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General anxiety disorder (GAD) is a serious issue that affects Shana’s ability to lead a normal life. Based on the case scenario, the appropriate intervention for her is cognitive behavioral therapy (CBT) together with motivational interviewing (MI). CBT as an approach has been proven to be effective in treating anxiety for patients by many studies. Westra, Constantino, and Antony (2016) conducted a research in which they examined the effects of the approach in treating GAD in adolescents.
The authors concluded that the combination of CBT and MI provides a method that allows to minimize possible risks and enhance the effects of CBT (Westra et al., 2016). Among those risks, there is a possibility of relapse and failure to respond to treatment or inadequate reaction to it.
A crucial aspect of such intervention is appropriately training therapist that would conduct the sessions. It is essential to ensure that patients do not drop out without finishing their treatment. Thus, a therapist has to apply empathy to provide an understanding of why the alteration is required instead of “taking the role of change advocate” when compared to a traditional CBT (p. 769). In this way, the patient will be in charge of his or her condition and will have full responsibility for the outcomes of treatment while being empowered by the MI.
A flexible CBT intervention can be helpful in severe cases of GAD, as it will address possible problems that obstruct a patient from being treated. According to Westra et al., (2016), some patients may not be ready to change or be unable to understand the issue correctly, which subsequently would affect the outcomes. Shana has not received treatment for extended periods of time, and thus, for her, it may be more difficult to adopt new behaviors. The approach of MI is aimed at guiding the patient to an understanding that the change is necessary (Westra et al.,2016). Overall, CBT and MI should help Shana learn new behavior pattern and coping mechanisms that she can apply to minimize her anxiety.
The described intervention can help Shana be treated from GAD. Westra et al., (2016) and the researches included in the initial response agree that an approach of CBT has many limitations. Thus, applying a combination of methods can mitigate possible risks and guarantee an improvement in Shana’s symptoms. Additionally, the response includes a crucial aspect of family support, which is especially vital for children and adolescents with GAD.
Other information that would help adjust this treatment plan to Shana’s case is the reasons that affected the decision not to seek treatment previously. Additionally, evaluating the level of anxiety by applying various tools can help determine the need for medication. For example, Southam-Gerow et al. (2016) state that CBT for Anxiety in Youth Adherence Scale helps in identifying the severity of symptoms and efficiency of treatment. Therefore, the proposed treatment offers an effective strategy that both minimizes risks and provides support for the patient.
The second response offers an effective strategy for Shana’s treatment through two primary approaches, pharmacotherapy and CBT. Due to the fact that the answer is supported by relevant research, the chosen medication can be beneficial in mitigating the current symptoms. Shana’s is experiencing severe GAD, and it is obstructing her from normal functioning as an individual; thus the offered plan can show the needed result more quickly than CBT alone.
The response mentioned several side effects that have to be monitored throughout the course of pharmacological treatment. Suicidal intentions are among the primary concerns in this case. Thus, additional information in the form of data assessment will be required (Sakolsky, 2017). Additionally, monitoring of physical indicators and general health assessment should be performed to identify possible limitations for the proposed treatment plan. Overall, the response acknowledges the importance of CBT while offering pharmacotherapy as an option in a treatment plan, which is an efficient approach.
Opioids
Both medications have shown positive effects in reducing drug use. McKeganey, Russell, and Cockayne (2013) conducted a study in which different groups of patients were prescribed either methadone or suboxone, over a period of six months. The researchers help a follow-up examination eight months after the intervention to further evaluate the approach. Both methadone and suboxone show good results in helping patients overcome their drug abuse issues.
Additionally, McKeganey et al. (2013) state that Suboxone has shown a significantly better outcome when compared to methadone. As was concluded the medication displayed a “larger magnitude reduction in heroin use than methadone” (McKeganey et al., 2013, p. 97). However, both were effective in preventive possible relapse cases for the observed patients. Therefore, methadone or suboxone can be chosen as options for treating R.J. in his detox process. Suboxone would be more efficient as it has shown better results in the mentioned study; thus, it should be a primary choice for this patient.
The patient from this case study has become addicted to opioids after an accident in his search to minimize pain. Therefore, identifying other options that can help him reduce the initial symptoms and thus, stay away from drugs should be the primary objective. Additionally, Stokes, Schultz, and Alpaslan (2018) suggest a 12-step program as assistance in the detox. Further education on substance abuse and its dangers can be helpful in this case as well. The important aspect of overcoming the condition is support from the external environment; therefore, additional therapy sessions for R.J and his partner can help both in this process. Overall, strong support and positive attitude throughout recovery should help R.J. remain sober.
References
McKeganey, N., Russell, C., & Cockayne, L. (2013). Medically assisted recovery from opiate dependence within the context of the UK drug strategy: methadone and Suboxone (buprenorphine-naloxone) patients compared. Journal of Substance Abuse Treatment, 44(1), 97-102. Web.
Sakolsky, D. (2017). Impact of selective serotonin reuptake inhibitor (SSRI) use on suicidal ideation and behavior in Child/Adolescent anxiety multimodal extended long-term study. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), 319. Web.
Southam-Gerow, M. A., McLeod, B. D., Arnold, C. C., Rodríguez, A., Cox, J. R., Reise, S. P., … Kendall, P. C. (2016). Initial Development of a Treatment Adherence Measure for Cognitive-behavioral Therapy for Child Anxiety. Psychological Assessment, 28(1), 70–80. Web.
Stokes, M., Schultz, P., Alpaslan, A. (2018). Narrating the journey of sustained recovery from substance use disorder. Substance Abuse Treatment, Prevention, and Policy, 13(1), 35. Web.
Westra, H. A., Constantino, M. J., & Antony, M. M. (2016). Integrating motivational interviewing with cognitive-behavioral therapy for severe generalized anxiety disorder: An allegiance-controlled randomized clinical trial. Journal of Consulting and Clinical Psychology, 88(9), 768-782. Web.
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