Activity Worksheet #3
C. Anxiety & Anxiety Disorders
Addressing Functional Decline and Social Withdrawal in a
Young Adult: A Community-Based Mental Health
Intervention
Student Name: ___________________________
Date: ___________________________
Case Study: Susan’s Story
Case Background
Martha Cummings contacted the Visiting Nurses Association (VNA) to discuss
her concerns about her 29-year-old daughter Susan, who is a graphic
designer. Martha explains that Susan has always been a shy person, has one
or two close friends, and has difficulty dealing with new situations.
Over the past 4 months, Martha reports that Susan has been increasingly
reluctant to leave her apartment, making excuses about not visiting her family
and asking her mother to run errands and even purchase groceries for her.
Susan has quit going to the office but has continued her job by working at
home. Her employer has allowed her to do this for several weeks but is
becoming more impatient with Susan. Martha fears Susan may lose her job.
When Martha attempts to talk to Susan about this situation, Susan becomes
very anxious and agitated. She doesn’t want to discuss her problems and
keeps insisting she can’t “go out there” anymore. Martha has not been able to
convince Susan to see a doctor, so she contacted VNA to see if they would go
to Susan’s apartment to see her. Susan has agreed to talk to the nurse if the
nurse comes to her apartment.
Learning Objectives
Analyze mental health conditions—such as anxiety disorders,
depression, and PTSD—by evaluating behavioral patterns and
psychosocial factors that contribute to social withdrawal, isolation, and
avoidance of public spaces.
Apply engagement strategies—including motivational interviewing,
empathy, and trauma-informed care—to build trust and rapport with
individuals who are reluctant to seek help, particularly during home
visits.
Develop individualized intervention plans by identifying, integrating,
and adapting appropriate resources—such as mental health referrals,
occupational therapy, and graded exposure techniques—to support
clients in maintaining employment and regaining independence.
C – Concept: Anxiety & Anxiety Disorders
Key Topics
Mental health assessment in home settings
Recognizing early signs of agoraphobia, anxiety, or depression
Building therapeutic rapport with reluctant clients
Balancing family involvement with client autonomy
Discussion Questions:
1. What possible mental health conditions should be considered
in Susan’s case, and how might her long-standing personality
traits contribute to or mask these symptoms?
2. How can the visiting nurse build trust and facilitate open
communication with Susan during the initial home visit,
despite Susan’s anxiety and reluctance to seek help?
3. What role can Martha play in supporting Susan’s recovery, and
how might the nurse engage the family without undermining
Susan’s autonomy or creating additional stress?
E – Experience: Analyzing the Case
Case Summary (For Review)
Review the detailed case study provided. Analyze behavioral patterns,
psychosocial stressors, and contextual factors contributing to Susan’s situation.
Analysis Questions:
1. What potential mental health conditions could be contributing
to Susan’s increasing isolation and reluctance to leave her
apartment, and how might her longstanding personality traits
influence the development or masking of these symptoms?
2. How can the visiting nurse effectively engage Susan in a home
visit, given her reluctance to discuss her problems and the
significant anxiety she is experiencing? What communication
strategies could help build trust and foster a therapeutic
relationship?
3. What role should family members, particularly Martha, play in
Susan’s care, and how can the visiting nurse balance family
involvement with Susan’s autonomy in decision-making, while
still addressing her growing anxiety and functional decline?
R – Reflection: Exploring Personal and
Professional Perspectives
Guided Reflection Questions:
1. How would you feel personally if you were in Martha's position,
watching a loved one struggle with increasing isolation and
anxiety while being unable to convince them to seek help?
How might your emotional response influence your ability to support
someone in a similar situation?
2. Reflecting on your professional experience, how would you
approach building trust with a client like Susan who is
resistant to seeking help and expresses significant anxiety?
What strategies or communication techniques would you use to create
a safe, supportive environment during a home visit?
3. Consider the ethical implications of balancing Susan’s
autonomy with the need for intervention.
How do you approach situations where a client’s mental health
condition may impair their ability to make decisions about their care,
while still respecting their independence and wishes?
A – Action: Developing a Care Plan for Susan
Activity: Create a Care Plan
Use the prompts below to develop a short- and long-term
intervention plan for Susan:
Short-Term Goals (Immediate Interventions):
Long-Term Goals (Sustainable Strategies):
Support System Involvement (Family, Community,
Providers):
Suggested Interventional Strategies (for reference):
1. Build trust and rapport: Start with validation and empathy, offer
support without pressure.
2. Motivational interviewing: Use open-ended questions, affirmations,
and reflection.
3. Gradual exposure: Plan small, achievable goals to reduce avoidance
and anxiety.
4. Family support: Guide Martha in promoting independence without
enabling avoidance.
5. Work accommodations: Help Susan communicate with her employer
and adjust workload.
6. Mental health referrals: Offer gentle suggestions for therapy and
community support.
E – Evaluation: Assessing Learning and
Application
Self-Assessment & Group Discussion:
1.What was the most important takeaway
from this case study?
2. How confident do you feel in managing a patient like Susan?
o ☐ Very Confident
o ☐ Somewhat Confident
o ☐ Need More Guidance
3.What additional training or knowledge
would help you feel more prepared?
References / Resources:
American Psychiatric Association. (2013). Diagnostic and Statistical
Manual of Mental Disorders (5th ed.). Arlington, VA: American
Psychiatric Publishing.
National Institute of Mental Health (NIMH). (2021). Social Anxiety
Disorder
Hofmann, S. G., et al. (2012). The Efficacy of Cognitive Behavioral
Therapy. Cognitive Therapy and Research, 36(5), 427–440.
White, B. A., & McDonough, L. (2019). Behavioral Activation for
Anxiety and Depression. Journal of Anxiety and Stress Management,
7(2), 93–103.
Brown, C. (2017). Family Dynamics and Mental Health. Psychology
Today.
