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Therapy Session Case Study: Dealing with Anxiety, Stress and Poor Self-Confidence

Therapist and counsellor dr. dawn ferrara gives her perspective on a uptv client session.

We’ve got something a little different for you this time. As you know, often I like to describe therapeutic approaches in depth.

This piece describes one therapy session in detail, but it’s a little different because it’s not written by me but by an “outside pair of eyes.”

Dr. Dawn Ferrara is a Licensed Professional Counsellor and Licensed Marriage & Family Therapist specializing in Anxiety/Stress disorders.

Dawn looks at the session from the perspective of her understanding and experience. It’s so valuable to get a perspective other than your own so we asked Dawn, a skilled psychologist to write a case study for us.

What you have here is an overview of one session with Alice* an  Uncommon Practitioners TV client who came for help with anxiety, stress and low self confidence. Please let me know in the comments section if you find this useful and whether you’d like more professional summations of these therapy sessions.

Here’s to improving psychological knowledge and emotional health,

Identifying information

Alice (age unspecified) is a female client who works in the Information Technology (IT) industry. She has been in the IT field for 25 years and has run her own business successfully for the last 10 years. She is married and she and her spouse work together.

Presenting problem

Alice is seeking help for anxiety, stress and poor self-confidence.

Social history

Alice is married with one daughter. She reports a good personal and professional relationship with her spouse.

Alice’s parents divorced when she was young. She describes feeling “cheated” by that situation. Her father died in 1994 from cancer and never met her daughter. Alice expresses some regret that her father didn’t live to see her succeed as an adult or to meet his granddaughter. Alice’s mother is alive but Alice describes the relationship as strained.

Alice owns her own technology company. She reports that she learned her IT skills as an early adopter of emerging technology and built a career on those skills. She did not receive formal training.

Alice describes her job as quite stressful. She reports that she sometimes has difficulty dealing with demanding clients, especially when she is unable to help them in the ways they expect her to.

These situations evoke bothersome feelings of disappointment and anxiety, and worries about being criticized or judged. She states she becomes annoyed and that these feelings affect her wellbeing.

Mental health history

Alice reports that she has a history of anxiety and depression , for which she has received treatment. Past treatments have included antidepressant medication (unspecified) and diazepam for panic attacks. She is not currently taking medication.

Alice says that following her father’s death, her symptoms worsened.

Alice reports that she has previously used hypnosis for smoking cessation . It appears to have been only partially successful, as she continues to use an e-cigarette.

Session summary

This video is a single therapy session. The first part of the session consists of information gathering and a number of suggestions and reframes to encourage relaxation and assist Alice in gaining insight into some of her issues. The latter part of the session is direct hypnosis. Throughout the session, Mark uses a relaxed, conversational approach .

Mark engages Alice in conversation to clarify and discuss her concerns. As she becomes more comfortable, Alice offers more information and insight into her issues.

She admits to having bursts of intense anxiety but has had a reduction in panic episodes. She attributes that to making better choices about managing situations that she finds provoke anxiety. She identifies criticism and self-doubt as particularly problematic triggers.

Because of her history, Mark asks Alice a series of questions to assess the risk of post-traumatic stress disorder (PTSD). It does not appear that PTSD is a diagnostic consideration at this time.

Mark then reframes anxiety symptoms as an “exercise response”. This is done in order to normalize the anxiety response and reduce the tendency to pathologize its symptoms.

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A metaphor for stress and anxiety

To create a visual representation of anxiety, Mark makes an analogy between unchecked anxiety and a mental bucket of water. Anxiety (water) pours into the bucket and, if left unchecked, eventually fills the bucket and overflows (panic). He equates regular relaxation to emptying the mental bucket so that it doesn’t overflow (anxiety/panic).

Throughout the session, Mark references water creating a sense of calm and flow: filling the bucket, anxiety response as a whirlpool, the surface of water calm and reflective, feelings of calm streaming over.

During this discussion, Alice is attentive and calm with a relaxed posture. She makes good eye contact and responds with ease.

Depressive thinking styles

Now Mark describes the biases of globalizing , internalizing negatives and externalizing positives using a number of examples and analogies. Alice is able to recognize some of those biases in herself. Mark frames Alice’s insight into her biases as “seeing through” them.

As Alice becomes more aware of her biases, she becomes less affected by them because she can recognize them for what they are: inaccurate. The purpose of this reframing is to help Alice to separate herself from her biases, and accept that they do not define who she is.

Because Alice is particularly sensitive to perceived criticism, Mark makes a similar distinction between complaint and criticism, framing them as separate and not reflective of who she is as a person.

Tools for reducing anxiety

Following a discussion of Alice’s physical anxiety symptoms, Mark explains the dynamics of tactical breathing and invites Alice to try the technique. She readily responds and is able to practise the technique successfully and feel the sensation of relaxing.

Using conversational strategies, Mark encourages Alice to visualize scenarios and notice her reactions, first recalling her feelings in the bothersome scenario then visualizing it from afar and noticing differences while breathing and remaining in the moment.

This therapeutic presupposition allows Alice to see that she can react differently to difficult situations and allows her to move towards the hypnotic state.

Guided relaxation

The hypnotic induction begins with Mark describing hypnosis. He references Alice’s enjoyment of mandala painting on stones as an anchor, a way to help her connect with the state of mind-body relaxation and its link to unconscious thought.

The focus of the induction is relaxation training and helping Alice learn to manage her anxiety response. Using a series of embedded commands and visualizations, Alice is able to recognize her anxiety without panic or heightened responses and gently reduce it or brush it aside. She is able to experience remaining in control of her physical and thought responses.

Mark then gives several suggestions for actions going forward. These actions empower Alice to continue to recognize and manage her anxiety response by remaining calm and in control.

“What I’d like you to do is just to notice in the coming weeks and months what you notice about yourself, maybe after the event… telling yourself perhaps that: “at one point this would have been a problem for me but I just didn’t feel anything. I just put it in perspective.”

“You can just notice those times in coming weeks and months and forever.”

Further strengthening the link between conscious and unconscious thought, the induction is completed with a final suggestion that her unconscious mind and body will continue to be accessible when needed.

Did you find this case study useful? Let us know in the comments below if you’d like to see more professional summations of therapy sessions from Uncommon Practitioners TV, and if there’s anything we can add to them to make them more useful to you.

