Case Study: Cognitive Behavioral Therapy Application for Anxiety

This case study delves into the application of Cognitive Behavioral Therapy (CBT) for an individual named Sarah, who is experiencing anxiety and potential substance abuse issues following a recent breakup. The case presentation highlights Sarah's feelings of rejection, social isolation, and increased alcohol consumption. The report identifies risk areas, proposes assessment criteria, and rationalizes the use of CBT as a therapeutic intervention. Evidence-based strategies, assessment tools like the Montreal Cognitive Assessment, and the ABC model for CBT are discussed. Suggested interventions include creating a safe environment, managing stress, developing self-management skills, and administering anti-abuse medication alongside CBT. The report outlines a recovery support plan encompassing physical, lifestyle, emotional, peer, and spiritual self-care, as well as long-term treatment care involving self-management education and engagement in positive activities. The expected duration of recovery is estimated at 24 weeks, with the conclusion emphasizing the importance of thorough assessment and comprehensive recovery strategies to support the client's positive perspective and overall well-being.

Running head: NURSING ASSIGNMENT
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Name of the Student:
Name of the University:
Author Note:

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Introduction:
Anxiety can be defined as a disturbed state of mind predominated by negative
feelings. Statistical ratio on an average reveals that 18% of women suffer from anxiety
globally compared to the total of 11% men (Bystritsky et al.,2014). Anxiety has further been
reported to be more prevalent in women who have experienced separation or divorce.
Moreover, research studies predict that 28% of the global population has faced some form of
depression in their entire life time (Bystritsky et al., 2014). Anxiety can be differentiated into
four kinds of disorders which include, Generalized Anxiety Disorder, Social Anxiety
Disorder or Phobia, Panic Disorder and Post-Traumatic Stress Disorder (Aldao et al., 2014).
Anxiety can affect people at any age and has been reported to be triggered by an
environmental episode. It should be taken seriously because the symptoms are not manifested
physically and intricate emphasis must be laid on the psychological symptoms. Immediate
professional help must be sought in case of the manifestation of serious symptoms.
This report intends to discuss the case scenario of Sarah, who has recently suffered a
breakup and is experiencing symptoms of anxiety. The report would first discuss the key
presentation facts of the case study and would then proceed with the effective implementation
of cognitive behavioural therapy so as to promote complete recovery.
Case Presentation:
The key facts as mentioned in the case study can be presented as under:
o The client mentioned in the case study, Sarah had a recent breakup
o Her friend invited her to a party to get over the breakup phase
o She meets Tom at the party and likes his company. They exchange numbers to
keep in touch. The client consumes a lot of alcohol at the party.

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o The following day, she receives no message from Tom and feels rejected and
anxious.
o She reports ‘being sick’ at work and cuts off social communication and
consumes alcohol to keep herself distracted.
Risk Areas Identified:
o The high risk areas identified from the case study includes, feelings of
nervousness and anxiety
o Also, substance-abuse and addiction can be identified as a high risk area that
could lead to major mental health concerns.
Assessment Criteria:
o Thorough screening
o Comprehensive Assessment
o Formal Diagnosis
Cognitive Behavioural Therapy:
o Cognitive behavioural therapy or CBT, is referred to as a psychosocial
therapeutic intervention that significantly improves mental health issues.
o CBT aims to develop a positive perspective towards life on the basis of
positive thoughts, coping tactics and emotional stability (Gallagher et al.,
2013)

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o It helps in channelizing the negative thoughts into positive ideas and well-
being
Rationale of administering CBT:
o Cognitive behavioural therapy can segregated into two segments, cognition
and behaviour
o Sarah is affected by her breakup and is reported to harbour negative feelings
which increases on being ignored by Tom
o She is into substance abuse and prefers to remain socially secluded
o Administration of CBT has been reported to facilitate correction of distorted
thoughts and maladaptive social behaviour
o CBT has been reported to yield positive results in treating PTSD, anxiety,
personality disorder and depression
Evidence Based Strategies:
o CBT is assisted to patients after the mental state evaluation
o CBT makes use of mindfulness-based therapies and primarily focuses on the
thought content and emotions of the client to assist recovery (Memoria et al.,
2013)
Assessment Tools:
o A number of assessment tools can be used to evaluate the mental health status
of the client

