A 27-year-old male with a diagnosis of depression prefers to avoid pharmacologic treatment. You agree to engage in a trial of therapy in your office. During the treatment process, you help the patient realize that some of his perceptions and interpretations of reality may be false and lead to negative thoughts. Next, you help him discover alternative thoughts that reflect reality more closely, and to learn to discard his previous distorted thinking. By learning to substitute healthy thoughts for negative thoughts, he finds his mood, behavior, and physical reaction to different situations are improved.
Which one of the following best categorizes this type of therapy?
Correct Answer C:
This patient is engaged in cognitive therapy, which is a treatment process that helps patients correct false self-beliefs that can lead to negative moods and behaviors. Cognitive therapy has been shown to effectively treat patients with unipolar major depression, and is particularly useful in patients who do not respond to medication or who prefer nonpharmacologic therapy.
→ Psychoanalysis (choice A) is a process of free association where repressed memories are recovered.
→ Biofeedback (choice B) involves instrumentation that gives feedback about a patient’s physiologic response to various situations in order to bring the autonomic nervous system under voluntary control.
→ Group psychotherapy (choice D) is a form of treatment in which people who are emotionally ill meet in a group guided by a trained therapist and help one another effect personality change.
→ Hypnosis (choice E) involves helping a patient enter a state of heightened focal concentration and receptivity that is typified by a feeling of involuntariness or an altered state of consciousness.
Which one of the following statements concerning insomnia is correct?
Getting up at the same time every day stabilizes the sleep-wake schedule and improves the restfulness of actual sleep in bed.
→ Insomnia is more prevalent among the elderly and is associated with depression.
→ Daytime drowsiness, excessive snoring, and confusion when awakened are associated with sleep apnea.
→ Hypnotics should be prescribed only for short-term use.
A 37-year-old female presents with concerns about difficulty initiating and maintaining sleep for the past 3-4 months. She is irritable and feels fatigued and sleepy during the day. After further evaluation, she is diagnosed with chronic insomnia. She asks about alternatives to hypnotic drug treatments.
Which one of the following management options is best supported by current evidence?
Correct Answer B:
Routine use of over-the-counter antihistamines should be discouraged because they are only minimally effective in inducing sleep, may reduce sleep quality, and can cause residual drowsiness.
Cognitive-behavioral therapy helps change incorrect beliefs and attitudes about sleep (e.g., unrealistic expectations, misconceptions, amplifying consequences of sleeplessness). Techniques include reattribution training (goal setting and planning coping responses), decatastrophizing (balancing anxious automatic thoughts), reappraisal, and attention shifting. Cognitive-behavioral therapy is recommended as an effective, nonpharmacologic treatment for chronic insomnia (SOR A).
Many herbs and dietary supplements have been promoted as sleep aids. However, with the exceptions of melatonin and valerian, there is insufficient evidence of benefit.
Alcohol acts directly on GABA-gated channels, reducing sleep-onset latency, but it increases wakefulness after sleep onset and suppresses rapid eye movement (REM) sleep. It also has the potential for abuse and should not be used as a sleep aid.
Moderate-intensity exercise can improve sleep, but exercising just before bedtime can delay sleep onset.
Promoting good sleep hygiene is basic in the treatment of insomnia.
Which one of the following measures will aid in promoting healthy sleep habits?
Correct Answer E:
Maintaining a regular sleep/wake schedule helps prevent insomnia. While a light snack before bed may be sleep inducing, heavy meals close to bedtime may be counterproductive. Alcohol should be avoided as a sedative, to prevent mid sleep awakenings. Hours spent reading or watching television in bed can lead to long awakenings in the middle of the night.
A 27 year old female complains of palpitations. Your clinical evaluation finds no abnormalities. You recommend that she discontinue her daily regimen of 3-4 cups of regular coffee.
Which one of the following symptoms is the most likely to develop?
In a study of patients with low to moderate caffeine intake, discontinuing caffeine resulted in moderate to severe headache in 52%. About 10% had depression or anxiety, and less than 10% had fatigue or flu-like symptoms.
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