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Christamae Zimpel

Lee Merchant

Abnormal Psychology (Psych 105)



                       Anxiety Disorder Case Study

Describe the symptoms of the disorder.

       I am writing this from the emergency room in the hospital. I just got some

surprising news and I am trying to mull it over. The doctor asked me to reflect on

my feelings and I reflect best when I write so here I go.

       Things haven't been right for a while. Not since I started high school and

now I am a senior. Once I started high school I was always on edge. I'd be

taking notes in class and notice that I was grinding my teeth and my hand would

cramp from gripping the pencil so tight. I was always so tense my muscles

drawn tight. My thoughts always in a whirl with what I needed to do and what

would happen if I didn't get it done. Like I needed to worry about studying for

that Spanish test because I had to get straight A's or I wouldn't get into college

and then I wouldn't get a job and I would be stuck living with my parents forever.

Seems pretty logical to me. I mean everyone knows that you need to study

before a test. But my friends got mad when I wouldn't go out with them to the

beach the Friday before the test. No way. I needed time to study. Besides the

beach is dangerous on a good day. I mean what if I hurt myself surfing!

Certainly can't take a test with a broken hand. That's the difference between me

and my friends. They never plan ahead. I always make sure that I am ready for
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anything. Before I go anywhere I make sure that I have a full tank of gas, a

mapquest, my cell phone, fifty dollars in cash, my emergency kit in the car, and

let my parents know when I should be back. That way I am covered for all

possible emergencies. Everyone knows that being prepared is vital especially in

today's crazy world. Though I have to admit that these worries and planning

keep me up at night. I'll lie in bed thinking about the plans I need to make and

imagining the different dangerous scenarios and what I would do. It's hard to

relax enough to sleep especially when the more I think the tighter my muscles

tense. I'll toss and turn trying to get to sleep. But then when I do sleep I'll wake

up repeatedly with horrible nightmares. Envisioning all the things that could go

wrong. So then I can't go to sleep until I have planned what to do if that bad

thing happened. Everyone tells me I need to relax and stop freaking out at

everything.

       Sometimes I think they are right. Why do I have to worry and plan for

every little detail? It's not normal. I'm just a freak. I mean what if I worry so

much that I can't do the things I love. I don't want to be stuck at home afraid to

go to school or work because I might be in an accident. Sometimes I worry so

much that I feel nauseas and it feels like my brain is going to explode.

       Last night was an especially bad night. I had two big tests on Monday. My

friends were mad that I had spent all day Saturday studying and didn't go to the

Harry Potter premiere like I had promised. I was worrying about my college

applications and if I had put the right thing and worrying about the tests and

worrying that I would lose my friends and worrying because I worry so much!
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That's when things got really bad. All the sudden I couldn't breathe and I felt like

I was choking. My heart was going a mile a minute and it hurt so badly. I

thought, `I'm too young for a heart attack!' I was shaking all over and was sure I

was going to pass out. I managed to call 911 before I fainted. I woke up in the

ambulance.

Describe the biological contributions to the disorder.

       The hospital ran a battery of tests. I was sure that I would be referred to a

cardiologist. That's why I was shocked and a bit mad when a psychiatrist

showed up. What they think I am just making this up, that it's all in my head?! I

am afraid that I wasn't very nice to this doctor. He was very nice, though, and

calmly explained how generalized anxiety disorder was a real disease. That it is

linked to neurochemicals in the brain. He said that I had no more power over my

anxiety than I do an infection. He said that generalized anxiety disorder is

caused by the malfunction of the neurotransmitter gamma-aminobutyric acid or

GABA for short. He explained that when there is a dangerous situation the brain

shoots off neurons making your heart race, muscles tense, and your body ready

to fight or run away. Then when the dangerous situation is over GABA binds to

receptors and tells them to stop firing thus ceasing the state of anxiety. In my

case the GABA isn't received or can't bind to the neuron so it can't stop firing.

So I am always anxious. He explained that the sensations I had that caused me

to call the ambulance were caused by a panic attack, which are sometimes

associated with generalized anxiety disorder.

Describe the psychological cause of the disorder using the humanistic,
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cognitive, psychoanalytic or behavioral theoretical orientation in

psychology.

      My counselor (Marriage and Family Therapist-M.F.T.) said that she

believes that thinking and thought patterns also contribute to generalized anxiety

disorder. Marriage and Family Therapist's refer to this as the cognitive

orientation. She said that part of the reason that I was so stressed was because

I had inaccurate and inappropriate beliefs about which situations can actually be

dangerous or cause long-term problems. Like I think that if I do badly on one test

it will ruin my chances of going to college and having an independent life.

Cognitive theorists refer to this as basic irrational assumptions. She also said

that I had this constant conflict in my mind because on the one hand I think that

worrying is a good thing because it makes you prepared and responsible, but on

the other hand I think that worrying is a bad thing because it keeps me from

doing what I want, consumes my thoughts, and my friends are always scolding

me for worrying. This is called metacognitive theory. Starting high school really

triggered my generalized anxiety disorder because high school is a launching

pad for the rest of your life where the decisions you make have long-term

implications and the opinions and socialization with peers becomes especially

important.

Describe the biological treatment. State the specific biological intervention

used. This may include diet, exercise, meditation, yoga, light therapy,

electroconvulsive shock therapy, medication or any other treatment that

affects the body to improve the mind. If using medication describe the
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exact type, what it does to the brain or endocrine system and the usual

dosage.

       The psychiatrist assured me that there are medicines to help. When my

brain sends off the neurons causing the anxiety it is like a machine gun, rapidly

firing. But in my case the trigger is stuck down so they never stop firing. He

prescribed BuSpar (buspirone) with an initial dose of 15 mg a day. Buspirone is

an antianxiety drug that affects the neurotransmitters in my brain. It will help the

anxiety neurons to stop firing. He said that we would evaluate my symptoms in

two weeks to see if we needed to raise the dosage, which can go as high as sixty

milligrams. It's not addictive like benzodiazepines and has fewer side effects. I

just can't drink grapefruit juice with it. He also said I would work on relaxation

training with my Marriage and Family Therapist. I should focus on different

muscle groups one at a time, flex them, and then relax them. This will teach me

to be more aware of my body and have better control of the muscle tension.

Describe the psychological treatment. First give a general description of

the techniques used by the therapists who practice from the theoretical

view you have chosen and then create a dialogue with 8 lines stated by the

therapist and 8 lines stated by the client showing therapy techniques used

by the theoretical view you are using. The dialogue lines must show

therapy and not be just conversation.

       My Marriage and Family Therapist said that we were going to use rational-

emotive therapy from the cognitive orientation. She would help me identify my

unrealistic and unfounded thoughts and change them to more appropriate ways

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