Abnormal Psych - Case Studies Exam Prep

In the case of José, what event precipitated his panic attack?

José’s first major panic attack occurred shortly after his plane took off from Miami. He suddenly felt unable to breathe and became intensely aware of his racing heart.

How is José’s development of panic disorder different from that of most cases?

José developed panic disorder at age 36, which is later than the typical onset of late adolescence or early adulthood.

What are the symptoms of most panic attacks?

Rapid heartbeat or palpitations, sweating, trembling, shortness of breath, choking sensations, chest discomfort, nausea, dizziness, hot/cold sensations, tingling or numbness, unreality, fear of losing control, and fear of dying.

Why do individuals first suspect a general medical condition?

Panic attacks produce intense physical symptoms that can closely resemble medical problems such as heart attacks, so people often believe something is physically wrong before recognizing the symptoms as panic.

Why was the social worker convinced that panic disorders are “best explained by a combination of biological and cognitive factors”?

The biological component involves a false fight-or-flight alarm and autonomic arousal. The cognitive component involves catastrophically interpreting those bodily sensations as signs of danger, which increases anxiety and creates a vicious cycle.

Describe the four steps the social worker took to help José overcome his panic attacks. List each of the interoceptive exposure exercises that were part of José’s treatment.

The four components were relaxation/breathing training, correcting cognitive misinterpretations, controlled exposure to panic sensations, and repeated practice in situations he was avoiding. The textbook’s interoceptive exercises included whole-body tension, breathing through a straw, head movement, changing head position, staring at a fixed point, breath holding, running in place, and hyperventilation. These were controlled therapeutic exercises rather than activities to perform independently.

How did José’s avoidance of going outside by himself contribute to his panic disorder?

Avoidance temporarily reduced his anxiety, which negatively reinforced the avoidance. It prevented José from learning that he could experience panic sensations safely and contributed to the development of agoraphobia.

How did his pattern of previous alcohol use complicate treatment for José?

Alcohol had become a way of reducing anxiety and physiological arousal, so it was negatively reinforcing his drinking. He also had a moderate alcohol use disorder, meaning his drinking had to be monitored and reduced while he learned healthier coping strategies.

When do obsessive-compulsive behaviors begin for most individuals?

They most commonly begin during adolescence or early adulthood.

What were Cherita’s primary obsessions and compulsions?

Her obsessions involved fears of disasters caused by negligence, worries that she had caused accidents, and disturbing unwanted thoughts or images of harming others. Her compulsions included checking, unusual driving behaviors, and mentally reviewing events for reassurance.

Why did Cherita finally decide to seek treatment?

She was increasingly distressed by the worsening symptoms, was tired of living with the disorder, and did not want her OCD to damage her relationship with James or their plans to marry.

Which specific treatment did Ms. Joyce decide to try to help Cherita overcome her obsessive-compulsive disorder? Why was this a type of cognitive-behavioral therapy?

She used exposure and response prevention. It is CBT because Cherita was repeatedly exposed to anxiety-provoking thoughts or situations while learning not to perform the compulsive responses that normally reduced her anxiety.

Ms. Joyce asked Cherita to keep track of her obsessions and compulsions. What did Cherita learn from entering this information, and how did Ms. Joyce use this information to assist in her treatment program?

Cherita learned how often her obsessions occurred, what triggered them, and how she responded. Ms. Joyce used the records to identify important fears, determine treatment priorities, and build an exposure hierarchy.

What was the purpose of recording Cherita’s visually imagined disaster scenes?

The recordings were used for imaginal exposure. Repeatedly confronting the feared images helped reduce their emotional power and taught Cherita that she did not need to treat the thoughts as dangerous.

How many sessions did it take for Cherita to overcome her household obsessions and compulsions?

About three sessions were enough to produce major improvement in her household checking behaviors, although treatment continued for other OCD symptoms.

Obsessions may take different forms. List three forms cited in the text.

Obsessions can take the form of wishes, impulses, images, ideas, or doubts. Any three of these are correct.

How many sessions were necessary for Cherita to overcome her obsessive-compulsive disorder?

Active treatment was essentially completed by session 13, after which sessions 14–18 were follow-up and relapse-monitoring sessions. Thus, 13 sessions were needed for the active treatment to overcome the major OCD symptoms.

What characteristics did Xian have as a child that are common in individuals who develop social anxiety disorder?

Xian was shy and socially inhibited, had difficulty with unfamiliar people and situations, and was more comfortable with a small number of familiar people.

