Description of the client
J. N. is a 13-year-old African American male who suffers from Generalized Anxiety Disorder (GAD) and the processing disorder. J. N. is brought up in an extended family; six family members live in a small house in a low-income African American community. The client constantly feels anxious regarding his performance at school, relations in the family, which are described as negative, and relations and conflicts with peers. He experiences difficulties with concentrating during lessons, and he needs more time to complete different types of assignments as well as do homework in comparison to classmates. Family members do not help the adolescent with completing his home tasks.
Problem #1: Generalized Anxiety Disorder (GAD)
Nature of Problem: J. N. was diagnosed to have GAD as he has been suffering from constant anxiety and associated fears about different situations for six months. GAD is characterized by a person’s constant feeling anxious about various daily activities, routines, and events regardless of their importance. An adolescent individual can worry about anything, even if there are no reasons or specific triggers; they cannot sleep, relax, feel positive, and concentrate.
AEB: Minor symptoms, such as troubles with relaxing, worries, and distress, became observed for the client a year ago. However, six months ago, when the family of the mother’s sister moved to their house, major symptoms became noticed: irritability, depressed mood, sleep problems, and the constant sense of dread. Currently, J. N. sleeps only five hours a day and experiences headaches and muscle tension minimum four times per week.
Goal: To reduce the intensity and frequency of anxiety episodes by 50% within 6 weeks with the help of developing coping skills.
Objectives
- Objective 1: During two sessions, the client will identify 6-9 situations, triggers, stressors, actions, thoughts, and feelings that mostly provoke or are associated with his anxieties and worries.
- Intervention 1: The counselor will apply Cognitive Behavioral Therapy (CBT) in order to identify potential triggers, specific situations, stressors, actions, thoughts, and feelings that are associated with anxiety for the client (Lee et al., 2019; Robinson et al., 2015). Thus, the client will be asked to describe past experiences of anxiety and worries and related situations or factors that could provoke those feelings. J. N. will discuss how those feelings influenced his functioning and what could help to cope with anxiety in those situations.
- Intervention 2: The counselor will use the Consequence-Activating Event-Belief method related to the Adapted-Coping with Stress Course as a CBT-based intervention. The client will be able to recognize different activating events (triggers), certain associated cognitions, and specific feelings that need to be reshaped in the context of a person’s coping mechanisms (Robinson et al., 2015). As a result, J. N. will be ready to reshape the feeling about possible triggers of his anxiety, as well as actions and behaviors.
- Objective 2: The client will learn and implement five appropriate coping skills to manage his anxiety symptoms and reduce anxiety levels.
- Intervention 1: The counselor will apply the CBT techniques to develop anxiety coping skills in the client. These techniques include the thought stopping technique and the “worry time” approach. The client will be taught how he can stop thinking about a certain situation and redirect his attention to another subject (Robinson et al., 2015). The client will also learn how to apply the “worry time” approach and recognize worries in his daily activities to be able to think about them during a specifically scheduled time period.
- Intervention 2: The counselor will apply the Mindfulness-Based Intervention (MBI) with a focus on teaching the client how to use relaxation techniques for coping with anxiety and worrying. The client will learn how to use mindfulness meditation and breathing, muscle relaxation, and biofeedback (Zoogman et al., 2015). These coping techniques will help the client to develop skills in overcoming anxiety on a daily basis as the client will be stimulated to use these approaches every time when feeling anxious and worrying about something.
Problem #2: Processing Disorder
Nature of Problem: The processing disorder can be associated with auditory and visual processing disorders as well as the slow processing disorder. When having this disorder, adolescents need time in order to concentrate on and understand visual or auditory information. As a result, the speed of learning and completing academic tasks becomes slower. This disorder can be provoked by certain impairments, stress factors, and other disorders, among possible triggers.
AEB: At school and at home, J. N. experiences problems when learning new information, following teachers’ instructions and explanations, and completing different tasks. It is rather difficult for J. N. to concentrate in order to perform an assignment effectively. In many cases, the client asks the teacher to repeat some information, and he works on a task better if he has visual cues. If J. N. has enough time for completing tasks, he can better concentrate and succeed. Nevertheless, he experiences problems with timed tests, and he fails in 8 out of 10 timed tests taken.
Goal: To learn and implement techniques that help become more concentrated and less distracted in 70% of study situations within 8 weeks.
Objectives
- Objective 1: The client will verbalize his problems associated with cognitive, physiological (auditory and visual), and behavioral aspects when completing tasks at school and at home.
- Intervention 1: The counselor will apply the technique of active listening in order to provide the client with an opportunity to focus on the nature of his problems when learning new material and completing tasks at school and at home (Lee et al., 2019). The counselor will help the client to identify possible physical aspects or changes in vision and hearing, changes in the adolescent’s physical stage associated with worrying, as well as emotional and behavioral reactions to the situation of being impossible to concentrate on the task or understand it. The counselor will focus on understanding how the client’s cultural group can influence his experience.
- Intervention 2: The counselor will focus on the specifics of the client’s self-talk in the situations when he feels anxious about not being able to understand the teacher’s instructions and complete tasks on time (Lee et al., 2019; Robinson et al., 2015). The client will be taught to identify negative thoughts and redirect attention on routine tasks to feel more organized.
- Objective 2: The client will learn how to implement four techniques in order to remove distractors and concentrate on understanding auditory and visually presented information.
- Intervention 1: The counselor will teach the client how to organize his work on academic tasks at school and at home in order to be concentrated. The client will be expected to develop a routine of preparing for completing home tasks or timed tests (Robinson et al., 2015). The counselor will help in developing the most effective routine depending on such external factors as the home and school environment in the African American community.
- Intervention 2: Referring to the MBI, the counselor will assign the home tasks during which the client will be expected to learn how to use relaxation breathing and quick muscle relaxation technique in order to be able to concentrate on the task when feeling disorganized, worried, distracted, and being able to make quick decisions (Zoogman et al., 2015).
Successful Development of a Treatment Plan
The research from the treatment plan research paper was effectively incorporated in this proposed treatment plan. The interventions and techniques that are useful to address the objectives related to the first problem (Generalized Anxiety Disorder) were selected depending on the results of the previous research. As a consequence, the interventions proposed to achieve the two objectives to complete the first goal were grounded in the principles of CBT and MBI (Robinson et al., 2015; Zoogman et al., 2015).
In addition, some of the techniques that are usually applied in the context of the MBI, such as relaxation approaches, were also offered to help the client decrease the symptoms of his processing disorder that is closely associated with GAD. The problem is that GAD often provokes the development of the processing disorder. In their turn, difficulties with concentrating and processing information cause adolescents’ being more anxious and worry about their academic achievements. In this context, techniques and strategies used in CBT and MBI are effective to be applied to treating the client’s both problems.
References
Lee, P., Zehgeer, A., Ginsburg, G. S., McCracken, J., Keeton, C., Kendall, P. C., Birmaher, B., Sakolsky, D., Walkup, J., Peris, T., & Albano, A. M. (2019). Child and adolescent adherence with cognitive behavioral therapy for anxiety: Predictors and associations with outcomes. Journal of Clinical Child & Adolescent Psychology, 48(sup1), S215-S226.
Robinson, W. L., Droege, J. R., Case, M. H., & Jason, L. A. (2015). Reducing stress and preventing anxiety in African American adolescents: A culturally-grounded approach. Global Journal of Community Psychology Practice, 6(2), 1-12.
Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness interventions with youth: A meta-analysis. Mindfulness, 6(2), 290-302.