approaches the pharmacy counter. She is concerned about heart palpitations she has been experiencing recently.

After inviting Joanne into the consultation room, you ask her if she is taking any medicines. She says that she is taking amitriptyline for the pain in her legs. She has also recently started taking a new medicine and states that she is on other medicines, but cannot recall the names. You ask for permission to view her summary care record and note that there is furosemide on her list of medicines. She was started on citalopram two weeks prior and was prescribed a seven-day course of clarithromycin three days ago.

You are concerned that Joanne is experiencing long QT syndrome, since the selective serotonin reuptake inhibitor (SSRI) citalopram is a risk factor for QT prolongation — as are the tricyclic antidepressant amitriptyline and the antibiotic clarithromycin [33] , [45] , [46] . In addition, furosemide can also precipitate hypokalaemia, which has been known to affect the QT interval [47] .

Advice and recommendations

You advise Joanne to stop taking the citalopram that has been prescribed to her until she can see a GP, which is a matter of urgency, as you believe it could be related to the medicines she is taking. You advise that she should try and get a same-day appointment if possible. The GP will likely request an electrocardiogram and stop the SSRI if results demonstrate long QT syndrome.

Case study 2: a man with concerns about his medicine

Gareth*, an investment banker aged 52 years, attends the pharmacy and asks to purchase sildenafil over the counter, owing to his erectile dysfunction. He is referred to you and you sit with him in the consultation room.

During the consultation, you begin to ask questions about his history and whether the erectile dysfunction is a new condition that he is experiencing. He states that he has been worried about it for the last couple of months. You then discuss his lifestyle and ask him questions about his medicines, in which he states he started taking a new medicine, fluoxetine, several months ago. He has been under significant stress at his workplace and was started on fluoxetine owing to his anxiety.

You consider the following:

• The erectile dysfunction that Gareth is experiencing could be related to the stress he is experiencing as part of his work;
• The possibility there could be an underlying reason for the problem related to his general health;
• That the prescribed fluoxetine may be causing his erectile dysfunction because this is a side effect of selective serotonin reuptake inhibitors [48] .

You explain your rationale with Gareth and indicate that you do not think it is appropriate to sell him sildenafil now. You suggest he goes back to his GP to discuss the symptoms that he has been having. The GP may decide to try an alternative medicine, but, given that he has been taking the fluoxetine for a few months, he should not discontinue it until advised to do so by his GP. You explain that if his GP advises him to stop the medicine, there will be a specific withdrawal process to minimise the side effects and that you would be able to advise him on this.

Case study 3: a man who is displaying symptoms of moderate anxiety

Anton*, a university graduate aged 21 years, attends the pharmacy and asks to speak to the pharmacist in private. He states he is worried about heart palpitations that he has been experiencing. He is visibly sweating and looks on edge.

You invite Anton into the consultation room and ask him about his symptoms. He states that he has started a new job and that the palpitations start when he is feeling anxious. His symptoms are occurring most days of the week and he says it makes him “feel on edge”. He adds that he does not want to socialise with his co-workers. It is starting to affect his sleep and he does not know what to do. He also states that he has occasional pain in his chest.

Treatment options

Anton is demonstrating symptoms of moderate anxiety, given his desire to avoid socialising, and has a degree of functional impairment. However, as he has potential cardiac symptoms, these issues could be related to another condition.

When questioned, he confirms he has no other problems with his health, but you feel the patient needs further investigation — for example, an electrocardiogram test to measure the electrical activity of his heart to rule out underlying cardiac problems. His presentation concerns you and you feel he needs to see a doctor today to assess the differential diagnosis, as you are worried about his chest pain and palpitations.

You encourage Anton by saying that it is great that he felt he could talk to a pharmacist about this, but explain that he would benefit from a consultation with a GP. You explain that his symptoms could be related to anxiety and that you think he may need something to help him manage. He agrees to let you contact his local practice. As you have a good relationship with the practice, you manage to secure an appointment for him to see a GP that day. If a GP appointment had been unavailable, you could have telephoned NHS 111 for Anton to seek access to support.

*All cases are fictional

Useful resources

• NHS: Do I have an anxiety disorder?

[1] Fineberg NA, Haddad PM, Carpenter L et al . The size, burden and cost of disorders of the brain in the UK. J Psychopharmacol 2013;27(9):761–770. doi: 10.1177/0269881113495118

[2] Anxiety UK. Frequently asked questions. 2018. Available at: https://www.anxietyuk.org.uk/get-help/anxiety-information/frequently-asked-questions/ (accessed May 2020)

[3] No Panic. Anxiety statistics. 2018. Available at: https://nopanic.org.uk/anxiety-statistics/ (accessed May 2020)

[4] NHS England. Women are more likely to suffer from anxiety than men. 2016. Available at: https://www.nhs.uk/news/mental-health/women-are-more-likely-to-suffer-from-anxiety-than-men/ (accessed May 2020)

[5] NHS Digital. Adult psychiatric morbidity survey: Survey of mental health and wellbeing, England 2014. 2014. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-and-wellbeing-england-2014 (accessed May 2020) 

