Case Study: Major Depressive Disorder and Social Anxiety Disorder
The issue being discussed is Laura’s mental health struggles, specifically her recurrent major depressive disorder and social anxiety disorder (social phobia). Her experience includes various depressive symptoms like feeling sad or losing interest, along with insomnia that leads to fatigue during daytime hours. Alongside concentration problems and being too critical about herself, she has also been facing other issues, for instance, facing fear when put into a situation where one needs to be socially active or having trouble communicating or asserting oneself. Maintaining relationships has been hard for her. She feels distressed and culpable because of her mother’s care, as well as not being able to have kids as a result of menopause (McBride & Atkinson, 2009).
Intervention of choice
My intervention of choice is solution-focused Therapy (SFT). SFT is a goal-oriented, present-focused, and brief psychotherapy model that focuses on solutions rather than problems. The premise is that solutions exist in the current time frame regardless of prior events. What matters most are recent and future events, and the past events are of little significance (Hammonds et al., 2019). The objective is to assist clients in distinguishing and developing solutions for their present issues. In this model, a therapist will aim to recognize the client’s unique set of skills, which are then utilized as a part of the solution-building process. The therapist aids the client in developing the vital abilities needed to establish and sustain a more positive outlook (Corcoran, 2021). The key focal point is on the present and future, and the therapist and client work collaboratively to develop an action plan to aid the client in attaining their objectives.
Solution-focused Therapy is a relatively new approach to counseling and psychotherapy, first created in the late 1970s by Steve de Shazer and Insoo Kim Berg. The creators were both trained in the traditional psychoanalytic approach to Therapy and sought to find a way to help their clients more effectively. Their intention was to design a therapy model that put more emphasis on being active and setting goals rather than looking back at the past or trying to uncover why someone is experiencing emotional pain (Zinnia Health, 2023). De Shazer and Berg based their model on the idea that people are resourceful and can solve their problems. They recommended that it was not essential to focus on the individual’s distress cause, and rather, the focal point should be on seeking solutions to the issue; therefore, while serving as an assistant, the therapist could help the patient recognize their resources and using them to achieve their goals.
De Shazer and Berg also argued that clients should be viewed as active participants in their Therapy rather than passive treatment recipients, which meant that the therapist should take a collaborative approach to Therapy, engaging the client in dialogue and allowing them to take ownership of their recovery (Zinnia Health, 2023). This approach was in contrast to conventional psychoanalytic approaches, which perceived the therapist as the power figure and the client as a passive guidance recipient of the therapist. De Shazer and Berg also argued that the goal of Therapy should be to achieve a preferred future rather than simply resolving the problem at hand, implying that the focus should be on assisting the client in developing a vision for their future and then taking action to attain it. This contrasts with more conventional approaches, which center around resolving the problem without future consideration.
De Shazer and Berg’s approach was revolutionary at the time and has since become one of the most popular psychotherapy approaches. The treatment of different psychological issues, for instance, depression, addiction, trauma, and relationship issues, has effectively utilized it. Aiding clients in reaching personal objectives and inducing favorable adjustments in their lives is another application of it (Zinnia Health, 2023). De Shazer and Berg’s approach’s success is because of its focus on solutions instead of the cause of the issue, its collaborative nature, and its spotlight on creating a preferred future. Countless individuals have found solutions to their problems and taken control of their lives through this approach.
Features of the intervention model
The SFT model is based on the humanistic psychology theory, which views individuals as having intrinsic worth and capable of making decisions for themselves. The model emphasizes that individuals are the primary agents of change and that they can create their solutions (Grant & Gerrard, 2020). Additionally, it rests on the assumption that individuals are able to develop new capabilities and modify their actions. By utilizing the SFT model, individuals can identify their goals and learn how to use resources effectively to create a positive impact. The therapist aids clients in recognizing and amplifying their strengths along with developing fresh abilities, which allows them to attain the results they want.
The SFT model views humans as having the ability to make a significant change in their lives and to take action to accomplish their goals. Additionally, it views humans as having the capacity to recognize and use their strengths to accomplish their goals and to make positive adjustments (Grant & Gerrard, 2020). The SFT model also emphasizes the significance of developing a “solution-focused” mindset, which incorporates learning to perceive and utilize resources, adjusting existing abilities and behaviors, and creating plans of action to attain goals. The therapist assists the client in identifying and building upon their existing abilities and resources and establishing a change plan.
