Which type of therapy assists the clients to alter their irrational thinking?

A. A client who has recently begun treatment with propranolol (Inderal) for the treatment of social phobia. Propranolol, a beta-blocker, does not have a significant risk for dependence or withdrawal symptoms. It is primarily used for physical symptoms of anxiety, such as tachycardia.

B. A woman who has been taking lorazepam (Ativan) for several months after witnessing a traumatic motor vehicle accident. Lorazepam is a benzodiazepine, which has a high potential for dependence and withdrawal, especially with long-term use. This client is the most at risk for these issues.

C. A man whose obsessive-compulsive disorder (OCD) is being treated long-term with paroxetine (Paxil). While discontinuation symptoms can occur with SSRIs like paroxetine, the risk of dependence is significantly lower than with benzodiazepines.

D. A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine (Prozac) earlier in the year. Like paroxetine, fluoxetine is an SSRI, and while discontinuation symptoms may occur, the risk of dependence is low.

A. "Are you feeling worse since taking the medication?" This is an important safety question to ask, as it helps to assess whether the client’s condition has worsened since starting the medication. However, it is not the first priority when evaluating the efficacy of a newly prescribed antidepressant.

B. "How long have you been taking the medication?" This is the most important question to ask first because the effectiveness of imipramine, a tricyclic antidepressant, can take several weeks to become apparent. If the client has not been taking the medication for an adequate period, the drug may simply not have had enough time to work yet.

C. "What time of day are you taking the medication?" While the timing of the medication can affect side effects, it is less critical than knowing how long the client has been on the medication when assessing its effectiveness.

D. "What dosage of medication are you taking?" This is an important follow-up question but not the first priority. The duration of treatment is more critical to assess before considering dosage adjustments.