[6] National Institute of Mental Health. Anxiety disorders. 2018. Available at: https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml (accessed May 2020)

[7] Braga SFF, Clark KJ & Shirer AE. US Pharm.  An overview of generalized anxiety disorder for the community pharmacist. 2019. Available at:  https://www.uspharmacist.com/article/an-overview-of-generalized-anxiety-disorder-for-the-community-pharmacist (accessed May 2020)

[8] McLeod DR, Hoehn-Daric R & Stefan RL. Somatic symptoms of anxiety: comparison of self-report and physiological measures. Biol Psychiatry 1986;21(3):301–310. doi: 10.1016/0006-3223(86)90051-x

[9] Ustün B & Kennedy C. What is “functional impairment”? Disentangling disability from clinical significance. World Psychiatry 2009;8(2):82–85. doi: 10.1002/j.2051-5545.2009.tb00219.x

[10] Durbano F.  A Fresh Look at Anxiety Disorders . InTech: Croatia; 2015

[11] Schuckit MA & Hesselbrock V. Alcohol dependence and anxiety disorders. Focus 2004;2(3):440–453. doi: 10.1176/foc.2.3.440

[12] Sareen J, Chartier M, Paulus MP & Stein MB. Illicit drug use and anxiety disorders: findings from two community surveys. Psychiatry Res 2006;142(1):11–17. doi: 10.1016/j.psychres.2006.01.009

[13] Mancini C, Van Ameringen M & MacMillan H. Relationship of childhood sexual and physical abuse to anxiety disorders. J Nerv Men Dis 1995;183(5):309–314. doi: 10.1097/00005053-199505000-00006

[14] Anxiety and Depression Association of America. Understanding the facts of anxiety disorders and depression is the first step. 2020. Available at: https://adaa.org/understanding-anxiety (accessed May 2020)

[15] Stein MB & Stein DJ. Social anxiety disorder. Lancet 2008;371(9618):1115–1125. doi: 10.1016/S0140-6736(08)60488-2

[16] Marks I. Fears, Phobias and Rituals: Panic, Anxiety and Their Disorders . Oxford University Press: New York; 1987.

[17] NHS. Phobias. 2018. Available at: https://www.nhs.uk/conditions/phobias/ (accessed May 2020)

[18] Hofmann S & DiBartolo P. Social Anxiety: Clinical, developmental and social perspectives . 3rd edn. Academic Press: San Diego; 2014.

[19] Marks I. Fears and Phobias . Academic Press: New York; 1969.

[20] National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline [CG113]. 2011. Available at: https://www.nice.org.uk/guidance/cg113/resources/generalised-anxiety-disorder-and-panic-disorder-in-adults-management-35109387756997 (accessed May 2020)

[21] National Institute for Health and Care Excellence. NICE Pathways. Generalised anxiety disorder. 2019. Available at: https://pathways.nice.org.uk/pathways/generalised-anxiety-disorder (accessed May 2020)

[22] British Thyroid Foundation. Hyperthyroidism. 2018. Available at: https://www.btf-thyroid.org/hyperthyroidism-leaflet (accessed May 2020)

[23] NHS. Generalised anxiety disorder in adults. 2018. Available at: https://www.nhs.uk/conditions/generalised-anxiety-disorder/ (accessed May 2020)

[24] National Institute for Health and Care Excellence. Clinical knowledge summaries. Generalized anxiety disorder. 2017. Available at: https://cks.nice.org.uk/generalized-anxiety-disorder (accessed May 2020)

[25] Spitzer RL, Kroenke K, Williams JB & Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Intern Med . 2006;166:1092–1097. doi: 10.1001/archinte.166.10.1092

[26] National Institute for Health and Care Excellence. Generalized anxiety disorder. Scenario: management of a person with generalized anxiety. 2017. Available at:  https://cks.nice.org.uk/generalized-anxiety-disorder#!scenario (accessed May 2020)

[27] British National Formulary. 2020. Available at: https://bnf.nice.org.uk/ (accessed May 2020)

[28] Ferguson JM. SSRI Antidepressant medications: adverse effects and tolerability. Prim Care Companion J Clinl Psychiatry 2001;3(1):22–27. doi: 10.4088/pcc.v03n0105

[29] Yekehtaz H, Farokhnia M & Akhondzadeh S. Cardiovascular considerations in antidepressant therapy. J Tehran Heart Cent 2013;8(4):169–176. PMID: 260058484

[30] Warden D, Trivedi MH, Wisniewski SR et al. Early adverse events and attrition in selective serotonin reuptake inhibitor treatment: a suicide assessment methodology study report. J Clin Psychopharmacology 2010;30(3):259–266. doi: 10.1097/JCP.0b013e3181dbfd04

[31] NHS. Antidepressants. 2018. Available at: https://www.nhs.uk/conditions/antidepressants/ (accessed May 2020)

[32] National Institute for Health and Care Excellence. Antidepressant drugs. 2020. Available at: https://bnf.nice.org.uk/treatment-summary/antidepressant-drugs.html