And if you haven’t joined yet, you can read about Uncommon Practitioners TV here and sign up to be notified when it’s open for new members.

About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses .

You can get my book FREE when you subscribe to my therapy techniques newsletter. Click here to subscribe free now.

You can also get my articles on YouTube , find me on Instagram , Amazon , Twitter , and Facebook .

*Not her real name

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Exercises • 7 min read

Under Pressure: a Stress Management Case Study

Helping team members reflect on the symptoms of stress and how to alleviate it.

By the Mind Tools Content Team

This plausible case study will enable participants to recognize the symptoms of stress in themselves or in colleagues and take action to remedy the situation.

Participants will be able to …

• develop a higher level of awareness of stress in the workplace
• highlight the symptoms of stress and recognize them in themselves and in colleagues
• learn methods of dealing with stress in the workplace

Facilitator’s Guide

This straightforward case study requires little in the way of facilitation but mingle with the groups and be on hand to answer any questions or prompt discussion.

It could be used as part of a stress management workshop or stress awareness campaign. It would work best with groups of up to six participants. Allow just over an hour for completion.

Suggested Resources

• copy of task sheet per delegate
• white board or flipchart

What to Do (35 Minutes)

• Introduce the case study explaining its objectives to the participants.
• If you are dealing with a larger group, split them into sub–groups of five or six people.
• Distribute the task sheets amongst participants and allow 30 minutes for completion.

Review Activity (10 Minutes)

Bring the group(s) back to discuss their results. Possible answers to the questions could include the following:

1. What behavioral and psychological changes in Jen suggest that she may be stressed? Jen has become short–tempered, forgetful, intolerant, feels constantly anxious, her concentration is impaired and she is under–eating.

2. Can you list two other behavioral changes suggestive of stress? This could include any two of the following:

• aggressive behavior
• pessimistic and negative
• increased alcohol/drug use or smoking
• carelessness
• over–eating
• withdrawal and listlessness

3. What physical symptoms is Jen showing that suggest she may be stressed? Jen has decreased appetite, sleep disturbance, weight loss and she is susceptible to minor illnesses.

4. List five other physical symptoms or signs of stress. This could include any of the following:

• tightness of the chest, neck, jaw, face, abdomen, shoulder and back muscles
• hunched posture and clenched fists
• breathing becomes shallow and rapid
• irritable bowel symptoms such as diarrhea or constipation
• shaking hands
• chronic (long–term) pain
• facial expression shows tension – frown, tightened eyebrows, clenched jaw, pursed lips

5. If you were Ahmed, what would you do to help Jen? There are a number of approaches Ahmed could take to help Jen. Depending on his seniority, he may be able to take action in one of the following ways:

• arrange a meeting with Jen. Give her some notice, and outline why you want to meet her. You’re concerned about her health and you want to establish if it is work related. If so, establish what can be done to resolve these issues and to support Jen
• allow half a day, in private, perhaps away from the workplace, to explore your observations and Jen’s response in detail
• review the project objectives, timescales, resources, processes. Establish realistic goals and think creatively around overcoming the constraints. But, the constraints must be addressed
• assign another project manager to co–manage the project with Jen
• look at the hours that Jen is working and, if they are excessive, try to reduce them
• change the hours of Jen’s work week so that she is not traveling in rush-hour traffic
• offer Jen the opportunity to work from home where appropriate

In addition to the above, he could also:

• encourage Jen to take up a sport or a hobby
• suggest that she takes up yoga
• suggest that she speaks to her GP who may refer her on to a counselor or suggest other forms of treatment
• encourage her to investigate other methods of relaxation including aromatherapy, relaxation exercises and breathing exercises

It could be that Jen would find some of these options intrusive, others less so. Make sure that the group is aware of the sensitivities surrounding this.

This list is by no means exhaustive. There are positives and negatives surrounding each of these suggestions. Make sure that you cover all of these with the group.

Apply Learning (15 Minutes)

Ask participants to work individually for five minutes and either select a colleague they are concerned about, or themselves and list up to three:

• behavioral or psychological changes
• physical symptoms

Encourage them to select a learning partner if they wish and discuss what they can do to manage their own stress or how they can help/support their colleague.

Under Pressure – Task Sheet

Jen Breeze is a project manager for Techtron, a multinational IT consultancy. She has always enjoyed her work, but has recently found herself under increasing pressure in the workplace. Although when in her early 20s and 30s Jen ‘thrived on stress’ she feels that now, at 45, her work is taking a toll on both her health and her personal life.

Jen was recently assigned to work on her biggest project to date. As an experienced manager, she recognizes that both the budget and the timescale for the project are highly unrealistic. She has discussed her concerns with senior management, but her words fell on deaf ears. She knows that she is accountable for the success of the project and feels constantly uneasy. She has even found herself lying thinking about it in the early hours of the morning. On top of this, Jen has to drive 30 miles, each way, every day to reach work through rush-hour traffic.

A senior colleague, Ahmed Nazir, meets with Jen in the staff canteen for lunch on a regular basis, and has seen a gradual change in her over the last few months. She never seems to listen to him anymore and he has difficulty holding a sensible conversation with her. She looks tired and rarely eats much. He finds her forgetful and is concerned that this will have a knock-on effect on the quality of work that she is producing. He is, however, more worried about Jen and wants to help.

Jen herself is also worried, not only about the forthcoming project launch meeting, but about herself. Although Jen has a reputation for being approachable, she has found herself regularly ‘snapping’ without good reason at team members. At home too, she feels that she is short–tempered and intolerant of her husband. She feels ‘wound up’ all the time and can’t seem to relax. She knows that she has inadvertently lost a significant amount of weight. Her friends complain that they have not seen her in weeks, but she cannot face the simple task of phoning them. To make matters worse she has had a recurring cold for over three months and has been unable to shake it off. The thought of going into work each day fills her with dread and she is unsure how much longer she can go on functioning like this.

Task Consider the following questions:

• What behavioral and psychological changes in Jen suggest that she may be stressed?
• Can you list two other behavioral changes suggestive of stress?
• What physical symptoms is Jen showing that suggest she may be stressed?
• List five other physical symptoms or signs of stress.
• If you were Ahmed, what would you do to help Jen?
• If you were Jen what steps would you take to help yourself, and the project?

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Counselling Case Study: Managing Anxiety

Leah is a 24 year old woman who was recently discharged from the Army on medical grounds. During her four years in the Army, Leah experienced high levels of stress and anxiety which she coped with by drinking heavily. When she presented for counselling, Leah had been sober for 55 days and was seeking strategies to cope with her anxiety that didn’t involve drinking.

