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Case Study-behavioral Issue Of Joe

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Case Study-behavioral Issue Of Joe

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Case Study-behavioral Issue Of Joe

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The ‘Case Study’ gives you a chance to explore the basic structure and process through which a psychological problem (behaviour, emotion, thought, etc.) may be addressed in a clinical setting. The assignment allows you to demonstrate your understanding of the motivations behind a particular behaviour, plan an intervention to change the behaviour, describe your implementation of the plan, and provide an evaluation of the outcome. We also want you to include an appendix containing support material you have made use of, most importantly including the data collection or behaviour tracking sheets you use. There are three aims for the Case Study: 1. To encourage you to self-reflect upon the motivations behind your own behaviours. 2. To allow you to research and explore evidence-based methods for modifying a motivated behaviour. 3. To introduce you to the basic process clinicians work through when attempting to understand and alter a motivated behaviour.

Reason for Referral
Joe is a 20 years old female, living at her home in Queensland, Australia with her parents and her younger brother. Presently, she is pursuing her bachelor’s degree in nursing from the University of Queensland. Joe is presently having difficulty falling asleep. She is neglecting her social and physical actives of her regular life. This problem initiated two months ago when Joe lost her best friend Momo who was suffering from a major ailment of heart. Neither Joe nor any other members of her family have a previous record of depression or insomnia. Joe needs urgent medical help here, or her situation can only get worse. Assessment
Description of behavioral issue
Joe is not able to sleep properly and often remains awake at night. She has trouble falling asleep, and when she wakes up, she feels drowsy and low on energy. Although she goes to bed at 10 pm, she rains awake until 2 am. Even when she falls asleep, she wakes up at about and is unable to go back to sleep. She keeps lying in bed when she wakes up; she feels drowsy and low on energy. She experiences anxiety at times and shows physical symptoms of dizziness.  Joe is unable to sleep and focus on her studies. As she feels low on energy, she does not feel like going to the college Although her general health is good, she recalls a stressful event in her life, and it is the untimely death of her best friend, Momo. She is showing symptoms of sleeping disorders and depression. She looks uneasy, nervous and there is a stained look on her face. Her stress and lack of sleep are interfering with her life and relationships. She complains of having negative thoughts all the time and her mind is floodedwith the thoughts of her close friends and her death. Despite taking sleep medication, she still remains awake almost every night. Her family tried to talk to her but, she refuses to respond or listen to them.
Analysis of motivational factors behind the behavioral issues
Joe’s problem with her sleep started after the death of her best friend. Earlier she had no sleep problems. She was very close to Memo, who was diagnosed with a significant heart ailment and unfortunately, she died with a massive heart attack at the age of 20 only. It is very difficult for Joe to accept this stressful event in her life and she remembers her friend whenever she is alone. Clearly, Joe is facing acute stress because of the loss of her very close friend. Joe’s behavioral issues and lack of sleep have developed after the stressful life event. Even if the event is gone and over, its impacts are manifesting as psychosocial stress and insomnia in Joe. Joe has probably developed sleep patterns that link her sleep environment to anxiety and stress, Thus, her sleep environment has become a stimulus for her sleep difficulties. When the bed time approaches, she starts developing those thoughts and it results in increasing tension. The result is that despite feeling sleepy, she is not able to sleep. The more she tries to sleep, the more difficult it gets for her. Her GP prescribed a low-dose of Amitriptyline (tricyclic antidepressant) to lower her stress and induce better sleep, but the medication leaves her even drowsier and her mouth becomes dry. It is obvious that the medication prescribed by her GP is not effective.  It is essential to treat Momo as her symptoms are causing significant damage to her social and academic life. Her physical and psychological health are likely to suffer if the patient is left untreated.
