Table 1.

Case timeline: symptoms and treatments from 2011 to 2024.

• March 2011: Great East Japan Earthquake, tsunami, and husband's death

• May 2011: Husband's body found

• March 2012: Diagnosed with diabetes and hypertension

• March 2019: Worsening of diabetes and referral to psychiatry

• April 2019: Start of treatment at our clinic (supportive therapy and pharmacotherapy)

• November 2019: Flooding

• March 2020: Impact of the COVID-19 pandemic

• May 2020: “Realization of having chosen and engaged in demanding jobs after the earthquake” and “Decision to resign.”

• February–March 2021: Another earthquake and suicidal ideation

• April 2021: Her son's employment

• December 2021: “Son's diagnosis of depression” and “Taking on a demanding temporary job.”

• March–April 2022: Another earthquake and manifestation of PTSD symptoms

• June 2022: Start of schema therapy

• April 2023: End of schema therapy (36 sessions)

• April–July 2023: PE (prolonged exposure) therapy (12 sessions)

• January 2024: Follow-up and maintenance of symptom improvement