Clinical Psychology Case Study: Social Anxiety Disorder Treatment

This case study report focuses on the therapeutic intervention for Mr. Piyal, a 30-year-old male diagnosed with Social Anxiety Disorder. The report details his presenting complaints, history, and mental status examination, which led to the diagnosis. The treatment plan emphasizes counseling, primarily Cognitive-Behavioral Therapy (CBT), along with medication (Benzodiazepines and Beta-blockers). The report outlines the roles of the therapist and client, ethical considerations, and the rationale behind choosing the treatment approach. It explores the use of exposure therapy and social skills training within the CBT framework, along with medication to manage physical symptoms. The evaluation section analyzes the effectiveness of the interventions, acknowledging their limitations. The report concludes by summarizing the treatment's strengths and weaknesses, reflecting on the overall therapeutic process and its implications.

Running head: CLINICAL PSYCHOLOGY
Therapeutic intervention of Case study 1
Name of the Student
Name of the University
Author Note

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Executive summary
This report deals with the therapeutic intervention of the Case study of Mr. Piyal who is a
30years old male presently living with his mother and younger brother. According to his
presenting complains where it is stated that for the last 12 years he has been suffering from an
unexplained fear whenever he is in any social situation. His difficulty level arises because in
such situations he thinks that he is being judged and critically analyzed by others. Thus,
because of these thinking he not only had to leave his job but also stopped himself from
visiting any family get together, parties or weddings. However, from his presenting
complaints, history of illness and mental status examination it has been observed that the
client is suffering from Social Anxiety Disorder. Based on this issue a treatment plan is made
which is emphasizing on treating the client with counseling and medication. Counseling
mainly comprises of Cognitive-behavioral therapy (CBT) along with medications
Benzodiazepines and Beta-blockers. The role of the therapist as well as the client is explained
along with the ethical considerations the therapist should keep in mind. Lastly, the
intervention approaches has been analyzed and reached to a conclusion that though
medications and therapies are effective they too have certain limitation.

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Table of Contents
Introduction................................................................................................................................3
Section A- Rationale..................................................................................................................3
Section B- Treatment.................................................................................................................5
Therapeutic plan.....................................................................................................................6
Section C- Evaluation and reflection.......................................................................................10
Conclusion................................................................................................................................11
References................................................................................................................................13

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Introduction
According to the DSM-5 category of Anxiety disorders, Social anxiety disorders are
also known as social phobia. It is a type of an anxiety disorder that includes disturbances in
an individual when and around social interactions because they are mainly concerned of
being uncomfortable and critically judged by others. However, with people suffering from
this disorder they are found to be discomfort by experiencing fear as well as anxiety along
with some may also experience autonomic arousals that involves nauseas, diaphoresis, apnea,
tremors and tachycardia. Moreover, social anxiety disorders can hamper the daily life
activities that involve social situations (Iverach and Rapee 2014). They may want to interact
with others but their anxiety becomes unbearable and restrains from participating. It can
further guide a person to isolation and stagnation of developing any social skills that can
further increase the already existing social anxiety. However this is a case report where the
theoretical intervention of the chosen case study that of the client named Mr. Piyal who is 30
years old male who is single and living with his mother and his younger brother. This report
will further explain the treatment plan, the rationale behind choosing the type of therapies and
lastly, evaluating the strength and weakness of the chosen approach.
Section A- Rationale
The client has come up with the presenting complaints that clearly states that he is
having difficulty in social situations where he is encountering with an unexplained fear
because he thinks that he is being critically observed and scrutinized by the people around
him in any social situation. From the last 12years, this client has been facing this difficulty.
Moreover, it has been observed from his history of presenting complaints that earlier also he
had faced the difficulty of not being able to talk to a person in the presence of others followed
by he was use to restrict himself from communication in the fear of being observed by others.

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In his following days, he not only had to resign from his post of being the prefect but also left
his workplace due to his increasing discomforts and limitation in articulating words. As days
passed he avoided family gatherings like get together, parties or weddings. Therefore, from
the symptoms it is clear that the client is suffering from Social anxiety disorder. Now, if the
perspective of psychodynamics is considered for this case then from that outlook social
anxiety disorder is assumed part of a wider problem that has emerged during childhood.
Researchers supporting the psychodynamic perspective consider social anxiety disorders to
be a disorder of childhood onset (Andersson et al. 2012). Thus, from the psychodynamic
perspectives social anxiety disorders are the outcome of the early experiences the client had
or the attachment he has with his caregiver as well as other essential people in his life.
There is no such reliable psychodynamic theory of social anxiety disorder however;
many beliefs seem to exist underneath this perspective. Thus, according to the
psychodynamic viewpoint it is seem that social anxiety disorder can be an outcome from the
following reasons in an individual-
 It might be the case that the individual may have been in a situation of shame and
humiliation evoked by autocratic parents
 There might be a constant conflict going on in the individual of what he needs to
achieve as well as succeed and the inner fear of success
 There might also be a conflict in the individual where his need for independence and
his fear of being rejected or abandoned by the parents
 Lastly, there might also be a narcissistic fear residing in the individual that he might
not make a perfect impression in the eyes of others.
Therefore, from the causes and the approach discussed it can be said that the treatment
plan for the client should focus mainly on counseling along with which medications can be