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o In order to access Sarah, the Montreal Cognitive Assessment tool could be
used to evaluate her cognitive ability
o The test evaluates the client on the basis of multiple cognitive domains that
include, language, attention, memory, visuo-spatial, executive function and
abstract thinking
o The score range is from 0-30 with <26 suggesting impaired mental health
Julayanont et al., 2017)
o The screening test is highly reliable, accurate and convenient to use
Models for CBT:
o The ABC model has been found to be effective in administering CBT (Jun &
Park,2013)
o The model essentially covers three important aspects that incorporate
activation of an event, negative feelings associated with the event and the
outcome as a result of the feelings
o The ABC model evaluates the feelings on the basis of which negative feelings
might have developed in an individual
o The model further states that the negative feeling does not develop on account
of the activating event but is caused due to the irrational beliefs that lead to the
consequence
Suggested Intervention:
o Suggested interventions would comprise of the following:
o Ensuring a safe environment

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o Regulating the stress-causing events
o Imparting self-management skills to effectively deal with anxiety
o Administration of anti-abuse medication
o Administration of CBT to cope with stress and ensure a positive environment
Preliminary Care:
o The preliminary care would comprise of reinforcing a safe environment so as
to regulate the dearth of feelings related to anxiety in the client
o The psychotherapist must actively stabilise the thought content of the client
through one to one counselling
o Administration of anti-alcohol drug such as disulfiram in mild doses to control
addiction (Bystritsky et al., 2013)
Recovery support plan:
The recovery support plan would widely comprise of five important elements such as
(Aldao et al.,2014),
o Physical self-care
o Life-style modification
o Mental/ Emotional self-care
o Peer support
o Spiritual self-care

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Long-term treatment care:
Long term treatment care would include imparting education about self-management
strategies so as to avoid stress causing elements
Involvement in creative activities such as gardening or crafting can help in focusing on the
positive aspects of life and boost up her confidence level (Julayanont et al., 2017)
Expected Duration of Recovery:
It can be expected that at the end of 24 weeks, the client could start feeling much
energised and better
Conclusion:
Hence, to conclude it can be said that administration of effective cognitive therapy
depends on a number of factors such as effective screening of the condition on the basis of
cognitive risk assessment tool. Further, after the proper assessment of the score evaluation,
intervention strategies must be planned so as to promote the recovery process. The recovery
process must not essentially focus just on the symptoms but should rather focus on the
complete recovery so as to support the client in developing a positive perspective towards life
and recover from the symptoms of stress and anxiety.

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References:
Aldao, A., Jazaieri, H., Goldin, P. R., & Gross, J. J. (2014). Adaptive and maladaptive
emotion regulation strategies: Interactive effects during CBT for social anxiety
disorder. Journal of Anxiety Disorders, 28(4), 382-389.
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and
treatment of anxiety disorders. Pharmacy and Therapeutics, 38(1), 30.
Gallagher, M. W., Payne, L. A., White, K. S., Shear, K. M., Woods, S. W., Gorman, J. M., &
Barlow, D. H. (2013). Mechanisms of change in cognitive behavioral therapy for
panic disorder: the unique effects of self-efficacy and anxiety sensitivity. Behaviour
research and therapy, 51(11), 767-777.
Julayanont, P., & Nasreddine, Z. S. (2017). Montreal Cognitive Assessment (MoCA):
concept and clinical review. In Cognitive screening instruments (pp. 139-195).
Springer, Cham.
Jun, H.J. and Park, M.K., 2013. Cognitive behavioral therapy for tinnitus: evidence and
efficacy. Korean journal of audiology, 17(3), p.101.
Memória, C. M., Yassuda, M. S., Nakano, E. Y., & Forlenza, O. V. (2013). Brief screening
for mild cognitive impairment: validation of the Brazilian version of the Montreal
cognitive assessment. International Journal of Geriatric Psychiatry, 28(1), 34-40.