Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

Subjective:

CC (chief complaint): “Mom thought you were going to help me be better.”

HPI: Dev Cordoba, a seven-year-old boy, presented to the clinic with concerns of anxiety and emotional distress as reported by his mother. Dev exhibited symptoms of generalized anxiety, including excessive worrying, bad dreams of being separated from his mother and baby brother, fear of the dark, and frequent concerns about his family’s well-being. He also mentioned feeling sad and “really bad” about his night accidents and being teased at school, where he was called “Mr. Smelly” due to his reluctance to take baths. Dev’s worries extended to his mother and brother, as he feared losing them, similar to his experience of his father being deployed in the military and subsequently killed, which he struggled to comprehend. His anxiety affected his school performance, as he found it difficult to concentrate, frequently gazed out the window, and had trouble sitting still. Dev’s mother also reported that he had trouble sleeping, refused to eat, had lost weight, and continued to experience bedwetting despite treatment with DDVAP. Furthermore, Dev had not received any previous psychiatric or therapeutic interventions for his emotional distress. Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

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Substance Current Use: no reported substance use.

Medical History:

• Current Medications: not currently on any medications.
• Allergies: no known allergies reported.

• Reproductive Hx: N/A

ROS:

• GENERAL: Dev has experienced recent weight loss due to his decreased appetite. No fever, chills, weakness, or fatigue
• HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.
• SKIN: No rash or itching.
• CARDIOVASCULAR: No reported chest pain, palpitations, or shortness of breath.
• RESPIRATORY: No respiratory symptoms, including cough, wheezing, or difficulty breathing.
• GASTROINTESTINAL: decreased appetite, leading to recent weight loss. No reported abdominal pain, diarrhea, or constipation.
• GENITOURINARY: N/A
• NEUROLOGICAL: Dev experiences bad dreams and nighttime fears. No headaches, dizziness, or seizures.
• MUSCULOSKELETAL: No joint pain, muscle aches, or difficulty with mobility.
• HEMATOLOGIC: No reported bleeding tendencies, anemia, or easy bruising.
• LYMPHATICS: No swollen lymph nodes or masses.
• ENDOCRINOLOGIC: No reported symptoms related to endocrine disorders. Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

Objective:

Diagnostic results: N/A

Assessment:

Mental Status Examination: Dev Cordoba, a seven-year-old boy, presented with a generally cooperative demeanor. He appeared his stated age, appropriately groomed, and dressed. Dev’s eye contact improved as the conversation progressed, and his speech was clear and articulate for his age. He displayed an anxious and worried affect throughout the interview, with occasional restlessness. Dev’s thoughts were preoccupied with concerns about his family’s safety, particularly his mother and baby brother. He described vivid bad dreams related to separation from them. His thought organization appeared age-appropriate, with no signs of delusions or hallucinations. Dev demonstrated intact orientation by correctly identifying his current location and providing the correct date when prompted. However, he struggled with the emotional impact of his father’s military deployment and death, suggesting potential difficulties in processing this traumatic experience. Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

Diagnostic Impression:

Generalized Anxiety Disorder (GAD):

GAD is a primary consideration due to Dev’s excessive and pervasive worrying about various aspects of his life, particularly his family’s safety and well-being. He also exhibits restlessness, impaired concentration at school, difficulty sleeping, and physical symptoms like weight loss and gastrointestinal complaints. The DSM-5-TR criteria for GAD specify excessive anxiety and worry about a variety of topics, along with somatic symptoms and restlessness. Pertinent positives include Dev’s excessive worry, restlessness, and impaired school performance. However, the critical-thinking process should consider that his symptoms may also be related to other factors such as trauma and adjustment difficulties, which should be explored. Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

Adjustment Disorder:

Adjustment Disorder is another possible diagnosis, given the significant life stressor of Dev’s father’s military deployment and subsequent death, which has clearly affected him emotionally. His worries and behavioral changes might be a reaction to this stressor. The DSM-5-TR criteria for Adjustment Disorder include the development of emotional or behavioral symptoms within three months of a stressor’s onset. Pertinent positives include the temporal relationship between his father’s deployment/death and Dev’s symptoms. However, GAD may be a better fit if the symptoms are more pervasive and not solely linked to the stressor.

Specific Phobia (Darkness or Separation):

Dev’s fear of the dark, frequent nightmares about separation, and preference for a night light may suggest a specific phobia. While these fears might be developmentally appropriate, they seem to cause him significant distress. The DSM-5-TR criteria for Specific Phobia include an intense fear of a specific object or situation, leading to avoidance. Pertinent positives here are Dev’s fears related to the dark and separation; however, the critical-thinking process should consider whether these fears are primary or secondary to underlying anxiety or trauma-related issues. Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

Reflections: Upon reflection, I would approach this patient, Dev Cordoba, with a more structured assessment of trauma and anxiety symptoms, taking into account the potential influence of his father’s military deployment and death. Although I considered Generalized Anxiety Disorder as the primary diagnosis, it’s crucial to delve deeper into the traumatic aspect of his experience and explore possible comorbidities, such as Post-Traumatic Stress Disorder (PTSD). In a follow-up session, I would initiate trauma-focused therapy, possibly including play therapy techniques, to address his unresolved grief and fears related to separation. Ethically, I would ensure informed consent from Dev’s mother and maintain a safe and confidential therapeutic environment, respecting cultural and developmental considerations. Health promotion and disease prevention strategies would involve providing psychoeducation to both Dev and his mother on managing anxiety and grief, as well as addressing issues like nighttime accidents. Additionally, considering the family’s socioeconomic context, I would explore available support services, including counseling or support groups for military families, to facilitate Dev’s and his mother’s coping and healing process (Lucier-Greer et al., 2022). Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

Case Formulation and Treatment Plan:

Case Formulation:

Dev Cordoba presents with symptoms indicative of Generalized Anxiety Disorder (GAD), exacerbated by unresolved grief and trauma related to his father’s military deployment and death. Dev exhibits excessive worry, restlessness, impaired school performance, nightmares, and physical symptoms, including weight loss and gastrointestinal complaints. Traumatic grief symptoms suggest potential comorbidity with Post-Traumatic Stress Disorder (PTSD).

Treatment Plan:

Psychotherapy: The primary intervention is trauma-focused Cognitive-Behavioral Therapy (CBT) tailored to Dev’s age and developmental level, which will address anxiety, traumatic grief, and nightmares (Curtiss et al., 2021). Play therapy techniques can be incorporated to facilitate communication and emotional expression. Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

Pharmacologic Treatment: Medication is not initially indicated for Dev, given his age and the preference for nonpharmacological approaches. However, continuous assessment for any worsening symptoms or lack of progress is essential, and consultation with a child psychiatrist may be considered if symptoms become severe.

Alternative Therapies: Mindfulness exercises and relaxation techniques can be introduced to Dev to manage anxiety symptoms. Art therapy and expressive therapies can complement traditional talk therapy.

Follow-Up Parameters: Regular follow-up sessions every 2-3 weeks to assess symptom progress and adapt treatment strategies. Assess for potential comorbidities and monitor for any medication considerations if indicated.

Health Promotion Activity: Encourage regular physical activity and outdoor play as a means to reduce anxiety symptoms. Promote a balanced diet and sleep hygiene to address weight loss and sleep disturbances.

Patient Education Strategy: Provide psychoeducation to Dev and his mother regarding the nature of anxiety, grief, and trauma. Explain the rationale behind treatment approaches and involve them in setting treatment goals. Educate on healthy coping mechanisms and relaxation techniques that can be practiced at home. Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus, 19(2), 184-189.

Lucier-Greer, M., McCoy, M., Gale, J., Goetz, J. W., & Mancini, J. A. (2020). Exploring the context of self-care for youth in military families. Children and youth services review, 108, 104599.

Review the video, Case Study: Dev Cordoba. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

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Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay
Objective: What observations did you make during the psychiatric assessment? 
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old). Cognitive-Behavioral Treatments For Anxiety And Stress-Related Disorders Essay