Case study
Case study is an in-depth analysis of a specific individual or a small group of
individuals. This research method involves the comprehensive examination of the person's
background, symptoms, experiences, and the therapeutic interventions used to address their
psychological issues. Case studies provide a detailed and holistic understanding of a
particular situation, allowing researchers and practitioners to explore the complexity of
human behavior and the effectiveness of various therapeutic approaches.
Here are the key components of Case Study
Introduction
Provide an overview of the individual's background, including demographic information,
personal history, and relevant contextual factors.
Client Description
Detail the client's psychological and emotional state, symptoms, and any relevant medical or
psychological history.
Diagnosis
Present the formal diagnosis of the psychological disorder based on recognized diagnostic
criteria (e.g., DSM-5 for many mental health disorders).
Therapeutic Goals
Outline the specific goals and objectives of the therapy. These could include symptom
reduction, improving coping skills, enhancing interpersonal relationships, or promoting
overall well-being.
Therapeutic Interventions
Describe the therapeutic approaches used in the case. This may include the type of therapy
(e.g., cognitive-behavioral therapy, psychodynamic therapy), therapeutic techniques, and any
specific interventions tailored to the individual.
Progress and Challenges
Document the client's progress throughout the therapy process. Highlight successes, setbacks,
and challenges faced during the treatment.
Outcomes
Evaluate the effectiveness of the therapeutic interventions by discussing the outcomes
observed in the individual's mental health and overall well-being.
Discussion
Analyze and interpret the findings within the broader context of psychological theory,
relevant research, and the field of therapy. Discuss the implications of the case study for
understanding and treating similar psychological disorders.
Conclusion
Summarize the key findings and insights gained from the case study. Discuss any limitations
and potential avenues for future research.
Ethical Considerations
Address ethical concerns related to the confidentiality of the client, informed consent, and
any other ethical considerations associated with conducting and reporting the case study.
Anxiety
Anxiety is a normal reaction to stress. Mild levels of anxiety can be beneficial in some
situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders
differ from normal feelings of nervousness or anxiousness and involve excessive fear or
anxiety. Anxiety disorders are the most common of mental disorders. They affect nearly 30%
of adults at some point in their lives. However, anxiety disorders are treatable with a number
of psychotherapeutic treatments. Treatment helps most people lead normal productive lives.
Anxiety refers to anticipation of a future concern and is more associated with muscle tension
and avoidance behavior.
Fear is an emotional response to an immediate threat and is more associated with a fight or
flight reaction – either staying to fight or leaving to escape danger.
Anxiety disorders can cause people to try to avoid situations that trigger or worsen their
symptoms. Job performance, schoolwork and personal relationships can be affected. In
general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:
Be out of proportion to the situation or be age-inappropriate Hinder their ability to function
normally.
There are several types of anxiety disorders: generalized anxiety disorder, panic disorder with
or without agoraphobia, specific phobias, agoraphobia, social anxiety disorder, separation
anxiety disorder and selective mutism.
Types of Anxiety Disorders
Generalized Anxiety Disorder
Generalized anxiety disorder involves persistent and excessive worry that interferes with
daily activities. This ongoing worry and tension may be accompanied by physical symptoms,
such as restlessness, feeling on edge or easily fatigued, difficulty concentrating, muscle
tension or problems sleeping. Often the worries focus on everyday things such as job
responsibilities, family health or minor matters such as chores, car repairs, or appointments.
Panic Disorder
The core symptom of panic disorder is recurrent panic attacks, an overwhelming combination
of physical and psychological distress. During an attack, several of these symptoms occur in
combination:
Palpitations, pounding heart or rapid heart rate,Sweating,Trembling or shaking,Feeling of
shortness of breath or smothering sensations,Chest pain,Feeling dizzy, light-headed or faint,
Feeling of choking, Numbness or tingling,Chills or hot flashes, Nausea or abdominal pains,
Feeling detached,Fear of losing control,Fear of dying
Because the symptoms can be quite severe, some people who experience a panic attack may
believe they are having a heart attack or some other life-threatening illness. They may go to a
hospital emergency department. Panic attacks may be expected, such as a response to a feared
object, or unexpected, apparently occurring for no reason. The mean age for onset of panic
disorder is 20-24. Panic attacks may occur with other mental disorders such as depression or
PTSD.
