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).  You select interoceptive exposure exercises to address the client’s anxiety and panic

Question: You select interoceptive exposure exercises to address the client’s anxiety and panic. How would you tailor this approach to match the client’s needs?
(A): Use in vivo exposure by first standing in front of a high-rise building.
(B): Imagine a staircase and vividly recount fear-evoking scenes.
(C): Use virtual reality technology to recreate a computer-generated staircase.
(D): Induce dizziness by spinning around in a swivel chair.

Correct Answer: Induce dizziness by spinning around in a swivel chair.
Explanation: An interoceptive exposure exercise that matches the client’s needs would be to have the client spin around in a swivel chair to induce dizziness. Interoceptive exposure exercises help recreate internal sensations associated with panic attacks. One of the client’s internal triggers is dizziness. Individuals with agoraphobia respond to somatic stimuli (eg, dizziness) by avoiding situations or engaging in safety behaviors. Individuals must stay with internal sensations during the exposure until they dissipate or reach a lower, predetermined SUD rating. Exposure exercises can be interoceptive, in vivo, imaginal, or experienced through virtual reality. Therefore, the correct answer is (B)
Competency: counseling skills and interventions