Individual Planning: A Treatment Plan Overview for Individuals with Anxiety Problems

Transcription

1 COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Individuals with Anxiety Problems A Treatment Overview for Adults with Anxiety Problems? Duration: 3 hours Learning Objectives: Obtain a basic understanding of how to identifying, causes, symptoms of children with lying problems or history, and learn different options to complete a treatment plan that includes: a. Behavioral Definitions b. Long Term Goals c. Short Term Goals d. Strategies to Achieve Goals e. DSM V diagnosis Recommendations ***Coming Soon - For a full list of 24 short term goals with dozens strategies listed next to each goal check the Child Treatment App for Windows or Apple PC and Android Devices, under our main menu Windows-Apple Apps. Download the Free Demo to Evaluate*** Course Syllabus:

2 Introduction Symptoms Causes Types Diagnosis and Treatment Steps to Develop a Treatment Plan that includes Behavioral Descriptors, Long Term Goals, Short Term Goals, Interventions/Strategies and DSM V CODE Paired with ICD_9 and 10-CM Codes for ODD Sample Treatment Plan Introduction: Occasional anxiety is a normal part of life. A person may feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships. There are several different types of anxiety disorders. Examples include generalized anxiety disorder, panic disorder, and social anxiety disorder. Anxiety disorder is a blanket term covering several different forms of abnormal and pathological fears and anxieties which only came under the aegis of psychiatry at the very end of the 19th century. Current psychiatric diagnostic criteria recognize a wide variety of anxiety disorders. Recent surveys have found that as many as 18% of Americans may be affected by one or more of them. Anxiety disorders are often debilitating chronic conditions, which can be present from an early age or begin suddenly after a triggering event. They are prone to flare up at times of high stress and are frequently accompanied by physiological symptoms such as headache, sweating, muscle spasms, palpitations, and hypertension, which in some cases lead to fatigue or even exhaustion. Although in casual discourse the words anxiety and fear are often used interchangeably, in

3 clinical usage, they have distinct meanings; anxiety is defined as an unpleasant emotional state for which the cause is either not readily identified or perceived to be uncontrollable or unavoidable, whereas fear is an emotional and physiological response to a recognized external threat. The term anxiety disorder, however, includes fears as well as anxieties. Indeed, phobias (fears which are "persistent or irrational") constitute the majority of anxiety disorder cases. Symptoms of GAD: Anxiety disorders are often comorbid with other mental disorders, particularly clinical depression, which may occur in as many as 60% of people with anxiety disorders. The fact that there is considerable overlap between symptoms of anxiety and depression, and that the same environmental triggers can provoke symptoms in either condition, may help to explain this high rate of comorbidity. GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD include: Excessive, ongoing worry and tension An unrealistic view of problems Restlessness or a feeling of being "edgy" Irritability Muscle tension Headaches Sweating Difficulty concentrating Nausea The need to go to the bathroom frequently Tiredness Trouble falling or staying asleep Trembling Being easily startled

4 In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessive-compulsive disorder and phobias), suffer from depression, and/or abuse drugs or alcohol. Other Symptoms to Check for: 1. Perceived threat or fear of dying 2. Disruptions drastic enough to meet a diagnosis of an anxiety 3. Episodes great body or muscle tension 4. Episodes of anxious behaviors 5. Social isolation 6. High levels of stress 7. Lengthy, repetitive irritating behaviors 8. Racing thoughts 9. Trembling 10. Restlessness-insomnia 11. Unable to concentrate 12. Nightmares 13. Autonomic hyperactivity-hyper vigilance 14. Cold hands 15. Dry mouth 16. Shortness of breath symptoms 17. Chronic fatigue 18. Dizziness-flush or chills 19. Irritable 20. Rapid heart beating symptoms-chest pains

