EXAMPLE CLINICAL CASE 2 CRISIS THERAPY

I. Development of the topic

1.1. Case description

33-year-old female patient, she is married and works as a secretary in the law firm of
her husband.

Reason for consultation:

He visited a clinic specialized in anxiety after reading an article about it in a magazine.

hypochondria. In the previous years, he had undergone numerous medical examinations.
because I believed I was having a heart condition.

The problem began after giving birth to her only son. During a gymnastics class
Postpartum, she suddenly noticed an increase in her heartbeat. She felt sharp pains.
in his chest and had difficulty breathing. He began to sweat and tremble, he felt
dizzy, she felt a tingling in her left arm and feared dying of a heart attack.
She immediately left the baby in class and went to the emergency room to be attended.
he had an electrocardiogram, but no abnormalities were detected. Since then he has
crisis of that type for 15-30 minutes about four times a month. I used to ask for help
and sought medical advice. For ten years, he has had too many medical examinations, each
one assuring that he had no physical illness. After the first crises,
he began to be afraid of being away from home or being in places where one cannot be
to get medical assistance. The patient only leaves her house if she carries her cell phone, which
that allows you to communicate with emergency services if necessary. Even from that
I avoid crowded places, shopping centers, and cinemas where I couldn't escape.
quickly. The attacks have continued, but they occur in the places where she fears the most.

Recognizes that both the symptoms and the way to avoid them are unreasonable and
excessive, but nonetheless they have dominated her life. She feels moderately depressed,
restless and has difficulty sleeping. She feels insecure and also has difficulty with.
concentrate.

EXAMPLE OF CLASS 2 ACADEMIC USE 1

 1. Background:

The patient grew up in a large city. Her father was a public employee and her mother was a teacher.
He had a brother two years younger, an engineer. He left high school to attend a
institute for secretaries and later worked as a secretary at a law firm. At the
At 22 years old, she married a lawyer ten years older than her, and the following year she had a child.

Due to her crises, she left her full-time job and started working part-time to
her husband. They have good income and have a good standard of living.

The patient described herself as "calm but nervous" and although at times
She felt tense and apprehensive in unusual situations. She had always been shy, sensitive to criticism.
and reluctant to form relationships with other people, unless she knew them well.

Since childhood, he had a fear of risky situations and as a result, developed fear.
to travel by planes and had difficulty getting his driver's license. He has always
she is insecure and tends to feel inferior to other people. Her mood has been unstable
and with a tendency towards depressive reactions when facing disappointments or criticisms.

His father was described as introverted and with little humor, but he had no contact with
psychiatric services. One of his sisters was hospitalized in a psychiatric ward for
"nerves", those that possibly represented an episode of depression.

In her childhood, the patient was considered to have a weak constitution. She seemed to catch colds often.
he had a stomachache and had the flu several times. He had sick leave repeatedly due to illness.

occasions due to transient discomforts, stomach pains, or tension pains in the neck
and back. Medical exams never found any kind of somatic disturbance.
Heronlypregnancywaswithoutcomplicationsexceptforamildpreeclampsiasomewhatbeforethe
delivery, and was treated successfully. Her blood pressure is normal and no illness was detected.
cardiac function.

EXAMPLE OF CLASS 2 ACADEMIC USE 2

 I. Therapeutic Plan
THERAPEUTIC PLAN FOR CRISIS WORK
Objetivo General:Lograr identificar las áreas afectadas quepresentalapaciente luego de un sucesoproblemático y así brindarles las herramientas necesarias que le ayudan a mejorar la situación.
No. Objectives Problem Symptoms Técnicas Duration To whom Chores at home Expected results Area
sessions go affected
directed
1 First meeting between the The patient believes that she is -sweating - Listen. 60 Patient Perform techniques Being able to communicate and express Behavioral
client and therapist for the to die from a heart attack -sensations of Of relaxation. minutes 33 years old of relaxation everything he/she feels before his/her
initiation of the process heart tingling Interview. in a crisis situation
therapeutic, giving anxious Establish from a state of
highlight what the evasive report. crisis.
patient has to count
about the why of the
search for help
2 Explain therapy under the The patient does not have sweating Psychoeducation 60 Patient A was delivered to him Facilitate a cognitive didactic explanation
which will be carried out on the the knowledge of the anxious minutes 33 years old brochure with about what anxiety is and how
intervention process. why does that happen sensations of in a information it manifests, thus eradicating this
feelings of what it is about ahogo state of about therapy I adjust to panic attacks and
to die crisis of the disorder that how will all this be addressed
presented the process
3 Knowing the concerns and The patient does me depression ABC technique 50 Patient Every time that That the patient is able to modify Affective
thoughts of the to know what it feels like isolation minutes 35 years old have a his thought
patient very depressed and it social in state thought
feels evasive -crying of crisis ["negative","to think"]
impotence in things
worry positive and
preventions
4 Knowing the impact that The patient believes Difficulty to Relaxation technique 50 Patient Cada vez que That the patient manages to cope Emotional
the patient had before this consider that you have breathe progressive minutes 33 years old have a a normal life this type of
hypochondriasis situation Fear of being
then in state thought condition.
to read an article completely outside of her of crisis negative, think
began after house in things
to give birth to her son, Vomiting positive and
I managed to notice certain -Difficulty in preventions
changes in her like to sleep
sweats, Dizziness
tremors and dizziness Insecurity

