A 35 years-old man complains of extreme fear of driving a car and the fear disrupted his daily activities. Which of the following is the most appropriate plan for this man?

Appeared in: NHM MP Staff Nurse-2022

Explanation

Systematic desensitization is the first-line, evidence-based treatment for specific phobias.
It is a gradual process that pairs relaxation with exposure, which is more tolerable and less distressing for the patient than other forms of exposure therapy.
The therapy works by counter-conditioning, helping the patient replace the anxiety response with a relaxation response through a process called reciprocal inhibition.
The patient maintains control over the pace of therapy, which increases the likelihood of adherence and success.

Why Other Options Were Wrong

Option B: Flooding involves immediate and intense exposure to the most feared stimulus without a gradual buildup. This can cause extreme distress and may be psychologically harmful, making it less 'appropriate' as an initial plan.
Option C: Assertiveness training is a communication-focused therapy designed to help people with interpersonal difficulties. It does not address the irrational fear characteristic of a specific phobia.
Option D: Reminiscence therapy involves recalling past life events and is used to improve mood and self-esteem, primarily in older adults with depression or dementia. It is not a treatment for anxiety disorders like phobias.

Related Visual

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Behavioral therapies for specific phobias as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in supporting patients undergoing behavioral therapy by reinforcing relaxation techniques, providing psychoeducation about the process, and helping manage anxiety during sessions.
It is a key nursing responsibility to assess the patient's readiness and ability to tolerate anxiety-provoking treatments and to advocate for the most appropriate, least restrictive intervention.
What if the patient experiences a panic attack during an exposure session? The nurse's priority is to ensure safety, guide the patient in using their learned relaxation skills to regain control, and then reassess the situation with the therapist. The session might be paused or returned to a less anxiety-provoking step in the hierarchy.

How to Approach the Question

First, identify the patient's primary diagnosis from the clinical vignette. The 'extreme fear of driving' that 'disrupted his daily activities' points to a specific phobia.
Next, review the options, which are all different types of therapies. Your goal is to find the one that is the standard, evidence-based treatment for a specific phobia.
Eliminate therapies that are clearly for different conditions. Assertiveness training is for interpersonal skills, and reminiscence therapy is for mood in the elderly.
This leaves two types of exposure therapy: systematic desensitization and flooding. Differentiate between them.
Recall that 'systematic' implies a gradual, step-by-step process, while 'flooding' implies an intense, all-at-once approach.
The question asks for the 'most appropriate' plan. The gradual, more tolerable, and less distressing option (systematic desensitization) is considered more appropriate as a first-line treatment than the intense, high-distress option (flooding).

Concept Tested & Keywords

Concept Tested: Behavioral therapies for specific phobias
Stem keywords: extreme fear of driving, phobia, disrupted daily activities
Lead-in keywords: most appropriate plan
Clinical cues: The patient's fear is specific (driving) and significantly impacts daily functioning, which points to a diagnosis of a specific phobia.

Question ID

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Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2422-2424

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 9186-9188, 5859-5861

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