At what age do most cases of social anxiety disorder emerge?

Most cases emerge during adolescence.

What patterns of Xian’s behavior were examples of negative reinforcement?

She avoided or escaped social situations when anxious, such as avoiding interactions or responsibilities that involved social evaluation. The immediate reduction in anxiety reinforced the avoidance and made future avoidance more likely.

How did Xian’s anxiety and related behavior affect her relationship with her friend Mara?

Xian’s avoidance, cancellations, and difficulty engaging socially made Mara feel frustrated and disconnected. Their friendship became strained because Xian’s anxiety increasingly interfered with normal social interaction.

What kinds of biological and childhood factors have been linked in research to social anxiety disorder?

Research links social anxiety to genetic vulnerability, heightened activity in fear-related brain systems, behavioral inhibition in childhood, and childhood experiences involving criticism, rejection, trauma, or overprotective parenting.

Describe the processes used in this cognitive-behavioral approach to treatment for social anxiety disorder.

The approach involved psychoeducation, identifying anxious beliefs, challenging inaccurate interpretations, reducing avoidance and safety behaviors, gradually confronting feared social situations, practicing new behaviors, and completing exposure/homework exercises.

According to research, how helpful is cognitive-behavioral therapy for people with social anxiety disorder?

CBT is an effective treatment that produces significant improvement for many people with social anxiety disorder, especially when it includes exposure to feared social situations.

List some of the beliefs Xian had about social situations that were at the core of her social anxiety disorder.

She believed others would judge her negatively, notice her mistakes, see her as incompetent or awkward, reject her, or think badly of her if she behaved imperfectly.

What principles of behavior change did Xian’s therapist use to help her overcome social anxiety?

The therapist used gradual exposure, reduced avoidance and safety behaviors, encouraged repeated practice, reinforced successful approach behaviors, and helped Xian learn that anxiety could decline without escaping.

What event precipitated Julie’s posttraumatic stress disorder?

Julie experienced a shooting while she was stopped at a traffic light. The event left her feeling unsafe and vulnerable in her new community.

How do the brain-body stress routes of people with PTSD generally react to stress, both prior to and after their traumatic event?

People who later develop PTSD may already have overly reactive stress systems. After trauma, the sympathetic nervous system and hypothalamic-pituitary-adrenal axis can become even more reactive.

Why do friends and relatives eventually distance themselves from a person who has had a traumatic incident?

The person may become preoccupied with the trauma, repeatedly discuss fears and danger, withdraw socially, or have difficulty focusing on other people. Over time, relationships can become strained and superficial.

Why did Julie finally decide to seek treatment?

Her trauma-related anxiety and avoidance had increasingly restricted her life and relationships, and she recognized that she was no longer functioning as she had before the trauma.

Why was Julie diagnosed with posttraumatic stress disorder rather than acute stress disorder?

Her symptoms continued beyond the period required for acute stress disorder and persisted long enough to meet the duration requirement for PTSD.

What modes of therapy did Mr. Barlow select to assist Julie with her disorder? Give an example of each type of therapy.

He combined exposure therapy and cognitive processing therapy. Examples were imaginal exposure to the traumatic memory, in-vivo exposure to avoided situations, and cognitive restructuring of beliefs about safety, power, and trust.

Early in treatment, Mr. Barlow outlined the various components of Julie’s upcoming therapy. Describe those components.

They would identify avoided activities, arrange them from least to most threatening, gradually expose Julie to those situations, repeatedly confront the traumatic memory through imaginal exposure, and work on trauma-related beliefs through cognitive processing.

What was the purpose of producing a recorded description of the traumatizing incident?

It provided repeated imaginal exposure to the traumatic memory. The goal was to reduce the memory’s emotional threat and help Julie integrate it as a past event rather than an ongoing danger.

Why did Julie initially fail to take notes of her feared activities as part of her treatment plan? How did Mr. Barlow handle this problem in his session with Julie?

She avoided recording the activities because even thinking about them increased her anxiety. Mr. Barlow explored the avoidance with her and helped her understand that recording and gradually confronting the feared situations were necessary parts of treatment.

What other incident in Julie’s early life may have contributed to her posttraumatic stress disorder?

Her father had repeatedly described his own traumatic experiences while she was growing up, which contributed to Julie’s longstanding expectation that traumatic events could happen to her.

What percentage of people with PTSD seek treatment?