As sleep disorders and insomnia lead to a poor quality of life and weaker social and workplace performance, they could further add to the stress levels. Lying awake in the dark would encourage more negative thoughts to develop and can trigger the depression. Loss of control over sleep or lack of sleep can make the individual feel helpless. In Joes’ case, the traumatic event in her life has led to her depressive mood and sleep disorders that can further aggravate the depression. It is essential to understand the relationship between depression and insomnia. The treatment plans in her case should target both her depression and her sleeping disorders.  As it is the traumatic event that led to her sleeping disorders, it is not enough to treat her insomnia but also look at the underlying cause behind her sleeping disorders and the cause of her stress.
A simple baseline intervention has been selected to be most suitable in the case of Joe. As it has been only two months that she is experiencing the problems, it would be easier to get rid of the problems being faced by her
As individuals with depression show significant levels of insomnia, it is essential to treat sleep disorders which could be a major health concern for the patient. A planned intervention and treatment can help the patient get rid of her anxiety that is affecting her sleep.
Planned Intervention
Research review
Stress exposure can increase the psychophysiological vulnerabilities such as stress disorders, depression, schizophrenia and the development of insomnia disorder (Drake, Pillai & Roth,2014). Research indicates that the majority of individuals with depression show significant levels of insomnia. Insomnia is the most prevalent sleep disorder and a significant public health implication that leads to lower productivity due to increased absenteeism and health care costs. The patient suffers worse quality of life and is associated with poor mental and physical health (Vgontzas Fernandez-Mendoza, Liao, & Bixler,2013). Sleep health is a strong indicator of other disorders and is used as a useful reference by the healthcare administrators (Buysse., 2014).   Poor quality of sleep can disturb the health stimulating functions that lead to poor health outcomes like stroke, obesity, diabetes, and depression have been linked to poor sleep (Johnson et al., 2016). Insomnia and depression are connected deeply as they share several intersection points. Disturbed sleep patterns become a risk for subsequent depression. It is essential to treat both depression and insomnia to maximize positive outcomes (Scogin et al., 2018).  Psychosocial stressors are linked with lack of sleep. 
The first line of treatment for insomnia is pharmacological interventions. US Food and Drug Administration advocates certain drugs such as zaleplon and amelteon for sleep maintenance problems (Pillai et al., 2015). Pharmacotherapy is one of the major approaches to treatment for insomnia, while cognitive behavioral therapies are considered an alternative. The clinicians must continue to exercise their clinical judgment based on their clinical experience, patient response, and preferences, plus any potential adverse effects of the treatment (Sateia et al., 2017).  Cognitive behavioral therapy for insomnia (CBTI) remains underutilized when it comes to targeting chronic insomnia and sleep disturbances as stated  by  Arnedt et al. (2013).  Although insomnia and depression are common comorbidities, the patient is usually treated for depression. Research has evidences that counseling is as effective as CBT for depression. The most commonly used psychological interventions for the treatment of depressive disorder are interpersonal therapy, cognitive behavioral therapy and supportive therapy (Health Quality Ontario. 2017). These therapies reduce depression symptoms while CBT is known to reduce anxiety symptoms in the patient.
Intervention goals
The objective of intervention for the current case is to improve her sleep patterns so that she is able to lead a normal and active life. In the current case, Joe is under acute stress due to the sudden death of her best friend, Momo. She is suffering from acute insomnia and shows signs of depression.  Her treatment should focus on both insomnia and depression. The goal of the intervention plan is to lower her stress levels and anxiety and improve her quality of sleep. Joe’s main goal in participating in this treatment was to overcome her depressed moods and insomnia.
Design and procedure
A simple baseline intervention has been selected here that includes both pharmacological and psychological treatment. Her current psychological stresses and depression symptoms must be adequately explored.

