Generalized Anxiety Disorder

In Case Study 1, I provided the diagnosis of Generalized Anxiety Disorder. An anxiety disorder is characterized by excessive or maladaptive anxiety reactions. Generalized Anxiety Disorder in particular is excessive worry about a wide array of topics. Kristen has had anxiety for eight months about losing her job and not being able to provide for her children. Generalized Anxiety Disorder is associated with restlessness, feeling tense, fatigue, difficulty concentrating, and sleep disturbance and Kristen has had moments feeling each. (Nevid, Rathus, & Greene, 2018) Kristen many times feels tired, and she feels restless when she attempts to go to bed.

When it comes to difficulty concentrating, she will be talking in a meeting in a meeting and then loses track of what she was going to say.

I believe the treatment plan for Kristen in Case Study 1 should be cognitive-behavioral therapy. Within cognitive-behavioral therapy, Kristen can work on both relaxation training and addressing her harmful thoughts. (Nevid, Rathus, & Greene, 2018)

In the study conducted by Henriksson, Anclair and Hiltunen in 2016, researchers examined the treatment effect of cognitive behavioral therapy (CBT), focusing on quality of life optimism and symptoms of generalized anxiety disorder.

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The group that received cognitive behavioral therapy were involved in about 11 therapy sessions compared to a wait-list control group. After treatment, the group that received CBT improved on general health optimism. They also improved in multiple mental health areas, and had a reduced amount of anxiety symptoms.

In 2011, Paxling, Almlöv, Dahlin, Carlbring, Breitholtz, Eriksson, and Andersson, evaluated the efficacy of an 8 week internet-delivered cognitive-behavior therapy program for participants with generalized anxiety disorder. This study used a wait-list control group. The CBT group showed significant improvement compared with the control group on all outcome measures except quality of life. Results were maintained after treatment.

In Case Study 2, I provided the diagnosis of Major Depressive Disorder (MDD). MDD is a major depressive episode without the presence of mania or hypomania. There are four common features of MDD: changes in emotional state, motivation, functioning and motor behavior, and cognition. Jessica has many tearful phone calls with her friend which is evidence of changes in her emotional state. When it comes to motivation changes, and has little interest in sex, withdrawing herself at work, and she pushes her husband away when he wants to make sure she is okay. Jessica’s function and motor behavior changes include having trouble falling asleep (insomnia) and calling in sick to work multiple times which is very unlike her. Jessica has felt worthless and shameful which means there is evidence of changes in her cognitions. Jessica also has a very stressful job which makes it more likely for her to have depression. (Nevid, Rathus, & Greene, 2018)

I believe the treatment plan for Jessica in Case Study 2 should be psychoanalytic therapy. Psychoanalytic therapy is a form of talk therapy that brings unconscious thoughts and feelings to the conscious mind so that they can be examined. (Nevid, Rathus, & Greene, 2018)

Zimmermann, Löffler-Stastka, Huber, Klug, Alhabbo, Bock, and Benecke (2015) aimed to investigate whether long term psychodynamic therapy (LTPP) is actually effective due to certain features of either psychodynamic or psychoanalytic therapies or if it is due the number of therapy sessions involved in the treatment. Researchers compared psychoanalytic, psychodynamic, and cognitive-behavioral therapies in participants with depression. Introject affiliation, symptoms of depression, and interpersonal relationship problems were assessed before and after treatment, and once a year for three years after the treatment. Participants receiving psychoanalytic therapy had fewer interpersonal problems, accepted themselves more after treatment. Both depressive symptoms and interpersonal problems improved after both CBT and psychodynamic therapy treatments, but not as effectively as psychoanalytic treatments.

Huber, Henrich, Clarkin, and Klug (2013) investigated the effectiveness of long-term psychoanalytic and psychodynamic therapies in patients with depression. Both therapies were compared after treatment once a year for three years. Researchers found significant outcome differences between both therapies in depressive symptoms, psychiatric symptoms, personality functioning, and quality in social relationships. Researchers found psychoanalytic therapy to be more effective.

In Case Study 3, I provided the diagnosis of Post Traumatic Stress Disorder (PTSD). Josh had witnessed a trauma 3 months ago and has had maladaptive reactions to the traumatic stress. He has also experienced common features of a traumatic stress disorder: avoidance behavior, re-experiencing the trauma, emotional distress, heightened arousal, and emotional numbing. Avoidance behavior is when a person avoids cues or situations associated with the trauma: Josh had to quit his job because his office was next to the cafe where he was supposed to meet his wife the day she died, and every time he tried to go back to work, it was unbearable. He continues to avoid that area of the town. Re-experiencing the trauma can include having intrusive memories, recurrent disturbing dreams, or momentary flashbacks. Josh has nightmares about the incident every night, and frequently relives the incident. Emotional distress can include being distant from others and constantly having negative thoughts. Josh’s parents claim he has become emotionally distressed, and has become withdrawn. Heightened arousal can include signs of increased arousal and Josh has been feeling jumpy. Josh is normally a fun-loving guy and has become withdrawn and emotionally flat, which can be a sign of emotional numbing. (Nevid, Rathus, & Greene, 2018)

A treatment plan for Josh in Case Study 3 should be Eye Movement Desensitization and Reprocessing (EDMR). EDMR identifies and addresses traumatic experiences hidden in the unconscious mind and helps reduce the impact of those events.

In 1997, Marcus, Marquis, and Sakai, compared Eye Movement Desensitization and Reprocessing treatment (EMDR) and standard care treatment (SC) in participants diagnosed with post-traumatic stress disorder (PTSD). Participants in each group were assessed before treatment, after 3 sessions, and at the end of their treatment. Participants in the EMDR treatment group showed faster and greater outcomes on depression, anxiety, and PTSD symptoms than participants that received SC treatment. Participants who received the EMDR treatment used less medications and needed fewer therapy sessions.

In 1998, Van and Taylor conducted a meta-analysis on 61 treatment outcome trials for post-traumatic stress disorder (PTSD). Conditions included drug therapies, psychological therapies, and relaxation training. Psychotherapies had lower dropout rates than the drug therapies. Psychological therapies had a greater positive effect on patients than drug therapies for symptom reduction. For the psychological therapies, EMDR was the most effective. Behavior therapy and EMDR both had lasting effects the 15 weeks following treatment.