Category: Anxiety

Introduction

According to Harrison (2006 pp13), anxiety can be described as a feeling of uncertainty and fear without an apparent objective. He further explains that Anxiety ranges from moderate to severe reactions which may lead to continuous avoidance of the feared situation or object.

According to Landow (2006 pp 98), indicators of stress are emerging especially among college students. He further adds that, depression, anxiety disorders, and suicidal tendencies are evident with time (Landow, 2006, p. 98). Moreover, anxiety feelings are a universal human experience, which could be as a result of fight or flight (Harrison, 2006, pp11). Generally, anxiety can be viewed as a normal reaction to any kind of stress that one is going through.

According to Hudson (2009, pp 173), results of a study carried out on twins who had anxiety disorders indicated that, it is individual’s environment and shared environment that contribute to the anxiety disorder. Anxiety disorders can also be caused by both psychological and social factors. For instance, if in a family there is a history of an anxiety disorder, then there is a high possibility that children born from that family will develop the same disorder at some point in their life.

According to Veeraraghavan (2006 pp 6), there are several types of anxiety disorders; these include separation anxiety disorder, generalized anxiety disorder, panic disorder, obsessive–compulsive disorder, social phobia, specific phobia and post traumatic stress disorder. In this essay, the main emphasis is on the generalized anxiety disorder.

Generalized anxiety disorder

According to Veeraraghavan (2006 pp 10), generalized anxiety disorder is associated with unreasonable and irrational worries, which are difficult to control for the affected ones. This anxiety sometimes results to the inability for the children to perform work, lack of concentration, a feeling of restlessness and irritation and sometimes, the children feel physically exhausted. These may hence result to distress and functioning problems.

The generalized anxiety disorder (GAD) is also associated with non- specific persistence fear and worry, and may affect both children and adults. According to Veeraraghavan (2006 pp 7), GAD is diagnosed if one has had frequent worries for close to six months. Moreover, according to Bourne (2011 pp 19), generalized anxiety disorder is includes heredity, neurobiology and childhood experiences such as rejection and sometimes, parents modeling worry behavior contributes to GAD.

Some of the symptoms of this anxiety include difficulty in remembering important issues, pale skin on the outward look and sometimes, sweaty hands and feet. Sometimes, the affected person may be sentimental and always crying, which is a signal of depression. This anxiety is said to be free-floating, whereby a person has problems when it comes to controlling the anxiety.

This anxiety is at times accompanied by restlessness, tiredness, petulance, muscle tension, inability to sleep; indeed, GAD not only contributes to stress in someone, but also interferes with the normal functioning of a person. Moreover, GAD is reported to have a high degree of life interference due to the worry present in this disorder.

According to Rygh and Sanderson (2004, pp 5), “GAD is associated with heritability trait, such as anxiety, negative effects, behavioral inhibition and depression.” According to Bourne (2011 pp 18), mostly, GAD is associated with depression and can occur at any stage both in children and adolescents. In addition, the generalized anxiety disorder can be influenced by the surrounding environment since it’s the surrounding events that contribute to worries.

Mostly, the generalized anxiety disorder is associated with worry and anxiety. For instance, after watching news report on the Japan tsunami and earthquake, a normal person will automatically feel tensed and worried temporarily, but for a person with generalized anxiety disorder, he might not be able to sleep at night at all and he may continue worrying for some days continuously. Most of these people worry exaggeratedly over issues over and over again.

Therefore, there is a clear indication on the difference between normal worry and generalized anxiety disorder. However, generalized anxiety disorder patients can deal with the anxiety problem in a number of ways; first, they should be able to deal with worry in a productive way which may involve learning how to deal with worry. This can be achieved through postponing one’s worries, ignoring the weird thoughts on one’s mind, and being able to deal with and accept the uncertainties that come in ones life.

In order to be able to relax, GAD patients should involve themselves in activities such as exercises, meditation, and taking deep breaths once in a while, hence reducing the rate of stress or depression. According to Smith and Jaffe-Gill (2010), self-sooth is the most essential tool to deal with anxiety and worry. Some of their tips include; taking a walk to the park and breathing the fresh air, listening to music when you feel tense, lighting scented candles and smelling of fresh flowers, cooking a delicious meal for yourself, and getting a massage.

Theories associated with generalized anxiety disorder

The generalized anxiety disorder is mainly associated with worry, hence the worry avoidance theory tries to explore further on GAD. According to Heimberg (2004 pp 14), worry can be defined as a chain of thoughts and images, with negative effect and uncontrollable problems arising there from.

He further explains that, worry can serve as a means of avoidance to the negative aversive images. Therefore, the best remedy for worry is avoiding worries at all times. According to the author, the cognitive avoidance theory of worry is actually an avoidance response to danger. He explains that the world is a dangerous place and one may not be able to cope with what the future brings; thus, one must anticipate all the bad things that happen so as to avoid or prepare for them.

Worry can serve as a cognitive avoidance strategy in three ways; worry suppresses anxious arousal, worry functions as an attempt to prevent or prepare for the future and worry as a focus on events that distract from more pressing emotion concerns. People who have GAD should avoid uncomfortable emotions and stop living in multiple emotions. In conclusion, this theory indicates that worry is a negatively reinforced cognitive avoidance response.

According to Hudson (2010 pp 155), young children are also aware of their worries, and according to research, they even admit that it is difficult to control these worries. According to Portman (2009 pp 33), Barlow’s emotion theory focuses on the generalized anxiety. He further explains that “there is a synergy that takes place between a generalized biological vulnerability and generalized psychological vulnerability” (Portman, 2009).