The SFT model views problems as developing when a person feels stuck in a certain situation or circumstance and is unable to move forward, which can occur when an individual feels overpowered by an issue or circumstance and cannot find a solution. Besides, the SFT model views problems as resulting from a lack of resources or skills and an inability to recognize and use existing resources or skills to move forward and is designed to assist clients in identifying and use their strengths and existing resources to move forward in a positive direction. Collaboratively, the therapist works with the client to recognize and build upon their strengths, foster new abilities, and create a change plan. The SFT model also stresses the significance of creating a “solution-focused” mindset and taking action to accomplish the desired results (Gupta & Fakhr, 2022).
I would apply solution-focused Therapy to the case by helping Laura to identify and focus on her desired outcomes. I would begin by asking her to describe her ideal life and then work cooperatively to recognize the steps she can take to move toward her objectives. I would also help Laura look at her current situation in a more positive light and identify any current strengths or successes that she can draw on to make progress. By doing this, we can build on her existing resources and strengthen the hope she has in achieving her goals. Furthermore, I would work with Laura to distinguish her qualities and the significance of her life, which can be a strong source of inspiration and can assist her with finding purpose in her life. Besides, I would urge Laura to take action consistent with her values and objectives, assisting her with making small improvements in her day-to-day existence that will ultimately prompt the desired result.
Model’s helpful aspects
I believe that SFT is a valuable approach to psychotherapy and can be beneficial in many cases. This collaborative approach prioritizes enabling the client to recognize and leverage their own resources toward positive change. Moreover, it is a present-oriented strategy that focuses on finding remedies for present problems rather than dwelling on the past. In addition, SFT is a goal-oriented approach that supports clients in creating a vision for their future and then working towards accomplishing it. Nevertheless, there are some restrictions to SFT that should be thought of. SFT does not address the underlying causes of the issue but rather centers around finding solutions in the present time and place (Jerome et al., 2023). It also relies on the client’s motivation and commitment to making positive changes, which can be difficult to maintain. Also, it may not be compelling for more complex mental problems, for instance, trauma.
Generally, I believe that SFT is a significant approach to psychotherapy and can be valuable in many cases. I would use the theory in practice, as it is a collaborative approach emphasizing the client’s ability to create change. Besides, it is a present-focused approach that does not dwell on the past and is goal-oriented, assisting the client to create a vision for their future. However, some restrictions to SFT should be considered, for instance, the lack of research on its effectiveness in managing specific types of psychological issues.
Corcoran, J. (2021). Theoretical Perspectives for Direct Social Work Practice.
Grant, A. M., & Gerrard, B. (2020). Comparing problem-focused, solution-focused, and combined problem-focused/solution-focused coaching approach: Solution-focused coaching questions mitigate the negative impact of dysfunctional attitudes. Coaching: An International Journal of Theory, Research, and Practice, 13(1), 61-77.
Gupta, H., & Fakhr, R. (2022). Solution-focused brief Therapy and depression. depression, 6(S2), 8892-8902.
Hammonds, D. S., Jordan, N. A., & Block, J. L. (2019). Clinical mediation: Advocating for a new role. Journal of Counselor Preparation and Supervision, 12(2), 7.
Jerome, L., McNamee, P., Abdel-Halim, N., Elliot, K., & Woods, J. (2023). Solution-focused approaches in adult mental health research: A conceptual literature review and narrative synthesis. Frontiers in Psychiatry, 14, 477.
McBride, C. and Atkinson, L. (2009). Attachment theory and cognitive-behavioral Therapy. In J.H. Obegi & E. Berant (Eds.), Attachment theory and research in clinical work with adults (pp. 434-458). New York: Guilford.
Zinnia Health. (2023, February 3). What is solution-focused brief Therapy?
Stress and Anxiety in a School Setting
Child health in school depends on the experiences they undergo in their day-to-day life that may cause anxiety and stress, effects that would affect their psychological well-being, cause trauma, and influence a child’s overall performance in school. It is, therefore, essential to create a structure that improves student mental health and prevents any possible psychological harm that is likely to affect the child in adulthood. Anxiety in a school setting is a sense of fear and stress that occurs when students undergo traumatic experiences that may increase and threaten their overall well-being (Anniko et al., 2019). Children may repeatedly undergo practical stress because of examinations, shooting in a school, or other events that prevent the individual’s ability to concentrate and act appropriately toward academic success.
Understanding Stress in a School Setting
Stress in school can result from emotional trauma because events and occurrences can create positive or negative impacts on children when they lack the necessary counteractive actions to manage stress in the school environment. Positive stress can occur because of anxiety about interacting with new friends and changing the environment to a new school. Negative stress occurs when students have to manage dreadful school events like fires and accidents and stressful events like examinations (Abrams, 2022). Children can experience anxiety in school because of the fear that they need to attain perfection in their work. They would also remain stressed after managing the urge to cope with a new environment away from their family because of separation from parents and close friends. The child may feel it challenging to concentrate in class or perform poorly because of concentration issues.
