Nursing Case Study: Generalized Anxiety Disorder and CBT Therapy

This case study presents the case of Jane Doe, a teenage girl struggling with Generalized Anxiety Disorder and Major Depressive Disorder. The case details her background, including family issues and the loss of her father, which contributed to her anxiety and reliance on food for comfort. The case conceptualization outlines the factors influencing her condition, and Cognitive Behavioral Therapy (CBT) is proposed as a treatment approach. Ethical considerations, multicultural factors, and a comprehensive treatment plan involving counseling, meditation, and psychoeducation are discussed. The assessment process includes tools like the PHQ-9 and MINIDEP, along with bi-weekly assessments to track progress. Referrals to a primary physician and nutritionist are suggested for holistic care. The prognosis is positive, with Jane showing improvement and engagement in her treatment, indicating a promising path to recovery. Desklib offers more case studies and solved assignments for students.

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

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Client background information
Jane Doe is a teenage girl who takes care of her younger brother. He is highly depressed
and tensed about the activities happening around her and does not have her father or mother to
support her in such situation. Her mother lives with her boyfriend whereas after taking her
custody, her father died when she was 15 year old and since then her brother and she have to
fend for themselves. Jane’s father took care of her by comforting her with food, and now she
does the same, due to which she is struggling with her weight.
Diagnosis
DSM-5 300.02 F41.1: generalized anxiety disorder.
V 62.89 Phase of Life Problem
296.21 (F32.0) Major Depressive Disorder, mild, single episode
List of problems faced by Jane are:
1. anxiety related frustration, worry and depression
2. Binge eating and comforting herself with food.
Case Conceptualization Summary Statement
Case Conceptualization Summary Statement is the discussion of the clinical
understanding collected by the clinician about the patient and his/her biological, psychological
and social aspects. In nursing process it is determined by presentation, precipitation, and
predisposition, perpetuate, and pattern (Berman, 2018). In this case of Jane, her symptoms were
primarily associated to depression and anxiety, lowered self-esteemed and ineffective confidence
which acted as presentation of her condition. Further, these symptoms were observed due to her
equations with her mother, father and brother as both of her parents separated and did not cared

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for her and her brother, determining the parents as the precipitant (Ehde, Dillworth& Turner,
2014). Her connection to her father and brother acted as predisposition and her current
developmental stage as a teenager determined her perpetuate stage. Finally, the combination of
all of these leads the onset of anxiety and she started comforting herself with food indicating the
pattern of her concern.
Theoretical Orientation and Research/Evidence-based treatment
As per my suggestion, Jane and I should implement the Cognitive Behavioral Therapy or
CBT for the achievement of her counseling and associated goals (Ehde, Dillworth& Turner,
2014). This is a therapy which helps the patient to understand their concerns and issues and then
moulds their thoughts and ideations in a positive way to support their growth and development
(Trauer et al., 2015). This therapy focuses on their present concerns and tries to solve them by
breaking the concerns in smaller parts. In keeping with the CBT related approach, Jane and I will
completely focus on creating achievable and observable goals so that her thought process could
be assessed and her progress will be tracked (Ehde, Dillworth& Turner, 2014). Further to
achieve this, the strengths and abilities of the patient will be utilized so that successful
counseling could be achieved.
Ethical Issues
The issue that will be primarily considered the privacy or confidentiality of the patient. I
will try to protect her past details and will talk to her if she wants to communicate so that her
privacy could be maintained. Further, her documents and statements will also be kept securely.

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Multi-cultural Factors
While communicating with Jane, I will consider our cultural, economic, social, ethnicity
and socio-economic status related differences as it will help me to communicate with her in a
comfortable way. Further, I will try to conduct additional assessment to understand the other
issues and preferences of the patient so that compliance to her preferences could be done.
Treatment Plan/Research/Evidence Based Treatments
Goals: the primary goal for the treatment of Jane will focus on decreasing the feeling of
anxiety as well as the decreasing the binge eating associated disorder so that her mood swings
could be decreased, her ability to communicate with others increased and she could feel
confident to talk about others.
Intervention: counseling, meditation and cognitive behavioral therapy would be used for
the treatment of Jane as interventions and depending on the intensity of the disorder, the
intervention will be applied (Dunlop, 2016). Such as, to treat her anxiety related condition, she
will be asked to meditate so that she can develop coping skills and mindfulness thoughts could
be imparted (Good et al., 2016). Further to increase her ability to communicate, Psychoeducation
will be used, to teach the client solution building and problem-solving skills and practice in
session (Lyman et al., 2014).
Ethical issues and multicultural factors: the primary ethical concern in this treatment
will be privacy of the patient and treatment and gender, socioeconomic status, age, education,
occupation, and ethnicity differences are some of the multicultural factors which will be taken
into consideration.

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Assessment
In this process, the baseline data from the scaling process or the session one, that includes
the prescribing the problems and concerns of the patient, their attributes and treatment
interventions will be done. To assess the patient and her condition of depression, PHQ or patient
health Questionnaire (PHQ-9) and MINIDEP assessment tool will be used (Rathore et al., 2014).
In these tools, the patient will identify her concerns, medical and counseling history will be
identified. Further in future weeks, she will be asked to participate in three generation genogram
and then a feelings wheel will be used to understand the feelings of the patient about her life
timeline (Seo & Park, 2015). Therefore, these assessments will help her to understand the type of
treatment she would require and depending on that the interventions will be determined. Further,
to take her assessment and associated improvement, bi-weekly assessment will be carried out so
that a track of her improvements could be managed in the care process (Rathore et al., 2014).
Referrals
To better understand the primary healthcare concerns associated with Jane, I will try to
communicate with the primary physician and the nutritional specialist so that benefit regarding
her healthcare interventions and requirement related to her emotional improvement could be
determined.
Prognosis
Prognosis of Jane and her interventions are satisfactory as she is continuous with her
sessions and takes every home assignments associated to her cognitive development seriously.
Her self-esteem and motivation is increasing every day and she is determined to reach the goals.

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Hence, it is easier for me to assess the additional improvement she is achieving besides her
assessment goals.

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References
Berman, P. S. (2018). Case conceptualization and treatment planning: Integrating theory with
clinical practice. Sage publications.
Dunlop, J. (2015). Meditation, stress relief, and well-being. Radiologic technology, 86(5), 535-
555.
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for
individuals with chronic pain: efficacy, innovations, and directions for
research. American Psychologist, 69(2), 153.
Good, D. J., Lyddy, C. J., Glomb, T. M., Bono, J. E., Brown, K. W., Duffy, M. K., ... & Lazar, S.
W. (2016). Contemplating mindfulness at work: An integrative review. Journal of
management, 42(1), 114-142.
Lyman, D. R., Braude, L., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-
Rittmon, M. E. (2014). Consumer and family psychoeducation: assessing the
evidence. Psychiatric Services, 65(4), 416-428.
Rathore, J. S., Jehi, L. E., Fan, Y., Patel, S. I., Foldvary-Schaefer, N., Ramirez, M. J., ... & Tesar,
G. E. (2014). Validation of the Patient Health Questionnaire-9 (PHQ-9) for depression
screening in adults with epilepsy. Epilepsy & Behavior, 37, 215-220.
Seo, J. G., & Park, S. P. (2015). Validation of the Patient Health Questionnaire-9 (PHQ-9) and
PHQ-2 in patients with migraine. The journal of headache and pain, 16(1), 65.

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Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive
behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals
of internal medicine, 163(3), 191-204.