Directions:  Review the case study below and apply the REBT approach to the case.  In doing so, be sure to address the following. Your case study analysis should be written in four sections according to the items listed below:

1. Identify the following:

activating event(s)
irrational belief(s)
consequence(s)
2. Identify 2-3 goals for this client

3. Intervention strategies and procedures that would be used. Be sure to describe how each strategy might look specifically with the client in this case. Be sure to use strategies that are specific to this therapeutic approach.

4. How you would determine if the client was showing improvement. Be specific how you would measure progress in relationship to the goals you set in #2

case
Dorothy is a 40-year-old female who entered counseling at an agency because of overwhelming anxiety. She had experienced a number of episodes of not being able to leave her apartment for periods of a few days to several weeks. She describes her anxiety as feeling like shes having a heart attack, with shortness of breath, rapid heart rate, dizziness, sweating, and feeling doomed. She has gone to the emergency room several times, and each time, been told that she is healthy and that her symptoms are due to anxiety.

Dorothy describes herself as being a worrywart. She reported that she has worried about things for as long as she can remember. As a child, she worried about her mother dying and went through periods of not wanting to attend school in order to make sure that her mother was all right. At the time, the family lived in a neighborhood that had some problems with crime, but by the time Dorothy was 12, the family had relocated to an area that was quite safe, and Dorothy continued to worry. Dorothy went through a period in ninth grade during which she had to receive home tutoring because her anxiety became so bad that she was unable to leave the familys house. She saw counselors and a psychiatrist during this period and, with a combination of medication and counseling, was able to return and complete high school. Dorothy went on to college and earned a bachelors degree in education, eventually teaching second grade for almost 15 years.

Since high school, Dorothy has been extremely careful about living a healthy lifestyle. She started running after the prolonged anxiety episode described above and eventually competed in cross country and track throughout high school and college. She continued her interest in running after college and has regularly run in middle distance races and marathons right until three years ago. Dorothy also has been very careful, almost obsessive, about eating healthy foods that are low in fat and sugar, not smoking, and not drinking. Her regular physical exams have always shown that she has low cholesterol, normal blood pressure, and no signs of cardiovascular disease, diabetes, or other chronic conditions.

Three years ago, Dorothy experienced four devastating losses: her mother and father died within a three-month period from heart disease. Less than a year later, her grandmother, who was in her late 80s, passed away from a stroke. Six months after that, Dorothys brother suffered a fatal heart attack at work. Shortly after his funeral, Dorothy stopped going to work because she began experiencing shortness of breath and rapid heart rate, and thought that she was also going to suffer a heart attack. While she continues watch her diet and exercises regularly on a treadmill, she is convinced that she will suffer a heart attack if she travels too far from her apartment. Thus, Dorothy now only goes out when its absolutely necessary, such as grocery shopping, but will only go to a store that is two blocks from her building. If she travels much farther than that, she begins experiencing the symptoms described above.