NCMHCE Practice Test 9

Presenting Problem

You are a licensed mental health counselor working in a community mental health agency, where you lead an eight-week, time-limited anxiety and stress-management group. Corinne, a 29-year-old hospital pharmacy technician, is referred by her primary care provider for a pre-group screening interview after months of tension headaches and jaw pain. Her provider found normal thyroid labs and no medical cause and wrote, "stress-related; please evaluate for anxiety."

Corinne says, "My brain never shuts off. If it's not work, it's my mom's blood pressure, or rent, or whether my car will make it through the winter." She reports worrying "almost every day" for about eight months; the worry began a few weeks after she moved from day shift to night shift. She says the worry "jumps from thing to thing" and that she cannot stop it even when she tries: "I tell myself to let it go, and ten seconds later I'm back in it." She describes feeling keyed up and restless, tightness in her neck and jaw, snapping at her roommate over small things, and lying awake for an hour or more after shifts. By midweek she feels drained. She rechecks medication labels so often that her supervisor has twice warned her about falling behind, though she has never made a dispensing error. Her heart races when she lies awake worrying, but she denies sudden surges of intense fear that peak within minutes. She has stopped going to her climbing gym because she feels "too tense to enjoy it."

She denies suicidal and homicidal ideation, says, "I want to fix this, not escape it," and has no history of self-harm. Her provider suggested the group because it is covered by her plan and begins next week. Corinne admits, "I'm terrified I'll freeze up and everyone will think I'm ridiculous for worrying so much."

Mental Status Exam

Corinne is neatly dressed in scrubs and well groomed, and she is oriented to person, place, time, and situation. Her affect is anxious and congruent with her stated mood of "wound up." She shifts in her chair and taps her foot through much of the interview; gait is normal. Eye contact is good. Recent and remote memory are intact, and she concentrates well when redirected. Thought process is logical, though she often returns to "what if" concerns; thought content centers on work performance, her mother's health, and money. She denies hallucinations, and none are observed. She denies suicidal and homicidal ideation and any history of elevated mood or decreased need for sleep. She drinks about two glasses of wine a month and denies other substance use.

Psychosocial and Family History

Corinne is the older of two daughters. Her parents live an hour away, and she calls her mother daily to ask about her blood pressure readings. She shares an apartment with a roommate and sees her small circle of friends less often since starting nights. She has worked at the same hospital for five years, and finances are tight but manageable. She was raised Presbyterian and attends services on holidays. A trauma screen is negative. She has never been in counseling and calls herself "more of a private person." Before the screening ends, she asks whether you can promise that what she says in group about her worries at work will never get back to the hospital.