Case Solution
We may learn from the case vignette that Anna is having some trouble balancing her job and personal affairs. She is struggling with the challenges of returning to work as well as the changes in her family’s relationships. This hypothetical case description concludes with the mention of Anna developing a “superwoman” coping style, which appears to be some sort of defence mechanism that allows her to cope with the stresses of her life while balancing the emotional turmoil that she is experiencing both outside and inside her home. Through this vignette, we learn that Anna is “on the verge of collapsing,” but we must also realize that Anna has become a caregiver for an old unwell man, as well as her two small children from her marriage. What should have been a joyous new chapter in Anna’s life has turned into a difficult period. This challenging period has resulted in a jumble of emotions that causes her to second-guess her every action. Even if her feelings are the result of societal factors, we still need to learn more about her background. We need to investigate Anna since her history might be a representation of a disease that remained undiagnosed. Anna stated that she had suffered from depression at various points in her life since her teens, which suggests that she has had some type of mental disorder in the past.
As clinicians may hypothesise and evaluate our guess about whether Anna has a mental condition or not using evidence-based diagnostic tools and methods. Based on the evidence offered in the case vignette, I guess that Anna is suffering from some type of anxiety problem (s). Along with this, I feel it may be associated with another illness, such as late-onset Persistent Depressive Disorder (Dysthymia) (PDD). Assessment methods are essential for determining what symptoms Anna has and their present intensity, as well as recognizing worried distress, unusual characteristics, mixed features, and so on. The criteria for (PDD) include “poor focus or difficulties making decisions, feelings of despair, and low self-esteem. In the vignette, we learn about Anna’s current situation; she appears to be suffering from poor self-esteem and having difficulty concentrating or making important decisions. One example is that Anna is continually concerned about the hazards that come with making mistakes at work, such as getting charged with malpractice. To examine Anna’s situation and establish an accurate diagnosis, I believe we need to review and conduct evidence-based examinations to discover, among other things, what is causing her feelings of confusion (Carta et al., 2019). The Beck Anxiety Inventory (BAI), the Rosenberg Self-Esteem Scale (RSES), the Beck Depression Inventory (BDI-II), the Global Assessment of Functioning (GAF), and the Beck Hopelessness Scale would be relevant assessment instruments for Anna’s case (BHS). In terms of evidence-based therapies, I feel Cognitive-Behavioral Therapy (CBT) and Emotionally Focused Therapy (EFT) would be best for Anna.
The Beck Anxiety Inventory (BAI) is a well anxiousness diagnostic and consequence assessment measure that has been validated in multiple languages. Substantial emotional indicators have emerged in a number of products, including diverse chronically ill individuals, panic disorder with or without panic disorder, teenagers with cognitive health challenges, older adult individuals with cognitive health issues, and non-clinical swatches (Kaviani & Mousavi, 2008). The BAI takes 5–10 minutes to give (about 10 minutes if administered orally) and less than five min to analyze the findings. Because of its low cost and ease of use, BAI is the tenth most commonly used instrument among psychiatrists in medical care environments in the United States. BAI has been demonstrated to have adequate internal constancy in both therapeutic and quasi specimens, as well as high test-retest reliability in both diagnostic and quasi specimens. Some concerns exist concerning the internal consistency of the BAI in the context of depressive diseases. Because of the high chance of comorbidities or the possibility of a distinct, shared actual mechanism, such as negative effect, differentiating anxiousness and melancholy diseases using self-report assessments has been a topic of debate. Although Beck’s first research found that those with depression and anxiety had much higher BAI mean scores than people with mental conditions, subsequent studies have attempted to match the results. In one study, the connection between the BAI and some other depressive evaluations such as the BDI and Likely produced was depicted to be even stronger than those of other anxiety measuring instruments in a Korean sample (Oh et al., 2018). BAI’s variability in terms of score variances and association sizes with other emotional and behavioral measures calls into question BAI’s use as an indication of general anxiety distinct from depression. Because other anxieties and depression instruments try to measure the same construct with different elements, more varied evaluations must be included in a study to offer a thorough view of the BAI’s deductive and inductive validity.
The Rosenberg Self-Esteem Scale (RSES) is a self-esteem measure that is commonly used in social science research. I would choose the RSES since Anna is struggling with her self-esteem, as described in the case scenario. The RSES is a brief, easy-to-administer Likert-scale type exam consisting of 10 items scored on a four-point scale ranging from strongly disagree to strongly agree. The RSES factor structure has been widely explored, with the argument centred on whether it is a one-dimensional or two-dimensional model. People with high self-esteem claim to be more personable and beautiful, have stronger relationships, and create a better impression on others than those with low self-esteem, although objective metrics contradict most of these claims. Narcissistic people are attractive at first, but they soon alienate people. It has not been demonstrated that self-esteem predicts the quality or length of partnerships. People who have a high sense of personal are more likely to speak up in groups and criticize the overall mission. Self-esteem may not directly cause leadership, although it may have an indirect influence. People with high self-esteem exhibit more in-group partiality than those with low self-esteem, which may promote discriminatory practices (Gnambs et al., 2018). Self-esteem, whether strong or poor, is not a direct cause of violence. In punishment for damaged pride, narcissism causes more aggressiveness. Low self-esteem may lead to behaviour problems and delinquency, while some researchers have found no impact or that the effect of self-esteem disappears when other factors are accounted for. Deception and harassing rates are the greatest and smallest in different subgroups of strong self-esteem. Happiness is strongly related to self-esteem. Although the study has not clearly shown causation, we are convinced that having a positive self-image leads to higher pleasure. In certain cases, low self-esteem is more likely than high self-esteem to contribute to depression (Supple et al., 2013). Rosenberg the Self-Esteem Scale does not discriminate equally and is connected to self-esteem in diverse ways. The sequence of the functionality of the items about their content was analyzed, and insights are provided with recommendations for evaluating and creating future personality tests.
The Beck Depression Instrument (BDI-II) is a 21-item, self-report rating inventory that examines typical attitudes and depressive symptoms. The Beck Depression Inventory (BDI) is also defined by the American American Psychological as a consciousness measure designed by patients to assist counsellors in measuring the signs and indicators of depression that a patient may encounter. This is similar to the introspective approach and is useful to both the patient and the therapist. Patients can promptly begin a period of therapy that particularly targets their difficulties with a complete evaluation at the start of treatment – identifying any hidden disorders that might create sadness and a predisposition to self-harm, thoughts, or actions. If you or a loved one is suffering from depression, you must receive comprehensive therapy. We arrived today to learn about the available solutions for those suffering from mental health difficulties such as depression (Beck et al., 1996). As much as patients have any amount of cognitive ability, the Beck Depression Inventory should take no more than 5 – 10 minutes. A study in the journal of Psychological health Counseling Nursing that assessed the appropriateness of the Beck Depression Inventory discovered that the trial was “a reliable and robust instrument for evaluating stress.” Tests are also required for persons suffering from alcoholism. Because double detection of drug misuse and emotional health problems such as depression is surprisingly widespread, good diagnostic techniques in this group can aid in the successful treatment of these issues. As a result, BDI assistance provides an excellent diagnostic tool for successful therapy.
The BDI-II was a 1996 Beck Depression Inventory version produced in response to the distribution of the American Psychiatric Association’s release of the Diagnostic and Manual Of psychological Disorders, Fourth Edition, which modified several of the Significant Burdensome Issue requirements. This improvement enhanced the care of people suffering from depression and alcoholism. Improvements in self-esteem, somatic symptoms, and functional disability were all replaced. Similarly, unlucky rest and longing for bad things were reversed to assess both the increases or decreases in rest and hunger. Except for three items, all have been refreshed; substances related to rejection, suicidal thoughts, and sexual attraction have remained unchanged. Finally, rather than last week as in the first BDI, members were called to determine how much they felt back in around fourteen days. BDI-II, like the Beck Depression Inventory, comprises 21 questions, each of which is evaluated on a scale of 0 to 3 (García-Batista et al., 2018). Higher ratings indicate the most significant signs.
The Global Assessment of Functioning, or GAF, the scale may be applied to Anna to determine the severity of her mental disease. On a scale of 0 to 100, it assesses how much her symptoms interfere with their daily life. It is intended to assist mental health specialists in determining how effectively a person can do daily tasks. The score can be used to determine what degree of care someone needs and how well particular therapies may work. The GAF is based on a scale initially introduced in 1962. It has been revised throughout time. In 2013, the handbook used by psychiatrists in the United States to identify and classify mental diseases abandoned it in favour of a World Health Organization-designed scale. However, government organizations, insurance firms, and others continue to use it, and it is not anticipated to be replaced anytime soon. A GAF score of 91-100 is considered normal, whereas lower values suggest psychological issues that make life difficult for the individual being evaluated. Mental health practitioners use the Global Assessment of Functioning (GAF) Scale to assess an individual’s psychological, social, and vocational functioning (Aas, 2010). The GAF system is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a guidebook for mental health practitioners that provides a systematic approach to diagnosing and assessing mental problems such as depression, PTSD, and anxiety. Because the score is standardized, practitioners from various mental health professions may interpret GAF scores in the same way. In other words, if one doctor awards a GAF score of 50, another doctor will be able to look at that number and have a decent grasp of the severity of that patient’s mental condition. The VA frequently evaluates GAF scores as part of a Compensation and Pension evaluation. VA Examiners will determine GAF ratings after speaking with the veteran and evaluating the veteran’s medical data. The VA then analyzes the findings of these assessments, in conjunction with the GAF score, to determine the appropriate grade for a veteran’s mental health state (Aas, 2010). GAF scores, however, can alter from day to day depending on a person’s level of functioning, thus they may not be the most trustworthy measure of sustained levels of impairment, according to psychologists.
Beck et al developed the Beck Despair Scale to further examine the idea of hopelessness (BHS). Beck developed it by grouping 9 questions from an unpublished survey examining attitudes toward the future and 11 items from a set of gloomy statements created by patients with mental disorders. Beck and colleagues discovered that BHS scores were substantially linked with clinical assessments of despair in their validation investigation. Several studies have found that the BHS has superior diagnostic validity. The BHS, for example, was significantly predicted thoughts of suicide and attempted in 289 severely mentally hospitalized suicidal teenagers across a 1–6-month follow-up following hospital discharge. Hopelessness, as evaluated by the BHS, was shown to be a strong predictor of attempted suicides among schizophrenic patients at the time of their initial hospitalization. The BHS was performed equally among patients and health care workers in both medical and psychosocial samples, and it may also be used to predict functional capacity and overall health status in psychiatric samples. The BHS consists of 20 categorical “true/false” items designed to examine three primary characteristics of hopelessness: thoughts about the future, incentive loss, and expectancies. Total scores were generated by reverse-coding nine things and then averaging the item scores. Higher overall scores (range 0–20) imply greater pessimism. The BHS has been translated and verified in Italian with the consent of Pearson Education (Balsamo et al., 2020). Several investigations have revealed that the BHS worked equally in mental inpatients, outpatient departments, and medical samples.
Anna will benefit from the introduction of CBT and EFT since she not only has to work on herself, but she also needs to work on her marriage, thus I believe it is critical to include these therapeutic interventions in addition to the offered evaluations. Furthermore, a meta-analysis of 115 trials found that CBT, in conjunction with medicines, is effective in treating persons with depression. Furthermore, research suggests that patients who received CBT had a reduced recurrence rate than those who just received medication. There have been several research conducted on the efficiency of CBT, thus he conducted an overall study of the efficacy of this therapeutic intervention (Stapleton et al., 2016). The authors found that, while more high-quality research is needed to adequately assess the size of the effect. Nonetheless, CBT is effective in treating adults with anxiety disorders in both randomized clinical trials and unstructured settings. In addition to CBT, I am confident that Anna and her husband will benefit from EFT to improve and strengthen their marital connection. The researchers used a quasi-experimental approach that included a pre-test, post-test, and control group. As a result, 14 couples with marital problems were selected through a screening procedure from a counselling centre in Shiraz City. Following that, these couples were allocated at random, and all participants completed the Intimacy Needs Questionnaire (INQ). According to the findings, EFT has boosted emotional, psychological, sexual, physical, relational, temporal, and intellectual closeness (Sebastian & Nelms, 2017). Finally, EFT is effective in boosting marital closeness.
Visualization of Anna’s Case
The assessments given to Anna indicated that she was suffering from depression as well as its companion, anxiety. As a result of the findings, she evaluates herself badly and complies with the concept of adjusting to this ‘superwoman’ position. Furthermore, based on the results of these tests, it is clear that Anna suffers from intrapersonal, social (communication skills), and vocational disabilities, all of which have a detrimental influence on her life. Furthermore, before digging deeper into the analytical spectrum of the assessment data, I’d like to present a brief narrative of what happened during and after the analysis process. As a result, I produced an observation analysis of Anna and highlighted any behaviours and emotional adsorption capacities that emerged throughout these evaluations. That is, I conducted an observation assessment with a cognitive analysis on my customer, Anna. In addition to these assessments, I notice a contrast between Anna’s’superwoman’s self and her actual-real self in the reality she has made for herself. It’s a fight of personalities, Superwoman Self vs. Actual Self, and my role as a therapist is to successfully cooperate with Anna to get her back to her real self and develop effective coping mechanisms to minimize or diminish her discomfort while also improving her quality of life. Furthermore, I will describe Anna’s findings and the next actions required to enhance her treatment procedure.
Psychological Assessment and Inference
Anna made limited eye contact and gaiety, appeared busy with her thoughts and achieved adequate prosody. She also shook her legs and clutched her wrists. Furthermore, she is demonstrating an apprehensive condition, which leads me to believe that other things are contributing to her misery. In terms of her cognitive state, Anna appears to grasp the questions I’ve asked her and has effectively answered them. Furthermore, she adhered to protocols and grasped the assessment’s objectives. Continuing, she is aware of what brought her to therapy, but she expresses a lack of knowledge about how to effectively manage her predicament. By the way, she expressed herself during our conversations, she appeared to have a sense of hopelessness and a lack of self-esteem to me. It is also important to note that she acknowledged having experienced depression in her adolescent years, demonstrating her awareness of her psychological wellbeing.
Outcomes
According to The Beck Depression Inventory 2nd Edition (BDI-II), Anna scored a raw score, indicating that she suffers from mild depression. She had symptoms of flat affect and restlessness, such as balancing a profession, social (interpersonal), and home/family life. Anna scored a raw score on The Beck Anxiety Inventory (BAI), suggesting that she suffers from severe anxiety. Furthermore, she was presented with behavioural symptoms such as restlessness and irritability, as well as cognitive symptoms such as excessive concern, racing thoughts, and unwelcome ideas. The Beck Despair Scale (BHS) scores suggest that Anna has moderate hopelessness. Anna obtained a score of 45 or below on the Global Testing of Functioning (GAF) assessment, indicating significant symptoms. As a result, she has a significant level of impairment in psychological, vocational, and educational functioning. Anna scored a raw score of 8 on the Rosenberg Self-Esteem Scale (RSE), indicating that she has very poor self-esteem.
