Discuss About The Pharmacological Treatment Of Psychiatric?
The essay presents the cause of anxiety problem in people with the case formulation using the 5P model for Greg. The major issue in Greg is feelings of anxiety and stress for a long period of time and the identification of several factors behind the problem has helped to discuss the best treatment options for Greg. The effectiveness of the treatment is determined with support from relevant research literatures.
The case study is about Greg, a 32 year old man with the following presenting issues:
Feelings of stress and anxiety:
Greg has been found to be suffering from anxiety since the past six months and currently he has been attending counseling sessions to manage his feelings of anxiety. Till now, he has attended three counseling sessions.
Anxious about socializing:
His feelings of stress and anxiety increase when he meets unfamiliar people. His heart starts to beat rapidly. He is finding it difficult to cope with such situations. Hence, he tries to escape such trouble either by leaving the place early or not socializing at all.
Greg is of the opinion that his father, Terry has high expectations from his children. Though Terry never scolded him, however Greg feels that his father gave a disappointed look when he underperformed at school.
Dislike for place of residence:
Greg’s family resided in countryside, but Greg move to Melbourne as his family’s interest in sports and community events and he hated sports.
Unsatisfied with career progression:
Another issue for Greg was that he was that he changes many job role and he expected that he should be in a much higher position by now. He tried to compare his career operations with his other colleagues who were in managerial roles. This has lowered his confidence and he has now stopped applying for new jobs now because of extreme anxiety before the interview and fear of having negative experience.
No romantic relationship:
Greg is gay, however he has not yet dated someone. Just like socializing and attending interviews, he also finds dating as stressful. But he has intention to be in a long-term relationship.
The case study has provided enough detail about the client, however there are still many areas where more information is required. These includes:
Reason’s for Greg’s anxiety in socializing:
Greg has reported about increased anxiety while socializing with unfamiliar people. However, there is ambiguous information regarding the cause of his anxiety. It might be possible that he has a negative experience during socializing in the past or he tried to escape socializing because people questioned him about his life and career. He is not happy with his career and it might be possible that he feared socializing because people would ask him about his career performance. So, in the next counseling session, knowing about the cause of anxiety in social situation would be a priority.
Terry’s expectation towards Greg:
Greg had briefly expressed in the past counseling sessions that his father has high expectations from his children and his father gave a disappointed look when he did not performed well in his studies. In this aspect, more information is needed to find out what was Terry’s expectation from Greg along apart from his other siblings. It might be possible that his father expected something from him and Greg followed some absolutely different approach towards life. Hence, knowing about this is also critical to understand Greg’s mental condition.
Clear career goal of Greg:
Greg’s concern regarding his poor progression in career also brings many questions. Firstly, he has not stated what is his exact career goals. He has been found to switch his job a lot of time and it might be possible that he is confused regarding what position he want. Secondly, as his other colleagues have reached the managerial position, then it is necessary to know about his job performance and commitment towards the work. This is important because poor job performance might be affecting his appraisal process. Knowing the reasons for his lack of confidence is also necessary because it might be possible that he did not have adequate job skills to be given a senior role.
The use of 5P model helps to conceptualize a case by analyzing the origins for his difficulty. This can be done by getting informations regarding presenting problems, predisposing factors, precipitating factors, perpectuating factors and protective factors of client. The case of Greg has been formulated with the use of 5P
Presenting problems: Extreme anxiety, fear of socialization feelings of stress, poor career in one’s ability and fear experience of negative issues in interview is the current problem for Greg. His condition has deteriorated because his feelings of stress and anxiety is seen not only during social interaction, but also during interviews and going for dating too.
Predisposing factors: The predisposing factors that might be affecting Greg’s mental health is his overall attitude towards life and relationship goals. He has been found to have negative perceptions or ideas in important areas of his life. Research has also showed that personality traits like competitiveness, aggression and pessimism increases risk of stress and anxiety (Staab et al., 2014).
Predisposing factors: Little is known about the factors that has triggered anxiety and stress in Greg. It might be cause by combination of things like personality factors, stressful events in life, negative life experience or poor physical healthy (Asselmann et al., 2016). Family history of mental conditions might also be a cause of feelings anxious.
Perpectuating factors: The need to socialize with people and trying to reach same position in job as others are the perpectuating factors that marketing it difficult for Greg to cope his stress and anxiety.