While working with Leah, the Professional Counsellor adopts a case management model in order to assist her to build a network of supports within the community, enabling her to maintain her sobriety and prevent recurrence of the factors which contributed to her high levels of stress. For ease of writing, the Professional Counsellor is abbreviated to “C”.

Leah was an only child whose parents separated during her teen years. She felt isolated and was often bored at school. Her love of art was the only thing that gave her any enjoyment and she expressed this by covering the school buildings with graffiti after dark. Already in conflict with her mother due to her poor school performance, the involvement of the police after she was reported for vandalising public property further worsened their relationship. Her father had moved away and was no longer involved in Leah’s life.

Leah left school intending to train as an ambulance medic. On being told she lacked the life experience required for this work, Leah joined the Army on a four year contract hoping to address this requirement. However the Army turned out to be a repeat of the constrictive structure within which she had struggled both at school and at home.

Being obligated to complete the full four years, she began to feel increasingly trapped and was often anxious and depressed. She was introduced to alcohol by her fellow recruits and began using this as a means of deadening her overwhelmingly negative feelings about the course her life was taking. After three years in the Army, Leah was discharged on medical grounds, having become dependent on alcohol and unable to control her intake.

Issues identified

A case manager’s initial function is to develop an understanding of the client and help build a resource network that the client can later access on her own. In this role, C performed an examination of Leah’s environment, behaviour and immediate needs which identified the following issues:

• Career indecision – although still wanting to be an ambulance medic, Leah had lost confidence in her ability to achieve this or any other career goal.
• Unsuitable accommodation – Leah was sharing a flat with a young man who yelled at her if she smoked and often made unwelcome passes at her.
• High levels of stress and anxiety – Leah continually craved alcohol during her period of sobriety and began using valium to replace the role alcohol had played in deadening her feelings
• Large amounts of unstructured time – Leah had no other strategies in place to cope with her negative thoughts and feelings and, now she was no longer working, found herself with large amounts of time during which she had nothing else to do but think.
• Lack of a personal support network – Leah was estranged from both her parents, had no siblings, and felt unable to contact any of her former Army colleagues because she felt inadequate due to the manner in which she had been discharged.

Following an identification of issues needing attention, the case manager then coordinates a plan to enable the client to access needed assistance within her community. In this role, C worked with Leah to outline a plan which involved the following strategies:

• Schedule pleasurable activities
• Obtain suitable accommodation
• Increase support networks
• Contact a supported job training network
• Access Centrelink benefits
• Undertake a drug and alcohol rehabilitation program
• Cognitive restructuring
• Medication monitoring
• Ongoing support

This plan was designed to utilise Leah’s strengths and was later outlined in clear measurable terms that allowed for periodic evaluation of her progress. This is particularly important when the client is becoming disillusioned as it illustrates to her that while she may not yet have reached her goals, she has made significant progress towards them. Leah’s goals were developed with her input to encourage her to feel ownership of them, increasing her motivation.

The following barriers to the above plan were identified:

• Craving for alcohol – Leah had used alcohol as a way of coping with overwhelming feelings, consequently she had strong cravings whenever she was feeling particularly stressed and anxious
• “Doctor shopping” – Leah had discovered that Valium served a similar purpose to alcohol and when her GP refused to give her any further prescriptions, she simply went to another doctor.
• Misinterpreting anxiety and stress symptoms – Leah had become hypervigilant towards her physical symptoms of anxiety (breathlessness, increased heart rate, hot flushes, dizziness), interpreting them as medical problems resulting from her drinking, which further increased her stress and anxiety levels
• Pessimism – Leah exhibited this internal barrier through her belief that she was solely responsible for the things that had gone wrong in her life and that because of this, there was no way for things to change and nobody would be able to help her. This left Leah feeling helpless, overwhelmed and at times suicidal.

Leah’s goals were written in specific behavioural terms as follows:

• Schedule enjoyable activities – C asked Leah to make a list of five activities that had either given her pleasure in the past or were things she would like to try in the future. She listed jogging, calligraphy, painting, reading and walking on the beach. C asked Leah to carry out at least one of these activities every day.
• Obtain suitable accommodation – C asked Leah to contact a former Army colleague who had always been very caring towards Leah and who had previously invited her to share her home. Leah did this and, upon moving in, she and her new flatmate bought a new puppy, providing Leah with further enjoyable activity on a daily basis.
• Supported employment / job training – C accompanied Leah to an appointment with a supported employment service run by the state government. This service aimed to support Leah in regaining her confidence in returning to the workforce, providing her with vocational counselling to guide her career choices and ongoing support when searching for and commencing employment. They were also able to provide funding for retraining.
• Centrelink benefits – C helped Leah obtain and lodge necessary forms to help her transition to Newstart Allowance once her Army benefits had run out.
• Rehabilitation – C connected Leah with appropriate contacts to commence drug and alcohol counselling and to undergo residential rehabilitation if needed.
• Cognitive restructuring – C provided short-term intervention aimed at identifying Leah’s irrational thought processes and replacing these with a more functional belief system. Here C took on the counselling function of the case management role and centred the work around Leah’s belief that she was a failure and would never get her life together. This process utilised Rational Emotive techniques such as Examine the Evidence and Thinking in Shades of Grey (Ellis as cited in Dryden & Golden, 1986).
• The Gestalt technique ’empty chair’ (Perls as cited in Patterson, 1986) and aspects of Dialetical Behaviour Therapy (Linehan, 1993) were also used to address Leah’s unresolved feelings towards her parents and to teach her to tolerate distress without having to escape through the use of drugs or alcohol.
• Medication monitoring – C arranged for Leah to be seen regularly by a psychiatrist in addition to her local GP to ensure she was receiving the correct medication and to facilitate hospital admission should the need arise. She was also educated about the fight or flight response that was leading to her physical symptoms.
• Ongoing support – C provided Leah with contact names and numbers for local chapters of Alcoholics Anonymous and, following successful completion of her immediate goals, C referred Leah to her local community health clinic for ongoing monitoring and medical follow-up.

Session Summary

C has provided a combination of case management and counselling functions while working with Leah. As counsellor, C has used Cognitive Behaviour Therapy, Dialectical Behaviour Therapy and Gestalt Therapy techniques to facilitate achievement of the client’s goals.