[33] Funk KA & Bostwick JR. A comparison of the risk of QT prolongation among SSRIs. Ann Pharmacother 2013;47(10): 1330-1341. doi: 10.1177/1060028013501994

[34] Kannankeril PJ & Roden DM. Drug-induced long QT and torsade de pointes: recent advances. Curr Opin Cardio 2007;22(1):39–43. doi: 10.1097/HCO.0b013e32801129eb

[35] Yap YG & Camm AJ. Drug induced QT prolongation and torsades de pointes . Heart  2003;89(11):1363–1372. doi: 10.1136/heart.89.11.1363

[36] Haddad P. The SSRI discontinuation syndrome.  J Psychopharmacol 1998;12(3): 305–313. doi: 10.1177/026988119801200311

[37] Horowitz M & Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry .  2019;6:538–546.  doi: 10.1016/S2215-0366(19)30032-X

[38] Volpi-Abadie J, Kaye AM & Kaye AD. Serotonin Syndrome. Ochsner J 2013;13(4):533–540. PMID: 24358002

[39] Specialist Pharmacy Service. What is serotonin syndrome and which medicines cause it? 2020. Available at: https://www.sps.nhs.uk/articles/what-is-serotonin-syndrome-and-which-medicines-cause-it-2/ (accessed May 2020)

[40] Kirpekar VC & Joshi PP. Syndrome of inappropriate ADH secretion (SIADH) associated with citalopram use. Indian J Psychiatry 2005;47(2):119–120. doi: 10.4103/0019-5545.55960

[41] NHS. Get fit for free. 2019. Available at: https://www.nhs.uk/live-well/exercise/free-fitness-ideas/ (accessed May 2020)

[42] Anxiety UK. Physical Exercise & Anxiety. 2018. Available at: https://www.anxietyuk.org.uk/get-help/anxiety-information/physical-exercise-anxiety/ (accessed May 2020) 

[43] Chekroud SG, Gueorguieve R, Zheutlin AB et al . Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross-sectional study.  Lancet Psychiatry 2018;5(9):739–746. doi: 10.1016/S2215-0366(18)30227-X

[44] NHS. Types of talking therapies. 2018. Available at: https://www.nhs.uk/conditions/stress-anxiety-depression/types-of-therapy/ (accessed May 2020)

[45] Vieweg WV & Wood MA. Tricyclic Antidepressants, QT interval prolongation and torsade de pointes. Psychosomatics 2004;45(5):371–377. doi: 10.1176/appi.psy.45.5.371

[46] Kamochi H, Nii T, Eguchi K et al . Clarithromycin associated with torsades de pointes . Jpn Circ J 1999;63:421–422.  doi: 10.1253/jcj.63.421

[47] Snitker S, Doerfier RM, Soliman EZ et al . Association of QT-prolonging medication use in CKD with electrocardiographic manifestations. Clin J Am Soc Nephrol 2017;12(9):1409–1417. doi: 10.2215/CJN.12991216

[48] Montejo-Gonzalez AL, Llorca G, Izguierdo JA et al . SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline and fluvoxamine in a prospective, multicentre and descriptive clinical study of 344 patients. J Sex Marital Ther 1997;23(3):176–194. doi: 10.1080/00926239708403923

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• J Chiropr Med
• v.7(3); 2008 Sep

Separation anxiety disorder in a 13-year–old boy managed by the Neuro Emotional Technique as a biopsychosocial intervention ☆

Fay karpouzis.

a Masters (Hons) Candidate (MQU), Department of Health and Chiropractic, Macquarie Injury Management Group, Macquarie University, Sydney, NSW 2109, Australia

Henry Pollard

b Associate Professor, Director of Research, Department of Health and Chiropractic, Macquarie Injury Management Group, Macquarie University, Sydney, NSW 2109, Australia

Rod Bonello

c Associate Professor, Director of Clinics, Department of Health and Chiropractic, Macquarie Injury Management Group, Macquarie University, Sydney, NSW 2109, Australia

This document may be redistributed and reused, subject to certain conditions .

To describe a case of an adolescent with separation anxiety disorder (SAD) presenting to a chiropractor for treatment.

Clinical features

The patient was a 13-year–old boy who had consulted with a clinical psychologist and had been diagnosed with SAD using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The patient was unable to attend school camps or sleep at friends' homes because of anxiety.

Intervention/outcome

The patient underwent 8 sessions with a chiropractor certified in the Neuro Emotional Technique (NET). Two days after his last NET treatment, he attended his first school camp without incident. He also slept away from home at a friend's home for the first time without incident. Six months postintervention, he returned to his clinical psychologist, where she independently reevaluated him stating that he no longer met the criteria for SAD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition .

This single case report cannot provide a causal relationship between the clinical outcome and NET without further investigations. Neuro Emotional Technique is a unique therapy that does not take the place of psychotherapy; however, it may be used as an adjunct to it. It is possible that, with valid and reliable follow-up research, the biopsychosocial principles that NET addresses may be of value to children and adolescents with SAD.

