Computerized Cognitive Behavioral Therapy

Question: Discuss about the Computerized Cognitive Behavioral Therapy. Answer: Introduction Psychological disorders are classified in several categories, based on the signs and symptoms of the disorder. Assessment is a crucial part for diagnosing the appropriate psychological disorder (Hasin et al. 2013, p. 26). A psychologist, working in a hospital with a multidisciplinary mental and allied health team should have proper skills and competence for recognizing the disorder correctly. In this assignment, the focus is a 33 years old female, Yvette, who is the experiencing alcoholism, which in turn has give rise to anxiety disorders. In this context, she has represented an anxious state and severe headaches. Though she has no medical issues and tried to quit alcohol use more than one time, but found it difficult. Thus, she is seeking assistance from a psychologist. From her previous history, it has been revealed that she did not have any other addition in current status, except alcoholism. Moreover, the anxiety symptoms are not only due to her alcoholism disorder, rather, she h as a family history of anxiety disorder and it embarrasses her, which in turn leads to stress. Now, in this assignment, the focus will be demonstrating the etiology of the disorder, proper diagnosis of the disorder, assessment and intervention plan along with a relapse prevention plan for the patient Yvette. Etiology Yvette is suffering from alcoholism. Her addiction towards alcohol consumption is increasing day by day and she stated that not a single day she can spend without consuming alcohol. She seeks support from the psychologist to reduce her addiction. The disorder usually develops gradually over time and predisposed by family histories (Hasin et al. 2012, p 30). One commonly known cause for alcoholism is anxiety or depression symptoms. In the case study, Yvette has depicted that his father had anxiety disorder and was alcoholic since he was 25 years. Thus, it can be interpreted that family history of alcoholism is a significant cause and predisposing factor for her psychological condition. On the other hand, evidences highlighted that depression and anxiety are causes of alcoholism. Moreover, work related issues are the cause of her anxious symptoms. Predisposing factors are the factors inherited in the person, leading to a health issue. In Yvettes case, heredity and anxiety are two predisposing factors for developing alcoholism. Her father was addicted towards alcohol, which was a predisposing factor (Klimas et al. 2013, p.1). Precipitating factors trigger the predisposition. In yvettes case, her partners regular alcohol consumption is the precipitation factor that triggers her tendency of consuming alcohol regularly. It is evident from the case study that Yvette used to consume alcohol on weekend, but her boyfriends regular alcohol consumption triggered her predisposition. Her anxiety symptoms, panic attacks are making her more anxious day by day, she does not want to be more anxious, but she is not able to control her symptoms, which makes her want to drink even more. She is busy in her work and unable to meet her dear ones, which is another factor that maintains her tendency to drink more. In addition, she revealed that she have three months left for her contract work, which enhances her stress and maintaining the symptoms (Vasconcelos et al. 2014, p. 115). Diagnosis Mental disorders are diagnosed with the help of Diaagnostic and Statistical Manual of Mental Disorder, the fifth addition; DMS-V is currently in use. It helps the mental health providers to make proper diagnosis of generalized anxiety disorder (GAD) and other psychological disorders. According to the criteria of DMS-V, Yvette is suffering from substance abuse disorder instead of generalized anxiety disorder. Followings criteria of substance abuse, according to DMS-V are the evidences for Yvettes diagnosis: The person will consume more alcohol than originally planned. Yvette used to consume once in a weekend and currently she is unable to spend a single day without consuming alcohol. The person will worry about stopping or consistently failed efforts to control abuse (Carroll 2014, p. 127). In the case of Yvette, she tried to quit alcohol consumption, once or twice since she started to drink 3 years ago; she was not able to control her drinking, instead of her significant efforts to stop drinking. Substance abuse will result in failure of fulfilling major role obligations. Yvette has revealed that her partner does not have problems like her, instead of consuming alcohol regularly. The patient will continue using the substance instead of having health problems caused by it. In Yvette case, she was panicking about severe headache, presented anxious state and previously experienced black outs on excessive drinking, but still cannot control it. The person will continue to use the substance instead of having negative effects on relationship. Yvette stated that she is no longer visiting her parents home, as she thinks her parents do not like to have someone as anxious as her (Hasin et al. 2013, p. 26). She has also experienced withdrawal symptom, i.e. anxiety and built up tolerance to alcohol. Assessment plan There are several tools and instruments for assessing substance abuse appropriate for their needs. Using the appropriate assessment tool is important for identifying the exact disorder and the stage of disorder. There are several assessment tools like AUDIT, SBIRT, NIDAMED, CAGE AID and others. The AUDIT tool, i.e. Alcohol Use Disorder Identification Test is a 10-item questionnaire used for screening or assessing the hazardous alcohol consumption. The tool instrument was developed by WHO. It is a 10-tem questionnaire, which tests 95% correctly, whether a person is alcoholic or non-alcoholic. As it is suitable to be used in primary care settings and used for a range of populations and cultural groups, it would be suitable to be used for Yvette. This assessment has 10 questions and takes only 5 minutes for the assessment. For women, positive score is 4 (Samhsa.gov 2016). The information which will be collected through this assessment tool includes the frequency of alcohol consumption p er day, information regarding patients attempt for cutting down the use, history of failure, patients feelings regarding drinking, violence related to abuse and health issues regarding alcohol abuse. The questionnaire is provided in appendix. It