Case Study
Sandra Ono, a 25-year-old woman of Japanese descent, arrived promptly for her appointment, dressed in professional attire, displaying a composed demeanor, and maintaining strong eye contact. Approximately four years ago, Sandra had a distressing experience during an unusually turbulent flight. She described feeling as though she might have a heart attack, experiencing dizziness, rapid heart rate, and breathlessness. In her mind, she was convinced that the plane was destined to crash, and she feared for her life. Upon landing, emergency medical services examined her and found no physical issues. This traumatic incident left Sandra feeling deeply embarrassed, causing her to avoid flying altogether.
For a while, Sandra managed her fear by making excuses to decline social invitations that required air travel, including missing her best friend's wedding, which saddened her. However, a new opportunity emerged—an once-in-a-lifetime job offer that necessitated international relocation. Despite her awareness of the irrationality of her fear, just the sight of an aircraft was enough to trigger intense anxiety. Sandra now faces the dilemma of potentially having to turn down this promising job opportunity due to her debilitating fear of flying.
Please answer the following:
- Primary Diagnosis (using diagnostic code if applicable):
- Secondary Diagnosis (using diagnostic code if applicable):
- Rule Out Diagnosis (using diagnostic code if applicable):
- Symptoms that support each of your diagnoses. Also, any psychosocial factors that may be of concern.
- A brief treatment plan for the patient.
Primary Diagnosis: Specific Phobia (F40.240)
Secondary Diagnosis: Panic Disorder (F41.0)
Rule Out Diagnosis: Generalized Anxiety Disorder (F41.1)
Symptoms that support each of your diagnoses:
Specific Phobia:
Fear and avoidance of flying, triggered by the sight of aircraft
Intense anxiety, including rapid heart rate, dizziness, and breathlessness
Distress and embarrassment caused by previous traumatic experience during a flight
Panic Disorder:
Experience of panic attacks during flight or at the thought of flying
Fear of having another panic attack, leading to avoidance behavior
Persistent worry about future flights, causing significant distress and impairment
Psychosocial factors:
Previous traumatic experience during a flight has led to embarrassment and avoidance behavior, impacting Sandra’s social life and potentially hindering career opportunities.
The prospect of turning down a promising job offer due to fear of flying is causing additional stress and anxiety.
Treatment plan for the patient:
a) Cognitive-Behavioral Therapy (CBT):
Exposure Therapy: Gradual exposure to the fear-inducing stimulus (aircraft) in a controlled and safe environment, helping Sandra to confront her fears and build resilience.
Cognitive Restructuring: Identifying and challenging irrational thoughts and beliefs about flying, replacing them with more realistic and helpful ones.
Relaxation Techniques: Teaching Sandra relaxation exercises (e.g., deep breathing, progressive muscle relaxation) to manage anxiety symptoms during exposure and in-flight situations.
b) Medication:
Selective Serotonin Reuptake Inhibitors (SSRIs): Prescribing SSRIs, such as sertraline or fluoxetine, to reduce anxiety symptoms and prevent panic attacks.
c) Supportive Measures:
Psychoeducation: Providing information about the nature of phobias, panic disorder, and the effectiveness of treatment options to increase Sandra’s understanding and motivation for therapy.
Social Support: Encouraging Sandra to seek support from friends, family, or support groups who can provide understanding and encouragement throughout the treatment process.
Lifestyle Changes: Emphasizing the importance of regular exercise, healthy sleep patterns, and stress management techniques to support overall mental well-being.
Overall,
the treatment plan aims to gradually expose Sandra to her fear of flying while providing her with the necessary tools to manage her anxiety symptoms. By addressing her specific phobia and panic disorder, it is anticipated that Sandra will be able to overcome her fear and pursue the career opportunities she desires.