Introduction

Separation anxiety disorder (SAD) is considered to be the most prevalent of the anxiety disorders. 1-5 It is characterized by excessive anxiety associated with the separation of a child from the primary attachment figure (eg, usually a parent) or from the home. The anxiety created from such a detachment is beyond what is considered normal for the child's developmental stage, and the resultant behavior must last for at least 4 weeks. Separation anxiety disorder causes significant distress or impairment in social, academic, or other important areas of functioning. 1,2

Children and adolescents with SAD have somatic problems, such as headaches, stomach aches, nausea, vomiting, palpitations, and insomnia, 2,6,7 which are either a direct result of the anxiety or manufactured by the child to avoid separation from the primary attachment figure. 8,9 The outcomes of anxiety disorders in children and adolescents range from remission to chronic illness. 10 If untreated, they are at risk of developing impairments that may last a lifetime, 11,12 such as chronic anxiety, depression, substance abuse; 13 attempting suicide, 14 or being hospitalized for psychiatric illnesses. 8,10 Definitive recommendations for treatment of childhood anxiety disorders are challenging, given the conflicting data among the psychopharmacologic and psychosocial intervention studies. 4,5,15 The purpose of this article is to report the use of Neuro Emotional Technique (NET) treatment on a 13-year–old boy diagnosed with SAD.

Case report

A 13-year–old boy presented to a chiropractor certified in the NET protocol in August 2005. The patient presented with a history of anxiety in relation to sleeping away from home and being away from his mother. This occurred whether it was at a friend's home or a school camp. He expressed his anxiety as a fear that something would happen to his mother and that she would not be able to return to pick him up. Whether the separation had occurred or was anticipated, the patient and his mother complained that he would experience fear, worry, trembling, sweating, “stomach churning,” and crying.

The patient's mother described him as very “clingy” during his preschool years aged 3 and 4 years, as he would not separate from his mother when she dropped him off at preschool. The patient would attach himself to his mother, and the preschool teachers would have to pry him off to create a physical separation. Between the ages of 5 and 10 years, the patient recalled having a repetitive nightmare in which his mother died and he was unable to help her.

At the time of the chiropractic consultation, the patient was not taking any medications, had never sustained any fractures, and had never received chiropractic care. At the age of 18 months, the patient had asthma and was regularly hospitalized with severe attacks after a cold during the winter months. The patient's hospitalizations lasted between 1 and 4 days, and his mother would stay with him during the day as well as overnight. However, during the hospital stay, the patient's mother would leave for short periods of time to eat and shower in the hospital facilities or go home to attend to her other child. The patient was medicated with Ventolin (GlaxoSmithKline, Philadelphia, PA) (asthma reliever medication, a bronchodilator), prednisone (anti-inflammatory), and Seretide (GlaxoSmithKline, Philadelphia, PA) (combination of an asthma preventer and controller) during those years. The asthma lasted for a period of 2 years; and according to his mother, he outgrew his condition. The patient had sutures inserted into his chin after a fall off his bicycle at the age of 6 years and had a concussion at the age of 12 years during a game of rugby. The patient comes from a stable, middle-class, 2-parent family environment and is otherwise a healthy teenager. He is a high achiever at school who enjoys playing basketball, tennis, and rugby, and enjoys interacting with adults and his peers. Other than the medical history noted above, the patient had no other clinically significant features.

In 2003 (grade 5) at age 11 years, the patient experienced “homesickness” while away on a school camp, which produced such a high level of distress that he vomited. The camp staff were unable to console his distress that the parents were notified and advised to collect him. It was after this event that the parents sought professional help for their son.

After consulting with an independent clinical psychologist at a specialist anxiety clinic, the patient was diagnosed with SAD in March 2004 (age 12 years). Parent and child interviews, as well as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ) 1 criteria, were used to confirm the diagnosis. It was recommend that the patient and his mother each attend separate 9-week cognitive behavioral therapy (CBT) group programs. Two other consultations were made with the psychologist before the patient's attendance at the grade-6 (2004) and grade-7 (2005) school camps.

In 2004 (grade 6), the patient, aged 12 years, had a 2-night camp to attend. For 2 months preceding the camp and at school before boarding the bus, the patient experienced his usual symptoms of anxiety. During the evening of the camp, his symptoms returned (fear, worry, trembling, sweating, stomach churning, and crying), followed by vomiting. The parents were informed of his distress; however, they were too far away to collect him from the camp. In 2005, when the patient was 13 years old, he experienced the same symptoms; and the same behavior ensued at the year-7 school camp. The patient reported that he did not settle or enjoy either camp.

Despite the patient's consultations with his clinical psychologist addressing his anxiety and his cognitive behavioral group therapy sessions in 2004, the patient was still unable to attend a school camp or sleep at a friend's home without having anxiety.

It was after the year-7 camp in 2005 that the patient's mother consulted the chiropractor.