In reducing her high levels of anxiety and stress, Leah was able to address her more practical needs, for example challenging her beliefs about what her former colleagues thought of her enabled her to contact one of them to follow up on the offer of accommodation. While C provided education and support in this regard, Leah carried out most of the practical tasks herself, thereby building on her strengths and further increasing her confidence levels and reducing her pessimism.

This process occurred over a three month period, during which two progress reviews took place between C, Leah and her psychiatrist. At this time, Leah was able to see the progress she was making and was also able to draw attention to any areas with which she was experiencing difficulty or concern.

Upon completion of the above plan for meeting Leah’s immediate needs, C has referred her to services able to provide her with ongoing but less intensive support. With Leah’s written permission, C provided the community health centre with a referral form outlining Leah’s history, medication regime, and a summary of the work undertaken with C, which C had documented following each session with Leah.

C maintained contact with Leah on a weekly basis during the transition to the new service and while she became comfortable in her local AA support group. In taking this step, C has ensured Leah has acquired the necessary skills for maintaining progress on her own, with assistance available to her as needed.

Author: Leanne Chapman

• Dryden, W. and Golden, W.L. (Eds). (1986). Cognitive-behavioural approaches to psychotherapy. London: Harper and Row Publishers.
• Linehan, M.M. (1993). Cognitive-behavioural treatment of borderline personality disorder. USA: The Guilford Press.
• Patterson, C.H. (1986). Theories of counselling and psychotherapy. New York: Harper and Row Publishers.

Related Case Studies: A Case of Stress , A Case of Social Anxiety , A Case of Low Self Esteem

• June 5, 2009
• Case Management , Case Study , Dialectical Behaviour Therapy , Gestalt Therapy
• Addictions , Case Studies , Stress Management

Comments: 1

As I was reading this I knew her issues and how to address them. I I could see the plan that I had made for her. I really love this thanks so much for this.

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Stress and Well-Being: A Systematic Case Study of Adolescents’ Experiences in a Mindfulness-Based Program

• Original Paper
• Published: 28 November 2020
• Volume 30 , pages 431–446, ( 2021 )

Cite this article

• Deborah L. Schussler   ORCID: orcid.org/0000-0001-5970-4326 1 ,
• Yoonkyung Oh 2 ,
• Julia Mahfouz 3 ,
• Joseph Levitan 4 ,
• Jennifer L. Frank 1 ,
• Patricia C. Broderick 1 ,
• Joy L. Mitra 1 ,
• Elaine Berrena 1 ,
• Kimberly Kohler 1 &
• Mark T. Greenberg 1  

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Research on mindfulness-based programs (MBPs) for adolescents suggests improvements in stress, emotion regulation, and ability to perform some cognitive tasks. However, there is little research examining the contextual factors impacting why specific students experience particular changes and the process by which these changes occur. Responding to the NIH call for “n-of-1 studies” that examine how individuals respond to interventions, we conducted a systematic case study, following an intervention trial (Learning to BREATHE), to investigate how individual students experienced an MBP. Specifically, we examined how students’ participation impacted their perceived stress and well-being and why students chose to implement practices in their daily lives. Students in health classes at two diverse high schools completed quantitative self-report measures (pre-, post-, follow-up), qualitative interviews, and open-ended survey questions. We analyzed self-report data to examine whether and to what extent student performance on measures of psychological functioning, stress, attention, and well-being changed before and after participation in an MBP. We analyzed qualitative data to investigate contextual information about why those changes may have occurred and why individuals chose to adopt or disregard mindfulness practices outside the classroom. Results suggest that, particularly for high-risk adolescents and those who integrated program practices into their daily lives, the intervention impacted internalizing symptoms, stress management, mindfulness, and emotion regulation. Mindful breathing was found to be a feasible practice easily incorporated into school routines. Contextual factors impacted practice uptake and program outcomes. Implications for practitioners aiming to help high school students manage stress are discussed.

Systematic case study provides nuanced data about how individuals respond to a mindfulness-based program (MBP).

High-risk adolescents received the most benefit from MBP participation.

Students who practiced were more likely to experience change across outcomes.

The MBP most impacted the way students responded to stress.

Mindful breathing may be the most accessible practice for students.

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Author Contributions

All authors contributed to the study conception and design. Qualitative data collection and analysis were performed by D.L.S., J.M., and J.L. Quantitative analysis was performed by Y.O., while J.L.M., E.B., and K.K. led the quantitative data collection. The first draft of the manuscript was written by D.L.S. and Y.O., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

The project described was supported by Award Number R305A140113 from the Institute of Education Sciences (IES). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Institute of Education Sciences or the U.S. Department of Education.

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Schussler, D.L., Oh, Y., Mahfouz, J. et al. Stress and Well-Being: A Systematic Case Study of Adolescents’ Experiences in a Mindfulness-Based Program. J Child Fam Stud 30 , 431–446 (2021). https://doi.org/10.1007/s10826-020-01864-5

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• Case Report
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A case of PTSD presenting with psychotic symptomatology: a case report

• Georgios D Floros 1 ,
• Ioanna Charatsidou 1 &
• Grigorios Lavrentiadis 1  

Cases Journal volume  1 , Article number:  352 ( 2008 ) Cite this article

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A male patient aged 43 presented with psychotic symptomatology after a traumatic event involving accidental mutilation of the fingers. Initial presentation was uncommon although the patient responded well to pharmacotherapy. The theoretical framework, management plan and details of the treatment are presented.

Recent studies have shown that psychotic symptoms can be a hallmark of post-traumatic stress disorder [ 1 , 2 ]. The vast majority of the cases reported concerned war veterans although there were sporadic incidents involving non-combat related trauma (somatic or psychic). There is a biological theoretical framework for the disease [ 3 ] as well as several psychological theories attempting to explain cognitive aspects [ 4 ].

Case presentation

A male patient, aged 43, presented for treatment with complaints tracing back a year ago to a traumatic work-related event involving mutilation of the distal phalanges of his right-hand fingers. Main complaints included mixed hallucinations, irritability, inability to perform everyday tasks and depressive mood. No psychic symptomatology was evident before the event to him or his social milieu.