Children are likely to undergo anxiety and stress that may affect their comfort and mental well-being. The effects of stress and anxiety may multiply if the school administration lacks the necessary stress management infrastructure needed to help students overcome stressful instances and anxiety. Some of these stressful instances are related to anxiety, as students struggle with social anxiety, selective mutism, generalized anxiety, and obsessive-compulsive disorder (Anniko et al., 2019). Multiple phobias also occur because of things like animals, heights, or other things in school that, when not identified, would cause traumatic psychological effects. These stressful occurrences can affect individual mental health and their ability to concentrate, focus, succeed, and perform appropriately in school.
The different types of anxiety that affect student performance because of poor mental well-being, improper concentration, and inappropriate focus involve worries that make the children uncomfortable in school. Some children can feel uncomfortable and worried when separating from their caregivers and therefore have difficulty learning in school depending on their level of attachment with the people they separate with as they leave for school ((Paulson, 2021)). Other children are pretty self-conscious and therefore lack the confidence to socialize freely in school with class and socialize with friends. Selective mutism frees children from various people and remains highly reserved in other people’s companies (Anniko et al., 2019). They may fear talking in the teacher’s presence but be highly talkative with particular friends. In the presence of dreadful social impacts that may result in obsessive-compulsive disorder, the students require appropriate stress management processes that improve social wellness.
It may be difficult to manage stressful thoughts affecting the kids because of trauma, stress, and anxiety that causes inattention. Inattention and restlessness are revealed when children squirm in their seats because of poor psychological health (Schluger, 2022). Children would not want to go to school when it becomes a fundamental cause of anxiety and discomfort. When children have to use phones in school, they may not concentrate on trying to reach their parents through messages and social media channels. Anxious kids tend to be inquisitive because they want assurances (Torrano et al., 2020). They may ask repetitively to seek reassurance. Children can act compulsively by kicking objects when they face highly traumatizing situations (Anniko et al., 2019). They may fight more frequently or throw objects. Anxious children are likely to break eye contact and avoid connection with their teacher because of their inability to engage effectively in class and socialize freely. Physical manifestations of anxiety can also occur in the form of complaints about stomachaches, headaches, nausea, or vomiting due to improper overall health.
Text anxiety is a common form of stressful behavior affecting children’s well-being. Examination anxiety may be continuous when it persists after exam failure, which occurs because of the fear that persists after the examination. Test anxiety combines physical and emotional responses that cause discomfort and poor focus during examinations (Hoffses, 2018). Examples of physical manifestations of test anxiety include headache, shortness of breath, and excessive sweating that arises as the body responds to stressful situations (Kaczmarek & Trambacz-Oleszak, 2021). The affected person may have an increased rate of heartbeat that would increase body temperature and cause persistent sweating. The result of this anxiety is the occurrence of frequent panic attacks that cause difficulties in breathing. Physical symptoms are a result of body reactions in the brain that translate the fear emotion to hormones and lead to the occurrence of these physical symptoms.
Emotional manifestations of test anxiety include stressful feelings that cause helplessness and disappointments. The mind might respond to this stress by going blank and increasingly unable to recall appropriately during the examination because of racing thoughts. Emotional symptoms of stress might also explain poor performance in class because of failures to concentrate appropriately in class (Paulson, 2021). Emotional impacts are also related to the cognitive influence that involves concentration difficulties, pessimism, and procrastination which may cause irresponsibility and procrastination (Caldwell et al., 2019). Research shows that text anxiety is more common in girls than boys and increases with age before reaching peak levels at mid-adolescence. Poor examination preparation is a crucial reason for test anxiety, fear of failure, and poor results’ adverse consequences. Therefore, emotional stress has a practical impact on the mental capacity to make proper academic decisions.
School shootings are other highly stressful instances in American schools, like the recent mass shooting on May 24, 2022, that claimed the lives of 19 children and two teachers in a deadly encounter with a gunman. Given the media’s highly effective portrayal of these instances, there is a significant impact on children all over the country who may become anxious about shooting possibilities in schools (Abrams, 2022). The frequency of school shootings is substantial, making children uncomfortable because of potential violence. Anxiety and panic disorders are common, and kids usually internalize these fears, which would multiply their mental health issues over time. Anxiety and PTSD are common in children of all ages but are more effective in younger kids. Teens are more scared because they can make sense of violence (Abrams, 2022). The psychological effects of school shootings are significant and therefore risk students’ mental health because of inflicted fears and dreadful influence because of poor health.