The textbook emphasizes that only a minority of people with PTSD seek treatment; the case highlights that many people with PTSD do not receive professional treatment.

What are the earliest risk factors displayed for Ashley to develop somatic symptom disorder?

Ashley showed high attention to bodily sensations, strong health concerns, a family environment focused heavily on health and achievement, and learned avoidance of unpleasant emotions and worries.

What role might the family and her family history have played in the development of her health-related worries?

Because both parents were physicians and health was frequently discussed, Ashley had extensive exposure to medical information and health concerns. Her family also modeled avoidance of uncomfortable emotions, which she and her sister learned.

In which ways did the COVID-19 pandemic impact Ashley’s life?

It increased her fear of illness, separated her from friends, increased isolation, disrupted college life, exposed her to illness and death among people she cared about, and increased family stress.

How did Ashley change psychologically in response to the pandemic?

She became more anxious, socially avoidant, hyperfocused on bodily sensations and illness, and increasingly used avoidance and substances to manage anxiety. Her GI symptoms also became a major source of worry.

Do you think a different diagnosis, such as an anxiety disorder, was warranted? If so, could an anxiety disorder diagnosis have significantly impacted Dr. Husain’s choice of treatment?

The textbook presents somatic symptom disorder as the diagnosis, although health anxiety was central. Even if an anxiety diagnosis had been used, ACT would still have been a reasonable CBT-based approach because it specifically targeted avoidance, psychological inflexibility, and anxiety-related functioning.

How do you think Ashley’s anxiety impacted her GI problems, and vice versa?

They reinforced each other. Increased anxiety increased her perception of GI discomfort, while the GI symptoms provided additional bodily sensations that increased her health anxiety.

Is Acceptance and Commitment Therapy a type of cognitive-behavioral therapy?

Yes. The textbook describes ACT as an acceptance-based form of CBT.

What were the targeted treatment mechanisms in Ashley’s therapy? In other words, which of her psychological processes did Dr. Husain try to change in order to help her?

He targeted psychological inflexibility, experiential avoidance, cognitive fusion, difficulty staying in the present, difficulty acting according to values, and her tendency to treat thoughts as literal truths.

What does “acceptance” mean in this treatment?

Acceptance means allowing thoughts, emotions, and bodily sensations to be present without needing to eliminate, control, or fight them.

What does “change” mean in this treatment?

Change means changing Ashley’s relationship with her thoughts and feelings and changing her behavior so she could act according to her values even when anxiety was present.

What did Dr. Husain do at the end of therapy to reduce the risk for relapse in anxiety?

He developed a relapse-prevention plan with Ashley, including values clarification, mindfulness, recognizing avoidance, reminders of helpful strategies, and scheduled follow-up appointments.

What tools and approaches were used to assess the efficacy of Ashley’s treatment?

They used repeated self-report measures of anxiety, valued actions, and experiential avoidance, along with measures of how closely she was living according to her values and observations of changes in functioning.

What are the first signs that a person might be depressed?

Early signs can include persistent sadness, loss of interest, low energy, withdrawal from activities, changes in sleep or appetite, difficulty concentrating, hopelessness, and reduced functioning.

Why did Phil initially see his primary care doctor?

He was experiencing significant physical and emotional changes and was having difficulty functioning normally at home and work, especially after his brother’s death.

What symptoms did Phil present that prompted his primary care doctor to suggest a psychologist?

He showed depressed mood, low energy, loss of interest, excessive worry, sleep changes, poor concentration, hopelessness, reduced activity, and major difficulties functioning at home and work.

What was the purpose of the social worker who talked to Phil after the primary care doctor?

The social worker explored his depression, helped him identify reasons for wanting to change, increased his motivation, and encouraged him to try CBT.

Why did Phil choose cognitive-behavioral therapy over medications?

He disliked taking medication and was concerned about side effects. CBT appealed to him because it was structured, brief, evidence-based, and did not involve medication side effects.

What helped Phil feel comforted by and trusting of Rosemary?

Rosemary’s warm, welcoming style, her engaging personality, her nonjudgmental manner, and the comfortable atmosphere of her office helped him feel safe and less anxious.

What concerns did Scarlet, Phil’s wife, have about her husband’s depression?

She was worried because Phil had withdrawn from his family and work, stopped functioning normally, seemed hopeless, and was no longer acting like the husband and father she knew.

What type of psychotherapy did Rosemary use with Phil?

She used cognitive-behavioral therapy, with a strong emphasis on behavioral activation.