Mental state examination

The patient was a well-groomed male of short stature, sturdy build and average weight. He was restless but not agitated, with a guarded attitude towards the interviewer. His speech pattern was slow and sparse, his voice low. He described his current mood as 'anxious' without being able to provide with a reason. Patient appeared dysphoric and with blunted affect. He was able to maintain a linear train of thought with no apparent disorganization or irrational connections when expressing himself. Thought content centred on his amputated fingers with a semi-compulsive tendency to gaze to his (gloved) hand. The patient was typically lost in ruminations about his accident with a focus on the precise moment which he experienced as intrusive and affectively charged in a negative and painful way. He could remember wishing for his fingers to re-attach to his hand almost as the accident took place. A trigger in his intrusive thoughts was the painful sensation of neuropathic pain from his half-mutilated fingers, an artefact of surgery.

He denied and thoughts of harming himself and demonstrated no signs of aggression towards others. Hallucinations had a predominantly depressive and ego-dystonic character. He denied any perceptual disturbances at the time of the examination. Their appearance was typically during nighttime especially in the twilight. Initially they were visual only, involving shapes and rocks tumbling down towards the patient, gradually becoming more complex and laden with significance. A mixed visual and tactile hallucination of burning rain came afterwards while in the time of examination a tall stranger clad in black and raiding a tall steed would threaten and ridicule the patient. He scored 21 on a MMSE with trouble in the attention, calculation and recall categories. The patient appeared reliable and candid to the extent of his self-disclosure, gradually opening up to the interviewer but displayed a marked difficulty on describing his emotions and memories of the accident, apparently independent of his conscious will. His judgement was adequate and he had some limited Insight into his difficulties, hesitantly attributing them to his accident.

He was married and a father of three (two boys and a girl aged 7–12) He had no prior medical history for mental or somatic problems and received no medication. He admitted to occasional alcohol consumption although his relatives confirmed that he did not present addiction symptoms. He had some trouble making ends meet for the past five years. Due to rampant unemployment in his hometown, he was periodically employed in various jobs, mostly in the construction sector. One of his children has a congenital deformity, underwent several surgical procedures with mixed results and, before the time of the patient's accident, it was likely that more surgery would be forthcoming. The patient's father was a proud man who worked hard but reportedly was victimized by his brothers, they reaping the benefits of his work in the fields by manipulating his own father. He suffered a nervous breakdown attributed to his low economic status after a failed economic endeavour ending in him being robbed of the profits, seven years before the accident. There was no other relevant family history.

Before the accident the patient was a lively man, heavily involved as a participant and organizer in important local social events from a young age. He was respected by his fellow villagers and felt his involvement as a unique source of pride in an otherwise average existence. Prior to his accident, the patient was repeatedly promised a permanent job as a labourer and fate would have it that his appointment was supposedly approved immediately after the accident only to be subsequently revoked. He viewed himself as an exploited man in his previous jobs, much the same way his father was, while he harboured an extreme bitterness over the unavailability of support for his long-standing problems. His financial status was poor, being in sick-leave from his previous job for the last four months following the accident and hoping to receive some compensation. Although his injuries were considered insufficient for disability pension he could not work to his full capacity since the hand affected was his primary one and he was a manual labourer.

Given that the patient clearly suffered a high level of distress as a result of his hallucinatory experiences he was voluntary admitted to the 2nd Psychiatric Department of the Aristotle University of Thessaloniki for further assessment, observation and treatment. A routine blood workup was ordered with no abnormalities. A Rorschach Inkblot Test was administered in order to gain some insight into patient's dynamics, interpersonal relations and underlying personality characteristics while ruling out any malingering or factitious components in the presentation as suggested in Wilson and Keane [ 5 ]. Results pointed to inadequate reality testing with slight disturbances in perception and a difficulty in separating reality from fantasy, leading to mistaken impressions and a tendency to act without forethought in the face of stress. Uncertainty in particular was unbearable and adjustment to a novel environment hard. Cognitive functions (concentration, attention, information processing, executive functions) were impaired possibly due to cognitive inability or neurological disease. Emotion was controlled with a tendency for impulsive behaviour; however there was difficulty in processing and expressing emotions in an adaptive manner. There were distinct patterns of aggression and anger towards others but expressing those patterns was avoided, switching to passivity and denial rather than succumbing to destructive urges or mature competitiveness. Self-esteem was low with feelings of inferiority and inefficiency.

A neurological examination revealed a left VI cranial nerve paresis, reportedly congenital, resulting in diplopia while gazing to the extreme left, which did not significantly affect the patient. The patient had a chronic complaint of occasional vertigo, to which he partly attributed his accident, although the symptoms were not of a persisting nature.

Initial diagnosis at this stage was 'Psychotic disorder NOS' and pharmacological treatment was initiated. An MRI scan of the brain with gadolinium contrast was ordered to rule out any focal neurological lesions. It was performed fifteen days later and revealed no abnormalities.

Patient was placed on ziprasidone 40 mg bid and lorazepam 1 mg bid. He reported an immediate improvement but when the attending physician enquired as to the nature of the improvement the patient replied that in his hallucinations he told the tall raider that he now had a tall doctor who would help him and the raider promptly left (sic). Apparently, the random assignment of a strikingly tall physician had an unexpected positive effect. Ziprasidone gradually increased to 80 mg bid within three days with no notable effect to the perceptual disturbances but with the development of akathisia for which biperiden was added, 1 mg tid. Duloxetine was added, 60 mg once-daily, in a hope that it could have a positive effect to his mood but also to this neuropathic pain which was frequent and demoralising. The patient had a tough time accommodating to the hospital milieu, although the grounds were extended and there was plenty of opportunity for walks and other activities. He preferred to stay in bed sometimes in obvious agony and with marked insomnia. He presented a strong fear for the welfare of his children, which he could not reason for. Due to the apparent inability of ziprasidone to make a dent in the psychotic symptomatology, medication was switched to amisulpride 400 mg bid and the patient was given a leave for the weekend to visit his home. On his return an improvement in his symptoms was reported by him and close relatives, although he still had excessive anxiety in the hospital setting. It was decided that his leave was to be extended and the patient would return for evaluation every third day. After three appointments he had a marked improvement, denied any psychotic symptoms while his sleep pattern improved. A good working relationship was established with his physician and the patient was with a schedule of follow-up appointments initially every fifteen days and following two months, every thirty days. His exit diagnosis was "Psychotic disorder Not Otherwise Specified – PTSD". He remained asymptomatic for five months and started making in-roads in a cognitively-oriented psychotherapeutic approach but unfortunately further trouble befell him, his wife losing a baby and his claim to an injury compensation rejected. He experienced a mood loss and duloxetine was increased to 120 mg per day to some positive effect. His status remains tenuous but he retains a strong will to make his appointments and work with his physician. A case conceptualization following a cognitive framework [ 6 ] is presented in Figure 1 .