Phobias, Specific Phobia
A specific phobia is excessive and persistent fear of a specific object, situation or activity that
is generally not harmful. Patients know their fear is excessive, but they can't overcome it.
These fears cause such distress that some people go to extreme lengths to avoid what they
fear. Examples are public speaking, fear of flying or fear of spiders.
Agoraphobia
Agoraphobia is the fear of being in situations where escape may be difficult or embarrassing,
or help might not be available in the event of panic symptoms. The fear is out of proportion
to the actual situation and lasts generally six months or more and causes problems in
functioning. A person with agoraphobia experiences this fear in two or more of the following
situations:
Using public transportation,Being in open spaces,Being in enclosed places,Standing in line or
being in a crowd,Being outside the home alone.
The individual actively avoids the situation, requires a companion or endures with intense
fear or anxiety. Untreated agoraphobia can become so serious that a person may be unable to
leave the house. A person can only be diagnosed with agoraphobia if the fear is intensely
upsetting, or if it significantly interferes with normal daily activities.
Social Anxiety Disorder (previously called social phobia)
A person with social anxiety disorder has significant anxiety and discomfort about being
embarrassed, humiliated, rejected or looked down on in social interactions. People with this
disorder will try to avoid the situation or endure it with great anxiety. Common examples are
extreme fear of public speaking, meeting new people or eating/drinking in public. The fear or
anxiety causes problems with daily functioning and lasts at least six months.
Separation Anxiety Disorder
A person with separation anxiety disorder is excessively fearful or anxious about separation
from those with whom he or she is attached. The feeling is beyond what is appropriate for the
person's age, persists (at least four weeks in children and six months in adults) and causes
problems functioning. A person with separation anxiety disorder may be persistently worried
about losing the person closest to him or her, may be reluctant or refuse to go out or sleep
away from home or without that person, or may experience nightmares about separation.
Physical symptoms of distress often develop in childhood, but symptoms can carry though
adulthood.
Selective Mutism
Children with selective mutism do not speak in some social situations where they are
expected to speak, such as school, even though they speak in other situations. They will speak
in their home around immediate family members, but often will not speak even in front of
others, such as close friends or grandparents.
The lack of speech may interfere with social communication, although children with this
disorder sometimes use non-spoken or nonverbal means (e.g., grunting, pointing, writing).
The lack of speech can also have significant consequences in school, leading to academic
problems and social isolation. Many children with selective mutism also experience excessive
shyness, fear of social embarrassment and high social anxiety. However, they typically have
normal language skills.
Selective mutism usually begins before age 5, but it may not be formally identified until the
child enters school. Many children will outgrow selective mutism. For children who also
have social anxiety disorder, selective mutism may disappear, but symptoms of social anxiety
disorder may remain.
Risk Factors
The causes of anxiety disorders are currently unknown but likely involve a combination of
factors including genetic, environmental, psychological and developmental. Anxiety
disorders can run in families, suggesting that a combination of genes and environmental
stresses can produce the disorders.
Diagnosis and Treatment
The first step is to see your doctor to make sure there is no physical problem causing the
symptoms. If an anxiety disorder is diagnosed, a mental health professional can work with
you on finding the best treatment. Unfortunately, many people with anxiety disorders don't
seek help. They don't realize that they have a condition for which there are effective
treatments.
Although each anxiety disorder has unique characteristics, most respond well to two types of
treatment: psychotherapy or "talk therapy," and medications. These treatments can be given
alone or in combination. Cognitive behavior therapy (CBT), a type of talk therapy, can help a
person learn a different way of thinking, reacting and behaving to help feel less anxious.
Medications will not cure anxiety disorders, but can provide significant relief from
symptoms. The most commonly used medications are anti-anxiety medications (generally
prescribed only for a short period of time) and antidepressants. Beta-blockers, used for heart
conditions, are sometimes used to control physical symptoms of anxiety.
Self-Help, Coping, and Managing
There are a number of things people do to help cope with symptoms of anxiety disorders and
make treatment more effective. Stress management techniques and meditation can be helpful.
Support groups (in-person or online) can provide an opportunity to share experiences and
coping strategies. Learning more about the specifics of a disorder and helping family and
friends to understand the condition better can also be helpful. Avoid caffeine, which can
worsen symptoms, and check with your doctor about any medications
Understanding Anxiety: State vs. Trait
Everyday Use of "Anxiety" In everyday language, "anxiety" is often used to describe
feelings of unease, nervousness, worry, or dread. It's a common human response to stress or
fear.