The chiropractor chose the NET protocol to address this patient's needs. Neuro Emotional Technique is a method of finding and removing so-called neuroemotional complexes. Neuroemotional complexes have been defined as “a subjective maladaptation syndrome adopted by the human organism in response to a real or perceived threat to any aspect of its survival.” 16 Neuro Emotional Technique is an intervention designed to alleviate negative distressing stimuli by removing these patterns by accessing the nervous system via somatic stimulation. Neuro Emotional Technique is a 15-step system that integrates the principles of several health modalities, including chiropractic principles, cognitive behavioral principles, traditional Chinese pulse assessment, acupuncture theory, meridian theory, and semantics. 16-18 Muscle testing is used throughout the procedure as an indicator for physiologic reactivity to cognitive recall under contemplation. 19 It has been found that, when patients make statements that they do not agree with (ie, noncongruent), their muscles become inhibited and test weak. 19 Conversely, when patients make a statement that they are congruent with, and are muscle tested, the muscles remain facilitated and test strong. 19

The patient was evaluated for a healthy deltoid muscle group, capable of resisting the light testing pressure of the practitioner. A practice trial was conducted to familiarize the patient with the muscle testing procedure (MTP), a procedure that has shown good interexaminer reliability. 20

The patient was asked to make the referential statement “I'm OK, going to camp overnight” and muscle tested. The muscle test to this statement tested weak, indicating that the patient was noncongruent with this concept. The patient was then asked to continually repeat the statement while the practitioner did the MTP with one hand, as the other hand palpated the different meridian access points (MAPs) on the patient's body. Each MAP is a specific skin point, which, based on acupuncture theory, 21 is associated with certain emotions. When the patient tests strong to the statement and a MAP, then it is said that there is an emotional component related to the presenting problem. According to applied kinesiology theory, 22 meridians have a psychologic and somatic association. In this patient's case, the kidney meridian was the active MAP, which, according to the NET protocol, has an alleged association to the emotion of “fear.” 16-18

Using the MTP, the concept of an “original event” that incited his emotional response was investigated. The semantic response to the current fear was related to a past event by asking “when,” “where,” and “who” type of questions. This was done to uncover what appeared to be a retained psychosomatic response to a previous traumatic event.

Neuro Emotional Technique hypothesizes that stimuli associated with the original event become associated via a process of pavlovian conditioning and are then reproduced through a process of repetition compulsion. 16 In this case, the original event occurred at the time when the patient first went to preschool aged 3 years. The patient's emotional reality (a perception of reality that may not actually be true) of the event was one of feeling “abandoned” at preschool by his mother. This is said to be the “original” traumatic event that set up this conditioned response in the patient when separating from his mother.

The treatment involved the practitioner applying a somatic stimulus by using a double-headed activator over associated vertebral sequences. In this case, for example, the kidney meridian requires activation of the following vertebral sequences: T1, T5, and T9. These vertebral sequences were identified by the MAP system developed by Walker. 16 At the same time, the patient was asked to contemplate the original event and the associated feelings in his conscious mind, while holding his forehead and MAP. The practitioner used the activator to provide a mechanical force along the plane of the vertebral facets, in the posterior to anterior direction, while the patient was asked to breathe in, hold his breath, and breathe out.

Finally, the practitioner retested the referential statement “I'm OK, going to camp overnight” using the MTP. The patient (who had originally tested weak) now tested strong to the MTP and that statement and so was considered to be congruent with that concept according to NET protocol.

Other referential statements used over the course of this NET treatment are listed in Table 1 .

Referential statements used and the outcomes of MT during the NET protocol

The patient underwent 8 NET sessions in a private chiropractic facility in Sydney, Australia, between August and November 2005 lasting approximately 15 minutes each.

Two days after his last NET treatment, the patient attended a 2-night school camp. The patient reported that he experienced only minor anxiety and not his usual symptoms of anxiety before leaving for camp. According to his mother's report, he appeared calmer boarding the school bus than on previous occasions. He reported that he experienced minor episodes of anxiety, although even after trying to “will” himself into a state of anxiety, he found he could not voluntarily induce the anxious state. He enjoyed himself so much on camp that he sent a text message to his mother during the evening, expressing this. Since returning from this camp, the patient has expressed a keen interest in going to a snowboarding camp in June 2006. The patient has happily stayed the night at a friend's home and is looking forward to his next school camp. He has also expressed interest in joining cadets and is considering boarding school.

Six months posttreatment, the patient returned to his clinical psychologist for reevaluation. The patient informed her that he did not experience excessive anxiety in relation to being away from home or his mother nor was he harboring fears that something bad would happen to her. He expressed some nervousness associated with going to camp; but he no longer worried about it for months, as he did in the past. The patient reported that he attended the camp without any incident and that he was able to enjoy himself on the camp at the end of 2005, as opposed to worrying about his mother. The patient's mother also confirmed that the level of interference the anxiety had caused her son in his social and family life had reduced significantly since consulting the chiropractor. The patient's mother also confirmed that the patient was looking forward to attending an overnight cadet's camp. As a result, the clinical psychologist concluded that the patient no longer met the criteria for SAD according to the DSM-IV . 1

It is suggested in the medical literature that the ideal treatment of SAD involves a multimodal approach. 4,5,23,24 The NET protocol provides children and parents with a management approach that attempts to resolve emotional instabilities involving the child being separated from the parents. It also attempts to establish behaviors within the child, which allows them to separate from the primary attachment figure without anxiety and related symptoms.

