Comprehensive Care Plan for Social Anxiety Disorder: Case Study Analysis and Treatment Recommendations

Case Study: J.T.

 

Purpose:	Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.
Scenario:	J.T.  is a 20 year-old who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. J.T. has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college. You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him – he assumes they will find him “dumb,” “boring,” or a “loser.” When he loses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the “stupid” things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drive him to engage in these avoidance behaviors.
Questions:	Remember to answer these questions from NP guidelines. At all times, explain your answers. 1. Generate a primary and differential diagnosis using the DSM-5 criteria. 2. Develop a biopsychosocial plan of care for this client. 3. Compare and contrast fear, worry, anxiety, and panic.

 

Submission Instructions:

· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

 

 

### Case Study: J.T.

#### 1. Primary and Differential Diagnosis

**Primary Diagnosis:** Social Anxiety Disorder (Social Phobia), according to DSM-5 criteria.

– **Criteria:**
– Persistent fear of social situations where scrutiny by others may occur.
– Fear is out of proportion to the actual threat posed.
– Avoidance of feared situations or endured with intense anxiety.
– Anxiety and avoidance interfere significantly with daily life.

**Differential Diagnosis:** Generalized Anxiety Disorder (GAD)

– **Criteria Considerations:**
– Excessive anxiety and worry about multiple domains.
– Difficulty controlling worry.
– Restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances.

#### 2. Biopsychosocial Plan of Care

**Biological Interventions:**
– **Medication:** Selective serotonin reuptake inhibitors (SSRIs) like sertraline for anxiety reduction.
– **Physical Health:** Regular exercise and balanced diet to support overall well-being.

**Psychological Interventions:**
– **Cognitive Behavioral Therapy (CBT):** Focus on cognitive restructuring to challenge negative thought patterns and exposure therapy to gradually confront feared situations.
– **Mindfulness-Based Stress Reduction:** Techniques to manage stress and increase present-moment awareness.

**Social Interventions:**
– **Social Skills Training:** Role-playing and practicing assertiveness skills.
– **Social Support:** Encouraging engagement with supportive peers and seeking mentorship.

#### 3. Comparison of Fear, Worry, Anxiety, and Panic

– **Fear:** Response to a real or perceived threat, immediate and intense, triggers fight-flight-freeze response.
– **Worry:** Cognitive process involving negative thoughts about potential future events, often accompanied by feelings of uncertainty and apprehension.
– **Anxiety:** Generalized feeling of unease, often about something unspecified or non-immediate, can be chronic and interfere with daily functioning.
– **Panic:** Sudden and intense episodes of fear or discomfort, often accompanied by physical symptoms such as palpitations, sweating, and trembling.

### Conclusion

In addressing J.T.’s case, understanding the nuances between fear, worry, anxiety, and panic is crucial for accurate diagnosis and effective treatment planning. Utilizing evidence-based practices like CBT and pharmacotherapy can significantly alleviate symptoms and improve his quality of life. Treatment should be tailored to his specific needs, integrating biological, psychological, and social interventions to address the multifaceted aspects of his social anxiety disorder.

References:
– American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
– 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.

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