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Introduction
Gary’s life experiences, signs and symptoms and experiences are indicative of a generalized anxiety disorder (GAD). This is a type of anxiety disorder that is characterized by tension, nervousness and worrying. Gary’s fears are not associated with a particular issue or situation; that would be a phobia.
They are caused by a myriad of factors such as financial obligations, difficulties in business, his wife’s illness and his role as a provider. The level of anxiousness that he feels is less severe than a panic attack, but it still exceeds normal worrying thresholds. He feels that his physical, emotional, personal and professional state is in decline, and that is indicative of the seriousness of this psychological disorder. It appears that the anxiousness is undermining his job, social life and his activities.
The key symptoms that led to this diagnosis were analyzed under the five axes of the DSM IV criteria. In Axis 1, clinical disorders are normally given particular attention. There was no acute symptom that required treatment such as an episode, panic attack or a schizophrenic event.
Gary had not reported any such events so this axis does not apply in the case study. In fact, generalized anxiety disorder does not have features that are related to other Axis I disorders such as social phobia, post traumatic disorder and obsessive compulsive disorder. The DSM IV criteria (Section D) for GAD specifically state that a person experiencing anxiety and worry ought not to have these Axis I symptoms (APA, 2000).
Axis II focuses on personality, developmental and intellectual challenges. Gary has not stated that he has had any problem with his intellect. He is also beyond developmental issues. His personality type has not also been associated with the problems he is going through, or the symptoms he has reported.
According to the DSM IV diagnostic criteria (section F), the disturbances encountered by the patient should not be linked to a pervasive developmental, psychotic or mood disorder. Gary does not suffer from any of the latter personality and developmental disorders so he qualifies for GAD.
Axis III dwells on neurological or medical conditions that can affect the psychiatric problem. Gary does not have any medical condition. The case study contains no information about any neurological condition. Section F of the DSM IV criteria for GAD also specify that for a person to have generalized anxiety disorder, he or she must not have a general medical condition that leads to the psychological disturbances.
Axis IV is all about environmental and psychosocial problems that may disturb a particular individual in his or her life. In GAD, a person worries or gets anxious because of these stressors, and the anxiety needs to occur continuously for six months (Section of DSM IV criteria for GAD).
Gary has stated that his professional and personal life is a source of worry to him. First, the dwindling economy is affecting his financial well being as his returns and savings are reducing. His business is not doing so well because his clients rarely pay on time. It always requires high levels of reinvestment, and he is finding it difficult to pay for his employee’s premiums. Additionally, Gary’s family obligations are stressing him.
He is finding it difficult to maintain their middle income status in the current economic climate. Furthermore he took on his wife’s medical premiums and this is causing him to worry. He is also anxious about the situation in his marriage as a result of providing inadequately for his family. All these problems are psychosocial and environmental; they are causing him anxiety. Such problems are classic causes of GAD.
Axis V deals with the patient’s functioning level. Here, the patient is rated between 0 and 100. Currently Gary’s functioning is not at its optimum. However, he has also not been severely immobilized by the disorder. DSM IV criteria for generalized anxiety disorder (section E) states that a person needs to demonstrate a significant degree of impediment in the professional realm, social realm, or other area of functioning.
Gary meets this criterion as well because he reports that his emotional, professional, physical and personal states are in decline. His functioning in these areas has been undermined so he meets this quality. He has also stated that that state of decline has been characterized by weight gain, insomnia, fatigue, anxiety, moodiness, guilt and irritability.
The DSM criteria for GAD (section C) states that a person needs to demonstrate three or more of the following symptoms for six months: restlessness or being on edge, fatigue, concentration difficulties, irritability, sleep disturbance and muscle tension (APA, 2000). Gary already has four out of the six symptoms so he definitely qualifies as a person who is suffering from GAD. Section B of the same criteria states that the person must find it hard to control the worry and this is going on with Gary.
The treatment goals for Gary will be to cope with the high stress levels, combat anxiety, and to teach him how to relax. The client will deal with high stress levels by first talking about the problems and then replacing negative thought patterns with realistic ones; this will be through cognitive behavioral therapy (Gould et al., 1997).
In this case, Gary thinks that he has created his wife’s condition because she has been trying too hard to be a businesswoman and a mother. This is a negative thought pattern that can be challenged. As a therapist, I would undo this kind of thinking by telling him that his wife probably wants to work regardless of Gary’s support. Besides, he does not have the ability to cause his wife’s physical ailments as these are tied to other physiological conditions, so he should free himself from these worries.
Other things that can be challenged are his low perception of the business. He should not consider the current challenges as a dead end. Gary might want to think about certain cost reduction measures in his business to survive the economic downturn. He can give his own suggestions on how he can do this.
Relaxation skills will be taught to the subject in order to combat anxiety. He will be taught about breathing exercises and use of biofeedback (where he will see and listen to feedback from his body’s physiological state).
The skills involved in this process will be outlined and then practiced in the session with Gary. However, he will be expected to practice the relaxation techniques at home. Many experts agree that failure to do relaxation homework is the number one cause of failure of these techniques. He will be expected to practice that for twenty minutes every day.
Gary has several strengths; first, he is concerned about his family’s welfare. He wants to provide for them, and also wants to see that his wife is physically well. This is someone who willingly takes the blame for everything.
He honors his family obligations and does not want to see his wife suffering. In fact, anxiety is an indication that this person is someone who does not take his family or professional duties lightly; it only acts as a warning that those concerns have gone overboard.
