Anxiety and alcohol use disorders are among the most prevalent health conditions among young people. Upon joining the university, most students experience culture shock, which affects their internal and external life experiences. The case worsens among students who leave their childhood homes for the first time. Some students may be unable to socialize well with their peers, while others may engage in risky behaviors to be accepted by their new friends. Other students experience increased psychological distress since they do not know how to behave in a new environment. These issues affect students’ mental and psychological health outcomes. First-year college students experience internal and external life struggles due to change in the surrounding, forcing them to engage in maladaptive stress coping mechanism that may affect their health outcomes; to avoid this problem, a therapist should implement cognitive-behavioral and gestalt therapies to improve the students’ health.
Brief Description of Client
For this review, the client is an 18-year-old heterosexual female of Mexican American and Irish descent. She is a first-year college student who, for the first time, is living away from her childhood home. The client resides in a quad-style dorm arrangement. While she has her bedroom, three other students share the common living space adjacent to the bedrooms.
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Identification of Issues
The new experience has adversely affected the client’s living conditions and worldview. She is experiencing difficulties with focus and concentration with her classwork, inability to sleep well. She tends to hold her face and pick her fingernails when she cannot process her emotions or explain how she feels. Recently, she began drinking alcohol to fit in with her roommates. Although she claims alcohol enables her to manage anxiety in the short-term, she is concerned about her parents’ histories of substance abuse and dependence. She fears becoming an alcoholic. Another concern is that the college management may expel her for underage drinking. The client is also worried that her parents may withdraw their support if they discover her alcohol use. Currently, she only relies on her parents’ financial support since the previous social support system retired its assistance when she was admitted to an out-of-state college. Her drinking problem originates from her upbringing. Being in a new environment, the client struggles to fit in her social circle. Besides, she wants her roommates to like her, but she does not know how to behave around them. These factors trigger her social anxiety, forcing her to drink to interact well with her roommates. Failing to talk to her peers or mental health professional may exacerbate her drinking problem.
Presentation of Theories
I will use behavioral and cognitive theories to attend to the client’s needs. Under the behavioral technique, I will apply gestalt therapy. This model entails implementing socially progressive ideas, such as pro-gay rights, support for creativity, and expression of self along with Zen Buddhism elements (Cole & Reese, 2017). Gestalt theory respects and upholds humanistic values by acknowledging the client’s experiences. Under gestalt therapy, the client reviews and reassess her situation. One of Gestalt therapy principles is creative adjustments that allow the client to make changes that would enable them to live in their current environment ( Mann, 2010 ). Gestalt therapy acknowledges that people’s environment change from infancy through old age. For this reason, it requires clients to focus on their strengths and creativity to solve current problems.
Gestalt therapy will be the most appropriate model for this client since she faces a moral dilemma in her new environment. Currently, the client is unable to implement healthy creative adjustments. She is using outdated survival tactics, such as alcoholism which may not have improved her current situation. Alcohol use is an obsolete and habitual strategy that the client implements due to a perceived lack of support and choice in her current environment ( Mann, 2010 ). Gestalt therapy focuses on the client’s immediate experience. It allows a mental health professional to focus on how the client perceives their current situation instead of investigating why she perceives their environment ( Mann, 2010 ). Gestalt therapy heightens the client’s awareness of the progressive survival techniques that will foster personal growth.
The fundamental constructs of gestalt therapy can be instrumental in addressing the client’s anxiety. One of its principles is the holistic approach. Gestalt therapy allows a mental health professional to investigate a client’s social life, past, and present and use these elements to provide appropriate care that would alleviate anxiety symptoms (Mann, 2010). It will enable me to investigate how the client moves, use her voice, fill space, and situate herself in the world. Gestalt therapy does not dwell on the client’s physical conditions; instead, it incorporates their sensorial, social, spiritual, and intellectual dimensions (Cole & Reese, 2017). It enables the client to find answers to her problems. Gestalt therapy will encourage the client to identify childhood factors and trigger events that promote anxiety disorder. Besides, gestalt therapy provides a solution to improve the client’s health. Dr. Joseph Zinker proposed a model with five stages: sensation, awareness, mobilization of energy, contact, and new equilibrium (Cole & Reese, 2017). This approach entails identifying the problem and providing a lasting solution that overcomes the fixed gestalts. In the sensation stage, the client determines the factors that make her angry or uncomfortable. After becoming aware of the factors that cause her discomfort, she will mobilize her strengths to address the problem. In the process, she will gain awareness of the factors that exacerbate anxiety disorder (Cole & Reese, 2017). Gestalt therapy allows the client and I to discuss the factors that affect her self-esteem. During the contact stage, the client learns how to address her deepest emotions and gains experience that will enable her to socialize well in the future. According to a recent study, gestalt therapy can alleviate anxiety disorders if applied in the long-term (Cole & Reese, 2017). Gestalt therapy enables clients to avoid dysfunctional closeness in relationships and instead focus on their strengths and self-growth.
