Case Study
Patient Demographic: Client Age: 41 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Behavioral Health Type of Counseling: Outpatient Presenting Problem: Fear and Panic Diagnosis: Agoraphobia 300.22 (F40.00)
Mental Status Exam: Mental Status Exam: The client appears her stated age, and she is dressed in casual attire. Her affect and mood are anxious. She is tearful and seems extremely distressed when recounting her panic attacks. The client denies suicidal or homicidal ideations but does endorse feeling hopeless about her condition. She is unsure if she will benefit from counseling and expresses mixed feelings about seeking help. The client denies audio and visual hallucinations. Fam
Presenting Problem: You work in a behavioral health outpatient center. Your client is a 41-year-old Caucasian female presenting with symptoms of fear and panic. The client has a history of anxiety and depression but explains that her anxiety has worsened within the last year and that she has begun to experience panic attacks. She states that she has an “overwhelming fear” of elevators and stairwells. When exposed to these situations, she has trouble breathing, begins to feel dizzy, and hyperventilates. The client remembers having her first panic attack while staying at a hotel one weekend. She was taking the stairs and suddenly felt intense fear and panic. On the same trip, she had a similar experience when taking the elevator. The client quit her last job due to travel requirements, and she is currently unemployed. She stays away from stairwells and elevators as much as she possibly can. When unable to do so, she asks her son to accompany her.
Other Contexts: The client receives psychoeducation on various treatment interventions for agoraphobia. She understands the risks and benefits, and you review informed consent each session. The client would like to work on her fear of stairs first, which is less anxiety-provoking than elevators. She expresses an understanding of exposure exercises and is willing to give them a try. You and the client use a Subjective Units of Distress Scale (SUDs) to measure the intensity of each anxiety-provoking situation, which can range from 0 units (no distress) to 100 units (extreme distress).  Capnometry-assisted respiratory training (CART) is an approach for agoraphobia that targets underlying biological factors

Question: Capnometry-assisted respiratory training (CART) is an approach for agoraphobia that targets underlying biological factors. The theoretical framework for CART is based on which of the following assumptions?
(A): Muscle tension resulting from anxiety and panic can be treated with progressive relaxation and deep breathing.
(B): Drops in body temperature resulting from anxiety and panic can serve as an alert to start using coping strategies and deep breathing.
(C): Low levels of carbon dioxide resulting from anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control.
(D): Increased heart rate resulting from anxiety and panic can be altered with autogenic relaxation and mindfulness meditation.

Correct Answer: Low levels of carbon dioxide resulting from anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control.
Explanation: The framework for CART assumes that low levels of carbon dioxide resulting from symptoms of anxiety and panic can be altered with shallow breathing and a cognitive sense of being in control. The CART approach measures PaCO2and respiration rates believed to be the primary or secondary causes of anxiety and panic. Individuals are instructed to breathe in ways that prevent hyperventilation. This is achieved by taking slow, shallow breaths. CART is based on the theory that deep breaths, such as those used in relaxation training, can induce hyperventilation, leading to increased fear and panic. Progressive relaxation, thermal biofeedback, and mindfulness meditation are also effective in reducing anxiety but do not attribute therapeutic change to increased levels of PaCO2. Therefore, the correct answer is (D)
Competency: counseling skills and interventions