Gary also cares about his own well being because he has come to look for help. He was also wise enough to notice that things are going wrong at an earlier stage. It would have been much harder to deal with his mental health if it had spiraled into a depression.
Gary has no personality issues that would further complicate treatment. The main focus will be to deal with each of the stressful factors rather than dealing with these personality or intellectual challenges. Gary is not in denial concerning the challenges that he is currently going through. He has accepted them and sought help. Problems would arise if the patient was angry about his disorder or if he was trying to resist it at all costs.
One of Gary’s shortcomings is that he does not know which situations are unhealthy. He needs to internalize how he deals with insecurities and fear (Tyler & Baldwin, 2006). When things go wrong, he tends to blame himself for those wrongs, and that is definitely harmful.
At the time when his wife fell ill, Gary started blaming himself for the situation. He does not have an effective social support system. Gary has not shared his problems with a close friend or relative, yet having a support system is vital in overcoming GAD. He is focusing so much on what could happen rather than what has actually happened. Instead of dealing with the present, he keeps worrying so much about the future.
It is almost as if he is always expecting the worst to happen. Gary has the capacity to continue functioning even when anxiousness steps in. He is currently slowing down when he feels anxious, yet one must try to function with the problem. Acting with the anxiety is vital in coping with it. Having a positive outlook is also essential. Gary seems to be expecting the worst whenever something different occurs. When the economy took a turn for the worst, he began talking about his inability maintain the middle-income lifestyle of his family.
His overemphasis on the what–ifs is preventing him from enjoying the fullness of life in the present. His sense of dread somehow tends to become a self – fulfilling prophecy. Aside from this, Gary is focusing too much on his job; he needs to work on his relationships as well. Having a healthy work-life balance is essential to dealing with a number of psychological disorders including this one (Wolitzy-Taylor et al., 2010).
He has not done much in terms of raising his children because he works for very long hours. This is what has led to the immense sense of guilt that he is struggling with currently. If he performs his duties as a father, then he will not have to blame his business for everything that has gone wrong.
As stated earlier, the treatment goals entail dealing with his high stress levels and coping with the anxiety. The first assignment that Gary must practice is relaxation. He will be taught a number of breathing and relaxation techniques in the sessions and must practice them at home. He will have to select a certain time of the day where he can do those breathing exercises and this will occur for twenty minutes. Not only will relaxation deal with the anxiety, but it will also relieve the stress.
It will cause him to focus on other things other than his problems and his mood will be elevated. His irritability will also reduce once he has taught himself how to relax even in the most strenuous circumstances (Wolitzy-Taylor et al., 2010). Gary will also be expected to do some research about delegation in his business.
He needs to consider hiring another colleague who can carry out some of his duties, so that he can have enough time to spend with his family. He needs to work on reengineering his business so that it can be just as profitable even without his excessive involvement in it. This would deal with the feelings of guilt about his wife’s illnesses and her workload as a mother and a working woman.
Since Gary rarely shares his challenges with a close friend or relative, he needs to identify one person that he can talk to about anything. Sometimes many GAD sufferers are stuck with their problems because they do not have a method of talking it out. He needs to think about someone who would give him an objective and balanced view on life even after the therapeutic sessions are over. This will ensure that his problems no longer seem as threatening as he is imagining them to be.
Some of the things that will be explored next are: Gary’s relationship with his wife, his professional goals, his conceptualization as a male figure in his family, and his attitude towards living a healthy lifestyle. Gary claims that there is a certain degree of tension in his marriage.
He feels that his wife must resent him for expecting her to do everything. He will need to talk about communication patters between the two of them. We should also explore what Gary expects of men (and himself) in families. He needs to talk about his goals as a father and husband, whether he is achieving them and what he can do to achieve them.
It will be essential for Gary to talk about his professional goals because he may need to evaluate how he can realize them as he continues to meet his obligations as a father and a husband. Additionally, maintenance of a healthy lifestyle is also helpful in coping with stress- induced disorders. We can explore what Gary thinks about changing his diet. He can be informed about the disadvantages of taking too much caffeine and sugar as these increase anxiety and cause sleeping disturbances.
Too much sugar intake leads to blood sugar spikes and crashes so that Gary is left feeling physically drained. Exercise can also be explored as a natural way of relieving GAD (Wolitzy-Taylor et al., 2010). It will assist in relieving tensions and stress through a process of releasing feel-good hormones and chemicals around the body. Gary may want to do some sort of aerobic activity that he enjoys for thirty minutes.
Conclusion
At the end of the sessions with Gary, he will need to remember that professional assistance cannot replace his ability to help himself. He needs to maintain the will to deal with his problems, and must work on them on a daily basis. This will ensure sustainable treatment of GAD.
References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorder. Washington DC: Psychiatric press
Gould, R., Tayp, L., Pollack, M. & Otto, M. (1997). Cognitive behavioral and pharmacological treatment of generalized anxiety disorder. Behavior Therapy, 28, 285-291
Tyler, P. & Baldwin, D. (2006). Generalized anxiety disorder. Lancet, 368(9553), 2156-2166
Wolitzy-Taylor, K., Castriotta, N., Lenze, E., Stanley, M. & Craske, M. (2010). Anxiety disorders in older adults: a comprehensive review. Depression Anxiety Journal, 27(2), 190-211
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