As the patient is unable to toleratethe low-dose of Amitriptyline (tricyclic antidepressant) prescribed by her GP, a non-benzodiazepine hypnotic drug, Zalepon (of Andante brand) is suggested for four weeks.
Joe needs grief counselling sessions for at least three to four months and education on good sleep hygiene.  Her counselor would discuss her emotions and the connection between her thoughts and emotions. He may suggest aerobic exercises and brain stimulation exercises to keep her body and mind active.

The treatment should be planned based on her preferences and how she responds to the treatment. It will be beneficial if her family and friends remain in close contact with her so that she can interact and share her feelings. The emotional support would help her get back faster to her regular life and deal with her trauma effectively. It essential in such cases to follow up and keep a check that the trouble in falling asleep can take a chronic course of action and develop into chronic psychophysiological insomnia.
Implementation and Evaluation
Joe’s treatment commenced on the 2nd July 2018, and she was taken to the GP on the 7th of July, 2018. However, as the prescribed medicines by the GP did not work out, she was taken to the grief counselling center on 13th of July. Mr. Hary, the counsellor conducted for her psychometric tests and scheduled for the 12 consecutive counselling sessions for Joe. The total time frame of this treatment was set to be three months. For these three months, Joe needs to attend the sessions every Friday.  A medical practitioner gave her medicines comprising of a non-benzodiazepine hypnotic drug, Zalepon (of Andante brand) and asked her to continue the drug for four weeks.
Critical evaluation
The counselling sessions by Mr. Hary was proven to be very much helpful for Joe. Counselling by the psychiatrist and the support of her family and friends showed positive improvements in Joe.  After attaining two or three sessions, Joe’s behavior showed positive changes. Gradually, she overcame the massive trauma of losing her best friend and her sleeping patterns improved. Moreover, this time this drug was much compatible with Joe. By the end of her 10th session she had almost overcome the trauma and was getting back to her regular course of life. The last two sessions took care of all her small issues regarding overcoming this life event. Moreover, after the completion of the treatment, her issues were completely gone, and she went back to her regular course of life. Today, as on the 6th of September, 2018 Joe is leading a normal college life.  She is regular at her college classes, attend gym thrice a week and gives adequate time to her family and friends. She visits her counselor once in a month as a follow up and to assess any further conditions.
Critical analysis of ways to improve intervention
Cognitive behavioral therapy (CBT) can be used to improve the treatment intervention for Joe. CBT can help the patient to get rid of unrealistic expectations about her sleep and get more practical. Her counselor can discuss those issues and reassure her. She needs to understand that fundamental causes behind her sleep disorders or insomnia. The intervention can further improve if she is instructed to keep a sleep diary and taught several behavioral strategies like muscle relaxation, meditation and stress management.
In the case of Joe, it is seen that she was very much traumatized because of the sudden death of her best friend. She was under stress because of the very traumatic event in her life which was like an extreme trauma that was making her restless and unable to sleep at night. It only by designing the right treatment plans and interventions that can help Joe and help her overcome here traumas, stress and the sleeping disorders. Timely recognition of Joe’s problem by her parents, their active support, and the proper treatment of the issue, Joe was able to recover soon, and resume her regular course of life by overcoming her traum
Reference List
Arnedt, J. T., Cuddihy, L., Swanson, L. M., Pickett, S., Aikens, J., & Chervin, R. D. (2013). Randomized Controlled Trial of Telephone-Delivered Cognitive Behavioral Therapy for Chronic Insomnia. Sleep, 36(3), 353–362.
Buysse, D. J. (2014). Sleep Health: Can We Define It? Does It Matter? Sleep, 37(1), 9–17.
Health Quality Ontario McMartinKristenGajic-VeljanoskiOlgaWellsDavidHigginsCarolineWalterMelissa, McMartin, K., Gajic-Veljanoski, O., Wells, D., Higgins, C., & Walter, M. (2017). Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment. Ontario Health Technology Assessment Series, 17(15), 1–167.
Drake, C. L., Pillai, V., & Roth, T. (2014). Stress and Sleep Reactivity: A Prospective Investigation of the Stress-Diathesis Model of Insomnia. Sleep, 37(8), 1295–1304.
Johnson, D. A., Lisabeth, L., Lewis, T. T., Sims, M., Hickson, D. A., Samdarshi, T., … Diez Roux, A. V. (2016). The Contribution of Psychosocial Stressors to Sleep among African Americans in the Jackson Heart Study. Sleep, 39(7), 1411–1419.
Pillai, V., Roth, T., & Drake, C. L. (2015). The Nature of Stable Insomnia Phenotypes. Sleep, 38(1).
Scogin, F., Lichstein, K., DiNapoli, E. A., Woosley, J., Thomas, S. J., LaRocca, M. A., … Geyer, J. D. (2018). Effects of integrated telehealth-delivered cognitive-behavioral therapy for depression and insomnia in rural older adults. Journal of Psychotherapy Integration, 28(3), 292–309.
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine?: JCSM?: Official Publication of the American Academy of Sleep Medicine, 13(2), 307–349.
Vgontzas, A. N., Fernandez-Mendoza, J., Liao, D., & Bixler, E. O. (2013). Insomnia with Objective Short Sleep Duration: the Most Biologically Severe Phenotype of the Disorder. Sleep Medicine Reviews, 17(4), 241–254.

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