| Course | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum |
|---|---|
| Week | 5 |
| Paper type | Psychotherapy rationale |
| Length | About 1,140 words, 4 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Psychiatric-Mental Health Nurse Practitioner (PMHNP) |
| Updated | October 2026 |
Free sample paper for NR 605 Week 5
Psychotherapy Rationale: Panic-Focused Cognitive Behavioral Therapy With Graded Return to the Loading Dock, Chosen for T.N.'s Avoidance, Not for Depression in General
Student Name
College of Nursing, Chamberlain University
NR 605: Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum
Instructor Name
Month Day, Year
Psychotherapy Rationale: Panic-Focused Cognitive Behavioral Therapy With Graded Return to the Loading Dock, Chosen for T.N.'s Avoidance, Not for Depression in General
The Target
The target is avoidance. Since the first panic attack on the loading dock six weeks before evaluation, T.N. has asked to stay in the office, called in sick twice and stopped walking the dock floor, which is part of a supervisor's job. T.N. now fears losing the position. The evaluation recorded about two panic attacks a week, each beginning with a pounding heart that T.N. reads as the start of a heart attack.
The depression is also a target, but the avoidance is the one that will cost T.N. the job first, and it is the one medication is least likely to change on its own.
The Mechanism, in Two Sentences
Panic attacks are kept going by fear of the body's own sensations and by avoiding the places where they happened, which prevents T.N. from learning that the sensations pass and nothing terrible follows. Cognitive behavioral therapy for panic teaches T.N. to understand the sensations, deliberately brings them on in a safe setting so they lose their threat, and guides a step-by-step return to the avoided place.
The Method a Reader Would Have Expected
General cognitive behavioral therapy for depression, which a reader might expect for a patient whose PHQ-9 is 17. I set it aside as the starting focus because it does not include the specific exposure work that addresses panic and avoidance. The plan does not drop depression: sessions 7 to 12 shift to depressive thinking and activity, once the panic work is under way.
Supportive therapy was also set aside; it gives comfort without the exposure work avoidance needs.
The Evidence for This Choice
A network meta-analysis of psychological treatments for panic disorder found cognitive behavioral therapy to be the most consistently supported option (Pompoli et al., 2016). In a randomized trial, cognitive behavioral therapy for panic was as effective as medication in the short term and more durable after treatment ended (Barlow et al., 2000). T.N. is also starting mirtazapine; combining therapy with medication is reasonable, and the therapy may make the gains last after the medicine is stopped.
The Plan, Session by Session
Sessions 1 and 2: understanding the panic cycle; recording attacks with what came before and after.
Sessions 3 and 4: bringing on the sensations deliberately, for example by running in place to raise the heart rate or breathing through a straw, until they become less frightening.
Sessions 5 and 6: a graded list of dock tasks, from standing at the dock door for five minutes to walking the full floor during a shift; T.N. practices one step a week between sessions.
Sessions 7 to 12: depressive thinking, activity scheduling and preventing relapse.
Frequency, Format, Duration
Weekly, 50 minutes, for 12 weeks, by video, with a licensed clinical social worker trained in cognitive behavioral therapy for panic.
Homework between sessions, about 20 minutes a day, plus one dock task a week.
Whether It Can Be Attended
Time: Tuesdays at 15:00, after T.N.'s daytime sleep and before the 22:00 shift. T.N. confirmed this works.
Place: video from home; no travel.
Cost: T.N.'s insurance covers 20 therapy sessions a year with a $25 copay. T.N. said this was manageable but asked whether sessions could be fortnightly later; the therapist agreed to review at session 8.
Childcare: the partner is home on Tuesday afternoons.
Work: T.N.'s manager agreed to the graded dock plan after T.N. explained it, without disclosing the diagnosis.
How the Therapy Relates to the Medicine
Mirtazapine was chosen partly to restore sleep and appetite, which will give T.N. the energy to attempt the dock tasks. The therapy, in turn, is expected to make gains last after the medicine is stopped. The two are timed to help each other: the first panic-focused sessions begin in week 2, when sleep is already improving. Cognitive behavioral therapy for depression has strong evidence on its own and in combination with medication (Cuijpers et al., 2013), which supports moving to depressive targets once the panic work is under way.
What T.N. Was Told About the Therapy
That the early sessions would involve deliberately bringing on the feelings T.N. fears, which would be uncomfortable at first; that the discomfort is part of how the fear fades; and that T.N. sets the pace of the dock steps with the therapist. T.N. asked whether the therapist would make T.N. "go out there and panic." I said no: each step would be agreed in advance, and T.N. could pause at any stage.
Why Video Rather Than In Person
Exposure work is often done in person, with the therapist present for the first steps. For T.N., the feared place is the workplace, which the therapist cannot visit, so the dock steps would be done alone in any format. Video removes travel time between sleep and shift, which is the difference between attending and not. If T.N. struggles with the first dock steps alone, one in-person session at the clinic, practicing the bodily sensations with the therapist present, can be arranged.
What the Therapy Will Not Do
It will not treat the hazardous drinking directly, which is addressed in the medication plan, though the therapist will note any use of alcohol to manage panic. It will not address the shift schedule itself, which T.N. cannot change. It will not replace the safety plan, which stays with the prescriber.