What were the criteria for Phil’s diagnosis of major depressive disorder?

He had a major depressive episode with more than the required number of depressive symptoms, significant impairment, and no history of mania or hypomania.

What are some of the methods that were used as part of behavioral activation?

Activity monitoring, scheduling pleasurable activities, completing avoided tasks, increasing valued activities, exercising, increasing social/family activities, and creating structured daily routines.

Phil wanted to know how long it would be before he felt normal again. Why did Rosemary not want to give him a definite timetable?

She did not want to create a specific expectation that could later become another source of hopelessness if recovery took longer than predicted.

What was the first assignment Phil was given for the first week of therapy?

He was asked to monitor his activities and emotional reactions throughout the week, recording what he did and what events or thoughts produced distress.

Why did Rosemary want Phil to clarify his values near the beginning of therapy?

Values helped identify what mattered most to Phil and provided a guide for choosing activities that would make his behavior more meaningful and reduce depression.

What was the homework assignment given in session 2? What was the purpose of this assignment?

He made lists of activities he used to enjoy, activities he was avoiding or needed to accomplish, and valued activities. The purpose was to identify specific behaviors that could increase pleasure, mastery, and meaningful engagement.

Why was it important to get Phil to set up an evening routine of activity?

Depression had caused him to withdraw and become inactive. A structured routine increased valued family activities, reduced isolation and rumination, and interrupted the negative cycle of depression and avoidance.

What were the three main components of BA that Rosemary used.

The three main components were valued activities, pleasurable events, and avoided/tasks-that-needed-to-be-done activities.

At approximately what point in treatment did Phil return to full function?

He had returned to full functioning by sessions 10–12.

What event prompted Hannah’s first symptoms of bipolar disorder?

Her first clear symptoms emerged during her senior year of high school while she became increasingly absorbed in and theatrical about a school play.

What events may have turned her mania into depression?

The consequences of her manic behavior, social rejection, risky experiences, embarrassment, and later traumatic experiences contributed to the shift into depression.

What was the reason for Hannahs second hospitalization?

She became manic again after stopping lithium, developed grandiose ideas, behaved recklessly, and began dramatically redecorating her parents’ house while sleeping very little.

What medications were used in the beginning of Hannahs treatment and then several years later to assist in reducing Hannah’s symptoms?

Lithium was the primary long-term medication. Lamotrigine was later used for an acute depressive episode, and eventually aripiprazole was added as a newer medication while lithium was reduced.

Why did Hannah decide to stop taking her medications, and what was the result?

She disliked the emotional flattening and side effects and felt medication was restricting her freedom. After stopping lithium, she became manic again and experienced serious consequences.

Which of Hannahs manic behaviors became a concern to her parents?

Her decreased need for sleep, impulsive behavior, grandiosity, excessive spending/activity, risky social and sexual behavior, and unrealistic projects became concerning.

Hannah suffered from delusions of grandeur. What was her specific grandiose idea?

She became convinced that she had a special talent for interior design and decided she could redecorate her parents’ entire house and use it to launch an interior-design career.

Explain the concept of the physician emergency certificate. Why was this necessary in Hannah’s case?

It is a procedure allowing a person to be temporarily hospitalized for psychiatric evaluation without a court order during an emergency. It was necessary because Hannah was severely manic, lacked insight, and was behaving in a way that required immediate psychiatric intervention.

Why do friendships suffer when an individual is bipolar?

During mania, impulsivity, unusual behavior, irritability, and poor judgment can alienate others; during depression, withdrawal and low confidence can make maintaining relationships difficult.

Why did Hannah decide to begin therapy with Dr. Stanley?

She recognized that medication alone was not enough to address her relationship problems, feelings about medication, and difficulties developing a stable life.

Why did Dr. Stanley choose the diagnosis of bipolar I?

Hannah had experienced a full manic episode with major impairment and psychotic/grandiose features, which is sufficient for bipolar I disorder.

Why did Dr. Stanley want to increase Hannah’s lithium level?

She suspected that Hannah’s previous medication problems were partly due to an insufficient lithium level rather than deliberate noncompliance, so she wanted a level capable of maintaining mood stability.

What is meant by the term rapid cycling ?

Rapid cycling means experiencing four or more mood episodes within one year.

Why did Dr. Stanley suggest that Hannah see a psychotherapist, Dr. Mydland?

She needed help understanding her feelings about medication, improving relationships, developing independence, and changing problematic behavioral patterns.