EXAMPLE OF CLASS 2 ACADEMIC USE 3

 Difficulty in
to concentrate
5 Know the current state The patient has given fear of going out Cognitive therapy 50 Patient Application of That the patient is capable of Interpersonal
of the patient to know certain from home behavioral minutes of 33 years techniques of accepting suffering will be
concerns and anxiety in state relaxation inevitable
manifestations that have worry of crisis
presented with isolation
regarding going outside social
from his house desperation
6 As the patient can The patient mentions fear Technique of 60 Patient Carry out That the patient tries to learn Cognitive
try to control your that always has to concern distraction/re-rouning minutes 33 years old activities that he/she to externalize the focus of attention Behavioral
state of anxiety leave your house with a Insecure in state they can take off toward external stimuli and not
when it is out of cell phone that he has with him of crisis his mind before towards your bodily sensations
comfort feel secure that if not thought
she brings it with her feels negatives
that can die
7 Know the intensity The patient mentions Fear Training in 60 Patient Perform technique The purpose is that the patient Cognitive
with what happen to their that the attacks of Problems for problem solving minutes with 33 corporal of reduce your fear of going out to Affective
anxiety attacks and anxiety they have breathe years in acceptance of places where there are
because they affect them continued, but only Insecure Training in state of sensations crowds of people power
happen in places in social skills crisis increase social support and
those he fears the most. acquire in turn
assertive behaviors.
8 In these last 3 The patient mentions Difficulty in Acceptance technique and 60 Patient Internal dialogue The purpose is to prevent relapses in Cognitive
sessions want to be achieved who felt improvement with to sleep commitment minutes with 33 the patient reviewing everything
that the patient relapses the technique left in Restlessness years in techniques that have been used to
continuing with the house, which also to him when does it come out of state of length of treatment.
learned skills, I help in the his house crisis
remembering the variables training in
cognitive in the solution social skills
the problem. to be able to reduce its
fear of going outside
your house, but still
present signs of
anxiety and evasion.
9 In this session, we want to The patient mentions Sleep better Prevention of relapses 60 Patient Make a list Reinforce the achievements made and Cognitive
to prevent the patient what was the visit with his Eat better (review of strategies) minutes with 33 of the places in continue motivating the patient affective
have relapses and that doctor and I lowered the More peaceful learned) years in those who have to overcome their fears and
I can know that dose of them state of less anxiety and anxieties through everything
situations provoke him/her medications feel crisis fear of visiting and aprendido.
less anxiety for what más tranquila,presenta that I tried to go out to
fewer difficulties, one of them.

EXAMPLE OF CLASS 2 ACADEMIC USE 4

 I can take them up again shortly. although upon leaving
little. my legs were trembling
but what was
facing it
10 They were fulfilled to The patient does not show Improvement in your Technique of 60 Patient Continue with The patient managed to understand that Cognitive
capability the objectives anxiety crisis and anxiety maintenance and minutes with 33 all the techniques it precisely its form of
expected during the few behaviors of SleepBetter follow-up years in what they were attend and interpret
therapeutic process safety avoidance. More security state of positions in catastrophically your feelings
After the sessions of Improvement in their crisis practice of corporeal the one that was
patient follow-up attacks of use during provoking the high and
it shows it feels panic and go out to the whole process unpleasant symptoms of
satisfied with the places with of attention anxiety causing him to suffer
obtained results, crowds. psychological. panic attacks.
recovering the As its activation decreases
activity prior to the physiological and their fear of it,
appearance of the problem consequently, it was
and facing recovering those activities
situations that I feared that previously were effective for him
totality rewarding, as well as a style
of a life similar to the one I had
previously.

EXAMPLE OF CLASS 2 ACADEMIC USE 5

 I. Techniques Used

Technique Description Area a Author or source

to work
Psychoeducation consists of the explanation by the Uliaque Moll. J. Psychology and Mind. The
psychologist in charge of the treatment of different constructs psychoeducation. Obtained from
psychological and variables that explain the patient's problem [Link]
the group of patients. In general, it explains what All the action
Psychoeducation the disorder (although in many cases areas are not necessary
labeling the problem as a 'disorder' in front of the patient,
without explaining its characteristics so that he or she
they understand it and can face it in a more adaptive way)
how the disorder affects the patient's life, symptoms
frequent, what treatments exist, what can be done to
mejorar, etcétera.
The ABC model is a theory proposed by the psychotherapist Nahum Montagud R. Psychology and Mind.
cognitive Albert Ellis (1913-2007), which aims to explain ABC Model. Obtained from
Why do people, despite experiencing the same event, can have cognitive differences? [Link]
develop different responses based on their own abc-ellist.
ABC Therapy beliefs. These beliefs are a fundamental pillar when it comes to (Albert Ellis)
to understand how a person sees the world and how they decide
to face the demands of everyday life.
Cognitive behavioral therapy helps you become aware. Mayo Clinic. Cognitive Behavioral Therapy.
of imprecise or negative thoughts so that you can Obtained from[Link]
visualize demanding situations with greater clarity and cognitive es/tests-procedures/cognitive-behavioral-
Therapy respond to them more effectively. behavioral therapy/about/pac-20384610
Cognitive- It is a way of understanding how one thinks about oneself.
Behavioral same, from other people and
the world around him, and how what one does affects his
thoughts and feelings.

EXAMPLE OF CLASS 2 ACADEMIC USE 6

 1. Description of the situation or the problem
2. Representation of what the patient does in this situation.
Training in 3. Identification of possible maladaptations Cognitive Horse, V. (n.d.). training in skills
skills 4. Identification of a suitable objective effective social. Madrid: closas orcoyen.
social 5. The patient practices how to carry out the behavior.
[Link] of the effectiveness of the response

It is about focusing on the most unpleasant feeling that

let's have and get in touch with her. Remain in
contact as if you were a light bulb that does not push or Dr. & Garcia Higuera, D.A. (n.d.). Techniques
forces nothing and also leaves nothing as it is. It is about Body techniques for anxiety.
to become friends with our sensations of seeing how they are and Cognitive [Link].
Acceptance of how they evolve on their own without our intervention.
Sensations Allowing the feeling to evolve as it may, if something us
it hurts to let the pain develop, grow or diminish
without intervening. Being an unpleasant sensation, we tend to
automatically trying to decrease and disappear,
now we have to let her grow, if that is her evolution
natural. Contact gently, let it be the sensations that
let our conscience guide us, let's not try to feel what
we want only what the body tells us. Let's observe the
sensation, see its characteristics, which part of the body is it
involved, whether it is sharp, deaf, whether it is always the same or goes
changing with time, etc. The most important thing is to observe
[Link]
the one we have contacted we are going to her. We will let that
all unpleasant sensations reach our
awareness.

EXAMPLE OF CLASS 2 ACADEMIC USE 7

 The goal of acceptance and commitment therapy is
Technique eliminate psychological rigidity for which it employs some Cognitive Higuera, D. J. (n.d.). Acceptance therapy and
acceptance and basic procedures such as acceptance, being in the commitment: third generation of therapy
commitment present, the development and commitment to values cognitive behavioral. [Link].
own, the discovery of the self as context and the
deactivation of thought (cognitive defusion). These
procedures are completely related, in such a way
that if the deactivation of thought is applied, one is
thoughts and feelings are present and accepted
emotions and sensations, discovering and living the self
as context, etc. (Hayes et al, 2004). The application of these
procedures are carried out following a therapeutic agenda,
that it is not a rigid procedure, but rather a guide
attempt that must be adapted to each patient and to each
problem (Hayes, et al, 1999). The technique of hopelessness
creative of acceptance and commitment therapy (Hayes, et al.
al, 1999; Wilson and Luciano, 2002) is a procedure
suitable for making the patient see that the methods they are
applying is not effective and you have to open your mind to
other alternatives, it is about making him understand that the
Attempts at control are not the solution, but the problem.
once the patient's plans are called into question, one is in
willingness to apply the procedures of therapy
acceptance and commitment.
Cognitive therapy acknowledges the importance of dialogue.
internal in the maintenance and modification of our
behaviors. Their influence on the generation of anxiety even
Internal Dialogue of panic attacks, depression, etc. has already been mentioned. Cognitive Dr. & Garcia Higuera, D.A. (n.d.). Techniques
As will be explained later, the internal dialogue has Body techniques for anxiety.
also a fundamental role in the genesis of emotions. [Link].