State Anxiety
Definition: State anxiety is a natural response to a specific threat or frightening situation. It
involves a mix of mental and physical symptoms.
Mental Symptoms: Worry, difficulty concentrating, irritability.
Physical Symptoms: Trouble breathing, rapid heartbeat, upset stomach, muscle tension.
Example: Driving in a downpour, heart pounding, sweaty palms. Once the threat (e.g.,
crossing a bridge) passes, emotional tension fades.
Trait Anxiety
Definition: Trait anxiety is considered a fixed part of one's personality—a predisposition to
feel threatened by specific situations or the world in general.
Characteristics: Higher trait anxiety may lead to increased anxiety and stress in everyday
circumstances.
Older Research Dimensions:Threat of social evaluation,Threat of physical danger,Ambiguous
threat,Threat in daily routines or harmless situations.
Longer-lasting Symptoms: Changes in mood, trouble concentrating, avoidance behaviors,
insomnia, appetite changes, fatigue, unexplained body aches.
Causes of Trait Anxiety
Neuroticism: Trait anxiety is linked to the personality trait of neuroticism. Higher
neuroticism scores correlate with increased tension, mood changes, and prolonged
examination of thoughts.
Connection with Anxiety: While some argue trait and state anxiety work together, others see
them as distinct constructs. Brain mapping studies suggest differences, but research is
ongoing.
Environmental and Genetic Factors: Family history and experiences during childhood and
adolescence contribute to the development of anxiety.
State and Trait Anxiety in Practice
State Anxiety in Specific Situations
Example Scenario: Receiving a vague, potentially alarming email from a supervisor.
Response: Walking to the supervisor's office with feelings of worry and fear.
Resolution: Discovering it was about a software security issue brings relief, dissipating
anxiety.
Trait Anxiety as a Personality Aspect
Example Circumstances: Feeling anxious about a partner's distant behavior or lack of
feedback on a thesis.
Response: Worrisome thoughts about relationship issues or academic failure.
Long-term Impact: Chronic anxiety symptoms affecting mood, concentration, sleep, and
physical well-being.
Therapy and Coping Strategies
Role of Therapy: Therapy can help identify triggers, teach coping techniques (e.g.,
meditation), provide a safe space to share feelings, and facilitate lifestyle changes.
Treatment Approaches: Cognitive behavioral therapy (CBT), acceptance and commitment
therapy, mindfulness-based approaches, exposure therapy, art therapy, and metacognitive
therapy.
CBT and Trait Anxiety: Some evidence suggests CBT may be particularly beneficial for trait
anxiety.
The State-Trait Anxiety Inventory (STAI)
Description of Measure: The State-Trait Anxiety Inventory (STAI), Construct: Adult
anxiety is a commonly used measure of trait and state anxiety (Spielberger, Gorsuch,
Lushene, Vagg, & Jacobs, 1983). It can be used in clinical settings to diagnose anxiety and to
distinguish it from depressive syndromes. It also is often used in research as an indicator of
caregiver distress (e.g., Greene et al., 2017, Ugalde et al., 2014).
Form Y, its most popular version, has 20 items for assessing trait anxiety and 20 for state
anxiety. State anxiety items include: “I am tense; I am worried” and “I feel calm; I feel
secure.” Trait anxiety items include: “I worry too much over something that really doesn’t
matter” and “I am content; I am a steady person.” All items are rated on a 4-point scale (e.g.,
from “Almost Never” to “Almost Always”). Higher scores indicate greater anxiety. The STAI
is appropriate for those who have at least a sixth-grade reading level.
Internal consistency coefficients for the scale have ranged from .86 to .95; test-retest
reliability coefficients have ranged from .65 to .75 over a 2-month interval (Spielberger et al.,
1983). Test-retest coefficients for this measure in the present study ranged from .69 to .89.
Considerable evidence attests to the construct and concurrent validity of the scale
(Spielberger, 1989).
Studies also have shown that it is a sensitive predictor of caregiver distress over time, and
that it can vary with changes in support systems, health, and other individual characteristics
(Elliott, Shewchuk, & Richards, 2001; Shewchuk, Richards & Elliott, 1998).