As a first-year college student, the client is learning how to adjust to adult life. Gestalt therapy will offer the most effective stress coping mechanisms. Most first-year college students encounter peer pressure to engage in substance abuse. Gestalt therapy will remind the client of her past survival tactics and encourage her to use intuition and creativity to succeed in college (Mann, 2010). One of the constructs of gestalt therapy is creative indifference. This model deters a therapist from imposing their idea of survival on the client; it allows the client to provide solutions to the anxiety disorder and self-esteem issues (Mann, 2010). The client can elicit the highest creative adjustment strategies since she is young and is from a different environment. Gestalt therapy will enable me to identify the meaning of her anxiety and use the information to improve the client’s health.
Cognitive-behavioral therapy (CBT) will be the second model. It allows a therapist to identify a client’s thought patterns that affect their behavior and emotions. In this case, the client has automatic negative thoughts that exacerbate anxiety. CBT is one of the most established treatments for anxiety disorders in young adults (Kodal et al., 2018). It comprises the following therapeutic approaches: cognitive therapy, dialectical behavioral therapy, multimodal therapy, and rational emotive behavioral therapy. Cognitive therapy identifies a client’s distorted thinking patterns, and dialectical behavioral therapy address changing behaviors and thoughts through mindful techniques (Kraemer et al., 2017). Multimodal therapy highlights psychological issues such as substance abuse, and rational emotive behavioral therapy focuses on irrational beliefs.
CBT is the most effective treatment method for this client. She is a college student with alcohol use disorders and general anxiety disorder who needs a technique that will improve her health outcome with an attitude of acceptance and nonjudgmental. One of the principles of cognitive-behavioral techniques is mindfulness which allows a therapist to observe her internal and external experiences, label her current situation and experiences, act with awareness, and take a nonjudgmental stance (Kraemer et al., 2017). Cognitive-behavioral therapy will enhance the client’s distress tolerance, identify the trigger events, and reduce her levels of worry in social circles. Researchers discovered that cognitive-behavioral techniques such as relaxation, anxiety management, and cognitive therapy could alleviate anxiety symptoms (Borkovec & Costello, 1993). Successful CBT treatment for general and social anxiety disorder can protect the client from later trigger conditions.
Cognitive-behavioral therapy is the most effective approach for a young client with alcohol abuse disorder and general anxiety disorder. Researchers discovered that CBT improves young people with anxiety disorders’ long-term health outcomes (Kodal et al., 2018). In the post-treatment anxiety diagnosis, clients who had undergone CBT had high self-esteem and socialized well with their peers. CBT’s anxiety management and mind relaxation techniques enable a client to let go of anxiety-arousing thoughts (Borkovec & Costello, 1993). As a result, the client’s behaviors, attention, beliefs, and appraisals improve. CBT guides a client to shift to minor threatening perspectives and thoughts, reducing the anxious meanings and reactions. Besides, mindful techniques can also enhance the client’s health outcomes. Recently, researchers discovered that mindfulness results in reduced alcohol intake, alcohol-related attentional biases, and craving (Kraemer et al., 2017). Mindfulness-based techniques encourage a client to manage stress and suppress negative thoughts. The outcome is psychological recovery from alcohol use.
CBT is an effective treatment for a young adult with alcohol and anxiety disorder. For instance, the mindfulness-based technique will enable the client to accept her thoughts, emotions, and bodily sensations (Kraemer et al., 2017). She will learn to grow mentally since she will associate these internal experiences with mental events. Instead of avoiding them, she will focus on addressing them. One of her problems is to drink to reduce physiological arousal and experience related to alcoholism. Mindfulness-based and relaxation techniques will enable the client to correctly label her internal experiences and interpret their meanings (Kraemer et al., 2017). Learning to tolerate negative affective states will reduce her alcohol intake.