5 Causes: Clinical and animal studies suggest a correlation between anxiety disorders and difficulty in maintaining balance. A possible mechanism is malfunction in the parabrachial nucleus, a brain structure that, among other functions, coordinates signals from the amygdala with input concerning balance. The amygdala is involved in the emotion of fear. Especially the basolateral amygdala has been implicated in anxiety generation. A relationship between anxiety and dendritic arborization of the amygdaloid neurons is well known. SK2 potassium channels mediate inhibitory influence on action potentials and reduce arborization. By overexpressing SK2 in the basolateral amygdala, anxiety was reduced and stress-induced corticosterone secretion at a systemic level decreased in an animal model. Mutations in related SK3 are suspected to be a possible underlying cause for several neurological disorders, including anxiety.[citation needed] Additionally, low levels of GABA, a neurotransmitter that reduces activity in the central nervous system, contribute to anxiety. A number of anxiolytics achieve their effect by modulating the GABA receptors. Selective serotonin reuptake inhibitors, the drugs most commonly used to treat depression, are also frequently considered as a first line treatment for anxiety disorders. A recent study using functional brain imaging techniques suggests that the effects of SSRIs in alleviating anxiety may result from a direct action on GABA neurons rather than as a secondary consequence of mood improvement. Severe anxiety and depression are commonly induced by sustained alcohol abuse which in most cases abates with prolonged abstinence. Even moderate, sustained alcohol use may increase anxiety and depression levels in some individuals. Caffeine, alcohol and benzodiazepines can worsen or cause anxiety and panic attacks. In one study in , illness in approximately half of patients attending mental health services at one British hospital psychiatric clinic, for conditions including anxiety disorders such as panic disorder or social phobia, was determined to be the result of alcohol or benzodiazepine dependence. In these patients, cessation of their anxiety symptoms corresponded with stopping the use of the benzodiazepine or alcohol. Intoxication from stimulants is likely to be associated with repetitive panic attacks. There is evidence that chronic exposure to organic solvents in the work environment can be associated with anxiety disorders. Painting, varnishing and carpet laying are some of the

6 jobs in which significant exposure to organic solvents may occur. Later in life, anxiety disorder can arise in response to life stresses such as financial worries or chronic physical illness. Somewhere between 4% and 10% of older adults are diagnosed with anxiety disorder, a figure which is probably an underestimate due to the tendency of adults to minimize psychiatric problems or to focus on their physical manifestations. Anxiety is also common among older people who have dementia. On the other hand, anxiety disorder is sometimes misdiagnosed among older adults when doctors misinterpret symptoms of a physical ailment (for instance, racing heartbeat due to cardiac arrhythmia) as signs of anxiety. Types Generalized Anxiety Disorder: Generalized anxiety disorder: Generalized anxiety disorder is a common chronic disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those suffering from generalized anxiety experience non-specific persistent fear and worry and become overly concerned with everyday matters. Generalized anxiety disorder is the most common anxiety disorder to affect older adults. Panic disorder: In panic disorder, a person suffers from brief attacks of intense terror and apprehension, often marked by trembling, shaking, confusion, dizziness, nausea, difficulty breathing. These panic attacks, defined by the APA as fear or discomfort that abruptly arises and peaks in less than ten minutes, can last for several hours and can be triggered by stress, fear, or even exercise; although the specific cause is not always apparent. In addition to recurrent unexpected panic attacks, a diagnosis of panic disorder also requires that said attacks have chronic consequences: either worry over the attacks' potential implications, persistent fear of future attacks, or significant changes in behavior related to the attacks. Accordingly, those suffering from panic disorder experience symptoms even outside of specific panic episodes. Often, normal changes in heartbeat are noticed by a panic sufferer, leading them to think something is wrong with their heart or they are about to have another panic attack. In some cases, a heightened awareness (hypervigilance) of body functioning occurs during panic attacks, wherein any perceived physiological change is interpreted as a possible life threatening illness (i.e. extreme hypochondriasis). Phobia: The single largest category of anxiety disorders is that of Phobia, which includes all cases in which fear and anxiety is triggered by a specific stimulus or situation. Sufferers typically anticipate terrifying consequences from encountering the object of their fear, which can be anything from an animal to a location to a bodily fluid.

7 Agoraphobia: Agoraphobia is the specific anxiety about being in a place or situation where escape is difficult or embarrassing. Agoraphobia is strongly linked with panic disorder and is often precipitated by the fear of having a panic attack. A common manifestation involves needing to be in constant view of a door or other escape route. In addition to the fears themselves, the term agoraphobia is often used to refer to avoidance behaviors that sufferers often develop. For example, following a panic attack while driving, someone suffering from agoraphobia may develop anxiety over driving and will therefore avoid driving in the future. These avoidance behaviors can often have serious consequences; in severe cases, one can even be confined to one's home. Social Anxiety Disorder: Social anxiety disorder (also known as social phobia) describes an intense fear of negative public scrutiny or of public embarrassment or humiliation. This fear can be specific to particular social situations (such as public speaking) or, more typically, is experienced in most (or all) social interactions. Social anxiety often manifests specific physical symptoms, including blushing, sweating, and difficulty speaking. Like with all phobic disorders, those suffering from social anxiety will attempt to avoid the source of their anxiety; in the case of social anxiety this is particularly problematic, and in severe cases can lead to complete social isolation. Obsessive-compulsive disorder: Obsessive compulsive disorder is a type of anxiety disorder primarily characterized by repetitive obsessions (distressing, persistent, and intrusive thoughts or images) and compulsions (urges to perform specific acts or rituals). The OCD thought pattern may be likened to superstitions insofar as it involves a belief in a causative relationship where, in reality, one does not exist. Often the process is entirely illogical; for example, the compulsion of walking in a certain pattern may be employed to alleviate the obsession of impending harm. And in many cases, the compulsion is entirely inexplicable, simply an urge to complete a ritual triggered by nervousness. In a minority of cases, sufferers of OCD may only experience obsessions, with no overt compulsions; a much smaller number of sufferers experience only compulsions. Post-traumatic stress disorder: Post-traumatic stress disorder or PTSD is an anxiety disorder which results from a traumatic experience. Post-traumatic stress can result from an extreme situation, such as combat, rape, hostage situations, or even serious accident. It can also result from long term (chronic) exposure to a severe stressor, for example soldiers who endure individual battles but cannot cope with continuous combat. Common symptoms include flashbacks, avoidant behaviors, and depression. Separation anxiety disorder: Separation anxiety disorder is the feeling of excessive and

8 inappropriate levels of anxiety over being separated from a person or place. Separation anxiety itself is a normal part of development in babies or children, and it is only when this feeling is excessive or inappropriate that it can be considered a disorder. Separation anxiety disorder affects roughly 7% of adults and 4% of children, but the childhood cases tend to be more severe, in some instances even a brief separation can produce panic. Diagnosis: Treatments and Therapies Anxiety disorders are generally treated with psychotherapy, medication, or both. Psychotherapy: Psychotherapy or talk therapy can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person s specific anxieties and tailored to his or her needs. A typical side effect of psychotherapy is temporary discomfort involved with thinking about confronting feared situations. Cognitive Behavioral Therapy (CBT): CBT is a type of psychotherapy that can help people with anxiety disorders. It teaches a person different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder. Two specific stand-alone components of CBT used to treat social anxiety disorder are cognitive therapy and exposure therapy. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder in order to help people engage in activities they have been avoiding. Exposure therapy is used along with relaxation exercises and/or imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that cognitive therapy was superior to exposure therapy for treating social anxiety disorder. CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social anxiety disorder. Often homework is assigned for participants to complete between sessions. Self-Help or Support Groups: Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician. Stress-Management Techniques: Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. While there is evidence that aerobic exercise has a calming effect, the quality of the studies is not strong enough to support its use as treatment. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, avoiding them should be considered. Check with your physician or pharmacist

9 before taking any additional medications. The family can be important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one s symptoms. Medication: Medication does not cure anxiety disorders but often relieves symptoms. Medication can only be prescribed by a medical doctor (such as a psychiatrist or a primary care provider), but a few states allow psychologists to prescribe psychiatric medications. Medications are sometimes used as the initial treatment of an anxiety disorder, or are used only if there is insufficient response to a course of psychotherapy. In research studies, it is common for patients treated with a combination of psychotherapy and medication to have better outcomes than those treated with only one or the other. The most common classes of medications used to combat anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped. Antidepressants: Antidepressants are used to treat depression, but they also are helpful for treating anxiety disorders. They take several weeks to start working and may cause side effects such as headache, nausea, or difficulty sleeping. The side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time. Please Note: Although antidepressants are safe and effective for many people, they may be risky for children, teens, and young adults. A black box warning-the most serious type of warning that a prescription can carry-has been added to the labels of antidepressants. The labels now warn that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. For this reason, anyone taking an antidepressant should be monitored closely, especially when they first start taking the medication. Anti-Anxiety Medications: Anti-anxiety medications help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines are first-line treatments for generalized anxiety disorder. With panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind antidepressants. Beta-Blockers: Beta-blockers, such as propranolol and atenolol, are also helpful in the treatment of the physical symptoms of anxiety, especially social anxiety. Physicians prescribe them to control rapid heartbeat, shaking, trembling, and blushing in anxious situations. Studies have also indicated that anxiety disorders are more likely among those with family history of anxiety disorders, especially certain types. Sexual dysfunction also often accompanies anxiety disorders, although it is difficult to determine whether anxiety causes the sexual dysfunction, or whether they arise from a common cause. The most common manifestations in individuals with anxiety disorder are avoidance of intercourse, premature ejaculation or erectile dysfunction among men and pain during intercourse among women. Sexual dysfunction is particularly common among people affected by panic disorder (who may fear that a panic attack will occur during sexual arousal)

10 and posttraumatic stress disorder. Treatment options available include lifestyle changes; psychotherapy, especially cognitive behavioral therapy; and pharmaceutical therapy. Education, reassurance and some form of cognitive-behavioral therapy should almost always be used in treatment.[citation needed] When medication is indicated SSRIs, such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and escitalopram (Lexapro) are generally recommended as first line agents. SNRIs such as venlafaxine (Effexor) are also effective. Benzodiazepines, such as alprazolam (Xanax), clonazepam (Klonopin) and diazepam (Valium) are also sometimes indicated for short-term or PRN use. They are usually considered as a second line treatment due to disadvantages such as cognitive impairment and due to their risks of dependence and withdrawal problems. Other medications commonly prescribed for anxiety disorders include GABA analogues such as gabapentin (Neurontin) or pregabalin (Lyrica), MAOIs such as phenelzine (Nardil) or tranylcypromine (Parnate), as well as the novel antidepressant mirtazapine (Remeron). TCAs such as imipramine, as well as atypical antipsychotics such as quetiapine, and piperazines such as hydroxyzine are also occasionally prescribed. These medications need to be used with extreme care among older adults, who are more likely to suffer side effects because of coexisting physical disorders. Adherence problems are more likely among elderly patients, who may have difficulty understanding, seeing, or remembering instructions. Treatment controversy arises because while some studies indicate that a combination of medication and psychotherapy can be more effective than either one alone; others suggest pharmacological interventions are largely palliative, and can actually interfere with the mechanisms of successful therapy. Meta-analysis indicates that psychotherapeutic interventions have superior long-term efficacy when compared to pharmacotherapy. However, the right treatment may very much depend on the individual patient's genetics and environmental factors. Regular aerobic exercise, improving sleep hygiene and reducing caffeine are often useful in treating anxiety. Steps to Develop a Treatment Plan: The foundation of a good treatment plan is based on the gathering of the correct data. This involves following logical steps the built-in each other to help give a correct picture of the problem presented by the client or patient:

11 The mental health clinician must be able to listen, to understand what are the struggles the client faces. this may include: issues with family of origin, current stressors, present and past emotional status, present and past social networks, present and past coping skills, present and past physical health, self-esteem, interpersonal conflicts financial issues cultural issues There are different sources of data that may be obtained from a: clinical interview, Gathering of social history, physical exam, psychological testing, contact with client s or patient s significant others at home, school, or work The integration of all this data is very critical for the clinician s effect in treatment. It is important to understand the client s or patient s present awareness and the basis of the client's struggle, to assure that the treatment plan reflects the present status and needs of the client or patient. There 5 basic steps to follow that help assure the development of an effective treatment plan

