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USMLE Step 1 Questions
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A 30-year-old woman comes to the emergency department because she thinks she has had a heart attack. One hour ago, she had the sudden onset of chest pain, faintness, pounding heart, flushed skin, and nausea that lasted 20 minutes. She now feels better. She has limited her activity because she has had two similar episodes over the past 2 weeks. Medical evaluation is normal. Which of the following is the most appropriate nonpharmacologic therapy?
Correct Answer: B. Cognitive behavioral therapy
The woman experienced a panic attack, which can mimic heart attacks. After the resolution of a panic attack, the medical evaluation would be normal, which distinguishes these attacks from multiple heart attacks. The most appropriate nonpharmacologic therapy is cognitive behavioral therapy. The goal of this therapy is to change the way a patient interprets the world in order to change the patient’s response to problems. For patients who experience panic attacks, cognitive behavioral therapy can help them to increase adaptive behavior and decrease emotional distress, thereby decreasing the amount of panic attacks.
Assertiveness training is a subtype of cognitive behavioral therapy. However, it is not the most appropriate therapy since it only address one aspect of the woman’s disorder. Assertiveness training may help decrease social anxiety, but if that is not the only trigger for this woman’s panic attacks, then it would not be sufficient for therapy.
Dynamic psychotherapy is a form of talking and relational therapy that is best used for adjustment, personality, depressive, and eating disorders. It also takes several months to years for the therapy to be effective. Therefore, it would not be appropriate for helping the woman with her recurrent panic attacks.
Psychoanalysis is a specific type of treatment where the analyst, upon hearing the thoughts of the patient, formulates and then explains the unconscious basis for the patient’s symptoms and character problems. It can be used for panic attacks and anxiety disorders, but it would not be the most appropriate therapy since this woman would benefit more from relaxation training and systemic desensitization that are associated with cognitive behavioral therapy.
Psychodrama is a kind of group therapy in which group members act out their problems in a way to better understand conflicts between people. This type of therapy would not be appropriate for the woman and may even provoke another panic attack.
1. QuestionCategory: Behavioral Sciences
A 30-year-old woman comes to the emergency department because she thinks she has had a heart attack. One hour ago, she had the sudden onset of chest pain, faintness, pounding heart, flushed skin, and nausea that lasted 20 minutes. She now feels better. She has limited her activity because she has had two similar episodes over the past 2 weeks. Medical evaluation is normal. Which of the following is the most appropriate nonpharmacologic therapy?Correct