The Barlow’s theory signifies that worry may be a process that is independent from anxiety (Rapee and Hudson, 2010). According to Barlow’s theory, generalized psychological vulnerability creates a neurotic temperament; but when the generalized biological factor that forms the genetic influence is added to the early experiences and vulnerability, it leads to GAD.

Treatment

According to Bourne (2011 pp 19), there are a number of treatments that one can refer to in order to curb the generalized anxiety behavior. Relation training involves deep breath relaxation techniques as an exercise. Secondly, the cognitive therapy involves identifying fearful worries and replacing them with realistic thinking.

This therapy helps one to understand that, worrying only increases the probability of odds of something negative happening. Thirdly, worry exposure includes strategies that would help one cope with the disturbing images or fears. Reducing worry behavior is another strategy that helps one reduce on a behavior that involves worry.

Problem solving is also another strategy that involves solving of that particular problem that one is worried about and also learning to accept the situations that one cannot change. Distraction involves diverting attention to some other activities apart from ones worries; this could include listening to music, gardening, cooking and swimming.

Lastly, there are medications such as Zoloft, luvox, and lexapro used and have been found effective in treating generalized anxiety disorder (Bourne, 2011 pp 19-20). Moreover, involving the family in the treatment of the anxiety disorders may yield to better outcomes. This is because the family members will be able to understand the disorder well enough in order to assist the affected person.

Conclusion

At any given time, it is normal for any human being to worry, but when ones worries become regular that they affect one’s normal routine, such that one cannot sleep, then, that is a problem. The generalized anxiety disorder is usually a combination of heredity, neurobiology and predisposing childhood experiences that include parental expectation, rejection and parent’s modeling worry behavior. Nevertheless, generalized anxiety disorder can be said to be any stressful situation that may contribute to fear (Edmund 2009 pp 34).

However, for every problem, there is a solution. Hence, GAD is a disorder that can be subsided through a number of ways such as treatment in form of medication or in form of therapy. GAD patients can also benefit from the acceptance of the anxiety, watching on one’s anxiety, functioning with the anxiety, and expecting the best if they continue accepting the functioning and watching the anxiety.

References

Bourne, E. (2011). The Anxiety and Phobia Workbook. Fifth Edition. CA: New harbinger publications.

Edmund, J. (2009). Anxiety & Phobia Workbook: Easy read Comfort. Fourth Edition. NY: ReadHowYouWant.com. Web.

Harrison, A. and Hart, C. (2006). Mental health care for nurses: applying mental health skills in the general hospital. Fifth Edition. NY: Wiley- Blackwell publishers.

Heimberg. R. (2004). Generalized anxiety disorder: advances in research and practice. NY: Guilford Press publishers.

Hudson, J. and Ellis, D. (2010). The Metacognitive Model of Generalized Anxiety Disorder in Children and Adolescents. NY: Springer science + business media publishers.

Landow, M. (2006). Stress and mental health of college students. NY: Nova publishers.

Portman, M. (2009). Generalized Anxiety Disorder Across the Lifespan: An Integrative Approach. NY: Springer publisher.

Rapee, R. and Hudson, L. Family and social environments in the etiology and maintenance of anxiety disorder. (Attached material).

Rygh, J. and Sanderson, W. (2004). Treating generalized anxiety disorder: evidence-based strategies, tools, and techniques. NY: Guilford press publishers.

Smith, M. and Jaffe-Gill, E. (2010). Generalized Anxiety Disorder (GAD). Web.

Veeraraghavan, V. (2006). Behaviour Problems in Children and Adolescents. Northern Book Centre publishers.

Introduction

Rene Descartes is one of the most outstanding philosophers who contributed to the development of philosophy. The foundations of the philosophy and methodology of Descartes lay in the disclosure and presentation of the particular basics and consequences. Descartes created his first outstanding work, Discourse on the Method and Meditations on First Philosophy, in which he analyzed the concept of “universal science” (Mathesis Universalis), which has its roots in the Aristotelian hypothesis of the main organon of knowledge (Descartes 20). Developing the methodology of cognition, Decartes strived to understand the incomprehensible truth about the world’s functioning. The unknown has always been terrifying for people’s minds. That is why philosophers strive to find the questions which potentially cannot be answered. Therefore, as was mentioned by Harry Frankfurt, philosophy is created through anxiety born of an understanding of the limitation of knowledge.

Descartes’ Method

The anxiety in philosophical views can be seen in many directions of modern society. The key aim of any philosophy is to define the processes of cognition functioning that are impossible to explain scientifically. The philosophy of Rene Descartes is one of the foundations of European rationalism. It is based on the search for irrefutable foundations for any knowledge. The philosopher sought to achieve absolute truth, reliable and logically unshakable. Descartes’s main focus was to develop the method of cognition through which humans comprehend the substance. The philosopher stated that “for to be possessed of a vigorous mind is not enough; the prime requisite is rightly to apply it” (Descartes 48). The problem of the method of Descartes’ philosophy was to bring the potency of the mind to the perception of the basis of any phenomenon in the world, in order to perceive the apparent truths. The philosopher called the ability of the mind to perceive the basis of something in its evident simplicity “intellectual intuition” (Descartes 65). According to the philosopher, everything can be questioned in search of absolute truth.

The only undeniable fact is human thinking and desire to understand the substance of things. The presence of thinking convinces people of their existence. Descartes expressed this belief in the famous aphorism “I think, therefore I am” (23). This truth was irrefutable and, therefore, is the first point on which the worldview of Descartes was built. In his opinion, humanity has no other criterion of clarity, and all philosophical positions should be built on it.

