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A young adult male patient by the name of Zack is presenting with some troubling

symptoms. Zack spends a great deal of his time worried, and has been unable to set these worries

aside, even when he recognizes that these worries might not be valid. He’s tried distracting

himself with other thoughts, to no avail. He’s been worrying for most of his time for the past

year. His trouble concentrating on day to day tasks has been interfering with his ability to get

things done, and he’s reporting that he sometimes feels as if his mind has gone blank. He’s

lethargic, and has not been sleeping as much as he used to.

To determine what psychological condition might be troubling Zack, we first must rule

out that Zack has not begun taking new medication or substances. Side-effects from medications

could cause some of the symptoms Zack is reporting. Stimulants could also create some of these

behaviors. Even an excess of caffeine consumption could cause reduced concentration and

sleeplessness. A physical and an order of bloodwork might be in order to rule these things out.

We also must be certain that he isn’t suffering from another health condition that could

create the symptoms Zack is reporting, like hyperthyroidism. “Hyperthyroidism can accelerate

your body's metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat,

sweating, and nervousness or irritability.” (Mayo Clinic, 2015) A patient who is feeling physical

anxiety may follow suit mentally without realizing why or understanding that their body is

leading the stress reaction.

These symptoms could also be caused by another psychological disorder, like panic

attacks, phobias, or major depression. Zack does not describe palpitations, chest pain, a fear of

dying, or other associated symptoms, so we can eliminate panic attacks as a possibility. Phobias

are typically triggered by specific events, objects, or animals. Zack is experiencing his symptoms

in a wide range of places and activities, so this is unlikely as well. Major depressive disorders

often reflect a depressed mood, reduced interest in activities, dietary changes, sleep disturbances,

fatigue, and concentration issues. Zack may have a few of these symptoms, but he does not

mention sadness. His worrying is limiting his ability to participate in activities, but he has not

lost interest in them. This helps us rule out a diagnosis of Major Depression. Now that we’ve

done our due diligence and ruled out other disorders and medical conditions, we can treat Zack,

after a look at his full medical and psychological picture.

Generalized Anxiety Disorder is the best fit for Zack, once we’ve ruled alternative

diagnoses out. “Excessive, persistent worries that diminish functioning are the cardinal

symptoms of GAD.” (Sederer, 2013, p. 119) The Diagnostical and Statistical Manual of Mental

Disorders (DSM-V) outlines clear criteria for diagnosing Generalized Anxiety Disorder. Zack fits

nearly every one of their criteria, which helps to confirm that he is indeed suffering from GAD.

Their first criterion is that the anxiety or worry must be “occurring more days than not for at least

6 months, about a number of events or activities…” (DSM-V, 2013) Zack has been experiencing

worry about a number of different things in his life for a year, so he meets that criterion. He also

meets the second of “The person finds it difficult to control the worry.” (DSM-V, 2013) Zack has

tried to stop worrying, or limit his worrying, with no success. Of the six symptoms the DSM-V

lists that Zack must meet three of to qualify, he demonstrates the minimum three. Zack finds

himself having difficulty with concentrating (criterion 3) on his everyday tasks, which interferes

with his ability to manage his life. He also feels tired often (criterion 2), which is a likely side

effect of his inability to sleep because he’s up worrying. We’ve already ruled out disorders and

conditions that could preclude him from this diagnosis, so the only criterion that remains is that

“the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in


social, occupation, or other important areas of functioning”. (DSM-V, 2013) Zack certainly feels

like his worry is distressing, based on the description of his symptoms.

It is important that when recommending a treatment plan for Zack, all recommended

treatments have been empirically tested and proved effective and safe. Experimental therapies

can do more harm than good to the patient, and to the patient-therapist relationship. Developing a

relationship where the patient can trust the clinician is vital for openness and honesty, but that

comes with some warnings. The therapeutic professional must be careful not to use

“inappropriate or coercive influence” (Wade, Tavris, Garry, 2015, p.439) with their patients. A

patient cannot be bullied or bribed out of their disorder. Therapists must also shed any

preconceived notions or prejudices when treating patients. Some people may have beliefs about

“millennials” like Zack being lazy or entitled, but bringing those mistaken ideas into therapy

with Zack would certainly not benefit him and would not enable the therapist to serve him to the

best of their ability. Zack may have cultural beliefs that the therapist will have to take into

account without judgement. Just as a therapist is entitled to respect from their patient, the patient

deserves respect as well. Another way a therapist could harm their client is to become sexually

intimate with them. The emotional intimacy of telling someone your deepest, darkest thoughts

and fears can open a patient up for confusing feelings. It’s imperative that the therapist not feed

those feelings and remain empathetic but professional and ethical at all times. A productive

patient-therapist relationship can do a great deal of good, if well-managed.