Protective factors: Protective factor is related to the support of the family, individual or the wider community in supporting patients to deal with stressful events. In case of Greg, no such protective factors exist who support him in dealing with the problem.
The main issue found in Greg is extreme anxiety and there are many treatment options available to address the issues. This includes pharmacological interventions, cognitive behavioral therapy, residential treatment or rehabilitation and complementary and alternative treatments. Baldwin et al., (2014) discussed regarding different evidence based pharmacological treatment available for anxiety disorders. Several classes of antidepressant drugs has been found effective in patients with anxiety disorders, however there is low evidence to prove the efficacy these drugs for treatment of patients with mild forms of anxiety. Secondly, many self-help and complementary approaches such as use of internet based educational sources is also preferred by some patients due to suboptimal effect of pharmacological or psychological treatment. The review of evidence based studies in this area has shown that efficacy of self-help group is high only when detailed instruction is followed in use of self-help manuals (Baldwin et al., 2014). Management of acute anxiety is also done by pharmacological or psychological treatments. For instance, a comparative study analyzed cognitive behavioral therapy and psychodynamic therapy in the treatment of stress disorders showed that both approach is equally beneficial in reducing symptoms of anxiety iin patients however cost effectiveness of both needed to determined when deciding to chose any one of the treatment options for a patents (Levi et al. 2016). Research also showed that psychological treatments can be combined with drugs like clomipramine when more efficacy is needed in short time (Baldwin et al., 2014).
For treating Greg, evidence based psychological treatment is preferred over pharmacological treatment considering patients preference for such treatment. As both psychological treatment and medication treatment have some level of efficacy, the study comparing patients preference for psychological vs. pharmacological treatment has showed that 75% patients prefer psychological treatment (McHugh et al., 2013). To ensure that Greg readily accept the treatment, cognitive behavioral therapy has been specifically chosen in terms of its cost-effectiveness as well as beneficial health outcome for patients. The research study by Dear et al., (2015) proved about the effectiveness and cost effectiveness of tailored internet based cognitive behavioral therapy by a study with primary care participants with anxiety disorder. All participants were randomized to treatment or control group and after one year follow up, it was found that cognitive behavioral therapy reduced the total cost of treatment compared to control group. Secondly, in terms of long-term outcomes too, significant improvements in measures of depression and stress were seen. Hence, use of cognitive behavioral therapy approach is likely to promote recovery and address the problem in Greg.
Cognitive behavioral therapy (CBT) is a short term and goal oriented psychotherapeutic intervention that uses problem solving approach to change attitudes and behaviors of patients. In case of Greg, CBT approach will be applied to change Greg’s attitude and behavior by focusing on his thoughts, beliefs and attitudes. Hence, the main goal of the treatment plan is to modify the cognitive process of the person to help him cope with the feelings of anxiety (Seligman & Ollendick, 2011).Weekly session will be taken with Greg lasting for 50 minutes duration and the therapy will counties for six months to improve symptoms of client.
One of the main elements of CBT is cognitive restructuring of anxious cognitions in affected person. The core assumption of the therapy is taken from cognitive behavioral theories and it provides greater flexibility in treatment targets (Kennerley, Kirk, & Westbrook, 2016). Hence, in case of Greg, didactic sessions will be taken. In case of Greg, attitude problems and pessimistic attitude has been found to be the cause of anxiety, hence CBT approach will be implemented to changes maladaptive thought patterns in client. Hence, the first few sessions will focus on interacting in a way to understand the roots of the presenting problems and inquire about areas where more information is needed. This will help to target the areas where more work is required to change the cognitive process of client (Olatunji et al., 2014). Hence, the first stage is the most crucial as it can help the therapist to identify negative thoughts and factors that are going to cause potential harm to client.
By the fourth session, it is planned to enter into the second stage of CBT. In this stage, the main plan is to challenge negative thoughts of Greg. This can be done by practically questioning Greg regarding rationality for feeling anxious and suggesting positive belief or action in such situation (Kerns et al., 2016). For instance, the counselor or therapy can question ‘Do you think it is right to feel anxious whenever you socialize?’ Then, the counselor can suggest that it is normal method of interacting with people and instead of running away from such situations, Greg could think in a positive way that he might meet some very good people. It might also be possible that he might find a friend who could give him good ideas about job opportunities. Hence, instilling positive beliefs will be a priority as this stage to make the mind believe that negative thoughts are baseless. Once Greg realize this, he might try to change his behavior.
