Psychology Theory Demographic Information

Mr. C, a 38-year-old married male recently contacted a faculty anxiety clinic seeking treatment. At the time he contacted the centre, he self-reported that he experiences social anxiety in different settings, for instance, when talking to strangers, speaking or writing in front of a group, and/or in hostile situations. Furthermore, Mr. C also reported that he often avoided settings such as the ones mentioned above because of social anxiety. Mr. C specifically pointed out that writing in front of a group of people was one of the worst experiences he had had to go through constantly due to the nature of his work (Weiss, Singh, & Hope, 2011).

Identifying Problem

According to his self-reports the client was born in Central America and immigrated to the U.S. (United States) when he was about 8 years old. Mr. C stated that he had had social anxiety since his childhood days before he moved to the United States. As a child he had moved from his rural village where most people spoke an indigenous language, to a city where the majority of the people conversed in Spanish. At that point in his life he started feeling anxious when interacting with them since he thought they would think of him differently if they knew he could not speak Spanish fluently. Mr. C continued in his report noting that from then up to now there are still a number of situations that make him anxious and that as an adult he had turned to drinking alcohol so as to cope with the condition. However, on a more positive note, he reported that he had recently become sober and purchased a self-help book to help deal with his social anxiety. He however noted that he felt that clinical therapy was the only way he could completely eliminate his negativity (Weiss, Singh, & Hope, 2011).

Source of referral

Referral to a specialist who could deal with the case was required and it was agreed that Mr. C should be sent to a mental health specialist. Different cases require different types of referral, at times it is best to send one to a community mental health interdisciplinary team. Such teams are usually made up of professionals from different disciplines who contribute towards better patient outcomes. The professionals included in a mental health team include: social workers, occupational therapists, clinical psychologists, psychiatric nurses and psychiatrists among other mental health specialists. Normally, one individual is appointed from the team to conduct a re-evaluation of the condition. The selected mental health specialist will usually inquire about previous interventions and their outcomes. The specialist may also inquire about the risk or contributory factors to the condition and the social support available to the patient. The specialist may then come up with his or her own intervention plan to deal with both the symptoms and the underlying causes of the disease effectively. His or her intervention plan may include a treatment not used before, either using clinical drugs or psychological interventions. Alternatively, Mr. C may be given a mixture of medication and psychological treatment or two different kinds of prescribed drugs (Generalized anxiety disorder in adults -- Treatment, 2014).

Treatment setting

A CaucAsian-American woman with a doctorate degree in clinical psychology will be dealing with this case. The white woman is a licensed clinical psychologist with expertise in treating different types of anxiety disorders will be supervising the treatment process. The psychological intervention will entail seventeen sessions which will concentrate on cognitive exposure and restricting and also psycho-education utilizing Hope and colleagues' (2000) Managing Social Anxiety: A Cognitive-Behavioral Approach manual. The sequence of treatment used from the work is presented in Table 1. Each of the seventeen sessions will be fifty minutes long. And there will only be a single session per week. Figure 1 for SASCI measures and corresponding treatment sessions will be used to evaluate the progress of the situation (Weiss, Singh, & Hope, 2011).

Diagnostic Evaluation

The symptoms that Mr. C reported were similar to those described under Social Anxiety Disorder (SAD) in the Anxiety Disorders Interview Schedule for DSM-IV. There were no additional diagnoses. Problematic symptoms included experiencing anxiety when talking to strange people, speaking or writing in front of a group, when reprimanding others or by being the centre of attention. A clinician's severity assessment was conducted using ADIS-IV and it was found that the patient had a severity of 5 out of a maximum possible score of eight, showing that his symptoms were between moderate and severe. Mr. C also noted that...

One of the most problematic issues he had to face every day was writing in front of others since the work he did required it. Moreover, Mr. C noted that the condition limited the kind of jobs he could do since he was only comfortable in doing those that required very little interaction of with others. Mr. C also reported that he had enrolled in a computer literacy program but did not complete it out of the fear that he would end up having to speak in-front of the whole class if he was requested or wanted clarifications on an issue he did not understand (Weiss, Singh, & Hope, 2011).
Assessment

Fear of Negative Evaluation -- Brief Version (BFNE)

The BFNE is a twelve-item assessment tool that measures the degree to which someone thinks that the society views them unfavorably, a characteristic which is thought to be at the centre of social anxiety. The participant/client/respondent is asked to rate to what extent each item is characteristic of them. BFNE has a good reliability and its scores can be associated with measures of depression and loneliness. The measure was utilized in the 1st and 17th sessions (Weiss, Singh, & Hope, 2011).

Social Interaction Anxiety Scale (SIAS)

SIAS is a twenty-item measure of anxiety during social engagements. Respondents using the scale indicate, on a scale of 0 to 4, how characteristic of them each item is with 0 being equivalent to not true and 4 extremely true. People with social anxiety have consistently scored higher on social interaction anxiety scales compared to those who don't have the condition, providing proof of the validity of the scale, Moreover; SIAS has a more than average internal consistency. The measure was utilized in the 1st and 17th sessions (Weiss, Singh, & Hope, 2011; Hope, Heimberg & Turk, 2010).

Social Phobia Scale (SPS)

This is a twenty-item measure of anxiety when interacting with others or doing something in front of them. Respondents using the scale indicate, on a scale of 0 to 4, how characteristic of them each item is with 0 being equivalent to not true and 4 extremely true. Scores on the social phobia scale range from zero to eighty, and a score of 24 and above shows that the respondent suffers from social anxiety disorder. Quite a number of studies published reveal that the scale is good discriminator, divergent and convergent validity. Its internal consistency and re-test reliability were also found to be above average. The measure was utilized in the 1st and 17th sessions (Weiss, Singh, & Hope, 2011).

Social Anxiety Session Change Index (SASCI).

This is a 4-item measure that is usually utilized/administered a week before a session. The client is asked to report the extent they think they have changed since the sessions begun in terms of problems associated with SAD symptoms, their feelings towards the shame or embarrassment they felt in front of people, their avoidance of social interactions or engagements, and general anxiety towards such interactions. The client indicates on the measure using a seven-point scale (similar to the Likert scale) with the score of 1 indicating negative changes, 4 indicating no changes and 7 huge positive change. Studies have also proven that SASCI has a good sensitivity to change, discriminant validity and internal consistency. The index was administered after each session except the fourth one (Weiss, Singh, & Hope, 2011).

Fear and Avoidance Hierarchy

As part of the overall intervention, a special Fear and Avoidance Hierarchy was collaboratively developed during session four. Upon drawing a list of possible feared scenarios, Mr. C was asked to rate the degree of anxiety that each scenario elicited and how frequently he avoided such scenarios/situations. The degree or severity of anxiety was rated using ratings of the level of discomfort ranging from 0 to 100, with 0 indicating no anxiety and 100 extreme anxiety. Avoidance was similarly rated on a scale of 0 to 100 with zero indicating no avoidance and 100 indicating total avoidance. Fear and Avoidance ratings were measured in the 4th and 17 intervention sessions (Weiss, Singh, & Hope, 2011).

Cognitive restructuring sessions will concentrate on determining and changing negative thought processes. Advanced cognitive restructuring concentrated on changing core beliefs. All anxiety-exposure sessions were conducted in two ways: as an assignment in worksheets and within sessions by role-playing (Weiss, Singh, & Hope, 2011).

The mental status assessment in our present case is a structured evaluation of the cognitive and behavioral functioning of Mr. C. It entails the assessments of his higher…