Student CaseName / #: Joanne
Problem identification & definition:
Joanne,a 64-year-old female, was referredto our clinic by herpastor who was worried about her health. Six weeks before herreferral, her partner, Anne, had died due to unexpected heartfailure. The couple had lived together fora period of 31 years.Joanne complains that she has problems “moving on” with her lifeand taking care of “basic things.” She has also not resumed herpart-time job at the local library and avoids contact with closefamily and friends. Although she has two sons, she claims that shedoes not want to burden them with her troubles. Also, she has beenavoiding the paperwork and legal responsibilities resulting from thedemise of her partner.
Inaddition to the above, Joanne has also been complaining that shefeels guilty of not appreciating Anne enough during the time the twowere in a relationship. As a result, she feels “lost” and without“purpose” in life. Shespends much time thinking abouthow she should have lived her life. Although she was very active inthe past – she was a hiker and a golfer – recent months have seenher transition toa sedentary type oflifestyle: shewakes up late, movesaround her house, and sleeps in the afternoon. Her diet is also poor:she relies on takeouts and sweets for meals.
Joannewas a full-time librarian before retiring at age 60. She embarked ongoing on trips with Anne and working part- time. She also had amaster’s degree in Library Science and enrolled for continuingcreative writing classes. She is, currently, moderately overweight,but was physically fit upto her late 50s. Herpregnancies (two) were also normal.
Joanneis the eldest ofher six siblings. Her father (deceased) served in the army,and the family frequentlymoved during her youth.Joanne is also very close to her mother who lives in an assistedfamily home, a few hours away from her place of residence. Joanne hasgood relations with her family members, except Roger, her youngestbrother, who is against her “lifestyle”: the two have not spokenfor nearly 15 years. Lastly, Joanne claims that she is an occasionaldrinker: she takes alcohol 3 to 4 times a month. She also does notuse any recreational drugs or smoke although her physician hasprescribed Ambien to her, which helps her sleep.
AxisI: Depression: 296.36
AxisII: Insomnia: 327.02
AxisIII: Hypertension andDiabetes: 796.2 and 250.60 respectively
AxisIV: GeneralisedAnxiety Disorder: 300.02
AXISV: GAF = 24
Joannedepicted the symptoms of anumber of ailments. Tobegin with, she reported feeling sad, hopeless, and down, most of thetime. During this period, she has startedlosing interest in things that she enjoyed and had trouble sleeping.She also mentioned that she experienced trouble with her dailyactivities, and what she should have done better when Anne was stillalive.
Psychology focuses on the applicationof evidence-based practices, which advocate for the improvement ofpatient outcomes through informing clinical or medical practice withrelevant research. With the before-mentioned considered, BehaviouralActivation therapy will be used to help Joanne regain normalfunctioning.
BehaviouralActivationfor Depression. Behavioural Activation (BA) focuses on increasing thecontact of the patient by helping him or her become active, and, byextension, improve his life, in general. BATD, a version ofBehavioural Activation, is briefer,and it focuses on identifying the values that guide how activitiesareselected. This approachwill be implemented to help Joanne resume her hiking and golfinghobbies.
PresentingIssue #1: Curing Depression through Behavioural Activation
The patient engages in activities that she used to enjoy before the onset of her depression.
The patient is involved throughout the process of treatment – the doctor asks her what she enjoys doing and requires her to engage in these activities, thus, stimulating the process of “wellness.”
Fewer sessions are required to experience positive outcomes: typically between 8 to 15 sessions.
Joanne’s beliefs about avoidance: she may opt to engage in the activities when she feels like it, which may not be very productive.
Adopt a more active type of lifestyle
Slowly but gradually begin interacting with close family friends and relatives
Get back to her hobbies: hiking and golfing.
Return to normal work as soon as possible. Joanne’s part-time job at the county library.
Accept Anne’s demise was not her fault, and that Anne is resting in peace.
Begin making new friends and going out more often.
Exercise and healthy eating
Acceptance and commitment therapy
Modality/ Duration: 8 to 15 weeks
Measure of Progress:
Progress will be measured by the patient’s ability to muster the strength to alter her negative emotions/behaviours on a daily basis.
PresentingIssue #2: Cognitive Behaviour Therapy for Insomnia
The patient will not use stimulants or alcohol to induce sleep
This approach involves exercising, which ensures the body of the patient acquires or remains optimally functional.
Cognitive interventions attempt to change people’s negative behaviour and belief patterns, which may heighten sleeping difficulties.
Negative avoidance beliefs. Joanne may begin feeling overwhelmed at a certain point and start using Ambien.
Establish regular sleep patterns
Eliminate negative beliefs about sleep
Focus on educational interventions to improve sleep hygiene, understand they various types of sleep cycles, and eliminate maladaptive behaviours like eliminating napping, exercising, and avoiding stimulants.
Stimulus control and sleep restriction
Eliminate maladaptive behaviours
Modality/ Duration: Bi-weekly sessions to teach the patient how to relax
Measure of Progress:
The ease with which Joanne goes to sleep every night without using medication.
PresentingIssue #3: Cognitive and Behavioural Therapies for Generalized AnxietyDisorder
This approach pays close attention to thoughts, behaviours, and feelings. It perceives them as being interrelated. Thus, a change in one element leads to a change in the other.
Cognitive and behaviour therapies must be used together bring into being the desired change in an individual. This is a disadvantage because the patient may feel overwhelmed by the numerous activities he or she has to go through.
Modifying catastrophic thinking patterns
Scheduling worry time to make worrying serve a useful function
Controlling exposure to situations and thoughts that are being avoided.
Scheduling specific worry time
Scheduling time for pleasurable activities
Combining cognitive and behaviour therapies to realize better and impactful results.
Modality/ Duration: sessions ofapproximately 1 to 2 hours over a 4-month period.
Measureof Progress: The ability ofa patient to engage in the activities that she is avoiding.
APAPresidential Task Force, (2006). Evidence-Based Practice inPsychology. AmericanPsychological Association.[online] Available at:https://www.apa.org/practice/resources/evidence/evidence-based-statement.pdf[Accessed 1 Nov. 2015].
Cornelius-White,J. (2002). Thephoenix of empirically supported therapy relationships: Theoverlooked person-centered basis.Psychotherapy:Theory, Research, Practice, Training,39(3), pp.219-222.
Knight,T. (2007). Showingclients the doors: Active problem-solving in person-centeredpsychotherapy.Journalof Psychotherapy Integration,17(1), pp.111-124.
SOCIETYOF CLINICAL PSYCHOLOGY, (2015). BehavioralActivation for Depression | Society of Clinical Psychology.[online] Div12.org. Available at:http://www.div12.org/psychological-treatments/disorders/depression/behavioral-activation-for-depression/[Accessed 1 Nov. 2015].
SOCIETYOF CLINICAL PSYCHOLOGY, (2015). Cognitiveand Behavioral Therapies for Generalized Anxiety Disorder | Societyof Clinical Psychology.[online] Div12.org. Available at:http://www.div12.org/psychological-treatments/treatments/cognitive-and-behavioral-therapies-for-generalized-anxiety-disorder/[Accessed 1 Nov. 2015].
SOCIETYOF CLINICAL PSYCHOLOGY, (2015). CognitiveBehavior Therapy for Insomnia | Society of Clinical Psychology.[online] Div12.org. Available at:http://www.div12.org/psychological-treatments/treatments/cognitive-behavior-therapy-for-insomnia/[Accessed 1 Nov. 2015].
SOCIETYOF CLINICAL PSYCHOLOGY, (2015). RelaxationTraining for Insomnia | Society of Clinical Psychology.[online] Div12.org. Available at:http://www.div12.org/psychological-treatments/treatments/relaxation-training-for-insomnia/[Accessed 1 Nov. 2015].
Veale,D. (2008). Behavioural activation for depression. Advancesin Psychiatric Treatment,[online] 14, pp.29–36. Available at:http://www.veale.co.uk/wp-content/uploads/2010/10/60-BA-for-depression-.pdf[Accessed 1 Nov. 2015].