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given to the client (Archer et al. 2012). Fears that is linked with the social anxiety disorder
must be overcomes and for that the best therapy is cognitive behavior therapy which should
involve the exposure therapy for treating this particular client with social anxiety disorder.
Counseling is way much important than medicines to reduce anxiety because here the client
can slowly exposed to fear evoking situations and the fear evoking situation gets linked to a
response of indifference and relaxation (McLeod 2014).
Section B- Treatment
My role in this case is that of a psychotherapist and the client’s role is to follow and
get involved in the therapy process that can take weeks, month or years to be cured.
However, as a psychotherapist my work will be to assist and treat my client Mr. Piyal who is
experiencing discomforts in the areas of psychological and emotional sphere. Thus, as per my
roles are concerned I need to help my client to understand their problems and help them make
proper changes in his lives. Therefore, with the help of a therapist the client can cope up
faster with the feelings and symptoms and modify their patterns of behavior that is
contributing to his illness (Dryden and Mytton 2016). The role of the clients who is here for
the treatment must possess the following characteristics like-
 He must be motivated enough to follow the therapist
 He must be flexible and adaptable with the changes he had to come up with
 Most importantly he must be honest to the therapist otherwise the treatment will have
no positive outcome
 The client should be consistent with his appointments and should continue his
sessions as scheduled by the therapist
 Must have proper verbal communicative skills so that he can tell his problems clearly

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Apart from the issues that are earlier stated in the above section, that are the important
issues pointed out from the client’s presenting complaints there are certain less necessary
issues as well that may have affected my client like self-esteem. In this type of disorders
individuals are very much low in their self-esteem and found to be depressed as well because
of their fear of being with larger group of people which may increase and become unbearable
to tackle it and thus, as a result they starts worrying too much about facing such situations
again in near future. Apart from this, my clinical eyes suggest that life experiences or social
factors also have contributed for my client (Yen et al. 2012). There are many other risk
factors prevailing for social anxiety disorders which are as following-
 Genetics
 Nurture- might be that the parents were overprotecting
 Life experiences- might have faced any kind of bullying, rejection or humiliation
compared to others or any kind of negative experience
 individual personality- inborn traits like withdrawn, restrained timid or shy in a
new situation
 demanding ordeal- A negative experience for the very first time in any situation
can evoke the stimuli for social anxiety disorder
Therapeutic plan
Aim of the
techniques
Timeframe Role of the client and
evaluation
Ethical
considerations
Counseling- the type
of counseling process
that seem to have
been more frequently
used in this treating a
These sessions will
be holding twice a
week for six months.
The role of the client
here remains that
apart from being
motivated as well as
determined that he
 The very first
ethical
consideration
is being
trustworthy to

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client of social
anxiety disorder are-
 cognitive
behavioral
therapy
(CBT)-
The aim behind
particularly choosing
this therapy is mainly
because it will help
the client to first
identify his anxiety
provoking situations
and the anxieties
itself that is making
the client anxious
(Hofmann et al.
2012). At the very
beginning, the client
can feel
uncomfortable in
describing his
situations that create
fear in him but with
the following
will be taking all the
medicines properly at
prescribed time.
Moreover, he should
be honest while
narrating his
experiences as well
as when doing
certain homework as
referred by the
therapists. He must
also be flexible and
adaptable in
welcoming the
changes with an open
arm that are coming
to his life due to the
therapies and
medications. Most
importantly, the
client must be
continuing the last
scheduled session of
counseling so that he
can be cured totally.
the client.
This will
make the
client have
the
confidence
that the
therapist will
guide them to
the right tract
and most
importantly
with
confidentialit
y.
 As a
therapist, he
must always
show respect
to the client.
Through this,
the client will
develop the
ability to be
self-directing