Descartes also discussed the existence of God in his philosophical positions. From the philosophers’ point of view, people recognize themselves as imperfect only in comparison with the all-perfect being (Descartes 75). Such an understanding could only be implanted in the minds of the people by God. This means that the idea of “God as a perfect existence is already proof of being” (Descartes 88). Considering God as a universal basis, the philosopher showed that there are concepts that people’s cognition cannot comprehend. In other words, there always should be the presence of some inevitable force which is the starting point of knowledge. Such an approach helps to overcome the fear of unknown and related to it anxiety and existential depression. Thus, the anxiety and inability to comprehend and interpret many notions of creation and existence empowered Descartes’s philosophical exploration.

Plato and Aristotle Philosophy

The anxiety and existential depression in philosophy is a moving engine of progress. For example, in Plato’s philosophy, the only way to avoid anxiety and understand cognition is through Beauty. Plato, in his writings, focused on Beauty and the importance of its search in the surrounding world and within oneself (Leigh 48). Contemplating and accepting physical beauty, the Soul is able to turn to the beauty of art and science. Having overcome this frontier, the Soul moves on to a positive assessment of good morals, helping to climb the “golden ladder” to the world of Higher ideas.

Another example is the philosophical approach of Aristotle analyzing the nature of cognition. According to the philosopher, the Soul distinguishes the existence of matter “spending a lot of time in mistakes to achieve something reliable in all respects about the soul is certainly the most difficult thing” (Leigh 89). Thus, the Soul suffers a lot before understanding the essence of being. In order to avoid these sufferings, related anxiety, and existential depression, the Soul should implement the forms of truly scientific knowledge. These are the concepts that define the nature of things through rational thinking. In other words, logic is the key element preserving people from continuous suffering.

Conclusion

The analysis of the major argument presented by Descartes, and other philosophers, supports Frankfurt’s idea that modern philosophy is born out of anxiety. Therefore, the beginning of philosophy is not a surprise but anxiety. Despair and fear provoke human thought to acquire new forces, leading to new sources of truth. Striving to avoid anxiety, people continue to think. The desire to find the answer to existential concepts leads people to philosophical discussions. As was mentioned earlier, many philosophers’ theories were created in attempts to explain the incomprehensible from the physical perspective notions. Being afraid of the unknown, people long to find the truths which can eliminate their anxiety. This is the reason why there are so many different philosophical theories. Even though philosophers’ profound experiences and developments exist, people probably will never be able to avoid the anxiety caused by the fear of unknown.

Works Cited

Leigh, Fiona. Themes in Plato, Aristotle, and Hellenistic Philosophy. Institute of Classical Studies Publishing, 2021.

Descartes, Rene. Discourse on Method and Meditations on First Philosophy. Translated by Donald Cress, Hackett Publishing Company, 1998.

Definition of the major DSM IV-TR categories of anxiety, somatoform, and dissociate disorders

The DSM IV-TR categorizes anxiety into post-traumatic stress disorder, acute stress disorder, obsessive-compulsive disorder, phobias, panic disorder and generalized anxiety disorder. According to Hansell & Damour, 2008, p.115), anxiety disorders arise when an individual encounters unpleasant emotions characteristic of sense of danger, and physiological arousal.

Somatoform disorders include hypochondriasis, pain disorder, body dysmorphic disorder, and somatization. These disorders focus on complaints without physical reason, or legitimate and unintended symptoms (Hansell & Damour, 2008, p. 233).

The DSM categories of dissociative disorders are dissociative fugue, dissociative amnesia, dissociative identity disorder, and depersonalization disorder (Feinstein, 2011, p. 916. The classification of dissociative disorders under the DSM eliminates chances of misdiagnosis of the disorder with other categories such as schizophrenia and borderline personality (Mayou et al., 2005, p.853).

Examination of the various classifications of anxiety, somatoform, and dissociative disorders

Individuals suffering from anxiety, somatoform, and dissociate disorders experience fatigue, weakness, pain, and medical symptoms (Feinstein, 2011, p.917). The impact of these mental disorders varies from minor disturbance in the life of an individual to major problems in the daily activities of the person. Generalized anxiety disorder is chronic and persists for a long period. People who suffer from generalized anxiety disorder lack control over their anxiety. In most cases, muscle tension, fatigue, and restlessness appear.

Obsessive-compulsive disorder causes overwhelming persistence of some habitual behavior (Hansell & Damour, 2008, p.205). The most common anxiety disorder is acute stress disorder. Symptoms of acute stress disorder may arise from a natural disaster, or a sudden loss of a loved one or employment. Phobias involve persistent unreasonable fear. Acute stress disorders and post-traumatic stress disorders concern various anxiety symptoms happening in traumatic events.

Individuals suffering from somatoform experience gastrointestinal, pseudoneurological, and sexual symptoms with no physiological factors (Mayou et al., 2005, p. 799; Hansell & Damour, 2008, p.205). Pain disorders involve physical pain without any physiological cause. Hypochondriacs have tendencies of believing that they have a serious disease. The DSM created the category of somatoform disorders to cover conditions displaced by the changing classification (Feinstein, 2011, p.916).

People experience dissociative fugue when they start to wander in confusion. They lack the ability to recall their own identity or recognize their surroundings or their own family (Mayou et al., 2005, p. 813). Depersonalization disorder causes observable distress. The symptom of dissociative amnesia is an inability to remember personal information, particularly of stressful nature. Dissociative identity disorder involves at least two personality states that control the person’s behavior.

Summary of the biological, emotional, cognitive, and behavioral components of anxiety, somatoform, and dissociative disorders.