Case formulation – (Persistent PTSD, adapted from Ehlers and Clark [ 6 ] ) . Case formulation following the persistent PTSD model of Ehlers and Clark [ 6 ]. It is suggested that the patient is processing the traumatic information in a way which a sense of immediate threat is perpetuated through negative appraisals of trauma or its consequences and through the nature of the traumatic experience itself. Peri-traumatic influences that operate at encoding, affect the nature of the trauma memory. The memory of the event is poorly elaborated, not given a complete context in time and place, and inadequately integrated into the general database of autobiographical knowledge. Triggers and ruminations serve to re-enact the traumatic information while symptoms and maladaptive coping strategies form a vicious circle. Memories are encoded in the SAM rather than the VAM system, thus preventing cognitive re-appraisal and eventual overcoming of traumatic experience [ 4 ].

The value of a specialized formulation is made clear in complex cases as this one. There is a relationship between the pre-existing cognitive schemas of the individual, thought patterns emerging after the traumatic event and biological triggers. This relationship, best described as a maladaptive cognitive processing style, culminates into feelings of shame, guilt and worthlessness which are unrelated to similar feelings, which emerge during trauma recollection, but nonetheless acts in a positive feedback loop to enhance symptom severity and keep the subject in a constant state of psychotic turmoil. Its central role is addressed in our case formulation under the heading "ruminations" which best describes its ongoing and unrelenting character. The "what if" character of those ruminations may serve as an escape through fantasy from an unbearably stressful cognition. Past experience is relived as current threat and the maladaptive coping strategies serve as negative re-enforcers, perpetuating the emotional suffering.

The psychosocial element in this case report, the patient's involvement with a highly symbolic activity, demonstrates the importance of individualising the case formulation. Apparently the patient had a chronic difficulty in expressing his emotions and integrating into his social surroundings, a difficulty counter-balanced somewhat with his involvement in the local social events which gave him not only a creative way out from any emotional impasse but also status and recognition. His perceived inability to continue with his symbolic activities was not only an indicator of the severity of his troubles but also a stressor in its own right.

Complex cases of PTSD presenting with hallucinatory experiences can be effectively treated with pharmacotherapy and supportive psychotherapy provided a good doctor-patient relationship is established and adverse medication effects rapidly dealt with. A cognitive framework and a Rorschach test can be valuable in deepening the understanding of individuals and obtaining a personalized view of their functioning and character dynamics. A biopsychosocial approach is essential in integrating all aspects of the patients' history in a meaningful way in order to provide adequate help.

Patient's perspective

"My life situation can't seem to get any better. I haven't had any support from anyone in all my life. Leaving home to go anywhere nowadays is hard and I can't seem to be able to stay anyplace else for a long time either. Just getting to the hospital [where the follow-up appointments are held] makes me very nervous, especially the minute I walk in. Can't seem to stay in place at all, just keep pacing while waiting for my appointment. I am only able to open up somewhat to my doctor, whom I thank for his support. Staying in hospital was close to impossible; I was very stressed and particularly concerned for my children, not being able to be close to them. I still need to have them near-by. Getting the MRI scan was also a stressful experience, confined in a small space with all that noise for so long. I succeeded only after getting extra medication.

I hope that things will get better. I don't trust anyone for any help any more; they should have helped me earlier."

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Abbreviations

stands for 'Post Traumatic Stress Disorder'

for 'Verbally Accessible Memory'

for 'Situationally Accessible Memory'

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Acknowledgements

The authors wish to acknowledge the valuable support and direction offered by the department's chair, Professor Ioannis Giouzepas who places the utmost importance in creating a suitable therapeutic environment for our patients and a superb learning environment for the SHO's and registrars in his department.

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Georgios D Floros, Ioanna Charatsidou & Grigorios Lavrentiadis

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GF was the attending SHO and the major contributor in writing the manuscript. IC performed the psychological evaluation and Rorschach testing and interpretation. GL provided valuable guidance in diagnosis and handling of the patient. All authors read and approved the final manuscript.

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Floros, G.D., Charatsidou, I. & Lavrentiadis, G. A case of PTSD presenting with psychotic symptomatology: a case report. Cases Journal 1 , 352 (2008). https://doi.org/10.1186/1757-1626-1-352

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Coping with the Stress of Retirement

• Ruth C. White

Every stage of the transition comes with its own challenges. Here’s how to handle each one.

Retirement can seem like a dream. Will we ever be able to stop working? Will we want to? Will we be able to afford it? For those of us who have built our lives around work, the transition to not working can be stressful. Whether your worry about retirement is grounded in financial questions, health concerns, or filling your time in meaningful ways, identifying your sources of stress can help you take proactive steps to prepare for this significant life transition from an emotional and psychological standpoint, helping you reduce and manage your stress and enjoy a more positive retirement. The sources of stress will differ for individuals depending on your personal context and where in the seven phases of retirement you are. Provides definitions and coping mechanisms for six of the seven phases to help you identify them and manage your response during them. Regardless of the specific circumstances of your retirement, preparing for it emotionally and psychologically will help ameliorate the stresses that it can bring so that you can focus on enjoying the life you planned for with a sense of purpose, accomplishment, and connection that lasts.

For many of us, retirement is a dream. At the start of our careers, we don’t often give it more thought than enrolling in a savings plan or filling out tax forms. When retirement age grows closer to becoming a reality, we joke about it, daydream about it, and perhaps worry about it. Will we be lucky enough to have the money, good health, and companionship of family and friends to enjoy our golden years?

• Ruth C. White is a mental health advocate and stress management expert who often shares her journey of recovery and resilience with bipolar disorder in her talks, workshops, and writings. White is a therapist who has authored four books on mental health, including Bipolar 101: A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms and More and The Stress Management Workbook: De-Stress in 10 Minutes or Less . She has written for Fast Company and Thrive Global , blogs for Psychology Today , and from 2020 to 2023 she appeared frequently as a mental health commentator and educator on KRON4 TV Bay Area. She is currently a project advisor in Equity, Diversity, and Inclusion in the Rotman School of Management at the University of Toronto, where she also teaches in the Factor-Inwentash Faculty of Social Work. ruthcwhite

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Montclair SCM Student Team Finishes Second in National Case Study Competition

Posted in: School of Communication and Media News

A team of Montclair State School of Communication & Media students finished second in the prestigious Bateman Case Study Competition, hosted by the Public Relations Student Society of America (PRSSA). The national contest challenges student teams to design, implement, and measure a public relations campaign to support the goals of a real-world client.