Literature supports CBT for the treatment of anxiety disorders in children and adolescents. 25-28 Cognitive behavioral therapy helps the child to identify possible cognitive deficits and distortions, teaches them new skills, and provides them with rational thinking skills. Cognitive behavioral therapy is based on the supposition that underlying the fear or anxiety are conditioned or learned responses, which can be eliminated. 25 In most approaches, CBT involves some form of cognitive restructuring. 5,12,28 The principle of NET pairs the anxiety-provoking stimulus in the conscious mind with a somatic stimulus. Neuro Emotional Technique attempts to eliminate any negatively charged feelings or emotions associated with the anxiety-provoking stimulus. 16-18 The aim is that patients are able to leave in a position in which they can deal with internal or external stressors in a healthy way. Neuro Emotional Technique does not take the place of psychotherapy; however, it can be used as an adjunct to it and may be included in the multimodal management approach. In a review of the mental health of young people in Australia, 29 it states that the mental health services provided are insufficient to handle the number of cases and that there is a “need to develop alternative approaches to reduce the prevalence of child and adolescent mental health problems.” 29 If new multimodal biopsychosocial management approaches such as NET can be validated through rigorous research involving large cohorts, then such treatment may be an option to the public when pursuing nonpharmacologic options. These additional resources may assist in the reduction of the high prevalence rates of childhood and adolescent mental health disorders in Australia.

The present study is limited by the fact that it reports on only a single case, making it impossible to generalize these findings to other children in other settings. According to the clinical psychologist's reevaluation and the reports by the child and the parent, it appears that the NET intervention produced a successful clinical outcome for this particular patient. Other possible explanations for the patient's improvement could be that the patient spontaneously improved or that he outgrew his condition. Furthermore, it is possible that a delayed response to the CBT for the patient and his mother produced the successful outcome. Given the chronicity of his condition and the fact that the condition improved directly after the last treatment, the authors hypothesize that the improvement resulted from the NET intervention. Another viable possibility that needs to be considered is that the combination of the CBT and NET therapies produced the successful outcome for this patient.

Another limitation is that standardized questionnaires, such as the Child Behaviour Checklist 30 or the Anxiety Disorders Interview Schedule for DSM-IV : Child Version, 31 were not used pre- and postintervention to objectively measure the outcomes of the NET intervention.

If future research findings are positive, NET may be considered as an adjunctive treatment in those patients for whom traditional psychotherapeutic or psychopharmacologic interventions were tried and deemed unsuccessful. Given the controversy surrounding the current management approaches for children with anxiety disorders, 4,5,15,32 additional research aimed at the assessment of psychosocial interventions, such as NET, may be of value.

A 13-year–old boy diagnosed with SAD for 3 years, along with his mother, was treated with CBT with no apparent effect. At the conclusion of the NET intervention, the patient and his mother reported a reduction in anxiety symptoms. Six months postintervention, the clinical psychologist concluded that the patient no longer met the criteria for SAD according to the DSM-IV . Caution is advised in application of these findings, as this single case report cannot provide the direct causal relationship between the clinical outcome and NET. We encourage further research such as a controlled clinical pilot study to evaluate the efficacy of such an approach.

☆ Partial funding was received from a CTS Scholarship from Macquarie University, Sydney, Australia.

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Generalized Anxiety Disorder Case Study: James

A paper on case studies.

If you are seeking help in this area, please let one of our therapists know. Theravive has thousands of licensed counselors available to help you right away. The following article may have multiple collaborators and thus, parts of it may not represent the official positions of Theravive.

Generalized anxiety disorder, (GAD) is a traumatic illness, and is hard to understand unless you are experiencing it yourself. While specific anxiety disorders are complicated by panic attacks or other features of the disorder, GAD has no specific focus. (Durand, 2007 p.130). The person constantly worries about everyday life; not being able to figure out what to do with their worries. All the while making themselves and everyone around them miserable. (p.130). The worries seem to take over control of one's life, almost to the point of not being able to function at all.

It seems that GAD tends to run in families based on studies conducted, and seems to happen more to women than men. (Durand, 2007 p.132). And evidence shows that GAD may be proved to be just as heritable, the same as other anxiety disorders. (p.133). The textbook states that this disorder originated in 1980, however therapists were working with patients with anxiety way before the criteria was developed. (p.133). For many years, clinicians believed that people who were generally anxious just didn't seem to have anything specific to focus on, thus calling it the 'free floating' disorder. (p.133).

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) has specific criteria that characterized GAD. As stated in our textbook, the features are:

• Excessive anxiety and worry for 6 months or more about a number of events or activities. • Difficulty in controlling the worry. • At least three of these symptoms: (1) restlessness of feeling all keyed up; (2) becoming fatigues easily; (3) difficulty concentrating; (4) irritability; (5) muscle tension; (6) sleep disturbance. • Significant distress or impairment. • Anxiety is not limited to one specific issue. (Durand, 2007 p.131).

