Case study

Screening (‘Roberta’)

Amy Mullins, University of Southern Queensland

‘Roberta’ is a 58 year-old married female, with three adult children who are living at home. She works part-time as a disability support carer. She enjoys baking and knitting and attends her local pool to swim and for water aerobics intermittently.

She has a BMI of 32 (which puts her in the ‘obese’ range) and a personal history of gestational diabetes. She also has a family history of heart disease and both of her parents died in their fifties due to health issues associated with obesity.

Roberta has recently been having a range of unusual physical symptoms (e.g., feeling tired, tingling in the hands, always feeling hungry), which she initially attributed to stress and anxiety related to her work role. Further tests at her GP have ruled out common potentially contributing medical causes of her symptoms (e.g., thyroid, low iron), and she has been referred to a psychologist to manage these symptoms.

Roberta’s GP has also asked her to complete some blood tests; however, she has been avoiding this now for six months because she is afraid there may be something very wrong with her health and she is afraid of dying young as her parents did. Over the last six months, her symptoms have intensified and now also include:

  • frequent urination
  • slow healing of cuts and wounds
  • blurry vision

She is so worried about her health that she has stopped attending work for the past two weeks due to health fears and has become increasingly socially isolated. Roberta’s husband and children are getting increasingly concerned regarding her decline in functioning, increasing physical symptoms and her refusal to attend for follow-up blood tests.

She has spoken with her psychologist about the conflict she is in regarding wanting to stay alive and healthy for her family, but feeling paralysed by fear to take action to get further medical advice and treatment. She is very worried she may have diabetes, and has limited knowledge or understanding regarding current effective treatments.

Discussion questions

1.   How would you build rapport with Roberta if you were her treating psychologist?

2.   What health theories relate to her thoughts and worries/fears regarding her health?

3.   What aspects of motivational interviewing and CBT might be useful for working with Roberta to enhance health-protective behaviours (e.g., attending further testing/treatment for diabetes)?