Neela has split up with her boyfriend of four years. “Nick was abusive, but now he’s in jail, so it’s been easy this year to make some changes,” she says. She is confident that she will never go back to him, but says she’s left with “some residue—like nightmares, hyperalertness, a little too much drinking, and the blues.” She says she has always been a light social drinker and denies a history of alcoholism, although she struggles with alcohol now. She also reports that she sleeps “too light”; she can’t get to sleep, and then when she does, she’s hypervigilant, sitting up and thinking that she hears him coming into her apartment every time she drifts off. She wakes up in such moments in a cold sweat with her heart pounding in her temples, she hyperventilates and everything feels unreal, “like I’m in some creepy slasher film on late-night TV. I’m always so glad when the sun comes up!”
The alcohol “takes the edge off” her nerves and “helps with the depression.” Asked if she is sad most of the time, she says, “No. I really am over him, but I’m still scared. I get collect calls from him in prison, but I never accept them. I think if I could just get a different job, a different apartment, in a different city, I’d be fine. I could start all over again. I’ve sent out résumés, but until something comes up, I’m sort of stuck here in limbo where he knows he can find me. Ultimately, then, I’m here to treat this depression. I’m depressed, right?”.
Explain to Neela at least three differences between depression and anxiety—choosing three that apply in particular to her case.
List your top two short-term goals and interventions you would recommend for Neela.
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