Case Study
Patient Demographic: Client Age: 42 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Agency Type of Counseling: Individual and Group Presenting Problem: Social Anxiety Diagnosis: Social Anxiety Disorder (Social Phobia), Provisional 300.23 (F 40.10)
Mental Status Exam: Mental Status: The client is meticulously dressed and well groomed. She is cooperative and periodically exhibits a nervous smile. The client is fidgety and frequently repositions herself when seated. Her mood is anxious, and she becomes tearful when discussing feeling “stupid” during job interviews. She exhibits cohesive thinking, and her insight and judgment are intact. The client is oriented to person, place, situation, and time. Her affect is reserved. She denies suicidal and homicidal ideation as well as audio/visual hallucinations.
Presenting Problem: You are a certified mental health counselor working in a community mental health center. Your client is a 42-year-old white female who presents today with symptoms of social anxiety disorder. The client reports debilitating anxiety when interacting with others, particularly when meeting unfamiliar people or going somewhere for the first time. She states that she cannot sleep and has a poor appetite on the days leading up to social events. When encountering anxiety-provoking situations, she says that her hands shake, she sweats excessively, and her voice trembles. The client is recently divorced and, after more than 15 years of being out of the workforce, she is seeking employment. She explains that job interviews have been “humiliating” because of what she perceives as an “inherent lack of knowledge and a substantially impaired skill set.”
Other Contexts: The client participates in her last group therapy session today. You and the client review her treatment plan goals, and she reports an overall decrease in anxiety and says that she possesses a greater awareness of social anxiety disorder and the associated interventions. She has recently completed a job interview after previously scheduling and canceling two interviews. She plans to stay in touch with two group members. The client is ready to begin termination but is anxious about ending counseling. You and the client review the psychoeducation material reviewed in the group, including factors associated with social anxiety disorder and learned coping strategies

Question: Which of the following is true of factors related to social anxiety?
(A): Postevent rumination helps accurately evaluate feared outcomes.
(B): Individuals with social anxiety underestimate how negatively others judge them.
(C): Relaxation and other safety behaviors are helpful for managing social anxiety.
(D): In feared social situations, avoidance behaviors help maintain anxiety.

Correct Answer: In feared social situations, avoidance behaviors help maintain anxiety.
Explanation: Individuals with anxiety disorder typically try to manage anxiety by engaging in avoidance behaviors, such as not making eye contact or not participating in conversations. Avoidance creates a positive feedback loop that reinforces anxiety and leads to additional self-defeating thoughts and behaviors. Relaxation is not an example of a safety behavior. Relaxation techniques are helpful for the long-term management of anxiety, whereas safety behaviors are not. Safety behaviors are used with and without avoidance behaviors. Safety behaviors include things used to protect individuals from perceived “catastrophic” consequences and include inappropriate giggling or stereotypical movements when performing. Like avoidance behaviors, safety behaviors are not effective for the long-term management of social anxiety. Individuals with social anxiety tend to overestimate rather than underestimate how negatively others judge them. Finally, postevent rumination, a cognitive factor associated with social anxiety, leads to inaccurate evaluations of feared outcomes. Postevent rumination occurs when aspects of the encounter are repeatedly mentally reviewed, thus fueling anxiety and confirming negative perceptions. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis