Anxiety and depression disorders constitute a significant proportion of the world’s burden of illness and are projected to create the second major common source of disability. Reports by the world health organization state that anxiety and depressive disorders threaten to be the global most common diseases affecting women. According to Thibaut (2022), middle-aged women report more mental distress, clinical problems, and significantly low morale than men. Anxiety and depression are among the major psychiatric diseases in contemporary society.
For the study, the paper will examine a case of an individual client system in the late middle stage of therapy suffering from anxiety and depression disorder. The name will remain private throughout the paper to protect the client’s confidentiality. The case will also include cognitive behavioral therapy (CBT) as the selected theory base to direct this case study. Therefore, this paper seeks to discuss a client presenting issue, interventions, goals, and how cognitive behavioral therapy, including ecological system theory, family system, and attachment theory, influences the conduct of the study case. Also, the paper will discuss various issues linked to intersectionality, culture, possible oppression, ethnicity, sexual orientation, individual differences, lifestyle, and race that affect the study client system.
The study client is a female, who will be named Jane Doe, aged thirty years of age. She has been married for five years and has a two-year-old son. The study client is observed to have sought various therapy sessions for depression and anxiety disorders. Jane Doe works at one of the busiest oil companies, which comes with many pressures and demands a lot from her, including more time, being left with none for herself, and spend with her family. As a result, from the gathered reports and interviews, Jane Doe claims she feels overwhelmed by her work, as it requires long working hours and elevated levels of pressure and stress. Additionally, the client reports difficulties in sleeping and a lack of energy, which are some of the symptoms of anxiety and depression disorders (Kessler et al., 2015). Moreover, from the interview reports, Jane Doe is observed to have a feeling of hopelessness concerning her future, and in the last few months, she has had suicidal thoughts a couple of times, planning to end her life.
Essentially, the main goals of the client for the case study are to reduce her depression and anxiety symptoms, increase her level of energy, improve her quality of sleep, and also develop various coping approaches to manage and control her level of stress at work. The first assessment disclosed from the case study is that the client has had a history of depressive and anxiety disorders that began in her teens. At the age of ten, Jane Doe lost her mom in a car accident which traumatized her by constantly having repeated dreams, subsequent fear, and flashbacks every time she closed her eyes to sleep. Consequently, Jane Doe sank into depression and anxiety disorder as she became isolated from her friends and the rest of the world, which continued to affect her throughout her adult life.
The second assessment revealed from the case study was that the client had a family history of psychological illness. Jane Doe’s mother was also suffering from anxiety and depression symptoms for most of her living years, and she battled with suicidal thoughts for a long time to appoint that she almost lost twice. However, she received help and went through therapy sessions before her death.
The third assessment disclosed from the case study was that it was observed that Jane Doe’s current work was a substantial cause of stress. Jane Doe often described that the pressures at her work were too much for her to handle, and she felt overwhelmed and at the point of breaking down and giving up in life. Other considerations in the assessment process included factors such as intersectionality, racism, possible oppression, individual indifferences, lifestyle, culture and ethnicity, and sexual orientation.
Effects of Intersectionality, Potential Discrimination, and Racism
Fundamentally, it is vital to recognize the potential effects of the intersectionality of the patient’s experiences and the presenting case problem. According to Holm et al. (2022), gender discrimination profoundly impacts mental well-being worldwide. Various mental effects of gender discrimination include elevated levels of pressure or stress, depression, post-traumatic stress illness, and depression in women and individuals of marginalized sexes. As a thirty years old female, Jane Doe may have encountered gender-based harassment in her working place, which might have added to her stress and pressure levels.
During one of the interviews with the client, Jane Doe mentioned having experienced gender discrimination in terms of receiving unequal wages, disparities in promotions, racism, and being sexually harassed multiple times. Jane Doe indicated that there are few chances for women to be employed in the company she currently works for due to racism and gender inequality. This results in a great burnout rate for the women working in the organization. This was one of the key causes of her anxiety and depression symptoms. Additionally, individuals exposed to discrimination and racism at workplaces reports tend to have high rates of anxiety and depressive moods. Racial injustice or discrimination can take a weighty emotional turn, triggering anxiety, racial depression, chronic trauma, and stress (Holm et al., 2022). Hence, it is important to consider how these factors affect the client’s recovery system to determine the right course of action for the case study.
Cultural or Ethnic Factors
The second factor for Jane Doe’s recovery system is her culture and ethnicity. From the assessment, Jane Doe’s family mental history might have been impacted by cultural and ethnic elements that are vital to consider in her therapy process. Research shows that social anxiety disorders vary depending on where individual lives and the cultures they are raised (Escovar et al., 2018). Moreover, environmental elements such as loneliness and traumatic events can result in mental disorders. Therefore, if an individual has a family mental history, there is a great possibility of developing a mental disorder in these states.
In the case study, Jane Doe was brought up by a mother who had struggled with mental illness for most of her life. Later in her teen years, she experienced a traumatic life event that could have activated her anxiety and depression. Significantly, cultural factors, including family mental history and stressful life events, may have contributed hugely to Jane Doe’s loneliness and feeling disheartened with life and work.
Sexual Orientation, Lifestyle, and Individual Indifferences
Sexual orientation, lifestyle, and individual indifferences are other factors to consider in determining the client’s recovery system. It is important to acknowledge the patient’s differences, including sexual orientation and lifestyle, concerning the presenting case issue. These elements might have impacted Jane Doe’s experiences of depression and anxiety disorders and might require certain considerations and interventions in therapy. According to Luk et al. (2018), there are differences in the risk of depression on sexual activities, orientation, and sex. Individuals of the sexual minority are in greater danger of anxiety and depressive illnesses compared to heterosexual individuals.
Lifestyle is a crucial aspect that can contribute to depression and anxiety disorders (Thibaut, 2022). The client indicates poor sleeping habits and low energy levels in the case study, which can significantly impact her condition. Thus, in determining the right therapy approach, it is crucial to understand how her lifestyle can be altered and incorporate different lifestyle changes such as improved sleeping habits, increased social support system, and regular exercises to help decreased the client’s depression and anxiety symptoms and reduce the stress levels at work and her everyday routine.
Further, personality characteristics are frequently thought to impact the stress that an individual perceives. According to Luk et al. (2018), certain types of personalities appear to be susceptible to stress effects compared to others. Also, work performance is linked with different stress levels. Ideally, the extent to which an individual experience pressure turns into poor performance regarding the quality of the patient’s care. For the case study, the client’s job performance is likely affected by her personality traits. Therefore, it is important to consider Jane Doe’s traits to help determine the right approach for successful treatment. Overall, therapists and practitioners must approach every client with a complete understanding of their distinctive experiences or identities and consider how various factors might influence their presenting issues and therapeutic procedures.
For the case study, cognitive behavioral therapy guided the interventions for Jane Doe’s case presentation. According to Otte (2022), cognitive behavioral therapy is a form of psychotherapy that modifies a patient’s thought pattern to help alter moods or behaviors. It is mainly based on the notion that negative behaviors or feelings are the outcomes of existing biased thoughts and beliefs, not the unconscious powers from the past. Notably, cognitive behavioral therapy combines mental therapy, which focuses on individual attitudes, and behavior therapy especially targets the patients’ conduct. Therefore, the therapist performing a combined method of CBT work with the patient to offer guidance or direction.
Additionally, treatment with CBT includes developing constructive and balanced means to respond to stressors. These responses help the client to cope and recover from challenging psychological health behaviors or unwanted conditions. Remarkably, the principles of cognitive behavioral therapy can be used outside the psychiatrist’s office, offering the client a coping tool to assist them through life’s challenges. According to Walsh (2015), cognitive behavioral therapy teaches individuals to become conscious and adjust the negative pattern, which can assist the client in reframing their thinking during intensified anxiety and panic. It provides coping skills, such as meditation and journaling, for individuals struggling with depression and anxiety.
Other theories the therapist can be used with CBT therapy for successful treatment of the patient in the case study are family system theory, ecological systems theory, and attachment theory. Family systems theory suggests that humans are shaped or formed by their family’s communication trends, behavior, and emotional appearance and expression (Walsh, 2015). The theory stresses the significance of grasping the interconnectedness of the family members and how their interactions affect individual behavior or growth. Therefore, by using the family system theory, the therapist could understand how Jane Doe’s family history with mental problems contributed to her current situation.
Secondly, the Ecological systems theory helped the therapist to determine the cultural and social factors adding to Jane Doe’s mental issues. The theory suggests that humans are shaped by the social and various environmental arrangements in which they interact. According to Walsh (2015), the theory stresses the significance of recognizing the individual and the broader cultural or social backgrounds in which they reside. Lastly, using the attachment theory, the therapist could understand how Jane Doe’s primary childhood involvements or experiences with caregivers formed her ability to create attachments or relationships throughout her life. This theory stresses the significance of safe attachments in the initial childhood for a healthy relationship and emotional growth later in life.
For the case study, the psychiatrist worked with the patient to challenge and identify negative beliefs or thoughts contributing greatly to her anxiety and depressive symptoms. Moreover, the therapist assisted the client in developing several coping approaches to manage and control stress and pressure levels at work. The first intervention applied in the case study using CBT theory-based guide was to educate the patient about the association between feelings, behaviors, and thoughts (Otte, 2022). The therapist enlightened the client that negative thoughts can result in negative behaviors or feelings, exacerbating depression and anxiety symptoms. Therefore, the therapist assisted the client in identifying all negative beliefs or thoughts that were adding to her symptoms.
Ideally, many individuals go through their lives thinking that the way they feel or how they end up doing things are directly impacted by what happened to them in their lives. One of the key elements of CBT is that there is an intervening stage in how individuals interpret those circumstances. The individual interpretation of those situations leads to them feeling or behaving in a certain manner. According to Hofmann & Gómez (2017), one of the primary things therapists would have patients do is to notice their thoughts. If the client notices a change in their mood, they should ask themselves what is going on through their minds before they feel bad or worse.
The goal of the therapy is not to think about the happy thoughts because they are fun but to help the patient to think carefully and truthfully about their situations, especially if the client has a pattern of drifting to negative thoughts when the situation or life gets hard (Hofmann & Gómez, 2017). Likewise, in the case of Jane Doe, the therapist focused mainly on helping the client to recognize her negative feelings and thoughts in various situations, like when frustrated at work and how they made her feel or behave in a particular way. Doing so would make the client aware of the negative thoughts contributing to her anxiety and depression symptoms.
The second intervention applied in the case study using cognitive behavioral therapy theory was challenging the patient’s negative beliefs or thoughts. The therapist assisted the client in reframing her negative beliefs into more realistic and positive ones. For instance, when Jane Doe expressed her hopelessness concerning her future, the therapist assisted her in recognizing her accomplishments and strengths. Also, the therapist encouraged Jane Doe to focus on the current moments and set attainable goals. According to Walsh (2015), goals can give individuals a life direction or purpose and promote healthy acts that are focused on improving an individual’s life. CBT coping technique the therapist applied in the case study involved approaching Jane Doe’s goals in a manner that improves her moods and quality of life. This was done by setting small versus big ones or breaking the big goals into more controllable chunks to avoid feelings of defeat and frustration.
Moreover, it is important for the patients always to think positively and feel themselves to feel positive emotions. Negative thoughts can slow depression and anxiety recovery. The objective of the CBT theory base is to recalibrate the patient’s part of their brain that is keeping a tight hold on their happy feelings (Otte, 2022). If the client in the case study stops the negative feelings, they can take care of themselves more and handle the work and life challenges better. Eventually, the client will feel optimistic and be in a better position to cope with the problems of sleep, depression, elevated levels of stress, and anxiety symptoms whenever they appear. Also, by recognizing her strengths and achievements, Jane Doe will be able to appreciate herself more and be motivated to improve for her family, which depends on her to take care of them.
