Case Studies of Patients with Anxiety, Mood Disturbances

Case 1

Background Information

The patient in the first case is Mr. Jones, and, according to his records, he comes from a loving and supportive full family. He also reports no behavioral deviations until the initial alcohol consumption at the age of 14 years old. The patient has completed high school and spent a year in the university before enlisting in the army. Consequently, he was sent to Vietnam, experienced a large number of traumatic events, and commenced taking substances. At the time of the report, Mr. Jones maintains a healthy relationship with his family; however, he suffers from several mental health issues.

Description and Diagnosis

The primary psychological complications that disturb Mr. Jones are anxiety and substance intake. The former is caused by the memories of the war in Vietnam and the traumatic experience of witnessing the woman getting pulled under the truck. Furthermore, Mr. Jones suffers from reoccurring nightmares, distressing memories, and anger management issues. According to Couette et al. (2019), post-traumatic stress disorder (PTSD) is frequently obtained from both direct and indirect exposure and is generally defined by the very symptoms that Mr. Jones experiences. War veterans, particularly WWII and Vietnam soldiers, are highly susceptible to the development of PTSD and social cognition impairment (Couette et al. 2019). The latter is observed in the behavioral patterns of Mr. Jones in crowds and consequent panic attacks. Furthermore, the patient experiences troubles with social interaction and frequently seeks to isolate himself from others, including family. The anger issues are most likely caused by hyperarousal that is a common complication in patients with PTSD (Vujanovic et al. 2018). Overall, the symptoms of Mr. Jones indicate a severe degree of PTSD with social cognition impairment.

The condition of Mr. Jones is considerably complicated by alcohol and drug addiction. Substance use disorder (SUD) is frequently noticeable in patients with PTSD and might be both the consequence and the accelerator of the problem (Couette et al. 2019). Lifetime alcohol addiction is associated with various types of psychological complications, including anxiety and antisocial behavior (Sher, Grekin & Williams, 2005). Anxiety sensitivity (AS) is another factor that is relevant to both PTSD and SUD, and the high degree of AS might be the cause of social cognition changes (Vujanovic et al. 2018). Furthermore, elevated AS increases the severity of the PTSD hyperarousal symptoms that are observed in the anger management issues of the patient (Vujanovic et al. 2018). Overall, the analysis of Mr. Jones’s psychological complications is the following:

• Comorbid conditions: anxiety, substance use disorder, panic attacks;
• Specifiers: Social cognition impairment, elevated anxiety sensitivity;
• Diagnosis: PTSD.

Theories and Treatment

Having established the diagnosis, it is possible to analyze the situation and propose treatment according to the prominent psychological theories. Treatment frameworks are generally focused on the cognitive state and focus on the memories and experiences of the patient. According to Jobson (2009), the primary psychological processes concerning PTSD are autobiographical memory, assumptions, belief and cultural perspectives, emotions, social roles, and the concept of self-awareness. Therefore, the treatment of PTSD is frequently aimed to alleviate or strengthen the aforementioned factors. For instance, one theory that is commonly discussed in PTSD treatment is self memory system (SMS), and it implies the utmost significance of autobiographical memory (Jobson, 2009). The conceptualization of autobiographical memory provides insights into the nature of PTSD and allows for innovative methods of medication. For instance, utilizing the framework of SMS, it is possible to re-access the distressing memories and attach new information and connotations to them (Jobson, 2009). Therefore, this theory is effective to alleviate the symptoms of PTSD and provides vital information concerning the etiology of the diagnosis.

While the majority of theories revolve around the memories of the patient, experts also recommend considering improvement of the quality of life to alleviate the symptoms of PTSD. For instance, Oppizzi and Umberger (2018) state that physical activity might significantly enhance the psychological state of the patient and increase the quality of sleep, assist in emotional regulation, and provide beneficial physiological effects. Therefore, while PTSD is a severe psychological complication and requires medical intervention, simple measures, such as physical activity, proper nutrition, and emotional support, might build a solid foundation for the recovery of the patient.

Case 2

Background Information

The patient of the second case is Mr. Garcia, a 38-year-old Latino man, and he has a history of childhood physical abuse. During his earlier years, the relationships within the family were tense, and his father frequently resorted to violence due to alcohol addiction. Growing up, Mr. Garcia received a major part of the abuse compared to his younger sister and older brother. At the time of the report, the patient maintains healthy relationships with his siblings; nevertheless, the situation regarding work and marriage seems to be continually worsening leading to mental health complications.

Description and Diagnosis

Mr. Garcia suffers from mood disturbances and reports that he frequently feels “empty and lonely”. Furthermore, the patient experiences guilt due to the worsening state of his mother and inability to meet his own expectations concerning his career. Mr. Garcia believes that he should be the provider for the family and support his wife; nevertheless, according to his perception, he has failed in this aspect due to physical complications and employment stress. The patient primarily experiences depressive episodes with no transparent signs of mania; however, Mr. Garcia is bothered by uncontrolled anger issues which are caused by the abusive family history. According to Kleine et al. (2013), physical abuse during earlier years, the worsening state of physical health and traumas, the declined self-esteem, stressful social environment, and lack of support from family and partners are among the most impactful predictors of major depressive disorder (MDD). Overall, the symptoms indicate the development of a particular form of mood disturbance complication.