Tested and approved therapies can be very successful when applied correctly. The

pharmaceutical industry offers a variety of drugs that can be used to treat everything from

psychotic disorders to anxiety. While these may add some temporary value for Zack, they have

not been proven to be effective for long-term management of GAD. Like depression, suicide


attempts, anger and impulsive violence, and health problems, GAD responds best to Cognitive

Behavioral Therapy. Anxiety disorders like agoraphobia, post-traumatic stress disorder, and

other phobias can be treated with exposure therapy over time. Motivational interviewing can help

the therapist and client identify and develop their motivation to overcome specific problems.

Zack’s motivation might be that he wants to feel clear-headed and be able to sleep through the

night without staring at the ceiling, afraid of what worries the next day will bring. Zack’s

treatment should be tailored to his needs and goals, to do the most good for him and to have the

best chance of his engagement in progress.

For Zack, I would not recommend medication for an extended length of time. If he was

truly desperate for respite from his worrisome thoughts, I might recommend a tranquilizer to

help him as he begins therapeutic treatment. This would increase the activity of the

neurotransmitter gamma-aminobutyric acid in his brain, contributing to a feeling of well-being.

(GABA) The tranquilizer, or anti-anxiety drug, would allow Zack to possibly get some sleep,

experience less muscle tension (a common side-effect of excessive worry), and provide him with

a more sedate feeling until he started to feel the effectiveness of constructive psychotherapeutic

treatment. After a brief period, he would taper off the medication to prevent any side-effects

from withdrawal. Zack’s real treatment would come in the forms of Behavioral Self-Monitoring

and Cognitive Behavioral Therapy (CBT).

Behavioral Self-Monitoring would enable Zack to track his patterns of worry. He might

worry more at certain times of the day than others, or following specific activities or experiences.

Documenting his anxious thoughts will empower him to get a handle on all the things he’s

feeling lack of control over. With his patterns established, he can bring a log of the thoughts that

plague him most to his therapist.


This journal or log would be incredibly helpful as an aid to his Cognitive Behavioral

Therapy. Psychology Today explains, “CBT focuses on solutions, encouraging patients to

challenge distorted cognitions and change destructive patterns of behavior.” Albert Ellis’s

Rational Emotive Behavior Therapy (REBT) would likely serve Zack well. REBT treatment via

the ABC(DE) model (Mullen, 2017, p. 16) would help Zack by having him address each anxious

thought or worry, examine the beliefs that go along with it, assess the emotional consequences of

those beliefs, disrupt his irrational beliefs with logical and self-formed responses, and replace

those toxic and irrational beliefs with effective ones that serve him better.

For instance, if Zack is worrying about whether or not he’s succeeding at his job and

could be fired soon, his therapist might ask him what ways you would know that a person is

succeeding at their job. Zack might respond that promotions, raises, and positive reviews are

indicators someone is being successful at work. The therapist might then ask Zack if he’s

received any positive reviews, promotions, or raises in the last year. Then the therapist might as

Zack if the business is in trouble financially. When Zack replies that the company just branched

out into a new location, and seems to be doing quite well, the therapist might ask him to look at

his thoughts versus the evidence. While Zack may feel that he’s doing poorly and could lose his

job, the evidence says otherwise because Zack did receive a raise and promotion, and the

company is doing quite well, so it is unlikely that he’d be let go for poor performance. This

method of putting his excessively worrisome thoughts next to logical evidence, will help him to

address those worries one by one. Eventually, Zack will do this automatically for himself.

The good news for Zack is that Generalized Anxiety Disorder is one of the most common

and most treatable forms of psychological disorder. In The Family Guide to Mental Health Care,

Lloyd Sederer states, “…people with GAD are more likely to seek help and adhere to treatment


regimens than are people with other kinds of mental disorders.” Once Zack learns to deconstruct

his harmful worrying habits and thoughts and begins to manage his anxiety, he will likely

experience a greatly improved quality of life and more peaceful and positive mental condition.



Cognitive Behavioral Therapy. (n.d.). Retrieved January 10, 2018, from

Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, Londres:

American Psychiatric Association.

Hyperthyroidism (overactive thyroid). (2015, October 28). Retrieved January 10, 2018, from


Mullen, R. (2017, December 18). Approaches to Treatment & Therapy PSC 1501. Retrieved

January 10, 2018, from


Sederer, L. I. (2015). The family guide to mental health care. New York: W.W. Norton &


Wade, C., Tavris, C., & Garry, M. (2015). Invitation to Psychology (Sixth ed.). Upper Saddle

River, NJ: Pearson.