Cognitive Behavioral Therapy for Generalized Anxiety Disorder with Agoraphobic Avoidance: A Clinical Case Report

Abstract

This case report describes the application of cognitive behavioral therapy (CBT) with a 44-year-old married male from Karachi, Pakistan, presenting with Generalized Anxiety Disorder, panic-like physiological symptoms and agoraphobic avoidance. The client reported excessive worry, disturbed sleep, irritability, low mood, fear of public places and public transport and reduced occupational and social functioning. Assessment was based on clinical interview, CBT assessment, DSM-5-TR diagnostic criteria, the Beck Anxiety Inventory and the Generalized Anxiety Disorder-7. The client obtained a score of 34 on the Beck Anxiety Inventory, indicating moderate anxiety and a score of 17 on the GAD-7, indicating severe anxiety. A formulation-based CBT intervention was delivered over 15 sessions through an online psychotherapy format. Treatment included psychoeducation, relaxation training, sleep hygiene, activity scheduling, mindfulness, grounding, thought monitoring, cognitive restructuring, downward arrow technique, Socratic dialogue, graded exposure, behavioral experiments, problem solving and relapse prevention. Improvement was observed in the client’s understanding of anxiety, ability to identify and challenge automatic thoughts, willingness to face avoided situations and confidence in managing physiological symptoms. The case highlights the clinical value of individualized CBT for anxiety presentations involving chronic worry, panic-like symptoms and avoidance within a Pakistani cultural context.