The final phase of treatment will focus on building strategies to replace negative thought in clients with more realistic and positive ideas. Ideas or suggestions will be given to Greg to come up accurate thoughts while socializing or going for job interviews. Once, he adapts the positive thought, it is expected that his anxiety level will significantly decrease by the end of the sessions.
While implementing the CBT therapy, many challenges might also arise during the sessions. Firstly, low effectiveness will be seen if patient if the therapist does not make CBT method a lifestyle changes. Hence, all positive thought patterns should be suggested in such a way that client can easily apply it in daily life. It is necessary to regard CBT methods as a lifestyle change to enhance its effectiveness. Another challenge that might arise is that client may not open up initially, hence that needs to be fixed by focusing build rapport with the patient first before identify his negative thought pattern (Doyle et al., 2016).
To evaluate whether the CBT therapy was useful in reducing symptoms of anxiety in patient or not, it will be necessary to keep follow up with patients after the therapy. It will benecessary to inquire, whether he is able to cope better during socialization process or during interviews or not. If he does not develop feeling of anxiety during socializations and job related activities, then it will be an indication of effectiveness of the CBT therapy in addressing issues in client. Hofmann et al., (2012) also points out to the effectiveness of the therapy in reducing symptoms of anxiety, stress and depression in people.
Conclusion:
From the analysis of Greg’s issue, it can be concluded that such behavioral issues in patients can be addressed by cognitive behavioral therapy. The essay mentioned the stages needed to implement such therapy by means of a treatment plan and overcoming certain challenges in the process will maximize its efficacy in reducing anxiety issues in patient.
Reference
Asselmann, E., Wittchen, H. U., Lieb, R., Höfler, M., & Beesdo-Baum, K. (2016). Does low coping efficacy mediate the association between negative life events and incident psychopathology? A prospective-longitudinal community study among adolescents and young adults. Epidemiology and psychiatric sciences, 25(2), 171-180.
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., … & Malizia, A. (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 psychology, 28(5), 403-439.
Dear, B. F., Zou, J. B., Ali, S., Lorian, C. N., Johnston, L., Sheehan, J., … & Titov, N. (2015). Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety: a randomized controlled trial. Behavior therapy, 46(2), 206-217.
Doyle, C., Dunt, D., Ames, D., Fearn, M., You, E. C., & Bhar, S. (2016). Study protocol for a randomized controlled trial of telephone-delivered cognitive behavior therapy compared with befriending for treating depression and anxiety in older adults with COPD. International journal of chronic obstructive pulmonary disease, 11, 327.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.
Kennerley, H., Kirk, J., & Westbrook, D. (2016). An introduction to cognitive behaviour therapy: Skills and applications. Sage.
Kerns, C. M., Roux, A. M., Connell, J. E., & Shattuck, P. T. (2016). Adapting cognitive behavioral techniques to address anxiety and depression in cognitively able emerging adults on the autism spectrum. Cognitive and Behavioral Practice, 23(3), 329-340.
Levi, O., Bar?Haim, Y., Kreiss, Y., & Fruchter, E. (2016). Cognitive–Behavioural Therapy and Psychodynamic Psychotherapy in the Treatment of Combat?Related Post?Traumatic Stress Disorder: A Comparative Effectiveness Study. Clinical psychology & psychotherapy, 23(4), 298-307.
McHugh, R. K., Whitton, S. W., Peckham, A. D., Welge, J. A., & Otto, M. W. (2013). Patient preference for psychological vs. pharmacological treatment of psychiatric disorders: a meta-analytic review. The Journal of clinical psychiatry, 74(6), 595.
Olatunji, B. O., Kauffman, B. Y., Meltzer, S., Davis, M. L., Smits, J. A., & Management, M. B. (2014). Cognitive-behavioral therapy for hypochondriasis/health anxiety: A meta-analysis of treatment outcome and moderators. Behaviour research and therapy, 58, 65-74.
Seligman, L. D., & Ollendick, T. H. (2011). Cognitive-behavioral therapy for anxiety disorders in youth. Child and adolescent psychiatric clinics of North America, 20(2), 217-238.
Staab, J. P., Rohe, D. E., Eggers, S. D., & Shepard, N. T. (2014). Anxious, introverted personality traits in patients with chronic subjective dizziness. Journal of psychosomatic research, 76(1), 80-83.
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