The cognitive impact of social media is alarming because of the increased number of hours spent on mobile phones and other social media technology. Social media has contributed to increased depression because of Snapchat, Facebook, Twitter, and Instagram. The children spent little time doing other valuable activities like socialization, hobbies, and physical activities that may help in individual cognitive development (Ehmke, 2022). beneficial practices like academic practice and research receive a slighter portion of individual time compared to social media, which may result in feelings of depression, anxiety, and poor body image (Caldwell et al., 2019). Children have little time experimenting and practicing valuable skills because they can remain held on their phones even until late at night. They may suffer immensely from decreased ability to create meaningful relationships and succeed in valuable school activities.
Social media tends to lower individual self-esteem because of increased social media consumption that adversely affects social life. This impact also increases irritability and poor confidence levels. They are likely to visit destructive sites, undergo movement disorders, and remain highly frustrated with people who prevent them from visiting these sites (Ehmke, 2022). Children might not have sufficient information and resilience to manage the effects of cyberbullying, dreadful viral trends, and online predation (Caldwell et al., 2019). They may share unnecessary information because they are unable to make a proper judgment on the information they release to the environment. Children are more likely to suffer depression because of cyberbullying because of access to the uncontrolled release of abusive comments on social media platforms. Racism and gender violence in social media can affect child health and therefore impact their performance in school.
Instances of anxiety can also occur because of mindfulness that arises because of the urge to know the results and outcomes of a given instance. It increases anxiety and worries as children become curious about their new environment after separation from their parents and seek reassurance and proper social protection (Caldwell et al., 2019). It may affect student attention and focus as children may be overwhelmed with other issues that affect their overall well-being. Mindfulness training can help control the impact when children get the necessary education concerning self-efficacy and preparedness and create an easy integration into the dynamic school environment (Dunning et al., 2019). attention and metacognition increase as children gain the ability to meditate about their school environment and create individual solutions concerning the issues that affect their peace and performance in school.
There are practical tools that children can apply to overcome anxiety, like correctly identifying the instances that cause anxiety. Children can also gain from school programs that examine their thoughts, emotions, and experiences and act empathetically to ensure they feel protected. Physical activities are effective in solving anxiety issues. They need to learn how to break down tasks and prepare appropriately for examinations through proper task assessments that promote individual efficiency and performance. Role-plays and recognition of individual accomplishments can multiply children’s success by building confidence and encouraging them to work more towards class efficiency.
Abrams, Z. (2022). The stress of mass shootings causes a cascade of collective traumas. Apa.org. https://www.apa.org/monitor/2022/09/news-mass-shootings-collective-traumas
Anniko, M. K., Boersma, K., & Tillfors, M. (2019). Sources of stress and worry in developing stress-related mental health problems: A longitudinal investigation from early-to mid-adolescence. Anxiety, Stress, & Coping, 32(2), 155-167.
Caldwell, D. M., Davies, S. R., Hetrick, S. E., Palmer, J. C., Caro, P., López-López, J. A., … & Welton, N. J. (2019). School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis. The Lancet Psychiatry, 6(12), 1011-1020.
Dunning, D. L., Griffiths, K., Kuyken, W., Crane, C., Foulkes, L., Parker, J., & Dalgleish, T. (2019). Research Review: The effects of mindfulness‐based interventions on cognition and mental health in children and adolescents–a meta‐analysis of randomized controlled trials. Journal of Child Psychology and Psychiatry, 60(3), 244–258.
Ehmke, R. (2022). How Using Social Media Affects Teenagers. Child Mind Institute. https://childmind.org/article/how-using-social-media-affects-teenagers/#:~:text=This%20can%20cause%20callousness%20in
Hoffses, K. (2018). Test Anxiety (for Kids) – KidsHealth. Kidshealth.org. https://kidshealth.org/en/kids/test-anxiety.html
Kaczmarek, M., & Trambacz-Oleszak, S. (2021). School-related stressors and the intensity of perceived stress experienced by adolescents in Poland. International journal of environmental research and public health, 18(22), 11791.
Paulson, D. (2021, August 31). Helping children manage anxiety. Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/9-tools-for-helping-your-child-manage-anxiety
Schluger, A. .E. (2022, October 13). Anxiety in Children and Teens – HelpGuide.org. Https://Www.helpguide.org. https://www.helpguide.org/articles/anxiety/anxiety-in-children-and-teens.html
Torrano, R., Ortigosa, J. M., Riquelme, A., Méndez, F. J., & López-Pina, J. A. (2020). Test anxiety in adolescent students: different responses according to the components of anxiety as a function of sociodemographic and academic variables. Frontiers in Psychology, 11, 612270.