FNP: Depression & Anxiety

A minimal change in the GAD-7 score after ten weeks at the maximum therapeutic dose indicates clear non-response. The most appropriate approach is to switch to a different medication class, such as a serotonin-norepinephrine reuptake inhibitor. Maintaining the dose is ineffective since the trial duration is already adequate. Adding a daily benzodiazepine is not recommended for long-term anxiety management due to tolerance and dependence risks. Exceeding the maximum recommended dose of sertraline increases the risk of adverse effects without offering proven clinical benefit.

The primary goal of CBT in PTSD is to reduce avoidance behaviors and improve daily functioning, rather than completely eliminating all anxiety. Driving on the highway demonstrates functional improvement and successful exposure. Option B is correct because she is functioning well despite experiencing mild anxiety. Option A is incorrect because eliminating all anxiety is an unrealistic therapeutic goal. Option C is contraindicated because benzodiazepines can interfere with fear extinction during trauma therapy. Option D is incorrect because an inpatient referral is an inappropriate level of care for mild, manageable residual symptoms.

CBT focuses on identifying and restructuring cognitive distortions that drive anxiety, such as this patient's irrational worry despite excellent evaluations. Option A accurately describes this mechanism. Option B describes psychodynamic therapy, which focuses on past conflicts rather than current behaviors. Option C describes dialectical behavior therapy, which emphasizes emotional regulation and distress tolerance. Option D describes eye movement desensitization and reprocessing, which is primarily used for trauma and PTSD. CBT is the first-line non-pharmacologic treatment for generalized anxiety disorder, making it essential for the FNP to explain its active, present-focused nature clearly.

Standard CBT focuses on identifying and restructuring current cognitive distortions and behaviors that maintain daily anxiety, aligning perfectly with the patient's request to address current worry patterns without delving into past trauma. Option A is correct. Option B is primarily used to process specific traumatic memories, which the patient explicitly wishes to avoid. Option C focuses on uncovering unconscious conflicts from childhood, directly contradicting the patient's preference. Option D focuses on emotional regulation and distress tolerance, typically reserved for borderline personality disorder or severe self-harm, rather than standard generalized anxiety.

The patient is demonstrating catastrophizing, a common cognitive distortion where an individual assumes the absolute worst possible outcome will occur from a single, manageable event. Option C is correct. Option A involves believing that because one feels a certain way, it must objectively be true. Option B involves taking personal blame for events entirely outside of one's control. Option D involves making broad conclusions based on a single past incident, whereas this patient is projecting a disastrous future. Identifying these maladaptive thought patterns helps the FNP justify the CBT referral.