PSYCHOTHERAPY FOR THE ADVANCED
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1
,Reference
Ch. 2 — The Neurophysiology of Trauma and Psychotherapy
Stem
A 28-year-old woman with chronic PTSD reports intrusive
flashbacks triggered by the smell of gasoline. In session she
begins to tremble, describes “falling back” into the event, and
looks to the clinician for guidance. You want to both ensure
safety and use the moment to help integrate traumatic memory
networks.
Options
A. Invite her to narrate the full sensory sequence of the trauma
now to exhaust the memory and thereby reduce re-
experiencing.
B. Co-regulate by slowing your breathing, offering grounding
prompts, and guiding a brief orienting exercise before any
memory exploration.
C. Recommend immediate pharmacologic stabilization (e.g.,
increase PRN benzodiazepine) and postpone psychotherapy
until the patient is calmer.
D. Use direct cognitive reframing to challenge maladaptive
appraisals of threat while she is in the tremulous state.
Correct answer
B
Rationales
, • Correct (B): Co-regulation stabilizes autonomic arousal
(polyvagal regulation) so neural networks can be safely
engaged for integration, aligning with AIP principles and
trauma-informed timing. It protects the therapeutic
alliance and prepares the memory systems for adaptive
processing.
• A (incorrect): Inviting full sensory recounting while the
patient is dysregulated risks further potentiation of trauma
memory (reinforcement via long-term potentiation) and
re-traumatization; timing is premature.
• C (incorrect): Immediate escalation of sedating
pharmacology without psychotherapeutic stabilization can
blunt processing and may undermine learning-based
integration; benzodiazepines are not an evidence-based
first psychotherapeutic response in-session.
• D (incorrect): Cognitive reframing during high autonomic
arousal is often ineffective because the prefrontal cortex is
downregulated; reframing is better delivered once
physiological regulation is achieved.
Teaching point
Stabilize physiology first—co-regulation enables safe memory
integration and preserves therapeutic engagement.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 2.
, 2
Reference
Ch. 2 — The Neurophysiology of Trauma and Psychotherapy
Stem
A 45-year-old male with a history of childhood emotional
neglect describes repeating relationships where caregivers
abandon him. During formulation you see repeated enactments
in the therapy room where he angrily accuses you of “leaving”
after a missed appointment. You must conceptualize and
respond to this enactment.
Options
A. Interpret immediately that the client is reenacting early
abandonment and confront the behavior to stop future
reenactments.
B. Use the moment to describe how his physiological state may
mirror earlier attachment experiences, validate emotion, and
set limits while exploring meaning later.
C. Refer back to the chart and insist that boundaries are
nonnegotiable, ending the session early to teach the client
consequences.
D. Offer reassurance that it’s “not a big deal” and minimize the
enactment to avoid escalation.
Correct answer
B
PRACTICE PSYCHIATRIC NURSE
A HOW-TO GUIDE FOR EVIDENCE-BASED
PRACTICE
3RD EDITION
• AUTHOR(S)KATHLEEN WHEELER
TEST BANK
1
,Reference
Ch. 2 — The Neurophysiology of Trauma and Psychotherapy
Stem
A 28-year-old woman with chronic PTSD reports intrusive
flashbacks triggered by the smell of gasoline. In session she
begins to tremble, describes “falling back” into the event, and
looks to the clinician for guidance. You want to both ensure
safety and use the moment to help integrate traumatic memory
networks.
Options
A. Invite her to narrate the full sensory sequence of the trauma
now to exhaust the memory and thereby reduce re-
experiencing.
B. Co-regulate by slowing your breathing, offering grounding
prompts, and guiding a brief orienting exercise before any
memory exploration.
C. Recommend immediate pharmacologic stabilization (e.g.,
increase PRN benzodiazepine) and postpone psychotherapy
until the patient is calmer.
D. Use direct cognitive reframing to challenge maladaptive
appraisals of threat while she is in the tremulous state.
Correct answer
B
Rationales
, • Correct (B): Co-regulation stabilizes autonomic arousal
(polyvagal regulation) so neural networks can be safely
engaged for integration, aligning with AIP principles and
trauma-informed timing. It protects the therapeutic
alliance and prepares the memory systems for adaptive
processing.
• A (incorrect): Inviting full sensory recounting while the
patient is dysregulated risks further potentiation of trauma
memory (reinforcement via long-term potentiation) and
re-traumatization; timing is premature.
• C (incorrect): Immediate escalation of sedating
pharmacology without psychotherapeutic stabilization can
blunt processing and may undermine learning-based
integration; benzodiazepines are not an evidence-based
first psychotherapeutic response in-session.
• D (incorrect): Cognitive reframing during high autonomic
arousal is often ineffective because the prefrontal cortex is
downregulated; reframing is better delivered once
physiological regulation is achieved.
Teaching point
Stabilize physiology first—co-regulation enables safe memory
integration and preserves therapeutic engagement.
Citation
Wheeler, K. (2023). Psychotherapy for the Advanced Practice
Psychiatric Nurse (3rd ed.). Ch. 2.
, 2
Reference
Ch. 2 — The Neurophysiology of Trauma and Psychotherapy
Stem
A 45-year-old male with a history of childhood emotional
neglect describes repeating relationships where caregivers
abandon him. During formulation you see repeated enactments
in the therapy room where he angrily accuses you of “leaving”
after a missed appointment. You must conceptualize and
respond to this enactment.
Options
A. Interpret immediately that the client is reenacting early
abandonment and confront the behavior to stop future
reenactments.
B. Use the moment to describe how his physiological state may
mirror earlier attachment experiences, validate emotion, and
set limits while exploring meaning later.
C. Refer back to the chart and insist that boundaries are
nonnegotiable, ending the session early to teach the client
consequences.
D. Offer reassurance that it’s “not a big deal” and minimize the
enactment to avoid escalation.
Correct answer
B
