Case Study

Mrs. C.

Mrs. C. is a 76-year-old woman who lives alone in an apartment in a quiet residential neighborhood. She frequently contacts her primary care physician (PCP) with concerns about her health. When seen by her PCP, she expresses a number of worries about other areas of her life. For example, she has concerns about the safety of the neighborhood where she lives, she worries about her finances even though she receives both social security and a retirement pension from teaching school, and she worries that other people avoid her because she is no fun to be around. She states that she has always been a “worry wart” and that this constant worry has made her life difficult. She states that she has difficulty concentrating and making decisions. She reports feeling restless and having difficulty going to sleep because of excessive rumination about her worries. She states that she feels fatigued and doesn’t feel like doing anything.

Activity #1. Have students divide into pairs. In the first part of the exercise, one student will be Mrs. C. and the other will be a social worker working in the ambulatory care clinic where Mrs. C’s PCP sees her. Ask the social worker to use Lang and Stein’s Useful Questions to elicit information about anxiety and about physical symptoms. The student portraying Mrs. C. will use the information provided in the vignette plus other information as needed to complete the clinical picture and context (e.g., symptoms, cultural factors, environment, family) as needed to develop the role. After the initial screening and overview, ask the students to switch roles.

Activity #2. Students should switch roles. The new social worker will either conduct a HAM-A interview and rate the symptoms or will introduce and administer BAI and review Mrs. C.’s scores with her after she completes the BAI.

Activity #3. Based on information gathered in the screening and the HAM-A/BAI, have the pair work together to develop a hypothetical plan. What should be done? By whom? [Activity #3 may be delayed until after the section on treatment, if desired.]

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