EXAMPLE OF CLASS 2 ACADEMIC USE 8

 In this work, relaxed performance is combined with the body to
a suitable dialogue. In the clinic, the situation has been employed.
of relaxation to induce changes in behavior.
Once the objectives were achieved, work was done on the
improvement and optimization of the techniques already
used, identifying possible risk situations and
Technique of facing them, also developing techniques such as the NIETO, M. Á. (n.d.). Cognitive intervention in
maintaining and solution of problems systematizing styles of Cognitiva a case of distress with agoraphobia. 24.
follow-up confrontation, and perfecting social skills of the
patient. Once the objectives set with the
the patient benefited from the work in reinforcement of
variables such as self-esteem.
the orientation or attitude towards problems is primarily
a motivational process that involves the operation of a
set of relatively cognitive-emotional schemes
establishments (both functional and non-functional) that reflect
the generalized thoughts and feelings of a person Bados, A., & Garcia Grau, E. (June 2, 2014).
Training on life problems and on one's own cognitive ability Problem resolution. University of
Solution of to solve problems (that is, valuations, beliefs, effective Barcelona, Faculty of Psychology, 31.
problems expectations and generalized emotional responses.
On the other hand, the resolution of problems per se
it involves the rational search for a solution or solutions to
through a series of strategies that help to solve or
confront a problematic situation. Four are considered
basic skills: 1) definition and formulation of
problem, 2) generation of alternative solutions, 3) decision making
of decision, and 4) application of the solution and verification of
itsusefulness.

EXAMPLE OF CLASS 2 ACADEMIC USE 9

 CONCLUSION

In this clinical case, the area most affected is cognitive, so it was proceeded to,
first, the use of relaxation techniques to stabilize the patient at
mental level and achieve physical results.
Subsequently, the decision was made to inform the patient about their condition and leave in
Of course, any confusion that the patient had through psychoeducation about the disorder.
affects your life, common symptoms, what treatments exist and what can be done to
improve, etc.
Also, with Albert Ellis's ABC model, it was explained how people can live.
htesameeventandrespondorreactindfierentwaysbasedontheriown
beliefs (these are fundamental pillars in the life of each individual).
Through the cognitive model, humans are able to modify their behavior, their way
to think and interpret things in favor of the objective that one wants to achieve through the
therapy this is a strategy that is used to improve the chances of patients
to modify their cognitive schemas and make them as adaptive as possible.
Cognitive therapy then helps each individual to become aware of their thoughts.
imprecise negative so that I can visualize demanding situations more clearly and
respond to them in a more effective way. This therapy allows the therapist to work on
collaboration with its clients to develop skills to identify and replace the
distorted thoughts and beliefs ultimately change behavior
the habitual associated with them generally focuses on the present and is a treatment oriented
to problem solving.

"Every person has the capacity to change themselves." Albert Ellis

EXAMPLE OF CLASS 2 ACADEMIC USE 10

 BIBLIOGRAPHY

Adrián Triglia. Psychology and Mind. Cognitive Restructuring. Obtained from

[Link]
Nahum Montagud R. Psychology and Mind. ABC Model. Obtained from
[Link]
Bados, A., & Garcia Grau, E. (June 2, 2014). Problem Solving.
University of Barcelona, Faculty of Psychology, 31.
NIETO, M. Á. (s.f.). Intervencion cognitiva en un caso de angustia con agorafobia.
24.
Dr. & Garcia Higuera, D. A. (n.d.). Body Techniques for Anxiety.
[Link].
Uliaque Moll. J. Psychology and Mind. Psychoeducation. Obtained from
[Link]
Higuera, D. J. (n.d.). Acceptance and Commitment Therapy: third generation of
cognitive behavioral therapy. [Link].
Dr. & Garcia Higuera, D. A. (n.d.). Body Techniques for Anxiety.
[Link].
Caballo, V. (s.f.). entramiento en habilidades sociales. Madrid:closas orcoyen.

Mayo Clinic. Cognitive Behavioral Therapy. Obtained from

[Link]
therapy/about/pac-20384610

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