Generalized anxiety disorder has been studied using various criteria. The National Comorbidity Survey (NCS) focused on noninstitutionalized American civilians ages 15 to 54. The results were reported and found there was a clear predominance of women with GAD, with a 2:1 female/male ratio. It was lowest among the younger age group but increased with age. (NA, 1997). 'There was a significant regional difference in GAD as well, with a higher lifetime prevalence in the Northeast than in other parts of the country.' (1997). Studies have shown that many people could not really pinpoint a clear age of onset of GAD or an onset dating back to childhood. (Barlow, 1993 p.156). There have also been twin studies which conclude that GAD is somewhat greater for identical female twins than for non-identical twins, but only if one twin already had generalized anxiety disorder. (Durand, 2007 p.132). But later researched showed that what seemed to be inherited was the ability to become anxious rather than GAD itself. (p.132). It's amazing to know that people with GAD seem to show less responsiveness on most physiological measures, such as heart rate, blood pressure, skin conductance and respiration rate than do people with other anxiety disorders. (p.133).

Although it seems to prove that GAD is quite common, I am amazed that more people don't have this disorder. I think that many people have general anxieties on a daily basis, but most people are able to handle them successfully. I did not realize that most people with GAD have usually had symptoms of anxiety or feelings of being worried throughout life, but just didn't know when it all started. The criterion has changed over the years as well as doctors have become more knowledgeable about this disorder. I first had knowledge of this disease in 1997 when I noticed strange things happening.

He was not really watching as he stared directly at the television set. I would notice that he had no expressions at all; nothing during the humorous scenes, or the dramatic ones. He once told me that it was as if he was someone else, watching himself try to crawl out of his own skin. That was 10 years ago when I was married to this man who was suffering from generalized anxiety disorder. I didn't understand and I really didn't want to. I thought he was just being lazy and unmotivated. Although this disorder seems to be simple to others, it is quite alarming to the person who is suffering from it, and the onset is rather quick, whereas, treatments are difficult. Everyone experiences anxiety, but in most people, it does not last for months at a time.

The case study I am choosing is about James who is a doctor suffering from generalized anxiety disorder. At 31 years of age and living in New York, he is unemployed because of his constant anxiety, even at the thought of working. He now lives with his parents off a small trust fund set up for him by an uncle. Although he was an overachiever throughout his academic career, James is having a hard time keeping it together, while his parents are somewhat supportive but disappointed with his medical career. Let's see what we can learn about this horrible and crippling disorder. 'Generalized anxiety disorder is associated with irregular neurotransmitters in the brain. Neurotransmitters are chemicals that carry signals across nerve endings. Neurotransmitters that seem to involve anxiety include norepinephrine, GABA (gamma-aminobutyric acid), and serotonin.' (na, 2001). So it was thought that reduced levels of GABA initiated excessive anxiety, although neurotransmitters are much to complex to be interpreted that simply. (Durand, 2007 p.45).

The brain is a very fascinating and intricate part of who we are and if the brain is not functioning properly, then our reactions to certain situations are not in balance. This is why some people still believe that undeniable psychological disorders are said to be caused by biochemical imbalances. (Durand, 2007 p.50). So in James' case, his brain was not functioning right and he was experiencing an unnatural balance of change within his various neurotransmitters, causing him to become anxious, easily irritated, distracted and quite tense. He also complained of headaches, body aches and pains and always feeling tired.

Genetics does play a major role is determining whether a person will or will not have a psychological disorder. The textbook states that the research is beginning to acknowledge genes that relate to some psychological disorders. (Durand, 2007 p.70). I feel that genetics does contribute to some disorders, but I also think that the environment and society can cause debilitating stress to induce certain disorders, such as anxiety. If the gene linked to the disorder is dormant, a stress related incident can bring it to the surface, thus bringing on the disorder. My research has shown that there are brain abnormalities indicated with generalized anxiety disorder. A study of 30 patients displayed that compared to 20 healthy volunteers, 11 patients had significant brain abnormalities mainly in the right temporal lobe. (Nutt, 2003 p.209). The temporal lobe controls the processes of recognizing various sights and sounds and long term memory storage. (Durand, 2007 p.48). However there are two temporal lobes on each side of the brain, located at the level of the ears. The lobes help a person distinguish one sound from another as well as one smell from the other. The right lobe controls visual memory while the left lobe controls verbal memory. (Johnson, 2006) So this would explain why James kept making mistakes because he was probably having a hard time remembering simple procedures.

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, 2007 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.17 p.6). The textbook states that the drub benzodiazepine (minor tranquilizers) is the most frequently prescribed. (Durnad, 2007 p.134). 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. (p.134) The most common antidepressants are prozac and zoloft. 'These drugs are shown to affect the concentration and activity of the neurotransmitter serotonin, a chemical in the brain thought to be linked to anxiety disorders.' (na, 2004). 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, 2006).

Prozac (Selective Serotonin reuptake inhibitors): nausea, insomnia, headaches, decreased sex drive, dizziness, weight gain or loss, nervousness, sweating, drowsiness/fatigue, dry mouth, diarrhea or constipation, skin rashes. (Smith et al, 2006) 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, 2006) 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 1990s, and is quite successful; however we need both medications and therapy to treat GAD. (Durand, 2007 p.134).