MDD is generally demonstrated by discrete well-defined major depressive episodes which occur separately one at a time; however, the psychological complications affecting Mr. Garcia have a persistent nature. Furthermore, while the depressive symptoms are obvious, the severity is mild. Therefore, Mr. Garcia most likely suffers from a persistent depressive disorder (PDD) or dysthymic disorder. This is demonstrated, in addition to the common depressive symptoms, by the continuous sense of emptiness and loneliness, unhealthy nutrition habits (for more than 2 years), and lifetime anger issues. Schramm et al. (2020) demonstrate that the classification of depressive disorders is complicated due to a large number of terminologies and conceptualizations; nevertheless, chronic mild depression, in most cases, is the consequence of dysthymia. Overall, the analysis of Mr. Garcia’s psychological complications is the following:

• Comorbid conditions: a sense of “emptiness and loneliness” and guilt, depression;
• Specifiers: prolonged unhealthy nutrition habits, lifetime anger issues, low self-esteem, physical chronic pain;
• Diagnosis: dysthymic disorder.

Theories and Treatment

The treatment of depressive and mood disorders is a well-established discipline in psychology, and there is a wide array of methods to alleviate the symptoms. One of the theories is emotion regulation (ER) which allows individuals to have a better understanding of their own experiences, and how they affect their mental health (Joorman & D’Avanzato, 2010). Depressive episodes are primarily associated with persistent negative connotations of daily experiences and the reduction in positive responses; therefore, ER strategies might directly affect the root of the problem – the deranged reaction to emotional stimuli (Joorman & D’Avanzato, 2010). There is a considerable number of ER frameworks that might effectively treat mood disorders and provide useful insights into the etiology of the psychological complications. They include rumination, cognitive reappraisal, acceptance, distraction, savoring, suppression, dampening, etc. (Liu & Thompson, 2017). Concerning dysthymic disorder, cognitive reappraisal has demonstrated a high degree of effectiveness in the treatment (Liu & Thompson, 2017). Overall, most ER strategies might greatly enhance the mental health of the patient with mood disorders.

The second framework concerns behavioral activation (BA) strategies and might also be highly effective in the treatment of depression. The current framework focuses on behavioral patterns of the patient and attempts to increase the engagement in the activities that the individual enjoys (or enjoyed before the symptoms) and decrease the number of activities with negative connotations (Dimidjian et al. 2011). BA framework has seen a rapid increase in recent years and is frequently combined with other methods of cognitive intervention to achieve the more effective results of the treatment (Dimidjian et al. 2011). Overall, there is a large number of practical methods to treat depressive disorders, and both ER and BA strategies might greatly assist in the treatment of the patient.

References

Couette, M., Mouchabac, S., Bourla, A., Nuss, P., & Ferreri, F. (2019). Social cognition in post-traumatic stress disorder: A systematic review. British Journal of Clinical Psychology. Web.

Dimidjian, S., Barrera Jr, M., Martell, C., Muñoz, R. F., & Lewinsohn, P. M. (2011). The origins and current status of behavioral activation treatments for depression. Annual Review of Clinical Psychology, 7, 1-38, Web.

Jobson, L. (2009). Drawing current posttraumatic stress disorder models into the cultural sphere: The development of the ‘threat to the conceptual self’ model. Clinical Psychology Review, 29(4), 368–381, Web.

Joormann, J. & D’Avanzato, C. (2010). Emotion regulation in depression: Examining the role of cognitive processes. Cognition and Emotion, 24, 913-939, Web.

Klein, D. N., Glenn, C. R., Kosty, D. B., Seeley, J. R., Rohde, P., & Lewinsohn, P. M. (2013). Predictors of first lifetime onset of major depressive disorder in young adulthood. Journal of Abnormal Psychology, 122(1), 1-6, Web.

Liu, D. Y., & Thompson, R. J. (2017). Selection and implementation of emotion regulation strategies in major depressive disorder: An integrative review. Clinical Psychology Review, 57, 183–194, Web.

Oppizzi, L. M., & Umberger, R. (2018). The effect of physical activity on PTSD. Issues in Mental Health Nursing, 39(2), 179-187, Web.

Schramm, E., Klein, D. N., Elsaesser, M., Furukawa, T. A., & Domschke, K. (2020). Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. The Lancet Psychiatry, 7(9), 801–812, Web.

Sher, K. J., Grekin, E. R. & Wlliams, N. A. (2005). The development of alcohol use disorders. Annual Review of Clinical Psychology, 1(1), 493-523, Web.

Vujanovic, A. A., Farris, S. G., Bartlett, B. A., Lyons, R. C., Haller, M., Colvonen, P. J., & Norman, S. B. (2018). Anxiety sensitivity in the association between posttraumatic stress and substance use disorders: A systematic review. Clinical Psychology Review, 62, 37–55, Web.