12 based on the collection of assessment data. Step 1, Problem Selection and Definition: Even though the client may present different issues during the assessment process is up to the clinician to discern the most significant problems on which to focus during treatment. The primary concern or problem will surface and secondary problems will be evident as the treatment process continues. The clinician may must be able to plan accordingly and set some secondary problems aside, as not urgent enough to require treatment at this time. It is important to remember that an effective treatment plan can only deal with one or a few problems at a time. Focusing in too many problems can lead to the lost of direction and focus in the treatment. It is important to be clear with the client or patient and include the client s or patient s own prioritization of the problems presented. The client s or patient s cooperation and motivation to participate in the treatment process is critical. Not aligning the client to participate my exclude some of the client s or patient s needs needing immediate attention. Every individual is unique in how he or she presents behaviorally as to how the problem affects their daily functioning. Any problems selected for treatment will require a clear definition how the problem affects the client or patient. It is important to identify the symptom patterns as presented by the DSM-5 or Diagnostic and Statistical Manual or the International Classification of Diseases (ICD). Behavior Indicators for Anxiety Problems: A. Repeated experiences of perceived threat and concern that impede normal fulfillment of essential roles. B. Experiences or disruptions drastic enough to meet a diagnosis of an anxiety. C. Forced episodes creating great tension and anxious behaviors. D. Social isolation, caused by the anxiety problem, that is causing stress. E. Lengthy, repetitive irritating behaviors. F. Muscle tension, trembling, or restlessness. G. Unable to concentrate, nightmares, or has insomnia.

13 H. Cold hands, dry mouth, shortness of breath symptoms. I. Chronic fatigue, dizziness, irritable, rapid heart beating symptoms. J. Flush or chills, chest pains, or fear of dying. K. Excessive and unwarranted concern, motor tension, autonomic hyperactivity, hypervigilance. Step 2, Long Term Goal Development: This step requires that the treatment plan includes at least one broad goal that targets the problem and the resolution the problem. These long term goals must be stated in non-measurable terms but instead indicate a desired positive outcome at the end of treatment. Long Term Goals for Anxiety Problems: A. Decrease overall level, occurrence, and strength of the anxiety so daily routines may be carried out. B. Increase capability to carry out daily routines by stabilizing anxiety levels. C. Determine the source of anxiety. D. Improve skills to successfully handle the full range of life's anxieties. Step 3, Objective or Short Term Goal Construction: Objectives or short term goals must be stated in measurable terms or language. They must clearly specify when the client or patient can achieve the established objectives. The use of subjective or vague objectives or short term goals is not acceptable. Most or all insurance companies or mental health clinics require measurables objectives or short term goals. It is important to include the patient s or client s input to which objectives are most appropriate for the target problems. Short term goals or objectives must be defined as a number of steps that when completed will help achieve the long-term goal previously

14 stated in non measurable terms. There should be at least two or three objectives or short-term goals for each target problem. This helps assure that the treatment plan remains dynamic and adaptable. It is important to include Target dates. A Target day must be listed for each objective or short-term goal. If needed, new objectives or short-term goals may be added or modified as treatment progresses. Any changes or modifications must include the client s or patient s input. When all the necessary steps required to accomplish the short-term goals or objectives are achieved the client or patient should be able to resolve the target problem or problems. If required all short term goals or objectives can be easily modify to show evidence based treatment objectives. The goal of evidence based treatment objectives (EBT) is to encourage the use of safe and effective treatments likely to achieve results and lessen the use of unproven, potentially unsafe treatments. To use EBT in treatment planning state restate short term goals in a way that steps to complete that goal and achieve results. For example, the short term goal 13. Increase positive self-descriptive statements. Can be restated as; By the end of the session the patient or client will list at least 5 positive self descriptions of himself or herself, and assess how they can help alleviate the presenting problem Remember, that it must be stated in a way one can measure effectiveness. It is important to note that traditional therapies usually rely more heavily on the relationship between therapist and patient and less on scientific evidence of proven practices. Examples of Short Term Goals for Anxiety Problems: A. Tell the story of the anxiety complete with ways he or she has attempted to resolve it and the suggestions others have given. B. Explore the past and present for major conflict. C. Recognize cognitive distractions that cause feelings of anxiousness. D. Be consistent in taking prescribed medication, report side effects. E. Construct a suitable relaxation technique to decrease levels of anxiety.