The biological aspects of anxiety disorders include the role of genetic factors, autoimmune processes, neurotransmitters, the limbic system, and the automatic nervous system (Hansell & Damour, 2008, p.142). Behavioral components include operant conditioning, classical conditioning, and modeling. The cognitive component involves negative distorted thoughts. Emotionally, people with anxiety disorders have tendencies of withdrawal. They experience emotional numbness or disengagement.

The biological components of somatoform and dissociation disorders are depression and anxiety. Hence, the same systems in the body form the focus of treatment. Emotionally, people suffering from somatoform and dissociation disorders repress their feelings on grounds that they are intolerable. The cognitive component of somatoform and dissociation disorders is the destructive interpretation of physical symptoms (Hansell & Damour, 2008, p.242). The behavioral components include reinforcements and social learning.

Brief overview of Mary’s post-traumatic stress disorder

Mary, a 37-year-old woman with three children enrolled for business classes at a neighboring college after her youngest child joined preschool. At a certain point, a stranger attacked Mary and raped her. Following the ordeal, Mary underwent medical treatment. She also reported the matter to the police. Fortunately, she came across the photograph of her assailant and the police arrested and jailed him immediately.

Although Mary’s assailant received a long jail term, Mary failed to recover emotionally. She experienced nightmares for months, in which a faceless man was pursuing her.

Mary never discussed the rape with anyone, not even her family or friends. She stopped attending her business classes due to lack of interest in the studies and the fear of going back to the place where a stranger raped her. Mary continued feeling nervous and edgy, even in her own home. Mary’s persistent fear and disturbances worried her husband so much that he advised her to seek therapy (Hansell & Damour, 2008, p.150).

Analysis of the biological, emotional, cognitive, and behavioral components of the disorder from the selected case

The emotional component of Mary’s case is her loss of enthusiasm in the business classes. She also experienced withdrawal as she evaded discussing the rape ordeal with her friends and family. Mary’s effort to avoid thinking and feeling about the rape resulted in general feelings of emotional disengagement or numbness. The biological component is the automatic nervous system. Mary found it difficult to get over the ordeal because it affected her nervous system.

The more she thought about it, the more she got nervous and edgy. The cognitive perspective (Hansell & Damour, 2008, p.242) relates to Mary’s persistent nightmares that a faceless man was pursuing her. She anticipated a similar ordeal in the future, despite her assailant having been put behind bars. The behavioral component relates to Mary’s avoidance of the business classes. The operant conditioning of her behavior is avoidance and escape. She refused to go back to college because of fear of experiencing rape again.

References

Feinstein, A. (2011). Conversion disorder: advances in our understanding. Canadian Medical Association Journal, 183(8), 915-20.

Hansell, J. & Damour, L. (2008). Abnormal Psychology (2^nd ed.). Hoboken, NJ: Wiley.

Mayou, R., Kirmayer, L. J., Simon, G., Kroenke, K., & Sharpe, M. (2005). Somatoform disorders: time for a new approach in DSM-V. American Journal of Psychiatry, 162(5), 847-855.

Introduction

I referred a number of patients for specialized assistance and care during my practicum setting. One of these patients was an African American female with severe anxiety disorder. The patient was aged 18 years. My patient seemed to worry constantly. She was unable to cope with different situations. She also felt embarrassed and uneasy. The mental position of the patient explains why it was necessary to refer the patient to a psychiatrist (Bleakley & Davies, 2014). The strategy would make it easier for her to get the best psychological assistance.

Epidemiology and Diagnosis

Severe anxiety disorder is a common condition characterized by anxiety and depression. Phobia is also associated with many people with this disorder. People between 25 and 45 years record the highest rate of anxiety disorders. However, any person can be affected by this disorder. This information was therefore useful throughout my practicum setting. A physical exam was administered in order to diagnose the condition affecting the patient (Bandelow et al., 2012). I asked several questions in order to ascertain the patient’s medical history. The physical exam also outlined the major symptoms, attitudes, and behaviors portrayed by the patient. The level of dysfunction showed clearly that the patient was suffering from an anxiety disorder. It was appropriate to refer him to a professional. The patient followed my recommendations in order to get the best medical assistance.

Treatment and Management

Psychological disorders should be carefully monitored and managed. Anxiety disorders should be treated using several approaches. Drugs should be used to reduce some of the symptoms associated with the condition. The second approach should focus on the power of psychotherapy (Kosteniuk, Morgan, & D’Arcy, 2012). This kind of counseling makes it easier for patients to deal with various disorders. Mental health practitioners and psychiatrists should therefore use effective strategies in order to support the needs of their patients.

Fostering Effective Communication

Professional partners providing specialized care and assistance to the targeted patients should use appropriate strategies to foster communication. The first strategy focuses on the best communication practices that can deliver quality care. The strategy encourages different partners to work together in order to get the best health outcomes. Professionals should also embrace the best competencies in order to communicate effectively. The second strategy that can deliver the best results is known as collaborative communication (Cowden, 2012). This kind of communication encourages individuals to partner and engage their patients. The partners should focus on the best practices in order to get the best patients outcomes. These two strategies also support the power of patient engagement.

Follow-up Care

It was also appropriate to provide outpatient follow-up care to the targeted patient. Family members should also “be equipped with appropriate communication skills in order to address the needs of the patient” (Baldwin et al., 2015, p. 29). Follow-ups should be conducted frequently in order to monitor the success of the patient. The patient was also advised to collaborate with the psychiatrist. The follow-up approach would have made it easier for her to cope with the disorder.

Conclusion

This discussion explains why patients should get the appropriate medical support depending on the targeted condition. A proper diagnosis of the condition should be done in order to recommend the best management practices. Professional partners providing specialized healthcare should embrace the best communication strategies in order to support the needs of their patients (Katzman et al., 2014). The patient was able to get the best assistance from her psychiatrist. Psychiatrists should therefore consider the above aspects whenever dealing with various mental disorders.