The last intervention applied in the case study using CBT as a guide is to develop coping mechanisms to help manage and control the client’s stress level at work. The therapist worked collaboratively with the client to pinpoint all the triggers of the stress at her work, such as discrimination and racism, and come up with effective approaches to manage and control them. For instance, the patient learned relaxation skills like mindfulness and deep breathing exercises. According to Otte (2022), cognitive behavioral therapy coping mechanisms can help change the patient’s thinking patterns, resulting in anxiety and depression disorders. They can help the patient manage or handle difficult situations and feelings better as they work by altering how the individual interprets the events and emotions.
In addition, other techniques such as deep breathing, mindfulness exercise, meditation, and progressive relaxation of muscles can help the patient relax their body in case they are anxious, thereby decreasing their emotions of anxiety. According to Hofmann & Gómez (2017), cognitive behavioral therapy teaches patients various coping mechanisms to deal with different issues. It focuses on how patients’ beliefs, attitudes, and thoughts impact their feelings and behavior. Thus, using these coping skills, Jane Doe could manage the feelings that trigger her to be anxious at work and elevate her stress levels, causing her to experience anxiety and depression symptoms.
After thoroughly assessing and applying interventions using the cognitive behavioral therapy theory, the client in the case study reported a substantial reduction in her depression and anxiety symptoms after various sessions. Notably, the client also reported improved sleep quality and increased energy levels. The client seemed happy and indicated that she was more positive and hopeful about the future. After several sessions with her therapist, she witnessed a few thoughts of committing suicide. Furthermore, the client expressed satisfaction with the whole therapy process. Jane Doe reported that she had established helpful coping mechanisms to control and handle her stress level at work, which has significantly helped her be happier and motivated to become strong and well for her family members.
Cognitive behavioral therapy, including family system theory, attachment, and ecological theories, was a successful theory base to direct the interventions for the Jane Doe case study. Essentially, the therapist assisted the client in recognizing and challenging her negative beliefs and feelings contributing to her depression and anxiety symptoms. Additionally, the therapist significantly assisted the client in developing various coping techniques to control her stress level at work and improve her job performance. Ultimately, the client reported substantial improvements in her anxiety and depression symptoms and expressed fulfillment with the therapy procedure. Therefore, this case study highlights the significance of applying evidence-based models to guide therapeutic interventions.
Notably, the case study signifies the importance of examining contributing factors to a client’s anxiety and depression illnesses. According to Otte (2022), it is crucial for therapists to significantly approach all patients with an understanding of their unique experiences and contemplate how various elements may impact their presenting problems and therapy processes. Some contributing factors that might cause anxiety and depression include family history, traumatic events, current work, intersectionality, cultural and ethical factors, individual indifferences, and lifestyle. Therefore, by understanding these factors, the therapist was able to successfully recommend the best course of action for Jane Doe’s recovery process.
Escovar, E. L., Craske, M., Roy-Byrne, P., Stein, M. B., Sullivan, G., Sherbourne, C. D., … & Chavira, D. A. (2018). Cultural influence on mental health symptoms in a primary care sample of Latinx patients. Journal of anxiety disorders, 55, 39–47.
Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-based interventions for anxiety and depression. Psychiatric clinics, 40(4), 739-749.
Holm, A. K. J., Johnson, A. N., Clockston, R., Oselinsky, K., Lundeberg, P. J., Rand, K., & Graham, D. J. (2022). Intersectional health disparities: the relationships between sex, race/ethnicity, and sexual orientation and depressive symptoms. Psychology & Sexuality, 13(4), 1068-1089.
Kessler, R. C., Sampson, N. A., Berglund, P., Gruber, M. J., Al-Hamzawi, A., Andrade, L., … & Wilcox, M. A. (2015). Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiology and psychiatric sciences, 24(3), 210-226.
Luk, J. W., Gilman, S. E., Haynie, D. L., & Simons-Morton, B. G. (2018). Sexual orientation and depressive symptoms in adolescents. Pediatrics, 141(5).
Otte, C. (2022). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in clinical neuroscience.
Thibaut, F. (2022). Anxiety disorders: a review of current literature. Dialogues in clinical neuroscience.
Walsh, J. (2015). Behavior Theory and Cognitive Theory. Theories for Direct Social Work Practice 3rd Edition (pp.146–168, 171–199). Stamford, CT: Cengage Learning.