Evidence-based practices
As Anna’s psychotherapist, I would use Cognitive-Behavioral Therapy (CBT) to assist her inefficiently controlling her sadness and anxiety, with sessions spanning from 10 to 20 minutes depending on the situation like level of severity or level of improvement. Nevertheless, when it comes to Emotional level Therapy (Emotional freedom), I would refer her or make a referral to send her to a practitioner who specialises in that type of psychotherapeutic intervention because I am not qualified to provide couples counselling, and as a professional therapist, I know my limits and must do what is best for my client. As a result, for my client’s sake and well-being, I am considering her requirements as well as alternative methods to improve her quality of life. With that stated, I’m offering her another outlet to learn more about her relationship with her spouse and what she can do to enhance it. So, attending this sort of therapeutic session will ideally help ease some of the tension that she is experiencing as well as improve their dyadic communication, thereby increasing her quality of life.
Conclusion
According to this hypothetical scenario, Anna is suffering from moderate-to-severe sadness and anxiety. That is to say, she has low positive affectivity and high emotional arousal. Her challenging predicament in juggling work, social, and family life has resulted in a serious degree of impairment that is badly affecting her. Furthermore, the levels of pressure she is under are impairing her vocational, social, and interpersonal performance. From the evaluations, she does exhibit signs of sadness and anxiety, which are impacting her persona and interfering with her personal and working life. In terms of the treatments that I will apply or refer my client to, I feel that these practices will assist my client by improving her psychological and physiological condition. These techniques will improve her mind-body connection, alleviate any maladaptive thinking/automatic thoughts, and, most significantly, will contribute to her general well-being. Regarding the progress monitoring tools, I would repeat all of the assessments to do a “post-evaluation” and see where my client, Anna, is at in terms of her level of depression and anxiety, as well as to see if the implementation of these practices in conjunction with a comprehensive treatment plan is producing positive results and/or is helping her to effectively cope. Finally, these assessments may be found in Pearson, which includes instructions that outline how to conduct these exams and accurately grade them.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association Publishing.
Oh, H., Park, K., Yoon, S., Kim, Y., Lee, S. H., Choi, Y. Y., & Choi, K. H. (2018). Clinical utility of Beck Anxiety Inventory in clinical and nonclinical Korean samples. Frontiers in psychiatry, 666.
Kaviani, H., & Mousavi, A. S. (2008). Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University Medical Journal.
Carta, M. G., Paribello, P., Nardi, A. E., & Preti, A. (2019). Current pharmacotherapeutic approaches for dysthymic disorder and persistent depressive disorder. Expert Opinion on Pharmacotherapy, 20(14), 1743-1754.
Gnambs, T., Scharl, A., & Schroeders, U. (2018). The structure of the Rosenberg self-esteem scale. Zeitschrift für Psychologie.
Supple, A. J., Su, J., Plunkett, S. W., Peterson, G. W., & Bush, K. R. (2013). Factor structure of the Rosenberg self-esteem scale. Journal of Cross-Cultural Psychology, 44(5), 748-764.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory (BDI-II) (Vol. 10, p. s15327752jpa6703_13). London, UK: Pearson.
García-Batista, Z. E., Guerra-Peña, K., Cano-Vindel, A., Herrera-Martínez, S. X., & Medrano, L. A. (2018). Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic. PloS one, 13(6), e0199750.
Aas, I. H. (2010). Global Assessment of Functioning (GAF): properties and frontier of current knowledge. Annals of general psychiatry, 9(1), 1-11.
Balsamo, M., Carlucci, L., Innamorati, M., Lester, D., & Pompili, M. (2020). Further insights into the Beck Hopelessness Scale (BHS): unidimensionality among psychiatric inpatients. Frontiers in psychiatry, 727.
Sebastian, B., & Nelms, J. (2017). The effectiveness of Emotional Freedom Techniques in the treatment of posttraumatic stress disorder: A meta-analysis. Explore, 13(1), 16-25.
Stapleton, P., Bannatyne, A. J., Urzi, K. C., Porter, B., & Sheldon, T. (2016). Food for thought: a randomised controlled trial of emotional freedom techniques and cognitive behavioural therapy in the treatment of food cravings. Applied Psychology: Health and Well‐Being, 8(2), 232-257.
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