Serotonin-norepinephrine reuptake inhibitors commonly cause effects from increased autonomic and GI activity. Nausea is frequent early on, dry mouth is common, and sleep disturbances (either insomnia or restlessness) often occur. They can raise blood pressure, especially at higher doses, and pupil dilation (dilated pupils) from sympathetic activation is not unusual. Because these drugs affect both serotonin and norepinephrine, withdrawal symptoms can appear if treatment is stopped abruptly, so gradual tapering is recommended. Hypoglycemia and rash are not typical, common adverse effects of SNRIs; hair loss or dry skin aren’t characteristic, and an effect described as improved energy with no side effects isn’t consistent with SNRI profiles.

Serotonin syndrome stems from excess serotonin triggering a rapid surge of autonomic and neuromuscular activity. The defining feature is neuromuscular hyperreactivity, especially hyperreflexia with clonus, occurring together with autonomic instability such as tachycardia, hypertension, fever, and diaphoresis. This combination of exaggerated reflexes and autonomic signs is the hallmark of the toxidrome, making this statement the best description. The other options describe patterns that don’t fit this acute serotonergic picture: hyporeflexia with rigidity is more typical of neuroleptic malignant syndrome, muscle atrophy with neuropathy points to chronic degenerative neuropathies, and weight gain with edema isn’t characteristic of the acute serotonergic syndrome.

Cognitive behavioral therapy focuses on how thoughts influence emotions and behaviors and uses structured, skill-based techniques to change those patterns. The techniques listed—positive reframing and decatastrophizing—target how a person thinks about events, helping reduce distortion and distress. Assertiveness training then translates those changes into improved behavior and communication, which is a core behavioral component of CBT. Together, cognitive restructuring and behavioral skills training exemplify CBT’s approach of modifying both thoughts and actions to improve functioning. Other options pull from different therapeutic traditions. Dream analysis, free association, and transference are classic psychodynamic techniques that explore unconscious processes and past experiences rather than the here-and-now thoughts and behaviors CBT emphasizes. Hypnosis, age regression, and trance states are not standard CBT components. Medication management alone represents pharmacotherapy, not a psychotherapy like CBT.

Assertiveness training focuses on handling interpersonal situations with clear, direct, and respectful communication. It teaches expressing your needs and boundaries, using I-statements, and negotiating solutions rather than giving in passively or erupting aggressively. This approach helps you advocate for yourself while respecting others’ rights, which prevents both passive submission and hostile confrontation. In essence, the emphasis is on teaching people to address interpersonal situations with assertiveness.