Reference List

Baldwin, D., Anderson, I., Nutt, D., Allgulander, C., Bandelow, B., Boer, J.,…Wittchen, H. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 1(1), 1-37. Web.

Bandelow, B., Sher, L., Bunevicius, R., Hollander, E., Kasper, S., Zohar, J.,…Moller, N. (2012). Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. International Journal of Psychiatry in Clinical Practice, 16(1), 77-84. Web.

Bleakley, S., & Davies, S. (2014). The pharmacological management of anxiety disorders. Progress in Neurology and Psychiatry, 18(6), 27-32. Web.

Cowden, P. (2012). Communication and Conflict: Anxiety and Learning. Research in Higher Education Journal, 1(1), 1-9. Web.

Katz, C., Stein, M., & Sareen, J. (2013). Mood and Anxiety Disorders Rounds. CANMAT, 2(3), 1-6. Web.

Katzman, M., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., & Ameringen, M. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14(1), 1-83. Web.

Kosteniuk, J., Morgan, D., & D’Arcy, C. (2012). Treatment and Follow-up of Anxiety and Depression in Clinical-Scenario Patients. Canadian Family Physician, 58(3), 152-158. Web.

Anxiety disorders are mental problems characterized by abnormally high levels of anxiety, which leads to negative outcomes in the life of the afflicted person. While anxiety is a natural human experience, anxiety in persons suffering from these disorders occur frequently and over prolonged periods.

Anxiety disorders include “Generalized Anxiety Disorder (GAD), Panic Disorder (PD), social anxiety disorder (SAD), Post Traumatic Stress Disorder (PTSD), and Obsessive Compulsive Disorder (OCD)” (Bandelow 78). Several similarities and differences exist among these disorders.

Similarity among the disorders is that they all negatively affect the lives of the patients. The people suffering from these disorders may be unable to carry out normal activities. Patients of SAD will avoid interactions with other people and employ tactics to avoid social performances (Lochner 377). This will negatively affect the social and professional life of the person. Individuals with PD will avoid taking part in everyday activities such as going to for shopping out of fear that a panic attack will occur.

GAD results in intolerance to everyday uncertainties in life since the person finds indefinite situations stressful. OCD causes the person to avoid certain activities out of irrational thought. The individual might avoid carrying out responsibilities assigned to them at work or school due to their disorder. Individuals with PTSD may find it hard to form or maintain close relationships due to the emotional numbness or anger and aggression caused by the condition (Dyer 1100).

There are differences in the causes of various disorders. SAD and PD are often caused by traumatic experiences faced during the individual’s childhood years. Lochner explains that physical and emotional abuses suffered in the early years by the individual are predictive to the development of these two anxiety disorders (377).

PTSD is caused by past exposure to shocking or traumatizing events, for example, devastating accidents, brutal crimes, or life-threatening incidents. On the other hand, GAD is mostly caused by stressful life events being experienced by the person. Research suggests that OCD might have a genetic link since most OCD patients have family members with the same condition.

The various anxiety disorders differ in their symptoms and physical manifestation. GAD is characterized by the chronic worry that might lead to stress and mild headaches. Symptoms of panic disorder include excessive fear, and a person can experience dizziness and chest pains.

SAD can be characterized by excessive blushing, shaking, and confusion. Signs of PTSD might include tense feelings, trouble sleeping, and emotional numbness (Dyer 1102). OCD is characterized by the presence of obsessive thoughts that might be benign or malignant. Tortora and Zohar explain that persistent thoughts can lead to extreme behavior by the individual (23).

The various anxiety disorders are similar in that they can all be cured or mitigated through professional help. Bandelow reveals that the most common form of treatment for anxiety disorders is prescription medication (78). Anti-anxiety medication and antidepressants can be used to cure or alleviate the effects of these disorders and enable the patient to enjoy a normal life.

Psychotherapy can also be used to help identify the causes or triggers of the disorders (Bandelow 80). From this information, the psychiatrist can help the individual adopt means to deal with the disorder. Through the various treatment options, the disabling impacts of anxiety disorders can be overcome, allowing the person to enjoy an improved quality of life.

Works Cited

Bandelow, Borwin. “Guidelines for the pharmacological treatment of anxiety disorders, obsessive – compulsive disorder and posttraumatic stress disorder in primary care.” International Journal of Psychiatry in Clinical Practice 16.2(2012): 77–84. Print.

Dyer, Kevin. “Anger, aggression, and self-harm in PTSD and complex PTSD.” Journal of Clinical Psychology, 65.10 (2009): 1099-1114. Web. 2 Dec. 2014.

Lochner, Christine. “Childhood trauma in adults with social anxiety disorder and panic disorder: a cross-national study.” Afr J Psychiatry 13.1 (2010): 376-381. Web. 2 Dec. 2014.

Tortora, Pato and Joseph Zohar, Current Treatments of Obsessive-Compulsive Disorder. NY: American Psychiatric Pub, 2008. Print.

Description of the Study

The article “Understanding Problematic Drinking and Social Anxiety among College Students” describes the impact of social anxiety disorder on the experiences of many students. Statistics indicate that 25 percent of learners in colleges encounter numerous academic problems due to increased levels of alcoholism (Hunley, 2016). Past studies have not explained how the problem of social anxiety can be addressed in colleges. The study was aimed at examining how social anxiety affected students’ motivation or desire to consume alcohol. This knowledge could be used by researchers to come up with evidence-based interventions to support the needs of many students with social anxiety disorder.

