Anxiety- Definitions, Treatment and Progress: A Case Study
- Lisa Shouldice
- May 14
- 8 min read
Anxiety Case Study: Introduction and Definitions
Anxiety is like a temperature. It tells us something is wrong, an infection or virus in the body. Anxiety is the mental health version of this, a signal that there is something to attend to. Anxiety Blog
It can be overload, too much, I can’t handle this much change at once.
It can be influenced by genetic factors, this means your threshold for anxiety is lower or it takes less to cause an anxiety response
Your body can be telling you what you are doing is a trauma response and not in line with who you are.
Your body can be telling you your boundaries have been violated.
You may have a trauma history that results in frequent anxiety due to a central nervous system wired for danger.
There are myriads of possibilities that I am looking for when I meet a client for the first time, to help determine what the body is saying and needed treatment. That is the first step in our work.
Due to the many complex details involved in anxiety, treatment must also be individualized and include several tools for continued symptom management.
Anxiety Case Study: Assessment and Treatment
After a full assessment to determine a client’s specific individual pieces and personal history, treatment is begun. Assessment ensures I know you and my interventions are informed.
I integrate chosen techniques to begin, while also building trust and getting to know each other.
Having a safe space to talk about hard things often results in symptom reduction after a handful of sessions, talking to a fully present person. Careful, this is when many clients feel better and leave therapy. But this initial symptom mitigation does not last long-term.
We begin using mindfulness-based and emotion-focused techniques to explore what is brought to sessions. Initially simply what is on your mind. This includes exploratory questions that bring you deeper into you body as you talk about something from your week.
We will talk about feelings, deepening them to get you full access to what your emotions are trying to tell you. Therapy Techniques Blog
Somatic pieces are important here. So I will take you through getting into your body to identify where the most intense emotional reactions are. This is done gently, pacing your experience as we build trust. Not just trust in me, but trust in the therapy treatment process so you know what to expect, as well as how you will feel the next day.
We will integrate self-care so you can take care of yourself as we do this powerful, transformative work. We will determine what works for you Ex. Exercise, painting. We may introduce meditation to calm the central nervous system. Journaling to process hard feelings between sessions.
Non-verbal techniques and exercises are usually an important piece as well. Trauma is held in the amygdala, the more pre-verbal part of the brain. So we need to process it through the neocortex, the more logical part.
I offer Sand Tray Therapy Blog link as it is a symbolic, less verbal way to access your inner world. You are in full control of it, a powerful, but also gentle experience.
We may draw a feeling you struggle with.
You may really like somatic pieces, getting to know what your body needs with body scans as we talk about hard things.
This builds self-insight and teaches emotional intelligence skills.
We will likely talk about attachment styles Blog. This refers to the way you learned to be close to people as an infant/child with your primary caregiver(es).
You may be fearful they will leave or judge you (Anxious attachment style). You may crave closeness but find people inconsistent so withdraw after awhile, but think about the relationship often (Disorganized attachment style). You may avoid intimacy and being close to people often (Avoidant attachment style).
While we learn this in our formative years, this attachment style is the one that activates in close relationships all your life.
You can learn to be close to people in new ways by healing the attachment wounds experienced in your family of origin and throughout your life. Ex. A toxic relationship.
You can also integrate relational techniques in your therapy treatment. Your attachment style is activated in every relationship, even with your therapist.
You may worry your therapist judges your choices. You may feel they will stop seeing you if your needs increase.
The therapeutic relationship can be a chance to safely address these fears directly, not always possible in our life.
As we determine your past experiences that need to be explored and healed, we will be talking about your relationships as all trauma includes other people.
We will determine the core beliefs about yourself and others along the way.
When you make a dinner for your family for the holidays, you may be triggered and bring that trigger to a session. This helps determine where the wounds are, so they can be healed and explored.
Throughout this process, there are some typical ways progress may be experienced.
Wounds begin to have less power in your life.
Symptoms mitigate.
You take more time for yourself.
You learn to like yourself more.
Your take more space to make new decisions, feel different in relationship.
You communicate needs.
You may choose new friendships where you can take space.
You may start to feel joy.
Anxiety: A Case Study
Elita presented as experiencing regular high anxiety, impacting her sleep and socializing. She reported having high self-insight and trying to do the “right” things for anxiety. But still felt anxious often, debilitating her. She feels she intellectualizes her feelings, analyzing and over-thinking, especially social interactions.
During the full assessment I learn Elita had an angry/kind nurturing, inconsistent mother that was emotionally sensitive. Her father traveled a lot for work. She is an only child. She was considered the perfect, adored child by both her parents and good in school, social. She feels she had a good childhood and is close to her mother, a sensitive, emotional woman.
