A nurse asks an adult patient, "Are you going to finish eating your dinner?" The patient yells at the nurse, "You are just like my mother: always trying to make me feel guilty if I don't eat my entire meal.”. Which occurrence is evident in the patient's statement?

Choice A rationale

Glutamate is the primary excitatory neurotransmitter in the central nervous system. Its facilitation would increase neuronal activity, which is generally contrary to the desired calming and sedative effects of anxiolytic medications, which typically aim to reduce nervous system overactivity to manage anxiety.

Choice B rationale

Dopamine is a monoamine neurotransmitter involved in reward, motivation, and motor control. While involved in various psychiatric conditions, decreasing excess dopamine is the primary mechanism of action for some antipsychotic medications, not the typical mechanism for anxiolytics, which primarily target anxiety symptoms.

Choice C rationale

Serotonin, a monoamine, modulates mood, sleep, and appetite. Increasing its release or effects is the primary mechanism for some classes of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), which are also used for anxiety, but is not the defining or typical mechanism of benzodiazepine anxiolytics.

Choice D rationale

γ-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the brain. Anxiolytic drugs, particularly the benzodiazepine class, exert their effect by binding to the GABA_A receptor. This binding enhances GABA's inhibitory effects, leading to hyperpolarization of the neuron, thereby reducing overall neuronal excitability and promoting an anxiolytic (calming) effect.

Choice A rationale

This statement reflects a global, self-defeating cognitive distortion known as overgeneralization, applying a single failure to all future attempts ("always fail"). Cognitive Behavioral Therapy (CBT) aims to challenge and modify such rigid, irrational beliefs toward more balanced, realistic thinking, making this statement a lack of progress within the therapeutic framework.

Choice B rationale

This is another example of pervasive cognitive distortion, specifically all-or-nothing thinking or catastrophizing, suggesting a view that all life events are inherently negative ("always go wrong"). Progress in CBT involves moving away from these absolute terms to recognize situational variance and positive outcomes, thus this statement indicates limited therapeutic change.

Choice C rationale

This statement, "Sometimes I do stupid things," demonstrates cognitive restructuring and de-personalization of failure, which are key goals in CBT. By using the word "Sometimes," the client reframes the self-criticism from a global, fixed self-identity ("I'm stupid") to a specific, contextualized behavior ("do stupid things"), showing an awareness that negative actions do not define the whole self.

Choice D rationale

"I'm disappointed in my lack of ability" shifts the language from a global self-label to a feeling about a performance deficit. While less absolute than the original statement, it still focuses on an internal, perceived deficit ("lack of ability") rather than separating the behavior from the self and acknowledging the situational nature of error, which is the hallmark of progress in CBT.