Related Case Studies
Generalized Anxiety Disorder: A Case Study on How a 28-Year-Old Overcame It
Information about the Patient
- Age: 28
- Gender: Female
- Background: Single, urban professional. A very driven marketing manager working for a mid-size entity out of Mumbai. A history of no substance use, supportive family, though geographically distant.
Cause and History of Anxiety Disorder
Simran (Name changed for Confidentiality) was the obvious “Go Getter” and had always been top valedictorian, top of her class in business school, and had secured an aggressive self-promotion to a new high-stress managerial position. With the COVID-19 pandemic making remote work together with different boundaries, she was expected to do more at her job, and finally, she started to crack.
But what Simran was experiencing was not regular anxieties. Every night tensed by minor workplace error anxiety. However, a general sense of unease remotely herself that if it was without a name, it must be awful and coming soon; it continued for months. When the stress finally began affecting her adversely in terms of reduced appetite, sleeplessness, and near-normal friends had started noticing and saying, “You’re a bit edgy today”. Simran also started to shy away from doing presentations at work and giving more authority to her team members than she was comfortable handling, even the ones who were so easily manageable.
What triggered this emotional tailspin all because of a single Combat error, [ picture missing ] in a campaign email, which resulted in a few lost clients; then she started blaming herself incessantly for weeks despite being assured by her team. That one little bug got the elephant moving, and well.. while to everyone around in the office things seemed normal, in her head, Simran’s self-talk had turned into a frightening, volatile, incessant circuit of “what ifs” and using academies, relative benchmarks, social context reasons for her fears.
Diagnosis:
Simran experienced symptoms for many weeks before consulting a primary care provider. The provider referred Simran to a clinical psychologist. Two headings of the diagnostic process are listed below:
- Clinical Interview: The clinical interview involved the psychologist going into depth with Simran regarding her symptoms, routines, work habits, and emotional state.
- Assessment Tools:
- GAD-7 Scale (Generalized Anxiety Disorder-7): Simran received a total score of 18 (severe).
- Beck Anxiety Inventory: Results indicated high levels of physiological arousal and excessive worry.
- GAD-7 Scale (Generalized Anxiety Disorder-7): Simran received a total score of 18 (severe).
- Beck Anxiety Inventory: Results indicated high levels of physiological arousal and excessive worry.
- DSM-5 Criteria Match: Simran met all six criteria for Generalized Anxiety Disorder, including:
- Excessive worry on more days than not for more than six months
- Difficulty controlling the worry
- Report some or all of the following symptoms, i.e., restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
- GAD-7 Scale (Generalized Anxiety Disorder-7): Simran received a total score of 18 (severe).
- Beck Anxiety Inventory: Results indicated high levels of physiological arousal and excessive worry.
Final Diagnosis: Generalized Anxiety Disorder (GAD), moderate to severe
Treatment
A comprehensive evidence-based approach was introduced, which utilised both medication and psychotherapy and addressed both symptom reduction and resilience building as long-term goals to combat the GAD program.
Program:
- Initial Phase (Weeks 1-2):
- Psycho-education regarding GAD to provide some normalisation of the client’s experiences and to reduce the tendency for self-blame.
- Introduction of breathing techniques and progressive muscle relaxation.
- Some improvements in sleeping hygiene.
- Psycho-education regarding GAD to provide some normalisation of the client’s experiences and to reduce the tendency for self-blame.
- Introduction of breathing techniques and progressive muscle relaxation.
- Some improvements in sleeping hygiene.
- Psycho-education regarding GAD to provide some normalisation of the client’s experiences and to reduce the tendency for self-blame.
- Introduction of breathing techniques and progressive muscle relaxation.
- Some improvements in sleeping hygiene.
- Therapy Sessions (Ongoing Weekly):
- Try Cognitive Behavioural Therapy (CBT) to help manage emotional challenges and mental health issues.
- Examine catastrophic thinking patterns.
- Engage in behavioural experiments to test irrational concerns.
- Become aware of thoughts in journals that identify maladaptive thinking that stimulates anxiety.
- Mindfulness-Based Stress Reduction (MBSR):
- Engaging in meditation practices to promote awareness of the here and now and contemplate mindful practices
- Body scans and imaging practices to reduce physiological activation levels associated with anxiety.
3. Lifestyle Adjustments:
- Scheduled worry periods, 30 mins per day, committed to mindful consideration of identifying negative thought patterns (helps reduce ruminating thoughts throughout the day).