If T.N. Cannot Attend
If shifts change and Tuesday afternoons are lost, the therapist offers Thursday at 15:00 as an alternative. If insurance coverage runs out before 12 sessions, the clinic's sliding-scale group program for panic, which meets online on Wednesday afternoons, is the fallback.
Measuring Progress in Therapy
The therapist will record the Panic Disorder Severity Scale monthly and share it with the medication prescriber, with T.N.'s consent, so that both use the same numbers when making decisions.
What Would Count as Working
Fewer panic attacks: from about 2 a week to no more than 1 every two weeks by session 8.
Return to the dock: walking the full floor during a shift by session 8.
Fewer sick days: none taken for panic after session 4.
These are counts from T.N.'s own diary and work schedule, reviewed at each medication visit.
What Would Change the Plan
If T.N. cannot attempt the dock tasks by session 6, the therapist will slow the steps; if panic attacks increase, the medication visit will review whether mirtazapine dose or another approach is needed.
References
Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2000). Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. JAMA, 283(19), 2529-2536. https://doi.org/10.1001/jama.283.19.2529
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58(7), 376-385. https://doi.org/10.1177/070674371305800702
Pompoli, A., Furukawa, T. A., Imai, H., Tajika, A., Efthimiou, O., & Salanti, G. (2016). Psychological therapies for panic disorder with or without agoraphobia in adults: A network meta-analysis. Cochrane Database of Systematic Reviews, 2016(4), CD011004. https://doi.org/10.1002/14651858.CD011004.pub2
What the NR 605 Week 5 assignment asks for
The Week 5 rationale names a modality and argues for it the way a prescription is argued. The target comes first and must be something the evaluation recorded: avoidance keeping someone out of work, a sleep pattern, thoughts arriving before panic. Choose the modality because it acts on that target, and set aside the method a reader would have expected. Give frequency, format and duration. Check whether the patient can actually attend: time, place, cost and childcare. Most rubrics mark down a modality with no target, a rationale for therapy in general and a plan that assumes a car, a schedule and a copay nobody checked. Pick the counts that would tell you the therapy is taking hold.
How the NR 605 Week 5 example is put together
The sample names avoidance of the loading dock as the target, with the job at risk. The mechanism is stated in two sentences: fear of bodily sensations and avoidance keep panic going, and exposure reverses it. General cognitive behavioral therapy for depression and supportive therapy are set aside with reasons. Two sources support panic-focused therapy. A session plan covers education, bringing on sensations, the graded dock list and depressive work. Frequency and format are weekly video sessions. Attendance is checked against time, place, cost, childcare and work. Sections relate therapy to medicine, prepare the patient for exposure, explain video, set measures and give a fallback.
Reading the NR 605 Week 5 grading rubric
The largest loss is a modality with no target, and this rationale names avoidance before any therapy. Arguing for therapy in general costs the next share, while this one explains how panic-focused work acts on this target. Ignoring access loses a row, and attendance is checked against shift times, cost and childcare. Missing frequency or duration loses marks, and twelve weekly sessions are planned. Naming the method a reader would expect, and setting it aside, earns the comparison criterion. Preparing the patient for exposure shows the plan was discussed. Explaining how therapy and medicine support each other shows the modality fits the whole plan. A fallback if sessions are lost shows attendance was taken seriously.
NR 605 Week 5 help from the desk
Weak NR 605 Week 5 rationales recommend cognitive behavioral therapy without saying what it targets. Others list benefits that any therapy could claim. Many assume the patient can attend weekly sessions without checking work hours, travel or cost. The expected alternative is rarely named. Frequency and duration are often missing. Start with a target from your evaluation, explain how the chosen therapy acts on it, name what you set aside and check that the patient can get there. If your patient's target differs, share it, and a rationale in this structure can be drafted. Decide in advance what replaces a missed session slot.
Get a NR 605 Week 5 example written to your instructions
Send the Week 5 prompt with whatever client or case material came attached to it. A custom rationale written to that material comes back in 24 to 48 hours and a first request carries no charge. Every claim inside it arrives with the reason that supports it. Nothing is left standing as an assertion for you to justify afterwards.
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NR 605 Week 5 questions, answered
Is naming a well-known modality enough?
No, and it is the commonest reason these lose points. The name is the start of the argument rather than the whole of it. What earns the marks is the link from this patient's target to the thing that modality actually does, followed by the frequency, the duration and the observation that would show it working.
What if therapy is not available to this patient?
Then say so and plan around it, which is a stronger answer than pretending otherwise. Group formats, brief structured work delivered in the clinic, remote sessions and a named place on a waiting list are all legitimate elements. A rationale acknowledging a real barrier and working through it reads as clinical rather than aspirational.
How do I show a therapy is working?
The same way you would for anything else in the plan. Pick something countable connected to the target, take a reading before the work begins, name the interval and say what size of change would mean the element is doing its job. Feeling better is not an observation anyone else can confirm or dispute.
Where can I find a free NR 605 Week 5 sample paper?
The full psychotherapy rationale for panic-focused cognitive behavioral therapy aimed at workplace avoidance is on this page.
Why not general depression therapy first in the NR 605 Week 5 rationale?
It lacks the exposure work that addresses panic and avoidance, which threaten the patient's job first; depressive work follows in later sessions.