Hypothesis

The article does not have a defined hypothesis. However, the researcher begins the article by indicating that post-event processing dictates the nature of “drinking behaviors in individuals with social anxiety disorders” (Hunley, 2016, para. 5). The study also wanted to understand the relationship between increased levels of post-event processes and problematic alcohol intake.

Study Method

The author of the article used a qualitative approach to review past studies completed by “a group of researchers at the Adult Anxiety Clinic of Temple University” (Hunley, 2016, para. 6). Led by Carrie Potter, the researchers used a correlation analysis to determine the relationship between post-event processing and problematic drinking especially in individuals suffering from social anxiety disorder (Hunley, 2016). The researchers used two groups to complete the study. The first group was comprised of individuals high in social anxiety. The second one targeted students low in social anxiety (Hunley, 2016). The participants were guided to interact with a student they had never met before. This exercise was followed by tasks that either inhibited or promoted post-event processing.

Results

The completed study showed conclusively that promotion of post-event processing after the completed social task encouraged the students to drink. Individuals suffering from social anxiety disorder were affected the most. The event appeared to produce long-lasting impacts on the students’ desire to take alcohol. Students who engaged in an inhibiting exercise did not portray similar signs. The inhibition task distracted the students from ruminating about the encountered past social experience (Hunley, 2016).

Interesting Points

The selected article presents interesting points that can be used to support the experiences of many students with social anxiety disorder. The first issue is to acknowledge that social anxiety disorder is a serious condition that should not be ignored. The article goes further to indicate that post-event processing dictates the connection between problematical drinking and social anxiety (Hunley, 2016). Activities aimed at inhibiting such post-event processing experiences can decrease an individual’s desire to take alcohol. The other interesting point is that the author has encouraged future scholars to analyze how different actions aimed at inhibiting post-event processing can deliver long-term results.

Agreeing with the Findings

The findings presented in this article are agreeable. This is the case because the researchers used an effective method to conduct the research study. It is also agreeable that actions that encourage post-event processing can increase a person’s urge to engage in unpleasant behaviors such as drinking alcohol. This is the case for individuals with social anxiety disorder. Tasks aimed at inhibiting post-event processing have the potential to decrease a patient’s urge to cope with alcohol. The other agreeable finding from the article is that high anxiety patients might have long-lasting impacts on the motivation to take alcohol (Schry & White, 2013). Psychiatrists can use the presented findings to provide sustainable support to more students distressed by social anxiety disorder.

References

Hunley, S. (2016). Understanding problematic drinking and social anxiety among college students. Web.

Schry, A., & White, S. (2013). Understanding the relationship between social anxiety and alcohol use in college students: A meta-analysis. Addictive Behaviors, 38(1), 2690-2706. Web.

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.

Negative emotions constitute an intrinsic part of each person’s life, and it is valid to say that every single individual has bad moods and feels anxious time after time. In a healthy mental state, negative feelings and emotions, as well as fears and psychological tensions, shortly become replaced with the neutral and positive ones. Nevertheless, when anxiety persists for a significant time, it may indicate the development of an anxiety disorder.

According to Bystritsky et al., anxiety disorders are usually less visible than many other mental disorders such as schizophrenia, yet they may have a similarly substantial adverse effect on one’s life and functionality (30). They are also among the most prevalent psychological conditions and are present in nearly 13% of the US people (Bystritsky et al. 30). There are different types of anxiety disorders identified in the literature, including phobias and panic disorders.

As Grison et al. note, all of them are associated with such a symptom as “excessive fear in the absence of true danger” (505). However, compared to phobias, which are usually characterized by fear of a particular thing, generalized anxiety disorder (GAD) is manifested in continual anxiety not related to anything in particular.

Bandelow et al. state that fears and overexaggerated dangers perceived and experienced by people with GAD can extend to almost every sphere of life including “health, family relationships, and their occupational or financial situation (or that of persons close to them)” (300). Additionally, Goodwin et al. note that GAD is associated with attentional biases to threat stimuli (107). It means that compared to healthy individuals, people with this disorder are constantly on alert because their attention to plausible and minor dangers is captured automatically.

Since such a condition is unnatural and exposes the human body to a high level of stress, it may lead to multiple physical symptoms. For instance, according to Grison et al., the anxiety-related chronic arousal of the nervous system can provoke hypertension, fatigue, headaches, muscle pains, restlessness, intestinal problems, lightheadedness, and sleep problems (506-507). All of these physiological signs can be used by healthcare practitioners to diagnose GAD.

As for the causes of GAD development, there is no clear evidence regarding this issue in the literature. The major etiological factors accepted by researchers are “traumatic life experiences, faulty conditioning, genetic influences, and neurobiological dysfunction” (Bandelow et al. 300).

Moreover, Newman et al. state that the given mental disorder may occur as a result of insecure attachment in childhood, parental loss, and separation (96). Along with physical symptoms, the subjective patient data derived from family and personal history can help differentiate GAD from other disorders. It is important to note these data considering that many patients with GAD have various psychological comorbidities including depression, fibromyalgia, post-traumatic stress disorder, panic disorder, and others (Goodwin et al. 94).

Additionally, it is worth noticing that since the causality of GAD is more likely multifactorial in nature, the disorder must be addressed through complex and comprehensive interventions. For example, Locke et al. suggest that the combination of medication and physiotherapy is particularly effective in cases of moderate and severe GAD (620). Moreover, patient education, lifestyle counseling, as well as the development of meaningful, trustful, and compassionate relationships with individuals who have GAD can largely contribute to the improvement of their condition.