- Digital detox by limiting screen use two hours before sleep.
- Creating manageable work-life boundaries that include “curfews” for emails, etc.
- Consistent exercise routine, including walking 30 minutes each day.
4. Medication (Optional but Chosen):
- Low dose Escitalopram (10 mg daily) prescribed by a Psychiatrist in Mumbai to help moderate moods and reduce anxiety symptoms.
- Also, a temporary prescription for Hydroxyzine for a few acute anxiety spikes to manage (on an as-required basis).
Improvements / Recovery Timeline:
Week 1-2:
- The client was resistant initially (DIDN'T THINK IT WAS WORKING FOR ME), but gradually started to engage in sessions.
- Seeing improvements in sleep with mindfulness and medication.
Week 3-4:
- A reduction in some of her physical symptoms (tension headache, tension stomach ache) was reported by the patient.
- Started to practice CBT techniques for smaller issues (ie, replying to critical emails).
Week 5-8:
- Simran said that she was 40% less anxious on a daily basis.
- Her GAD-7 score went from 18 to 10 (moderate).
- Again began feeling comfortable speaking in public and led a team meeting without overanalysing it.
Week 9-12:
- Taking a big leap, she faced client rejection fears and pitched a bold new campaign.
- Met regular sleep patterns and made it to socialise on the weekends.
- Improvement in her basement journals - From depressed self-talk to self-care.
Months 4-6:
- By the end of this period, Simran was completely free of the GAD diagnostic criteria.
- Completely tapered off Hydroxyzine (staying on Escitalopram).
- Started going to an in-person support group locally and has begun helping others going through a similar situation.
Week 1-2:
- The client was initially resistant (IT WOULDN'T WORK FOR ME) but slowly started to engage in therapy sessions.
- Improved sleep with mindfulness and medication.
Week 3-4:
- The client reported a reduction in some of her physical symptoms (tension headache, tension stomach ache).
- Started using CBT techniques for minor issues (e.g. replying to critical emails).
Week 5-8:
- Simran reported a 40% reduction in daily anxiety.
- GAD-7 score decreased from 18 to 10 (moderate).
- Gained confidence in public speaking again and led a team meeting without panicking.
Week 9-12:
- She made a significant breakthrough and faced her fear of client rejection by pitching a bold new campaign.
- Her sleep schedule became normal, and she started socialising again on weekends.
- Clear positive change in her self-assessment journals - transition from negative self-speak to self-kindness.
Months 4-6:
- Simran had full clinical relief from the GAD diagnostic criteria.
- Completely tapering off Hydroxyzine (staying on Escitalopram).
- Began participating in a local anxiety support group and began assisting those struggling with the same difficulties.
Our Success
What you have here is a story about Simran, who not only felt a renewed sense of confidence about life and her career, but also that it's more important now. She learned how to live outside of her anxiety, not so much get rid of it. This gave her enough tools and a level of awareness to be able to differentiate between normal worry and paralysing worry.
She had started to receive good performance feedback and was asked to lead a major marketing campaign at work, even though she never thought it was possible a day before therapy.
She spent more time pursuing interests like painting that she had not acted on for years, and planned a solo trip to Ireland – something she would have just kept daydreaming about because of "what if".
Family and Community Impact:
Whilst a new sense of hope and consistent family relations (71) we established, Simran as well. As soon as she started sharing her therapy findings with her co-workers to bridle the conversations/dialogues about mental health in the workplace, two of them ended up liaising with a therapist for their mental health issues.
Ta passed on the same message that her recovery journey is non-linear and that it is a series of difficult and often bold decisions.
Future Steps:
This case is a good example of how Generalised Anxiety Disorder can conflict virtually on every aspect of life of an individual, mostly invisible and yet can cause much shattered or stolen lives too. It's also a good story of perseverance and reconnection with people.
With a scope of help, proven interventions, and a willingness to tolerate some distress, healing is not just possible- it is phenomenal.
Final Word
There is no favouritism in Generalized Anxiety Disorder. It doesn’t care if you're successful, outgoing, and an apparent overachiever. Every enemy loses that hostile grip once it is acknowledged, faced, and walked through bit by bit as it should be.
Dr. Amar Shinde, founder of Jagruti Rehab, is a renowned psychiatrist in India with over two decades of experience in mental health, addiction recovery, and neuropsychiatry, dedicated to holistic, compassionate patient care.