This year’s client was Culturs , a global lifestyle network that enhances community and fosters human connection between cross-cultural populations including racially and culturally blended individuals. The missing “e” in Culturs represents the often-hidden diversities of these populations. 

Throughout the academic year, the Montclair team conducted extensive research with the Montclair community to discover insights for its robust on and offline campaign.  Their findings highlighted that more than half of students who identify as multi-ethnic have felt out of place or not fully belonging to one culture; and that 60% of respondents felt their culture was represented on campus but didn’t feel fully seen or heard.

The Montclair Culturs campaign was developed by five SCM students: Rianna Cafaro (’24), Gabriella Castillo (’24), Diana Ochoa-Perez (’24), Kaylee Seitz (’25) and Gina-Marie Zoccoli (’25). Professor Mary Scott served as the faculty advisor for the third consecutive year, SVP Communications at United Entertainment Group Heter Myers was the industry advisor and SCM Professor Erin Weinberg provided critical support and guidance to the team. 

“Participating in this competition provided my team and I a deep understanding of and experience in executing a PR campaign from start to finish.” Cafaro said. “Montclair Culturs created a movement that soared beyond our expectations and I am so proud of the work we accomplished.”

The Montclair students advanced to the finals of the competition against teams from BYU and winner University of Florida, and over eight other semi-final teams that received honorable mention. PRSSA received 45 campagn entries. 

The Montclair Culturs campaign set out to establish an inclusive community that celebrates cultural diversity through engaging conversations and shared learning experiences, fostering a deeper understanding and appreciation of multiculturalism.

Highlights of the Montclair team’s campaign and presentation to a panel of judges on May 2 in New York City included:

• The Melting Pot Meals :  a collaborative digital and printed cookbook featuring Montclair students sharing cultural dishes from around the world and the significance of these recipes.
• Cultur-ella: Inspired by Coachella, the team hosted a festival celebrating the cultures of Montclair State through dance, music, and art. The more than 300 attendees made cultural bracelets, danced alongside the LASO dance troupe, Montclair West African Drumming, and influencer Jerseyy Joe, and also learned about the many cultural organizations on campus including Daughta Speaks, the Dominican Student Organization (DSO), the Korean Culture and Language Association (KCLA), the Latin American Student Organization(LASO), the Mexican-American Student Association (MASA), and the Veteran and Military Resource office.
• Cultural Print: More than 500 people took the pledge to embrace cultural diversity and shared their personal cultural print on our world map representing their heritage and ethnicities.
• Living in Full Color: An Intimate Conversation on Culture:   a curated conversation with NBC and Telemundo, Montclair faculty and students on multiculturalism and 21st-century diversity.  Kicked off by Provost Junius Gonzales and hosted by Associate Provost for Hispanic Initiatives and International Programs Katia Paz Goldfarb, the event featured WNBC reporter Checkey Beckford and  Telemundo 47’s Ashley Chaparro, Yessi Hernandez and Alexa Rodriguez.  

“Participating in this year’s Bateman Challenge was a dream assignment for our team especially since we saw an authentic impact on the entire campus community,” Professor Scott said. “Inspired by our client Culturs’ mission, the team built and successfully implemented a campaign that provided a platform and addressed the unmet needs of our richly diverse campus – enabling important conversations, rich storytelling, fostering a more connected community and a commitment to future actions. I am immensely proud of our students who worked incredibly hard to execute a strategic campaign that was worthy of this national recognition.”

About the School of Communication and Media:  The School of Communication and Media offers a range of dynamic programs in communication and media to a talented and diverse student population of over 1,800. Offering degrees in film and television, social media and public relations, advertising, journalism and digital media, sports communication, communication and media studies, animation and visual effects, and an MA devoted to strategic communication, the School prepares the next generation of communication and media practitioners and leaders. The School houses award-winning student programs that include  WMSC Radio ,  The Montclarion  newspaper,   Hawk Communications  Agency, the  Red Hawk Sports Network ,  Hawk+  OTT streaming platform, and  News Lab , as well as the  Center for Cooperative Media , which serves the public by working to grow and strengthen local journalism. Student projects and programs have recently received national recognition from PRSSA’s Bateman Competition, an Edward R Murrow Award, several Marconi Award nominations, and a College Television Award from the Academy of Television Arts & Sciences.

Media Contact : Keith Green, School of Communication and Media, 973-655-3701 or  [email protected]

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Reproductive rights in America

What's at stake as the supreme court hears idaho case about abortion in emergencies.

Selena Simmons-Duffin

The Supreme Court will hear another case about abortion rights on Wednesday. Protestors gathered outside the court last month when the case before the justices involved abortion pills. Tom Brenner for The Washington Post/Getty Images hide caption

The Supreme Court will hear another case about abortion rights on Wednesday. Protestors gathered outside the court last month when the case before the justices involved abortion pills.

In Idaho, when a pregnant patient has complications, abortion is only legal to prevent the woman's death. But a federal law known as EMTALA requires doctors to provide "stabilizing treatment" to patients in the emergency department.

The Biden administration sees that as a direct conflict, which is why the abortion issue is back – yet again – before the Supreme Court on Wednesday.

The case began just a few weeks after the justices overturned Roe v. Wade in 2022, when the federal Justice Department sued Idaho , arguing that the court should declare that "Idaho's law is invalid" when it comes to emergency abortions because the federal emergency care law preempts the state's abortion ban. So far, a district court agreed with the Biden administration, an appeals court panel agreed with Idaho, and the Supreme Court allowed the strict ban to take effect in January when it agreed to hear the case.

Supreme Court allows Idaho abortion ban to be enacted, first such ruling since Dobbs

The case, known as Moyle v. United States (Mike Moyle is the speaker of the Idaho House), has major implications on everything from what emergency care is available in states with abortion bans to how hospitals operate in Idaho. Here's a summary of what's at stake.