Overall, GAD can substantially disrupt important activities in the individual’s daily life. For this reason, it is essential to understand the disorder well and diagnose it correctly. GAD diagnosis requires a wide differential and accuracy to detect contributing factors and comorbidities. At the same time, right identification of GAD is key to the prescription of effective therapy.

Works Cited

Bandelow, Borwin et al. “The Diagnosis and Treatment of Generalized Anxiety Disorder.” Deutsches Ärzteblatt International, vol. 110, no. 17, 2013, pp. 300–310.

Bystritsky, Alexander et al. “Current Diagnosis and Treatment of Anxiety Disorders.” Pharmacy and Therapeutics, vol. 38, no. 1, 2013, pp. 30–57.

Goodwin, Huw, et al. “Generalized Anxiety Disorder, Worry and Attention to Threat: A Systematic Review.” Clinical Psychology Review, vol. 54, 2017, pp. 107–122.

Grison, Sarah, et al. Psychology in Your Life. 2nd ed., W. W. Norton & Company, 2016.

Locke, Amy B., et al. “Diagnosis and Management of Generalized Anxiety Disorder and Panic Disorder in Adults. ” American Family Physician, vol. 91, no. 9, 2015, pp. 617−624.

Newman, Michelle G., et al. “Developmental Risk Factors in Generalized Anxiety Disorder and Panic Disorder.” Journal of Affective Disorders, vol. 206, 2016, pp. 94–102.

In today’s fast-paced world, high-pressure jobs, demanding households and unbalanced lifestyles can put a great deal of mental strain on the average human being. This, coupled with several other factors, can lead to various abnormal phobias, panic attacks, and other mental conditions categorized as anxiety disorders. While they are often considered trivial and are ignored, they can be seriously incapacitating and damaging to not only the victim’s life but also to others around him or her. Hence medical attention and therapy are required for those suffering from such disorders to continue leading normal lives.

The symptoms of anxiety disorders are so commonly experienced and non-threatening that one is prompted to underestimate the occurrence of such disorders and therefore assume them to be just a minor stress-related anomaly. The causes of such disorders are just as varied and commonly found in our everyday lives. Theoretically, hypersensitive brain receptors react abnormally to normal stimuli. Different regions of the brain such as the amygdala, hypothalamus, and brainstem are thought to house ‘fear areas’ that suffer from aberrant electrical/metabolic activity resulting in anxiety attacks. Low levels of GABA (Gamma Amino-Butyric Acid), a neurotransmitter that is responsible for suppressing the central nervous system is one ‘internal’ cause of anxiety. Alcohol, caffeine, and drug abuse are the biggest ‘external’ contributors to such disorders. Benzodiazepines are specifically known to be responsible for causing or aggravating panic attacks. Ironically, alcohol might be taken by the victim to relieve minor stress, which ends up prolonging and worsening the existing condition. Other chemical causes include stimulant drugs and possibly prolonged exposure to organic solvents, varnishes, and paints.

The term ‘anxiety disorder’ covers several different forms of mental disorders, all of which have the following in common: they all involve some form of irrational fear or anxiety. In this regard, they can be differentiated from other forms of mental disorders such as psychosis. Perhaps the most well-known form of anxiety disorder is phobias. A phobia is an unreasonable and extreme fear of a specific stimulus. Examples include fear of heights, confined spaces, blood, spiders, etc. Exposure to stimuli provokes an exaggerated anxiety response, and the patient either avoids the situation or endures it with great difficulty.

One form of anxiety disorder is known as Acute Stress Disorder (ASD). Patients are said to be suffering from ASD if they have had some kind of traumatic experience (which could be witnessing someone’s death, suffering from an injury, or any kind of experience during which one’s physical integrity was threatened) following which they exhibit three or more of the following symptoms – a ‘numbing’ of the senses, emotions, and responsiveness, being in a daze or confusion regarding one’s surroundings, derealization, depersonalization and dissociative amnesia (being unable to recall an important part of the traumatic incident). The patient regularly experiences flashbacks, dreams, and other forms of mental reminders of the incident, and intentionally avoids any stimuli which may relive memories of the incident. Several of the typical symptoms of stress, such as irritability, difficulty sleeping, and exaggerated startle response are seen in the patient. The onset of symptoms lasts from 2 days to 4 weeks and occurs within 4 weeks of the incident. Post-traumatic Stress Disorder (PTSD) is similar to ASD but is different in that the symptoms last for over four weeks. If the symptoms last for less than 3 months then the condition is acute, otherwise, it is chronic. The symptoms can be delayed for as much as 6 months after the traumatic incident.

Panic attacks are an important form of anxiety attacks. According to the Diagnostic and Statistical Manual of Mental Disorders, developing any four of the following symptoms, in less than 10 minutes and quite abruptly, together with worrying over these attacks and their consequences persistently (for over a month) is suggestive of panic disorder. The symptoms are palpitations or accelerated heart rate, sweating, trembling or shaking, shortness of breath or smothering/choking, chest pain, nausea or abdominal distress, feeling dizzy, unsteady, lightheaded, or faint, derealization or depersonalization (feeling detached from oneself), fear of losing control or going crazy, fear of dying, numbness or tingling sensations and chills or hot flashes. Panic attacks often accompany but are different from agoraphobia, or ‘fear of open spaces. This kind of phobia is characterized by the avoidance of any place outside one’s home or ‘safe zone’.

Generalized anxiety disorder comprises typical anxiety symptoms, along with other symptoms such as insomnia, fatigue, irritability, poor concentration, and hypertension. The patient finds controlling the worries to be difficult and finds himself or herself worrying about almost everything in his or her life – school or workplace, finances, and deadlines to name a few. The onset lasts from a few days to about 6 months.