What type of therapy did Dr. Mydland use with Hannah?

He used insight-oriented psychotherapy, focusing especially on her relationships with her parents, her self-concept, intimate relationships, and personal goals.

How many years did it take for Hannah’s moods to stabilize?

Her life began to show substantial stabilization by about the third year of treatment, although she continued treatment and medication management for many more years.

What new medication was used to replace the lithium? What are the advantages of these newer medications over lithium?

Aripiprazole was introduced as part of a newer medication combination. The newer medication allowed lithium to be reduced while helping maintain mood stability and restoring more emotional richness with fewer unwanted effects for Hannah.

What was the concern that Lilly had, along with many others who have bulimia nervosa?

She was intensely concerned about gaining weight and becoming larger, with her self-worth strongly tied to thinness and body shape.

Describe Lilly’s eating plan, including her “good” and “bad” eating habits. Do you think her eating plan was reasonable?

Lilly labeled foods as good or bad, restricted her intake, often skipped or minimized meals, and attempted to control calories through dieting. The plan was not reasonable because the restriction increased hunger and contributed to binge eating.

When did Lilly’s eating behaviors begin to become pathological?

They became pathological when ordinary dieting and concern about weight developed into increasingly restrictive eating, recurrent bingeing, and compensatory behaviors.

What prompted Lilly to decide to purge after her binges?

She became extremely afraid of gaining weight after binge episodes and believed purging could undo the calories she had consumed.

What was Lilly’s nonpurging activity to lose weight?

She used excessive exercise and restrictive dieting as additional methods of trying to control her weight.

According to the information provided in the text, how do individuals with bulimia generally perceive their body size compared to control subjects?

They tend to overestimate their body size and experience greater body dissatisfaction than control subjects.

How did Lilly’s eating disorder affect her relationships with her coworkers?

She became increasingly preoccupied with food, weight, and comparisons with other women, which made her more socially withdrawn and strained some workplace relationships.

Why did Lilly finally decide to seek treatment?

Her bingeing, purging, dieting, and exercise were worsening, she feared the problem would become even more extreme, and she was distressed enough to contact an eating-disorders clinic.

Describe the cognitive-behavioral theory of the maintenance of bulimia nervosa.

Strong concerns about shape and weight lead to restrictive dieting and other weight-control behaviors. Restriction increases hunger, which contributes to binge eating. Bingeing then produces distress and compensatory behaviors, which temporarily reduce fear of weight gain but help maintain the cycle.

Dr. Weinfurt asked Lilly to keep a record of her eating behaviors. What did Dr. Weinfurt see as advantages to this exercise, and why was Lilly reluctant to participate in this assignment?

The records allowed the therapist to identify patterns, triggers, restriction, bingeing, and compensatory behaviors. Lilly was reluctant because she felt embarrassed, feared confronting the seriousness of the disorder, and worried that monitoring would increase her focus on food and weight.

At what age do most cases of bulimia begin?

Most cases begin during adolescence or young adulthood.

From reading about Lilly, list all of the reasons you think she developed bulimia nervosa.

Contributing factors included strong concerns about weight and appearance, restrictive dieting, labeling foods as good or bad, pressure to be thin, body dissatisfaction, weight-related beliefs about success, increasing hunger from restriction, emotional distress, and the reinforcing effects of bingeing and purging.

What is one of the most common reasons individuals with antisocial personality disorder end up in therapy?

They often enter treatment because of legal, relationship, financial, or other external pressures rather than because they recognize their behavior as a psychological problem.

Throughout this case study, what behaviors did Dee manifest that fit a diagnosis of antisocial personality disorder?

She showed chronic deceitfulness, theft and other lawbreaking, impulsivity, aggression, irresponsibility, reckless behavior, manipulation, and little concern for the effects of her behavior on others.

What did Dee do that is consistent with antisocial personality disorder during her time in the emergency room?

She provided misleading accounts of events and used claims of psychological crisis to influence the situation and avoid legal consequences.

What are the statistics regarding the gender of people with antisocial personality disorder?

The disorder is substantially more common among men; the textbook states it can be as much as four times more common among men than women.

How did the clinical interviews in the inpatient admission unit help inform Dee’s diagnosis?

The interviews revealed a longstanding pattern of antisocial behavior beginning in childhood, including truancy, fighting, theft, lawbreaking, aggression, and lack of concern for others. Psychological testing also supported the diagnosis.