Scoring
Scoring Each STAI item is given a weighted score of 1 to 4. A rating of 4 indicates the
presence of a high level of anxiety for ten S-Anxiety items and eleven T-Anxiety items (e.g.,
“I feel frightened,” “I feel upset”). A high rating indicates the absence of anxiety for the
remaining ten S-Anxiety items and nine T-Anxiety items (e.g., “I feel calm,” “I feel
relaxed”). The scoring weights for the anxiety-present items are the same as the blackened
numbers on the test form. The scoring weights for the anxiety-absent items are reversed, i.e.,
responses marked 1, 2, 3, or 4 are scored 4, 3, 2, or 1, respectively. The anxiety-absent items
for which the scoring weights are reversed on the S-Anxiety and T-Anxiety scales are: S-
Anxiety: 1, 2, 5, 8, 10, 11, 15, 16, 19, 20 T-Anxiety: 21, 23, 26, 27, 30, 33, 34, 36, 39 To
obtain scores for the S-Anxiety and T-Anxiety scales, simply add the weighted scores for the
twenty items that make up each scale, taking into account the fact that the scores are reversed
for the above items. Scores for both the S-Anxiety and the T-Anxiety scales can vary from a
minimum of 20 to a maximum of 80.
Case Study of XYZ
Identifying Information
Name: XYZ
Age:21
Sex: Male
Employment Status: Unemployed, currently a student
State of Residence: Delhi
Chief Complaints
Mr. X, a 21-year-old male, presents with chief complaints centered around profound
trait anxiety manifesting in various facets of his life. Foremost among these concerns is the
relentless worry and fear surrounding the impending results of his Master of Business
Administration (MBA) exams, coupled with a pervasive sense of apprehension about the
impact on his future career. Additionally, he expresses significant distress regarding the
prospect of having to undergo further MBA exams and grapples with a general sense of
instability in his career trajectory. He also states that he wants to earn well not just for himself
but also for mother which makes him feel a bit burdened and anxious which is not given by
his mother but he has taken that upon himself. Interpersonally, Mr. X experiences heightened
anxiety within his romantic relationship, fearing abandonment and rejection, especially when
his partner is occupied.
Case History
Mr. X, a 21-year-old [Link] (Hons) student in his final year at Delhi University.
Raised in a family marked by his parents' separation, in a middle class family. While
maintaining a strong academic record, concerns about academic performance, particularly as
he approaches graduation, have intensified. The specter of his parents' separation contributes
to his overall anxiety, and his father's absence may be influencing his sense of stability and
support. The client's academic anxieties and fears about the future intertwine with the
emotional complexities stemming from family dynamics, adding layers to his psychological
distress. Fears of abandonment and rejection surface, particularly when his partner is
occupied, revealing communication barriers and relationship strain.
Mental Status Examination (MSE) for Mr. X
Appearance and Behavior: Mr. X presents as a 21-year-old male with appropriate grooming.
He exhibits restlessness, fidgetiness, and tense body language during the conversation.
Affect and Mood: The predominant affect is anxious, with a constricted emotional range. Mr.
X reports a pervasive mood of unease, particularly evident when discussing academic, career,
and relationship concerns.
Thought Process and Content: Thought process is marked by worry and rumination,
especially related to fears of academic failure, uncertainties about the future, and insecurities
in relationships. Cognitive distortions and catastrophic thinking are apparent.
Perception: No perceptual disturbances are noted. Mr. X maintains a realistic appraisal of his
surroundings.
Cognition: Cognitive functioning appears intact, with coherent conversation, appropriate
answers, and reasonable insight into challenges. However, cognitive distortions influence his
perspective.
Insight and Judgment: Insight is fair, acknowledging the impact of anxiety. Judgment is
influenced by anxiety, leading to avoidance behaviors in academic and interpersonal realms.
Sensorium: Sensorium is clear. Mr. X is oriented to person, place, time, and situation.
Impulse Control: Impulse control seems intact, but avoidance behaviors may indicate a
coping strategy for managing overwhelming anxiety.
Case Summary
Mr. X, a 21-year-old [Link] (Hons) student at Delhi University, presents with
escalating trait anxiety rooted in academic, familial, and relational stressors. Raised in a
family marked by parental separation, he faces unique challenges compounded by the
absence of his father. Academic concerns about graduation and the job market intertwine with
chronic fears of abandonment within his romantic relationship. Mr. X exhibits a tense
demeanor, restlessness, and cognitive distortions, reflecting a pervasive anxious mood. His
motivation to succeed is driven not only by personal aspirations but also a deep-seated desire
to support his mother financially. The Mental Status Examination reveals a complex interplay
of anxiety impacting various facets of his life, underscoring the need for a comprehensive
treatment approach to address immediate stressors and deeper psychological factors.
Differential Diagnosis:
Mr. X presents with symptoms consistent with Generalized Anxiety Disorder (GAD).
The pervasive and excessive worry across multiple domains of life, such as academic
performance, future career, interpersonal relationships, and accompanying sleep problems,
align with the diagnostic criteria for GAD. The chronic nature of his anxiety, cognitive
distortions, and the impact on daily functioning suggest GAD as the primary differential
diagnosis.
Table 1
Coping Mechanisms
Coping Mechanisms Description
Problem-Solving Skills Mr. X engages in identifying and implementing practical
solutions to address academic and career-related challenges.
- Self-Talk and Explanation: Talking to himself, explaining
concepts internally, and self-guiding through problem-solving
processes.
- Occupational Engagement: Going to work and keeping
himself busy as a means of distraction and focus on productive
tasks.
Seeking Social Support Reaching out to friends, family, or a support network for
emotional assistance and advice regarding academic and
relationship concerns
Positive Reframing Attempting to reframe negative thoughts into more positive
and constructive perspectives to alleviate anxiety.
Time Management Developing effective time management skills to handle
academic pressures and responsibilities more efficiently.
Table 2
Defense Mechanisms
Defense Description
Mechanisms
Denial Unconsciously avoiding or refusing to acknowledge the full extent of
anxiety and stressors, potentially impacting realistic problem-solving.
Projection Attributing one's own fears and insecurities onto others, potentially
manifested in suspicions of abandonment within the romantic
relationship.
Intellectualization Overemphasis on logical analysis and detachment from emotional
aspects, possibly as a way to cope with overwhelming feelings
associated with academic and relational stressors.
Avoidance Deliberate avoidance of anxiety-inducing situations, such as
procrastination in facing academic challenges or avoiding open
communication within the romantic relationship.
Result and Discussion
Table 3
Mr X’s Test Results
Trait Anxiety State Anxiety
Weighted Score 60 49
Percentile Rank 98 88
Mr. X's STAI results indicate significantly elevated trait anxiety, reflected in the 98th
percentile, suggesting a chronic predisposition to experience anxiety across various life
situations. The state anxiety score, while still high at the 88th percentile, suggests a current
heightened anxiety level in response to specific stressors. The discrepancy between trait and
state anxiety scores may indicate that Mr. X generally experiences a high baseline level of
anxiety, which becomes more pronounced during specific stress-inducing circumstances.
These results align with Mr. X's presentation of pervasive anxiety across academic, familial,
and relational domains. The high trait anxiety score suggests a long-standing tendency to
perceive situations as threatening, while the elevated state anxiety score reflects the current
impact of stressors on his emotional well-being. The absence of his father, academic
pressures, and fears of abandonment in his relationship likely contribute to the observed
anxiety levels.
Mr. X's high trait anxiety score may be influenced by various factors, including familial
dynamics, academic pressures, and relational insecurities. The chronic nature of his anxiety
may stem from early life experiences and ongoing stressors. The state anxiety score, although
slightly lower, indicates that current stressors are exacerbating his baseline anxiety.
References
American Psychological Association. (n.d.). Anxiety. Retrieved from
[Link]
National Institute of Mental Health (NIMH). (n.d.). Anxiety Disorders. Retrieved from
[Link]
Anxiety and Depression Association of America (ADAA). (n.d.). Retrieved from
[Link]
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Retrieved from
[Link]
Bourne, E. J. (2015). The Anxiety and Phobia Workbook. New Harbinger Publications.
McDonagh, B. (2015). Dare: The New Way to End Anxiety and Stop Panic Attacks.
HarperCollins.
Teasdale, J. D., Williams, M., & Segal, Z. V. (2005). The Mindfulness and Acceptance
Workbook for Anxiety. New Harbinger Publications.
Anxiety Canada. (n.d.). Understanding Panic Attacks. Retrieved from
[Link]
International OCD Foundation. (n.d.). Retrieved from [Link]
Social Anxiety Institute. (n.d.). Retrieved from [Link]