Description of Techniques
I will use cognitive restructuring and specific, measurable, attainable, relevant, and time-bound (SMART) criteria under cognitive-behavioral therapy. Cognitive restricting will involve identifying the client’s negative thoughts, emotions, and behaviors (Kraemer et al., 2017). She has an anxiety disorder, meaning her thoughts and feelings are in a negative feedback loop and maintain a negative mood state. The first step will be to identify the automatic negative thoughts that affect the client’s campus experience. Later, I will guide her to consider the thoughts as guesses of their situations and consider alternate views (Kraemer et al., 2017). Consequently, the client will develop a critical approach to the internal experiences that causes her distress. I will teach her to develop a non-judgmental attitude to her thoughts, emotions, and body sensations to prevent maladaptive cognitive processes such as worry. This approach will also enable the client to adapt to her environment, avoid alcohol use, and interact well with her peers.
Another CBT intervention is SMART goals. If CBT is not well-implemented, a client may relapse in the long-term; thus, it is vital to develop sustainable and measurable goals that will improve her health outcome (Kodal et al., 2018). The first goal is to ensure the client reflects on the daily thoughts and quits drinking alcohol. I will lead a 30-minute yoga session every day. This approach will give the client a chance to be in touch with their thoughts and emotions. I will incorporate some Zen Buddhism elements to ensure the client understands herself well and avoids judging her internal experiences. At the end of every session, I will ask her how she feels to determine the intervention’s effectiveness. I will also ensure that the goals are measurable. For example, the client is in distress due to a sudden change in environment. For this reason, she will have 10-minute meditation sessions twice a day. She will keep track of her daily meditations, progress, and stress levels. I will review her progress every week and adjust the sessions to meet her mental strength. Another goal will be to have at least five friends by the end of the month. I will request the client to meet people in positive social circles such as book clubs, yoga classes, and sports events. She will learn to communicate with them without taking alcohol and report her feedback to me at the end of every two weeks. I will assess her progress for one year. This approach will enable the client to overcome anxiety and alcohol use disorders.
I will use a group setting under gestalt therapy using person-centered talk to deliver “here and now” and empty chair techniques. By allowing the client to express her ideas, I will understand the trigger events for anxiety and alcohol use disorder. The empty chair technique is vital since it enables the client to communicate with her past and present events (Mann, 2010). After learning about the factors that affect the client’s social life. I will encourage her to provide progress gestalt techniques that will enhance her current situation. This strategy entails highlighting the experiences and people who may have adversely affect her social life. I will form a group consisting of six members who will address the factors that impact their campus experience. The first agenda will be to address each member’s childhood story. According to researchers, childhood experiences affect people’s relationships and attachment styles (Cole & Reese, 2017). I will inform the client that ambivalent, secure, and avoidant attachment styles are welcomed in the group. Besides, the members will be encouraged to express their excitements and needs to explore their opportunities and grow (Cole & Reese, 2017). I will allow the client to interact with her group members. I will have a passive role which will be to regulate the group members’ utterances. This approach will enable the members to be free and address their fixed gestalts. A group setting will encourage the client to read other people’s body language and connect physically and emotionally. Consequently, she will learn how to socialize and express herself in public.
Future Suggestions
Overall, the client is facing internal and external life struggles, which have distorted her cognitive abilities. For this reason, she is unable to focus on her schoolwork. Currently, cognitive-behavioral techniques like relaxation and mindfulness-based tactics may enhance her cognitive skills. The client needs to focus on her strengths and abilities to socialize with others and tolerate stressful conditions. The group setting model under gestalt therapy can also enable her to overcome outdated survival tactics and constantly evolve and realize personal growth. Other CBT methods such as self-monitoring and problem-solving skills may enhance her ability to maneuver through the new environment. The client needs to understand her attachment style and research on how to improve her emotional intelligence to avoid situations that may trigger a relapse.
References
Borkovec, T. D., & Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology , 61(4), 611-619.
Cole, P., & Reese, D. (2017). An introduction to contemporary gestalt therapy for group therapists. Group , 41 (2), 95-117. https://www.jstor.org/stable/10.13186/group.41.2.0095
Kodal, A., Fjermestad, K., Bjelland, I., Gjestad, R., Öst, L. G., Bjaastad, J. F., Wergeland, G. J., et al. (2018). Long-term effectiveness of cognitive-behavioral therapy for youth with anxiety disorders. Journal of Anxiety Disorders , 53 , 58-67. https://doi.org/10.1016/j.janxdis.2017.11.003
Kraemer, K. M., O’Bryan, E. M., Johnson, A. L., & McLeish, A. C. (2017). The role of mindfulness skills in terms of anxiety-related cognitive risk factors among college students with problematic alcohol use. Substance Abuse , 38 (3), 337-343. https://doi.org/10.1080/08897077.2017.1340394
Mann, D. (2010). Gestalt therapy: 100 key points & techniques . Routledge.