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sessions, he will
realize that it is an
important part of his
recovery
(Leichsenring et al.
2013). However,
there are several
CBT therapies that
can be used for
treating individuals
with social anxiety
disorders but the
selected ones for this
particular client is
Exposure and Social
skill training
therapies (Meuret et
al. 2012). These two
are selected mainly
because in the first
one the client will be
eventually exposed to
a feared situation
until the fear
diminishes. In
However, during
these sessions the
client will be given
certain homework
that by the therapist
that they should
sincerely perform in
the absence of the
therapist and report
honestly in the next
session to his
therapist. For
exposure theory, the
client can be said to
go out and eat in
public. At the
beginning, the
therapist himself
might accompany
him but then he has
to go alone and finish
his meal. Then for
social skill training,
the client might have
to do rehearsals at
in the therapy
as well as in
other aspect
of his life.
 From the
therapist’s
side the client
should get
fair and
unbiased
treatment and
the assurance
of adequate
services
needed for
him to be
cured. This is
how the
therapist
respects the
human rights
and dignity
(Pope and
Vasquez
2016).

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addition, in the
second one the client
will be guided to
develop those skills
that are needed in
social situations.
Medication- The
medicines that can be
effective to this client
is Benzodiazepines,
which is effective in
relieving anxiety
because they act
quickly, and Beta-
blockers, which is
very much effective
in treating with the
physical symptoms
of anxiety (Bostwick,
Casher and Yasugi
2012). For this client
this medicine will
help reduce this
pounding of heart.
home as well as role-
playing even in the
absence of the
therapist to continue
his practice to
become more
comfortable and feel
prepared to face any
feared social
situation.

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Section C- Evaluation and reflection
The approaches that are outlined above in the treatment plan are mainly counseling
which comprises of the cognitive behavioral therapy along with medication. The strength and
weakness of both are discussed below-
Strengths of CBT in treating social anxiety
 CBT is very much instructive in nature thereby the clients learn skills of rational self-
counseling.
 The average number of CBT sessions is very few as compared to other therapies.
 CBT mainly focuses on how to make the client overcome his anxieties rather than
only making him feel better for a shorter time. This therapy gives long-term results to
the client because it corrects the cause of the issue.
 CBT therapies are mainly well structured because it minimize the possibility for
which the sessions will not turn into a chat period which will not help much in
accomplishing the therapy.
Weaknesses of CBT
 Client’s commitment is most important in CBT because a therapist can only guide
him but the rest have to be carried out by the client himself.
 A much of initial time is wasted because the client suffering from Anxiety disorder
might feel uncomfortable in confronting their emotions and anxieties.
 Few critics have stated that because CBT is only focused about the present and
specific problems in a client therefore it fail to define the possible mental health
conditions that are underlying causes for instance an unhappy childhood.
Strength and weaknesses of medication in treating social anxiety disorder

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There are various types of medications through with social anxiety can be treated
from which for this particular client of this report the medicines chosen are the traditional
anti-anxiety drug called Benzodiazepines which is mainly prescribed for being in a short term
use and Beta blockers. Benzodiazepines if taken regularly guides to physical dependence as
well as increases the person’s tolerance, therefore it makes the person opt for larger doses to
get relief. The strength point is that this medicine works quickly and is very impactful when
taken during panic attacks or in any immense anxiety episode. It helps the person to slow
down both physically and mentally by relaxing the nervous system. Whereas, the common
side effects of this medication on people can be blurred vision, headache, stomach upset,
confusion, issue related to memory, drowsiness, slurred speech, improper coordination,
problem in concentrating and dizziness (Dell’Osso and Lader 2013). On the other hand, Beta-
blockers help the person to limit the effects of norepinephrine which is a kind of stress
hormone in is a part of the flight or fight response in a person, which in turn control the
physical symptoms in anxiety like for this client this medication, is prescribed for pounding
heat rate. It is not much effective for decreasing the emotional symptoms of anxiety disorders
like worry which the biggest drawback. This medicine is most trustworthy for people with
Phobias especially social phobia and performance anxiety. The common side effects of this
medication are sleepiness, fatigue, dizziness, weakness, diarrhea, constipation, nausea and
headache (Steg et al. 2012).
Conclusion
To conclude this report, it can be said that that the client named Mr.Piyal who is of
the age of 30years has been presented with the complaints of suffering from an unexplained
fear in social situations which made him feel that others are observing and is critically
judging him for the last 12years. Due to this his history of illness suggests that he left his job

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and even avoided family get together, parties and even weddings. Based on his presenting
complaints, history of illness along with his mental status examinations it has been found that
the client is suffering from Social anxiety disorder. Thus, considering this a treatment plan
has been made which stated that counseling and medication could be of great help to this
particular client. In the counseling, process the therapy chosen for him is the cognitive
behavioral therapy along with medications Benzodiazepines and Beta-blockers. CBT has
been chosen because it is a well-structured therapy that focuses on the long-term cure of the
client and followed by the medications, which apart from their side effects will help the client
to get over his panic or anxious episodes and to help him to get over his physical issues.