438 Depression Case Study

Using the PACER Method

Counselor Toolbox Podcast Episode 438

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director, AllCEUs.com

Podcast Host: Counselor Toolbox and Case Management Toolbox

Objectives

- Review a case study using the transdiagnostic, transtheoretical PACER approach

- As they say on Law and Order…

- The following story is fictional and does not depict any actual person or event.”

Case

- Tom is a 36 year old male and has been struggling with depression on and off for years, but the past 2 months it has gotten intolerable. He recently lost 85 pounds to try to help get his diabetes under control and improve his sleep apnea and blood pressure. He was thrilled with his weight loss progress, but he hit a plateau and feels like he is going backwards.

Physical

- Sleep

- On an average night how much sleep do you get- REM _1__ Deep _.5__ Light _6___

- On an average night how many times do you wake up- __3-4 but has sleep apnea___ Has not been waking up as much since he lost weight and started on the CPAP

- After an average night’s sleep how do you feel- Tired _x__ Okay ___ Energetic ____

- When you wake up feeling refreshed, how much sleep do you get- REM __3_ Deep __2+_ Light __3+__

- Sleep hygiene self assessment.

Physical

- Nutrition

- Using a free app like SparkPeople, track your nutrition for a week.

- Which nutrients do you get less than 75% the full RDA- Zinc

- Which nutrients do you get less than 25% of the RDA- None

- When was the last time you had a full panel blood test to examine your kidney and liver function, thyroid and vitamin D levels- 6 months

- Describe your eating habits: I have been eating healthier on my diet and try not to get too crazy because of diabetes

- Do you eat due to stress or for comfort when you are upset- yes

- Do you drink at least 64 ounces of noncaffeinated, nonalcoholic beverages each day- yes

- How much caffeine do you have on an average day- (100-150 mg/8oz of regular coffee; 35-50 mg/8oz of soda) ~600mg

Physical

- Nutrition

- How much nicotine do you have on an average day- (1mg/1 cigarette; 6-24mg/vaping cartridges) __0___

- Are you currently over or under fat- (Note: People can have a lot of muscle and not be unhealthy) _no____

- Have you recently had any problems with excessive thirst or hunger- __no

- Do you have problems with hypoglycemia (your blood sugar dropping)- _yes (diabetic)

- Have you recently gained or lost a lot of weight- Yes

- Has your doctor tested your blood sugar lately (fasting blood test)- __yes

- Do you mainly gain weight around your belly- __yes__

- Referral to PCP

Physical

- Pain

- Do you have any chronic pain- __Yes__

- If so what causes it-__bad knees___ How long have you had it- _since college___

- What makes it worse- __standing, walking_________

- What makes it better- _heat, ice, elevation

- How has it impacted your mood/relationships/energy/sleep/self-esteem- Knee pain is annoying and keeps me from playing tennis with my daughter

Physical

- Exercise/sedentariness

- Do you exercise- ____not anymore ______ If yes, how often and for how long- ____daily 45 minutes_____

- How is your energy, mood and appetite after you exercise- ___I’m exhausted________________

- Do you sleep better on days you exercise- __-___ Does muscle soreness make it harder to sleep- __No___

Physical

- Energy

- Which best describes your average energy level Low__x_ I can get through the day___ Great! ___

- Have you had your thyroid levels tested lately- __N__ If so were they in normal range- __-__

- Using a pulse ox monitor: What is your resting heart rate- __85_ What is your O2 saturation- __98___

- Do you have high blood pressure- _Y__ (managed with medication) Heart conditions- _N____ if so, what

Physical

- Libido/Sex hormones

- How is your sex drive- Low __x___ Good _____ Incredible______

- Has there been any c