Another major form is Obsessive-Compulsive Disorder (OCD). Such a disorder causes one to experience temporary obsessions or repeated thoughts about usually inappropriate things and/or feel a strong urge to carry out a certain action or ritual. Usually, the patient is completely aware that the obsession or compulsion is a product of his or her own mind, attempts to ignore or neutralize the obsession or compulsion by other thoughts or actions, and even feels that the actions and thoughts brought upon by such a disorder are excessive or unreasonable. However, children seem to be exempt from such control over the disorder. The actions or obsessions are distressing to the patient and time-consuming – usually take about an hour a day.

All of the aforementioned anxiety disorders do not occur due to the use of drugs or an existing medical condition. What differentiates them from a simple bout of anxiety or a minor, temporary obsession or fear is that they make the patient’s life very difficult, embarrassing, and miserable – in all its social, marital, professional, and personal aspects.

Chief Complaint

M. is a 22-year-old African American male patient, who has developed bipolar disorder and GAD. The patient complained about frequent mood swings and increased inattention and excessive worrying, as well as increased muscle tension.

Past Psychiatric History

The patient used to have mild depression caused by bullying at school. However, after several months of therapy, the problem disappeared. Since then, the patient has not expressed major concerns about his psychological health.

Substance Use History

The patient smokes about 0.5 packs of cigarettes per day, which he admits to being a bad habit. M. started smoking at the age of 18, yet his use of it has varied depending on his mood swings and stress factors.

Past Medical History

M. has experienced hypertension caused by stress.

Family History

The patient does not communicate with his family members often, although there are no conflicts between them.

Past Surgical History

M. has not undergone any surgeries.

Social and Environmental History

M. is currently studying for a Bachelor’s degree in Aviation. The patient has been in relationships for two years, yet he prefers to live separately from his partner in a 1-room apartment. M. does not have any legal issues. The patient seems to be dependent on social media since he checks his status regularly and is easily distracted from other activities due to the unceasing monitoring of social media activities. Furthermore, the patient should restore his connection to his family members since the specified issue contributes to the problem significantly.

Developmental History

During the first crisis according to Eriksson’s theory, the patient has experienced abandonment from his parents resulting in mistrust. The specified issue has shaped the patient’s further life, causing him to develop anxiety out of fear of being abandoned.

Trauma History

The patient denies having had any physical traumas in the past.

Allergies

The patient is allergic to peanuts, which makes him check his food for possible allergens regularly.

Review of System

General: No fever observed

HEENT: Nasal issues, chest pain, or respiratory issue shave been noticed

CV: No edema, chest pain, or murmur

GI: Neither diarrhea nor constipation has been detected

GU: Neither frequency nor urgency has been noticed

Skin: No rash or abscess has been observed

Hematology: No bleeding or bruises noticed

Endocrine: no issues concerning intolerance toward heat or cold noticed

Neurologic: no weakness or headache noticed

Immunologic: the patient is allergic to peanuts; no asthma or asthma-related issues

Musculoskeletal: No pain in joints or back

Psychiatric: anxiety and depression as the key signs of GAD and bipolar disorder observed.

Risk Assessment

M. does not display any traces of suicidal ideations or hallucinations.

Mental Status Exam

The patient has proper time-space orientation, yet his speech is slightly quickened.

Screening Tool

Using the Mood Disorder Questionnaire; M. has answered: “Yes” to 11 items in question #1, answering “Yes” to question #2, and responding “Serious” to question #3.

Differential Diagnosis

Bipolar I disorder, moderate, current episode: depressed 296.42;

Generalized Anxiety Disorder 300.02 (F41.1) ).

DSM-5 Diagnosis

Bipolar I disorder, mild, current episode: depressed 296.51 (F3131);

Generalized Anxiety Disorder 300.02 (F41.1).

Medications

Selective Serotonin Reuptake Inhibitors (SSRIs);

Tricyclic Antidepressants (TCAs) (Amitriptyline and Amoxapine);

Side effects destabilization of mood

Vitals

Height: 72 inches, Weight: 168lbs, Blood Pressure: 117/82, Heart rate: 75, Respiration: 15.

Medical Problem

The patient also experiences high-pressure levels. The specified concern is likely to shape the further treatment process to avoid possible side effects.

Interventions: Plan

Both medication-based treatment and cognitive behavior therapy (CBT) is recommended to reduce stress. A drop in anxiety levels is expected as the primary outcome following the specified intervention. Therapies to be used include cognitive-behavioral, interpersonal, and relaxation ones. The described combination will help to reduce the threat of a manic episode, at the same time relieving M. of the stress that he is constantly experiencing.

Outcome

It is believed that the proposed intervention will have a positive impact on M.’s well-being. By considering the connection between anxiety disorder and bipolar disorder together with the effect that each has on the other, one will be able to avoid the further deterioration of the patient’s state. Moreover, the tools for assisting M. in controlling his behavior can be provided. As a result, there are reasons to believe that the treatment will produce a positive outcome.

Questions About the Case

The connection between bipolar disorder and anxiety disorder will have to be studied. Moreover, one will have to determine whether the use of SSRIs as the means of managing both disorders simultaneously is warranted. Finally, the strategies for avoiding side effects caused by the selected treatment tools will have to be offered.

Reasons for Choosing the Case

The need to observe a scenario involving a combination of bipolar and generalized anxiety disorders (GADs) is the key reason for considering the case. Since each of the disorders requires a unique treatment approach, one needs to explore each problem individually. However, to create a solution, the disorders have to be addressed simultaneously, thus, the case provides a unique conflict.