Case Study – Anxiety Disorder & Obsessive Compulsive Disorder Clinical Signs of Anxiety
One of the signs of anxiety observed in Lauren is having a sense of impending doom or danger, as she claims to have a bad feeling every 5 minutes that something bad might happen to her grandfather. She has racing thoughts and is an uncontrollable over-thinker, always worrying that she might say the wrong thing or stumble and fall. Lauren also shows signs of restlessness and nervousness as she constantly bites her nails and touches her hair during the interview. She is also easily irritable (she is irritated by the nurse’s questions, believing that she does not care for her but is only paid to have sessions with her). Trembling is another sign; she claims to have trembled an entire day worrying about her grandfather when she failed to make breakfast for him.
Obsessive-Compulsive Behaviors
Lauren seems bothered by uneven things, such as an unattended shoelace or backpack. She also claims to fear that someone around her might be sick, say with flu. She constantly ruminates on the well-being of her grandfather, constantly worrying that he might not be okay. Lauren also has the need to count things, such as cars or students, and ensure that they match in a certain way. She is highly bothered when things are not in a certain pattern or manner, say, her bed or the water’s temperature. She also has the need to constantly check the door to ensure that it is locked once everyone has gone to sleep. All these are obsessive-compulsive behaviours.
Therapeutic Communication Techniques Used
The nurse makes use of active listening throughout the video. She shows great interest in the patient, engaging her in the conversation and being attentive to everything she says, sometimes having to repeat what she says. The nurse strives to seek clarification whenever Lauren says something that is inconclusive or ambiguous. She asks her to expound on something, seeking to find out when some of her behaviours began and how she feels about some of her behaviours or thoughts. The nurse also employs empathy throughout the video, showing interest and understanding in the things going on in Lauren’s life. For instance, she acknowledges that it must be tedious for Lauren to have to ensure that everything in her room is organized and neat. On some occasions, the nurse employs silence. For instance, when she seeks clarification on a certain issue, but Lauren seems to offer little information, she deliberately gets silent for a few seconds, allowing Lauren to compose herself and break the silence by giving clarification.
Appropriate Nursing Interventions
Cognitive Behavioral Therapy and interpersonal psychotherapy are among the best ways to deal with a social anxiety disorder. Whereas CBT focuses on the altering of biased information processing as well as dysfunctional beliefs common in social anxiety disorders, interpersonal psychotherapy aims at altering problematic interpersonal behavior patterns. Both of these therapies are said to result in significant improvements for patients, but cognitive therapy is said to have a higher likelihood of lessening social phobia symptoms (Stangier et al., 2011). In this case, CBT could be used to help Lauren avoid embarrassment over certain situations and learn to be more assertive. Furthermore, it will help her deal with negative thoughts like fear of public speaking, which she believes might cause her embarrassment for saying something inappropriate. Aldao et al. (2014) claim that patients with social anxiety disorders have maladaptive strategies of rumination, expressive suppression, and experiential avoidance, and CBT can help increase self-efficacy in applying reappraisal.
CBT will also be helpful in the treatment of an obsessive-compulsive disorder. CBT is a treatment that helps individuals to cope with and alter problematic emotions, behaviours, and thoughts. Coupled with Exposure and Response Prevention procedures, Blakey et al. (2017) claim that CBT can be highly effective in treating OCD. Exposure entails a recurrent systematic confrontation with events and stimuli that cause obsessional anxiety, and response prevention entails fighting impulses to perform aversion and escape behaviours. Mindful-based cognitive therapy has also proven effective in treating OCD (Külz et al., 2019). Using such interventions, Lauren’s conditions can be effectively treated.
References
Aldao, A., Jazaieri, H., Goldin, P. R., & Gross, J. J. (2014). Adaptive and maladaptive emotion regulation strategies: Interactive effects during CBT for social anxiety disorder. Journal of Anxiety Disorders, 28(4), 382-389.
Blakey, S. M., Abramowitz, J. S., Reuman, L., Leonard, R. C., & Riemann, B. C. (2017). Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 57, 113-117.
Külz, A. K., Landmann, S., Cludius, B., Rose, N., Heidenreich, T., Jelinek, L., … & Moritz, S. (2019). Mindfulness-based cognitive therapy (MBCT) in patients with obsessive-compulsive disorder (OCD) and residual symptoms after cognitive behavioural therapy (CBT): a randomized controlled trial. European archives of psychiatry and clinical neuroscience, 269(2), 223-233.
Stangier, U., Schramm, E., Heidenreich, T., Berger, M., & Clark, D. M. (2011). Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial. Archives of General Psychiatry, 68(7), 692-700.
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Question 
Case Study – Anxiety Disorder & Obsessive Compulsive Disorder Clinical Signs of Anxiety
Course Competency
- Assemble nursing care interventions for clients with behavioural or cognitive disorders.
Case Study – Anxiety Disorder & Obsessive Compulsive Disorder Clinical Signs of Anxiety
Scenario
Lauren has been diagnosed with Social Anxiety Disorder and experiences obsessive thoughts that result in compulsive behaviours. This has a major impact on her life and day-to-day functioning.
Instructions
View the video segments 1, 2, and 3 for Lauren.
Notice how the nurse continues to gather information to assess the extent of Lauren’s illness. The content relates to the objective that you will be able to describe the symptoms of anxiety and OCD.
Create a document which contains this information:
- Describe at least three clinical signs of Anxiety observed in the videos.
- Describe at least three Obsessive-Compulsive behaviours observed in the videos.
- Explain at least three therapeutic communication techniques used by the nurse in the videos.
- Discuss at least two nursing interventions appropriate for Lauren. Support your choices with rationales.
- Support your ideas with at least two credible resources.
Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.
Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below: