The student nurse has been assigned a 37-year-old woman admitted to the psychiatric hospital with an anxiety disorder. This morning, the student notices that the client has a tense facial expression and is walking constantly around the group room.

QUESTION

Case Study, Mohr

CHAPTER 3, Conceptual Frameworks and Theories:

In completing the case study, students will be addressing the following learning objective:

Give examples of behavioral and cognitive-behavioral interventions.

The student nurse has been assigned a 37-year-old woman admitted to the psychiatric hospital with an anxiety disorder. This morning, the student notices that the client has a tense facial expression and is walking constantly around the group room. The student walked over to the client and used reflective communication by stating, “I see that you have a tense expression and are walking around almost all of the time. Is there something that we could discuss?” The client replied that she has talked on the telephone to her mother who was keeping her children while she was in the hospital. The client said that her mother had told her that she was not a good mother, and then said, “I guess I am a bad mother, but I could never measure up to my mother’s expectations.” The student has learned that negative self-talk can greatly aggravate anxiety and lead to depression. The student decided to use a behavioral intervention with the client and asked the client who is a good artist and why the client liked the artist’s works. The student and the client then made a list of activities that the client liked. The student taught the client to engage in one of these activities when an unpleasant experience evoked negative thoughts. The following day, the student decided that the client needed some cognitive restructuring for her relationship with her mother. The student taught the client that during discussions with her mother, feelings of incompetence might be experienced when the mother made negative comments. The client was instructed that if her mother made negative comments about parenting, she was to immediately tell her mother that she was a good parent to her children and terminate the conversation at the first opportunity.

(Learning Objective: 3)

a. Will the client be able to learn cognitive restructuring in her relationship with her mother?

b. How will engaging in activities help the client with her anxiety?

ANSWER

“Exploring Cognitive Restructuring and Activity Engagement as Interventions for Anxiety: A Case Study Analysis”

Whether or not the client will be able to learn cognitive restructuring in her relationship with her mother depends on various factors, including the client’s motivation, willingness to change, and ability to practice new coping strategies. Cognitive restructuring involves challenging and modifying negative thought patterns and beliefs that contribute to distressing emotions and behaviors.

In the case study, the client expressed feelings of inadequacy as a mother due to her mother’s negative comments. The student nurse recognized the need for cognitive restructuring and taught the client a specific strategy to counteract these negative comments (McHugh et al., 2010). The client was instructed to assertively affirm her competence as a parent and end the conversation if negative comments were made.

The success of cognitive restructuring depends on the client’s ability to implement these strategies consistently and effectively. The client may face challenges in confronting her mother’s negative comments, especially if there are underlying emotional issues or a long-standing pattern of negative interactions. The client’s level of self-confidence, assertiveness skills, and ability to manage her anxiety will influence her ability to apply cognitive restructuring techniques in real-life situations.

Additionally, the client’s level of engagement and trust in the therapeutic relationship with the student nurse may impact her receptiveness to learning and applying cognitive restructuring. The student nurse’s ongoing support, guidance, and reinforcement of positive change can contribute to the client’s progress in restructuring her relationship with her mother.

It is important to note that cognitive restructuring is a gradual process, and the client may require additional therapeutic interventions, such as psychoeducation, self-help resources, and continued therapy, to reinforce and generalize these skills beyond the hospital setting. Regular follow-up and support are crucial to ensure the client’s ongoing progress and maintenance of cognitive restructuring in her relationship with her mother.

Engaging in activities can help the client with her anxiety through various mechanisms. When individuals with anxiety disorders participate in enjoyable activities, it can have a positive impact on their emotional well-being and overall mental health.

 Here are some ways in which engaging in activities can help the client with her anxiety:

Distraction and relaxation: Engaging in pleasurable activities can divert the client’s attention away from anxious thoughts and worries, providing a temporary break from distress. Activities such as painting, listening to music, or engaging in physical exercise can promote relaxation and stress reduction.

Mood enhancement: Participating in activities that the client enjoys can boost mood and provide a sense of accomplishment and satisfaction. This can counteract negative emotions and enhance overall well-being (Yamamoto-Mitani et al., 2016). Positive experiences and emotions generated from engaging in activities can help counterbalance the negative self-talk and reduce anxiety levels.

Increased self-esteem and self-efficacy: Successfully engaging in enjoyable activities can enhance the client’s self-esteem and self-confidence. Accomplishing tasks and experiencing a sense of mastery can challenge negative self-perceptions and foster a more positive self-image. This increase in self-esteem and self-efficacy can contribute to reducing anxiety and promoting emotional resilience.

Social interaction and support: Participating in activities often involves social engagement, which can provide an opportunity for the client to connect with others, reduce feelings of isolation, and receive support. Positive social interactions can help alleviate anxiety symptoms and provide a sense of belonging and validation.

Behavioral activation: Engaging in activities can serve as a form of behavioral activation, which involves increasing pleasurable and rewarding experiences in one’s life. By incorporating enjoyable activities into the client’s routine, the student nurse helps the client break the cycle of avoidance and withdrawal often associated with anxiety disorders (Vazifehkhorani et al., 2020). Behavioral activation can promote a sense of purpose, motivation, and improved overall functioning.

In summary, engaging in activities can serve as a therapeutic intervention for anxiety by providing distraction, relaxation, mood enhancement, increased self-esteem, social interaction, and behavioral activation. The student nurse’s approach of identifying activities the client enjoys and teaching her to engage in them when negative thoughts arise demonstrates the application of a behavioral intervention to address anxiety symptoms effectively. By combining both cognitive and behavioral strategies, the student nurse aims to provide a comprehensive approach to managing the client’s anxiety and facilitating positive change.

References

McHugh, R. K., Hearon, B. A., & Otto, M. (2010). Cognitive Behavioral Therapy for Substance Use Disorders. Psychiatric Clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012 

Vazifehkhorani, A. K., Rudsari, A. B., Rezvanizadeh, A., Harzang, L. K., & Hasanzadeh, K. (2020). Behavioral Activation Therapy on Reward Seeking Behaviors in Depressed People: An Experimental study. Journal of Caring Sciences, 9(4), 195–202. https://doi.org/10.34172/jcs.2020.030 

Yamamoto-Mitani, N., Noguchi-Watanabe, M., & Fukahori, H. (2016). Caring for Clients and Families With Anxiety. Global Qualitative Nursing Research, 3, 233339361666550. https://doi.org/10.1177/2333393616665503