Rosh Psychiatry Board Practice Exam

For a patient with post-traumatic stress disorder who is stable on paroxetine, what is the next appropriate therapeutic step?

1. Initiate interpersonal therapy

2. Begin mindfulness-based stress reduction

3. Implement psychodynamic psychotherapy

4. Commence trauma-focused cognitive-behavioral therapy

The correct answer is: Commence trauma-focused cognitive-behavioral therapy

For a patient with post-traumatic stress disorder (PTSD) who is stable on paroxetine, commencing trauma-focused cognitive-behavioral therapy (TF-CBT) is the appropriate next therapeutic step. TF-CBT is specifically designed to address the symptoms and experiences associated with PTSD. It integrates elements of cognitive-behavioral therapy with trauma-specific interventions, focusing on helping patients process their traumatic experiences, manage distressing symptoms, and develop coping strategies. This therapeutic approach is supported by extensive research evidence demonstrating its effectiveness in reducing PTSD symptoms, offering valuable tools for patients to understand and challenge maladaptive thoughts related to their trauma. Additionally, TF-CBT can be beneficial alongside pharmacotherapy, leading to improved outcomes in managing PTSD. In the context of other interventions such as interpersonal therapy, mindfulness-based stress reduction, or psychodynamic psychotherapy, while these methods may offer support, they are not specifically tailored to address the core features of PTSD in the same direct manner as TF-CBT. Therefore, for a patient already stabilized on an antidepressant like paroxetine, integrating TF-CBT into their treatment regimen is a strategic and effective choice to continue their recovery and address their PTSD symptoms more comprehensively.