1. Idaho physicians warn patients are being harmed

Under Idaho's abortion law , the medical exception only applies when a doctor judges that "the abortion was necessary to prevent the death of the pregnant woman." (There is also an exception to the Idaho abortion ban in cases of rape or incest, only in the first trimester of the pregnancy, if the person files a police report.)

In a filing with the court , a group of 678 physicians in Idaho described cases in which women facing serious pregnancy complications were either sent home from the hospital or had to be transferred out of state for care. "It's been just a few months now that Idaho's law has been in effect – six patients with medical emergencies have already been transferred out of state for [pregnancy] termination," Dr. Jim Souza, chief physician executive of St. Luke's Health System in Idaho, told reporters on a press call last week.

Those delays and transfers can have consequences. For example, Dr. Emily Corrigan described a patient in court filings whose water broke too early, which put her at risk of infection. After two weeks of being dismissed while trying to get care, the patient went to Corrigan's hospital – by that time, she showed signs of infection and had lost so much blood she needed a transfusion. Corrigan added that without receiving an abortion, the patient could have needed a limb amputation or a hysterectomy – in other words, even if she didn't die, she could have faced life-long consequences to her health.

Attorneys for Idaho defend its abortion law, arguing that "every circumstance described by the administration's declarations involved life-threatening circumstances under which Idaho law would allow an abortion."

Ryan Bangert, senior attorney for the Christian legal powerhouse Alliance Defending Freedom, which is providing pro-bono assistance to the state of Idaho, says that "Idaho law does allow for physicians to make those difficult decisions when it's necessary to perform an abortion to save the life of the mother," without waiting for patients to become sicker and sicker.

Still, Dr. Sara Thomson, an OB-GYN in Boise, says difficult calls in the hospital are not hypothetical or even rare. "In my group, we're seeing this happen about every month or every other month where this state law complicates our care," she says. Four patients have sued the state in a separate case arguing that the narrow medical exception harmed them.

"As far as we know, we haven't had a woman die as a consequence of this law, but that is really on the top of our worry list of things that could happen because we know that if we watch as death is approaching and we don't intervene quickly enough, when we decide finally that we're going to intervene to save her life, it may be too late," she says.

2. Hospitals are closing units and struggling to recruit doctors

Labor and delivery departments are expensive for hospitals to operate. Idaho already had a shortage of providers, including OB-GYNS. Hospital administrators now say the Idaho abortion law has led to an exodus of maternal care providers from the state, which has a population of 2 million people.

Three rural hospitals in Idaho have closed their labor-and-delivery units since the abortion law took effect. "We are seeing the expansion of what's called obstetrical deserts here in Idaho," said Brian Whitlock, president and CEO of the Idaho Hospital Association.

Since Idaho's abortion law took effect, nearly one in four OB-GYNs have left the state or retired, according to a report from the Idaho Physician Well-Being Action Collaborative. The report finds the loss of doctors who specialize in high-risk pregnancies is even more extreme – five of nine full time maternal-fetal medicine specialists have left Idaho.

Administrators say they aren't able to recruit new providers to fill those positions. "Since [the abortion law's] enactment, St. Luke's has had markedly fewer applicants for open physician positions, particularly in obstetrics. And several out-of-state candidates have withdrawn their applications upon learning of the challenges of practicing in Idaho, citing [the law's] enactment and fear of criminal penalties," reads an amicus brief from St. Luke's health system in support of the federal government.

"Prior to the abortion decision, we already ranked 50th in number of physicians per capita – we were already a strained state," says Thomson, the doctor in Boise. She's experienced the loss of OB-GYN colleagues first hand. "I had a partner retire right as the laws were changing and her position has remained open – unfilled now for almost two years – so my own personal group has been short-staffed," she says.

ADF's Bangert says he's skeptical of the assertion that the abortion law is responsible for this exodus of doctors from Idaho. "I would be very surprised if Idaho's abortion law is the sole or singular cause of any physician shortage," he says. "I'm very suspicious of any claims of causality."

3. Justices could weigh in on fetal "personhood"

The state of Idaho's brief argues that EMTALA actually requires hospitals "to protect and care for an 'unborn child,'" an argument echoed in friend-of-the-court briefs from the U.S. Conference of Catholic Bishops and a group of states from Indiana to Wyoming that also have restrictive abortion laws. They argue that abortion can't be seen as a stabilizing treatment if one patient dies as a result.

Thomson is also Catholic, and she says the idea that, in an emergency, she is treating two patients – the fetus and the mother – doesn't account for clinical reality. "Of course, as obstetricians we have a passion for caring for both the mother and the baby, but there are clinical situations where the mom's health or life is in jeopardy, and no matter what we do, the baby is going to be lost," she says.

The Idaho abortion law uses the term "unborn child" as opposed to the words "embryo" or "fetus" – language that implies the fetus has the same rights as other people.

Shots - Health News

The science of ivf: what to know about alabama's 'extrauterine children' ruling.

Mary Ziegler , a legal historian at University of California - Davis, who is writing a book on fetal personhood, describes it as the "North Star" of the anti-abortion rights movement. She says this case will be the first time the Supreme Court justices will be considering a statute that uses that language.

"I think we may get clues about the future of bigger conflicts about fetal personhood," she explains, depending on how the justices respond to this idea. "Not just in the context of this statute or emergency medical scenarios, but in the context of the Constitution."

ADF has dismissed the idea that this case is an attempt to expand fetal rights. "This case is, at root, a question about whether or not the federal government can affect a hostile takeover of the practice of medicine in all 50 states by misinterpreting a long-standing federal statute to contain a hidden nationwide abortion mandate," Bangert says.

4. The election looms large

Ziegler suspects the justices will allow Idaho's abortion law to remain as is. "The Supreme Court has let Idaho's law go into effect, which suggests that the court is not convinced by the Biden administration's arguments, at least at this point," she notes.

Trump backed a federal abortion ban as president. Now, he says he wouldn't sign one

Whatever the decision, it will put abortion squarely back in the national spotlight a few months before the November election. "It's a reminder on the political side of things, that Biden and Trump don't really control the terms of the debate on this very important issue," Zielger observes. "They're going to be things put on everybody's radar by other actors, including the Supreme Court."

The justices will hear arguments in the case on Wednesday morning. A decision is expected by late June or early July.

Correction April 23, 2024

An earlier version of this story did not mention the rape and incest exception to Idaho's abortion ban. A person who reports rape or incest to police can end a pregnancy in Idaho in the first trimester.

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