Elita had several serious relationships before she met her husband. She prefers sensitive, caring men.
She has an infant daughter. She was inspired to try therapy as the anxiety is increasing, and she does not want it to negatively impact her daughter.
She is also drinking less as a new mom, feels drinking did help mitigate anxiety symptoms in her past, but does not want to bring this into her future.
As Emotion-focused and mindfulness techniques were used to access Elita’s experience and anxiety symptom mitigation begins, Elita has a safe place, all her own, to talk about whatever she wants.
Elita is really positive and struggles with allowing herself to simply be sad and hopeless when her anxiety is at its highest. She finds as she let’s herself “squawk” (her word) in session she feels initially better, but the anxiety returns within hours.
We determine that Elita is always positive with others. She feels she is strong and good at helping others. She does not have a lot of negative emotions, she is a happy person, except for anxiety and overthinking any feelings she does have.
What slowly comes out is that her mother is very sensitive and quick to feeling hurt. When hurt she gets angry and yells.
Elita is smart and learns quickly that managing her mother’s feelings and trying to be perfect meant her mother stayed grounded in being a nurturing, caring mother.
As a child, Elita learns to study often, joins social groups and have long, friendly talks with her mother while her father is away.
Elita takes little emotional space as she is always happy and high functioning. She supports her mother that really misses her dad.
She has close friends and finds herself in a support role often. She always supported the emotionally sensitive guys she dated.
Elita learns it is not that she does not have hard feelings. She has wired her body and brain to ensure they do not even hit the radar of awareness. And if they do, she numbs them by being busy or drinking. She has to care for others. She has to get a lot done. She works in finance, she is busy.
Elita is triggered by an angry boss. She cannot handle his irritability, her anxiety increases and she takes a stress leave. She feels guilty as she was only back 6 months after her parental leave.
She also feels increasingly anxious as she spends time with her mother. She gets angry and snaps at her at a lunch, then begins avoiding her.
Elita begins to take more space to let herself feel, get to know her body’s emotional signals.
She starts allowing herself to feel sad, even angry.
She notices the friendships she has that she finds it impossible to take emotional space in.
They bring it back to themselves when she tries to do so, she begins spending less time with them .
Elita starts spending more time alone when her husband watches their daughter. She gets upset if he says he is tired and not feeling up to watching her on afternoons they have agreed he will do so. She has come to depend on her walks in the woods to stop thinking.
Elita does not learn to be assertive perfectly for a long time. As she feels raw and begins to feel sadness and irritability, as they come to the surface more often, she sometimes snaps at her loved ones, feels shame and apologizes.
She slowly learns better assertiveness skills in real time. It seems easy to say how, but hard in the moment as she just wants everyone to be happy. But then resentment builds and she snaps.
She makes a new friend after she goes back to work. She talks to this friend about her therapy process and how her relationship with her mother has suddenly become hard.
Her mother thinks she has become selfish and angry. Elita just finds it hard to listen to her mother’s problems everyday, previously easy.
Elita learns that pottery and working with her hands is therapeutic. She craves the alcohol less the more she makes vases/bowls for her loved ones.
Elita finds the more she listens to her body, tries to take space and please others less, do less for others, that she is less anxious.
When Elita sees her mother only monthly she is able to be present and less resentful. She tries to talk to her but finds her mother victimizes herself, not really hearing her.
She tries more authentic relationships with her old friends, new friends and partner.
One day she realizes she is happier than she has ever been. She is less afraid her husband will leave her if she gets angry with him. He says he just wants to know how she feels and what she needs. She tries to tell him.
Elita still has anxiety sometimes. But she sees it as a gift. It tells her that she needs to get to the pottery studio, take a walk in the woods by her house, play with her 3-year-old daughter.
She realizes she wants another baby.
She listens to her body, identifies hard feelings and lets them course through her. She trusts they will pass and also tell her what she needs. She now feels she can better communicate her needs. She can be closer to others. She is still a caretaker but chooses it when it feels right, not all of the time, expected.
Elita has created a daily self-care routine. She begins her day walking in the woods. She brings her daughter with her sometimes. She journals after emotions flood her. She meditates for 20 minutes before bed.
This routine keeps her anxiety manageable. She knows she can make a therapy appointment to process seeing her mother over the Christmas holidays.
She knows her self-care matters and she deserves it.
Disclaimer: This is not a particular client I have ever worked with, but a prototype or amalgamation of many. These pictures were found on Wix, not client pictures.
Thanks for being here! I hope you fell inspired by Elita.
Lisa S.