Acupuncture, which is one medical treatment that does no harm to the body, only releases energy and gets it moving in the system; (NA, 2007) biofeedback, which is the ability to allow the patient hear or see feedback of their body's physiological state while relaxing;(Grohol, 2004) and hypnotherapy shown as an appropriate treatment modality for those individuals who are highly suggestible, have also been used to treat anxiety. (Grohol, 2004).

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. (Durand, 2007 p.144). 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. (p.144).

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. (NA, 2001). When they do finally get help, they claim they have been anxious and nervous all their lives. (2001). These people cannot just 'get over it' but society seems to not grasp that concept. Some of the environmental influences that could lead to general anxiety are: • Work. 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. • School. Although James did not experience anxieties until after he graduated from medical school, I'm sure he still felt anxious with tests and schoolwork. • Relationships. 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. • Health. 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. • Financial. 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. I feel that if a person is genetically prone to have anxiety and fear; if the person never leaves the house, then what does he/she have to worry about? 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?' He would always be having threatening thoughts and images playing over and over in his mind. (Alloy, 2006 p.189).

Our textbook states that GAD generally runs in families, which I mentioned earlier. (Durand, 2007 p.132). 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. (p.133).

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.' (Durand, 2007 p.134).

Research has indicated that psychological treatments work very well for children who suffer from GAD. (Durand, 2007 p.135). 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. (p.135).

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. (Smith et al, 2006). 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, 2004 p.228). 'There are two types of worries; Type 1 and Type 2. 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. It's basically worry about worry.' (Wells, 1997 p.202). The cognitive model claims that the varieties of worry are typically type 2 worries in which the patients negatively appraise the activity of worrying. (p 202). I feel that the cognitive psychological model best applies to understanding and treating this disorder. I believe that by using cognitive therapies and similar research studies, we can begin to know what it takes to treat the people who are suffering with better results now and in the future. There are new medications that can help people with GAD, but there are side effects that may be too harsh or severe. I believe that more psychosocial therapies may need to be developed in order to help these people, so they can live a normal life without medications, because of the problems they present to the body.

I believe that James could once again become a successful doctor if and when he gets his generalized anxiety disorder under control. The treatments are available; all he has to do is seek them out. I feel that with therapy coupled with medications would benefit James tremendously. Eventually he will be able to stop taking the medications and perhaps enjoy a fairly normal life. The good news is that only 4% of the population meets the criteria for GAD during a given one-year period. However it is still one of the most common anxiety disorders. (Durand, 2007 p.132). . My research for this paper has helped me so far in understanding what a person is going through with crippling anxiety. It's not something that a person can just 'get over' and I know I wanted to tell my ex-husband that many, many times. However, he became addicted to the prescriptions drugs, and became a drug addict in about two weeks. Because of my first hand experience with this disorder, I chose to do my projects on it.

References N.A. (1997) Retrieved Oct. 20, 2007 from The Natural History of Generalized Anxiety Disorder website: www.medscape.com N.A. (2001). Retrieved Sept. 16, 2007 from General Anxiety Disorder website: http://www.mentalhealthchannel.net N.A. (2004). Retrieved Sept. 13, 2007 from Anxiety Disorders Association of America website: http://www.adaa.org N.A. (2007) Retrieved Sept. 17, 2007 from Anxiety Panic Guide website: http://www.webmd.com N.A. (2007). Retrieved Oct. 21, 2007 from Acupuncture for Generalized Anxiety Disorder website: www.revelutionhealth.com Barlow, D. (1993) Clinical Handbook of Psychological Disorders: A step-by-step treatment Manual 3rd ed. Guilford Press Retrieved Oct. 20, 2007 from libsys.uah.edu. Durand, V. & Barlow, D. (2007) Essentials of Abnormal Psychology: Mason, OH. Thomson/Wadsworth Publishing. Grohol, J. (2004) Retrieved Oct. 20, 2007 from generalized anxiety disorder treatment website: www.psychentral.com/disorders Johnson, G. (2006) Retrieved Sept. 15, 2007 from A Guide to Brain Anatomy website: http://www.waiting.com/brainanatomy Nutt, D. & Ballenger, J. (2003). Anxiety Disorders. Malden, Ma: Blackwell Publishers Retrieved Sept. 18, 2007 from Net library search: libsys.uah.edu Papageorgiou, C. & Wells, A. (2004). Depressive Rumination Nature, Theory and Treatment. Hoboken, NJ: John Wiley & Sons, LTD. Roberts, M. (nd). Introductory Guide to Psychology Kaplan University Class SS-124 Alloy, L. & Riskind, J. (2006). Cognitive Vulnerability to Emotional Disorders. Mahwah, NJ: Lawrence Erlbaum Associates Inc. Smith, M., Kemp, G., Larson, H., Jaffe, J., Segal, J. (2006). Retrieved Oct.8, 2007 from Anxiety Attacks and Disorders website: http://www.helpguide.org Wells, A. (1997). Cognitive therapy of Anxiety Disorders: A practice manual and conceptual guide. Chichester, NY: John Wiley & Sons, LTD.

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