15 Step 4, Strategies or Interventions: Strategies or interventions are the steps required to help complete the short-term goals and long-term goals. Every short term goal should have at least one strategy. In case, short term goals are not met, new short term goals should be implemented with new strategies or interventions. Interventions should be planned taking into account the client s needs and presenting problem. Examples of Interventions for Anxiety Problems: A. Project an area of trust and support that will assist the client in revealing his or her fears. B. Through probing allow the client to develop the logical reasons of their anxiety being present. C. Have client explore and list past and present incidents presenting conflict and anxiety. D. Help client in become conscious of major unsettled problems in his or her life in order to lead to a level of resolution. E. Assign relaxation and anxiety-prevention exercises. Step 5, Diagnosis: The diagnosis is based on the evaluation of the clients present clinical presentation. When completing diagnosis the clinician must take into account and compare cognitive, behavioral, interpersonal, and emotional symptoms as described on the DSM-5 Diagnostic Manual. A diagnosis is required in order to get reimbursement from a third-party provider. Integrating the information presented by the DSM-5 diagnostic manual and the current client s assessment data will contribute to a more reliable diagnosis. it is important to note that when completing a diagnosis the clinician must have a very clear picture all behavioral indicators as they relate to the DSM-5 diagnostic manual. DSM V Code Paired with ICD_9-CM Codes (Parenthesis Represents ICD-10-CM Codes Effective ): Possible Diagnostic Suggestions for Adults with Anxiety Disorder

16 (F93.0) Separation Anxiety Disorder (F94.0) Selective Mutism Specific Phobia Specify if: (F40.218) Animal (F40.228) Natural environment Specify if Blood-injection-injury: (F40.230) Fear of blood (F40.231) Fear of injections and transfusions (F40.232) Fear of other medical care (F40.233) Fear of injury (F40.248) Situational (F40.298) Other (F40.1 0) Social Anxiety Disorder (Social Phobia) Specify if: Performance only (F41.0) Panic Attacks (Only if causes for Panic Attack can not be be better explain as a specifier within the context of that main disorder such as Anxiety Disorder, Post Traumatic Stress Disorder etc,). Panic Attack Specifier (F40.00) Agoraphobia (F41.1) Generalized Anxiety Disorder Specify if: Substance/Medication-Induced Anxiety Disorder Specify if: With onset during intoxication, With onset during withdrawal, With onset after medication use (F06.4) Anxiety Disorder Due to Another Medical Condition (F41.8) Other Specified Anxiety Disorder

17 (F41.9) Unspecified Anxiety Disorder (F43.22) Adjustment Disorder with anxiety (F43.23) Adjustment Disorder with mixed anxiety and depressed mood (F43.8) Other Specified Trauma- and Stressor-Related Disorder (F43.9) Unspecified Trauma- and Stressor-Related Disorder (F43.1 0) Posttraumatic Stress Disorder (includes Posttraumatic Stress. Overall Integration of a Treatment Plan: Choose one presenting problem. This problem must be identified through the assessment process. Select at least 1 to 3 behavioral definitions for the presenting problem. if a behavior definition is not listed feel free to define your own behavioral definition. Select at least long-term goal for the presenting problem. Select at least two short-term goals or objectives. Add a Target Date or the number of sessions required to meet this sure term goals. If none is listed feel free to include your own. Based on the short-term goals selected previously choose relevant strategies or interventions related to each short term goal. If no strategy or intervention is listed feel free to include your own. Review the recommended diagnosis listed. Remember, these are only suggestions. Complete the diagnosis based on the client's assessment data. Sample Treatment Plan Present Behavioral Descriptors of Problem: Forced episodes creating great tension and anxious behaviors.

18 Excessive and unwarranted concern, motor tension, autonomic hyperactivity, hyper vigilance. Long Term Goals: Increase capability to carry out daily routines by stabilizing anxiety levels. Determine the source of anxiety. Short Term Goals Objectives: Explore the past and present for major conflict causing anxiety. Construct a suitable relaxation technique to decrease levels of anxiety. Strategy or Intervention for Goal 1: Have client explore and list past and present incidents presenting conflict and anxiety. Help client in become conscious of major unsettled problems in his or her life in order to lead to a level of resolution. Strategy or Intervention for Goal 2: Assign relaxation and anxiety-prevention exercises. Have client participate in image desensitization techniques to relieve anxiety.

19 DSM V Diagnosis: (F41.1) Generalized Anxiety Disorder Copyright 2011 THERAPYTOOLS.US All rights reserved