Introduction
Anxiety diseases are mental well-being disorders that are characterized by reactions of distress or fear and worry that can interfere with typical day-to-day activities. Panic attacks, social phobias are some of the examples of anxiety disorders. The disorders can affect one’s life in various ways, like always expecting a disaster to occur and continuous worry about health, money, family, work, or school. This research paper discusses the DSM-5 anxiety disorders reviewing the diagnosis, a case conceptualization, and a treatment plan.
Differential Diagnosis
The DSM-5 anxiety disorders consist of anxiety, depression, neurodevelopment, eating, active rheumatic heart disease (ARHD), obsessive-compulsive, sleep, and suicidal-related problems. The suicidal-related problems include a suicidal plan, attempt, and ideation (Chen et al., 2020). Mr. Smith reported two failed suicide attempts by hanging during his last depressive episode after being fired from his job. Sleep disorders are insomnia (lack of sleep), nightmares, sleep arousal, hypersomnolence, and circadian rhythm sleep-wake disorders (Mursaloglu et al., 2020). Neurodevelopmental disorders include Autism spectrum, Attention-deficit – hyperactivity disorder (ADHD), and Tic (Mursaloglu et al., 2020). Depressive disorders comprise of significant and persistent, DMDD whereas anxiety disorders are generalized, separation, panic, specific phobia, and social (Chen et al., 2020). Eating disorders are ARFID and anorexia nervosa, while obsessive-compulsive are gender dysphoria, reactive attachment, schizophrenia, and post-traumatic stress.
Smith reported panic attacks, which sometimes occur before dates or when he has been “spiraling” in his worries for an extended period. During these attacks, Mr. Smith reported experiencing elevated heart rate, increased sweating, trembling, nausea, and fear of dying. These attacks typically come on quickly, leading him to take prescription benzodiazepine. He reported that he, therefore, never leaves the house without his medications and would be terrified to do. Mr. Smith experiences problems of anxiety, worry, social interaction, and concentration difficulties in work. These signs clearly indicate that he has anxiety disorders that need s treatment. In comparison with the DSM-5 diagnosis, he has depressive disorders where he has been having episodes of depression.
In addition to the DSM-5 diagnosis test, a blood test can be recommended to determine the disorders. Some of the conditions such as hypothyroidism might be present, which may be causes of such diseases. The medications taken such as cyclosporine and levodopa may cause symptoms of anxiety. Some medical conditions like sleep apnea and systemic lupus may cause stress. Further, screening for anxiety and related disorders can be helpful in the diagnosis plan (Mursaloglu et al., 2020). Screening helps detect potential health disorders which may not show symptoms.
Case Conceptualization
In the case of Smith, a diathesis-stress model was used in the explanation of his disorders. This model is psychological, and it attempts to explain a disorder as a result of the interaction of risk factors such as adverse life events. He has experienced various challenges like a divorce from his parents, failure in studies, and then being bullied. He had multiple vulnerabilities, which are behavioral, biological, and cognitive. The behavioral vulnerability was manifested in his irritability, where he become upset quickly. Cognitively, he lacked concentration, especially in his studies leading to failure. Biologically, he experienced unwanted depression where he reported various episodes.
Stressors
This refers to both biological, environmental external stimulus and events which are likely to cause stress. He lost his job, and most attempts to find a permanent were all in vain. His relationship with people is deteriorating, and his circle is very tiny. He finds it hard in romantic relationships and has experienced heartbreak from his girlfriend, who had parted ways from him. His situation at home following a divorce when he was only 13 years and the fact that he is staying with his mother even at his age. All this contributes to the repeated disorders for a long time.
Maintaining Factors
Smith possesses many maintaining factors like worsening relationships and continued failed attempts to find a job. Regular alcohol and marijuana consumption also contribute to his anxiety disorders. The avoidance and negative cognitive biases maintain Mr. Smith’s presenting problems by avoiding bad attitudes, which create stress. This upsets the body’s hormones and depletes the brain chemicals required for happiness leading to attacks.
Treatment Plan
The Exposure Therapy
Exposure therapy aims at exposing the affected victim to the source of anxiety without any intention of causing any dangers to them. It has been proven to be an effective method for treating anxiety and depression disorders (Craske et al., 2014). It conceptualizes treatment by exposing a situation or stimulus that causes fear to the patient, and with time, they can be able to control their worries. It can help Smith by asking him to confront his situations that bring about the disorder and find a solution. One exposure I would conduct with Smith to help him is interoceptive (Crake et al., 2014). I would create a physical response that most people associate with panic, especially in the case of panic attacks, I will instruct him to run on the place in a secure setting to produce heartbeats which are similar sensations. I would them inform him that this sensation is not dangerous but a normal body reaction.
For further treatment, I would try to use other recommendations, which can be effective to him. Recommendations such as deepened extinction, expectation violation, occasional reinforcements extinction, safety signals, and variability can be helpful in the treatment (Craske et al., 2014). I would maximize the benefits of exposure therapy by deepening the extinction and removal of safety signals. I would inform him that reducing of fear itself is a better safety signal. I would then use the extinction approach to advise Smith on how he can weaken the learned association of heartbeats with fear. This would affect the exposure I choose to him by demonstrating other activities that can generate heartbeats to make him not associate it with panic. If Mr. Smith were afraid of the exposures, I would demonstrate first by running and then control the heartbeat for him to accept my treatment. I would further explain to him that it could not cause any harm or increase his worries.
Cognitive Treatment
The cognitive theory involves the asking of questions and answers to enable thought reconstruction. It conceptualizes treatment by Third wave therapies include dialect behavior therapy, acceptance and commitment, and mindfulness-based interventions. The main purpose is to allow people to become aware of their thoughts and treat them in nonjudgmental ways. The cognitive theory is different from the others since it focuses on eliminating psychological distress. The mental reconstructing process begins with the calming of thoughts by either deep breathing or meditation. The situation that triggered the downbeat mood is identified, and the spirit analyzed. Automatic views or natural reactions are recognized, and a piece of objective, supportive evidence is recorded. Smith has a core belief in setting unrealistic high standards. It would lead to an automated thought of being successful. I would reconstruct the idea by explaining to him the steps of success, and one must follow.
Acceptance and Commitment Therapy
The therapy is an empirical approach that is based on psychological intervention, which uses acceptance and mindfulness strategies together with behavior change therapies. It conceptualizes treatment through behavior modification by avoiding practices that contribute to this disorder. It can be applied to Smith’s presenting problems by encouraging him to avoid worries, irritability, and panic. One ACT exercise I would do with Smith is breathing in. During the exercise, I would demonstrate mindful breathing in and explain its importance, especially when one is in fear. Since he experiences panic, anxiety, and worries, this exercise would be helpful to deal with this problem.
Treatment Selected
The pros of cognitive therapy are the effectiveness of treating mental illness, it can be completed within a short time, and the practicability of the skills learned. The cons are time-consuming, individualistic, and do not address possible underlying causes such as childhood experiences. Reduced anxiety, decreased fear, mental stability, and recognition of one’s power to overcome e challenges are pros of the exposure approach. The cons are the exposure limit, a hit and run approach, the cognitive part not being built, and the limitation in exercise.
The third wave therapies focus on both the psychological and behavioral modification and focus on the relationship with the internal experiences. The cons are that it can influence lousy decision-making when external factors are not considered. It can also be prone to judgment where nonprofessional is involved. Therefore, I would recommend the third wave therapies treatment since it focuses on both the behavioral and psychological aspects. It will enable him to become aware of himself and achieve his goal and developments.
Conclusion
In summary, anxiety disorders can be caused by various factors, which are psychological, emotional, and external factors. Tragic events in our life can also influence anxieties. Stressors can be eliminated, and some medications can be taken to reduce the effects. A screen and blood test can be used in addition to the DSM-5 diagnosis. Treatments can be done using cognitive, exposure and acceptance, and commitment therapies.
References
Chen, Y. L., Chen, W. J., Lin, K. C., Shen, L. J., & Gau, S. S. F. (2020). Prevalence of DSM-5 mental disorders in a nationally representative sample of children in Taiwan: Methodology and main findings. Epidemiology and Psychiatric Sciences, 29, e15. Web.
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour research and therapy, 58, 10-23.
Mursaloglu, H. H., Ergenekon, P., Yegit, C. Y., Gokdemir, Y., Eralp, E. E., Karakoc, F., & Karadag, B. T. (2020). P385 Screening of depression and anxiety disorders in cystic fibrosis patients and their parents. Journal of Cystic Fibrosis, 19, S163-S164. Web.