will help to identify Yvettes status, whether she is alcoholic or not. Analyzing the question, it can be interpreted that Yvettes will score more than 4, indicating her experience of alcoholism (Kelly, Daley Douaihy, 2012). Based on the results, intervention plan would be established. In the assessment plan multidisciplinary team would be involved for instance the registered nurse and GP would be required for evaluating he physical health status. Intervention plan In case of Yvette, alcohol use disorder has been occurred with other mental health issue, like anxiety disorder. Thus, psychotherapy, pharmacotherapy or the combination of both would be required for improving Yvettes status. Several previous literatures have proved the successful outcomes of combined therapy including psychotherapy along with medication for reducing anxiety symptoms. This treatment is known as medication assisted treatment (MAT) (Uchtenhagen et al., 2015, p. 1390). The intervention would be planned on the basis of CBT-based integrated approach to alcoholism treatment; Yvette is a patient with a comorbid anxiety disorder. At the initial step, detoxification or withdrawal would be done. As Yvette has reported to the hospital, she would be administered with sedating medication for preventing withdrawal symptoms. Based on the screening and assessment outcomes, a treatment plan would be established by setting priority goals for Yvette. The psychological counselling would be the next step of the intervention plan. Yvette would undergo a 3 months psychological counselling for a supportive recovery (Bowen et al., 2014, p. 555). Through the sessions, she would be discussed about her symptoms and the coping strategies. The counsellor would help her to adopt the coping mechanisms. The treatment plan would include psychoeducation through the counselling sessions. The psychoeducation would include explanation of biopsychological model of anxiety disorder, alcohol use disorder and their interaction. On this education platform the next phase of treatment would be established. After providing sufficient information, Yvette would be taught about a standard paced diaphragmatic breathing exercise for minimizing hyperventilation associated with anxiety disorder (americanaddictioncenters.org, 2016). In the next phase, cognitive restructuring, Yvette would be taught about thinking patterns contributing to the anxiety and panic symptoms. She will also be taught about the ways of recognizing and restructuring the cognitions promoting alcohol use, which will in turn assist in coping with anxiety (Kane et al. 2014, p. 127). Here expert CBT skills would be required by the psychologist to help the patient in cognitive restructuring exercise. The final step is cue exposure that involves systematic therapist-guided exposure to sensations and panic attacks, aiming to decouple these from anxiety-inducing thoughts related to catastrophic outcomes. It will help Yvette to allow her in practicing new anxiety management skills and increasing her sense regarding successful coping in panicked situation, through enhancing her self-efficacy. Simultaneously mild anti-anxiety drug will be administered. Relapse prevention plan Relapse prevention plan is crucial for patients experiencing substance abuse, as it is very important to maintain the impact of interventions for longer period. A key to an effective addiction relapse plan is to determine what types of activities, habits and connections will be replaced previously associated with substance abuse. Three factors are required for Yvettes relapse prevention plan, these are managing triggers, providing a strong support system with family, friends and professionals and developing readiness, preventing a momentary slip into a return to alcohol abuse. Initially, stabilization is very important, as this plan might not work unless relapser is sober and in control of Yvette. Detoxification would be needed for making the plan to work (Spanagel Vengeliene, 2012). Initially, the psychiatrist should go slow and focus on the basic needs. In the nest step assessment would be designed for recognizing the pattern of recurrent of symptoms that are associated with previ ous relapse and to reduce pain related to these problems. Reviewing her life history would help the care provider to reconstruct recovery and relapse history. Since the first attempt at sobriety, every period of abstinence and substance use would be monitored crucially, this in turn set the stage for relapse. It will be difficult if Yvette starts drinking and resist talking about these things during the abstinence period. To reduce the chance of these things, relapse education will be provided to Yvette, which will include the process of relapse, chemical dependence and triggers, negative consequences of feeling embarrassed to reveal relapse. Relapse prevention therapy can be helpful for her, as it help to teach the patient about recognizing and managing warning signs (Witkiewitz Bowen, 2010). For instance, for Yvette, job related stress is a warning sign, which may trigger relapse of her symptoms. Involving her family, like her partner, best friend and partner will help her to be felt valued, thereby reducing her stress and anxiety related symptoms, which in turn will reduce the chance of alcohol use relapse. Conclusion In this assignment, from a psychologists perspective, the present scenario of 33 years old woman Yvette has been explored. According to the case study of Yvette, she was experiencing alcohol use symptoms along with anxiety disorder. The etiology, predisposing, precipitating and maintaining factors has been identified, which in turn helped in selecting appropriate diagnosis tool. The diagnosis has been done according to DMS-V diagnostic criteria. Then assessment plan was established for recognizing the current disorder of the patient, from the assessment, her alcoholism status was revealed, based on which the plan of the focused intervention has been developed, concerning all the factors associated with Yvettes health. Finally, the relapse prevention plan has been developed in accordance with her current recovery status and other factors presented by the patient. This plan will help to reduce recurrence of her anxiety and alcohol use symptoms, thereby assisting the patient to get back to her normal life. Reference List americanaddictioncenters.org,. (2016). Treating Addiction with Anxiety Disorders. 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