| Course | NUR-7620 Family System Psychopathology and Psychotherapeutics Across the Lifespan |
|---|---|
| Module | Module 3 |
| Paper type | Child and adolescent therapy: anxiety |
| Length | About 1,050 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7620 Module 3
Brave Steps for a Fourth Grader: Choosing CBT, Sertraline or Both for Separation and Social Anxiety in a 10-Year-Old
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7620: Family System Psychopathology and Psychotherapeutics Across the Lifespan
Mentor Name
Month Day, Year
Brave Steps for a Fourth Grader: Choosing CBT, Sertraline or Both for Separation and Social Anxiety in a 10-Year-Old
A Girl Who Cannot Let Go
Ana, an invented patient, is 10 and in fourth grade in Paterson. Since her grandmother's death a year ago, she has refused to sleep alone, crying until her mother lets her into bed. Each morning she complains of stomachaches and clings at the classroom door. In class she freezes when called on and has stopped raising her hand, though her grades on written work remain good. She will not go to birthday parties unless her mother stays. Her parents are exhausted and worried that she is "falling behind socially." She has no medical problems; her pediatrician found nothing to explain the stomachaches. Screening scales completed by her mother and teacher, and an interview with Ana, support diagnoses of separation anxiety disorder and social anxiety disorder, with no depression or suicidal thinking.
What the Trials Show
Walkup et al. (2008) ran the Child/Adolescent Anxiety Multimodal Study, assigning 488 young people between 7 and 17 whose anxiety took separation, generalized or social forms to one of four 12-week arms: CBT, sertraline, both, or a placebo pill. Four in five children receiving the combination were rated much or very much improved, compared with about three in five with CBT alone, a little more than half with sertraline alone and fewer than one in four with placebo. CBT and sertraline alone did about equally well. Suicidal thoughts were no more common on sertraline than on placebo, and the children in therapy alone slept better and felt less tired and jittery than those taking the drug.
Two later reviews widen the picture. James et al. (2020), in a Cochrane review of 87 studies, found that CBT probably increases remission of a child's main anxiety disorder compared with waiting list or no treatment, with about three children needing treatment for one additional remission. Wang et al. (2017) compared therapies and drugs across 115 studies of children and found that SSRIs and CBT both reduced anxiety, that the combination of sertraline and CBT did better than either alone on some outcomes and that benzodiazepines did not help.
Choosing With Her Parents
Ana's parents are open to therapy and uncertain about medication. The evidence allows two reasonable starts: CBT alone, with sertraline added if she has not improved enough by about eight weeks, or both from the start. Because her symptoms are interfering heavily with school and sleep, and because the combination produced the best results in the largest trial, the nurse practitioner recommends both, while making clear that CBT alone is a reasonable choice. Her parents choose to begin CBT immediately and start sertraline after two sessions, once they have seen how the therapy works.
The CBT Plan
Sixteen weekly sessions combine work with Ana and with her parents. In the first sessions she learns to recognize anxiety in her body, names her worries with a stuffed animal she calls her "worry monster" and learns calming breathing. Next comes cognitive work at a child's level: catching "scary thoughts," such as "Mom will get hurt if I am not with her," and finding "brave thoughts" to answer them.
Before any skills are taught, Ana and her therapist spend the first session getting to know each other through games and drawing, since a child who trusts the therapist will try harder steps later. The plan is explained to her in words she chose herself: anxiety is a false alarm, and practice teaches the alarm to quiet down.
The heart of the plan is graded exposure. Ana and her therapist build a ladder of feared situations, from easiest to hardest, and she climbs it one step a week with a reward chart. For separation anxiety the ladder runs from her mother sitting in the hallway during a session, to sleeping with the bedroom door open, to sleeping in her own room for one night, to a sleepover at her cousin's. For social anxiety it runs from answering one question from her teacher with a prearranged signal, to reading aloud to a small group, to raising her hand once a day.
Her parents attend part of every session. They learn to praise brave behavior, to stop answering repeated reassurance questions and to stop letting her into their bed, while staying warm and calm. The plan is shared with her teacher, who agrees to the prearranged signal and to praise each attempt.
A booster plan matters for anxious children, whose fears often return at transitions such as a new school year. After the sixteen weeks, two monthly booster sessions are scheduled for late August and September, when fifth grade begins, so that she can practice the steps again before the first morning at the new classroom door.
| Exposure step | Target |
|---|---|
| Mother waits in the hallway during a session | Separation |
| Sleeps with bedroom door open, mother checks twice | Separation |
| Sleeps in own room all night | Separation |
| Answers one question after a signal from the teacher | Social |
| Reads aloud to three classmates | Social |
| Raises her hand once a day | Social |
Medication and Safety
Sertraline is started at 12.5 milligrams daily for a week, then 25 milligrams, and increased gradually according to response and side effects, commonly to 50 to 100 milligrams in children her age. Her parents are told about common early effects such as stomach upset and restlessness, and about the boxed warning on antidepressants regarding suicidal thinking in young people; although the CAMS trial found no increase, she will be asked directly about such thoughts at every visit, weekly at first.
Measuring Progress
Her mother and teacher complete the same anxiety scale at baseline, week 8 and week 16, and the clinician rates global improvement at each visit. Specific goals are tracked: nights in her own bed, mornings without stomachaches and times she raises her hand.
Conclusion
Ana's separation and social anxiety are interfering with sleep, school and friendships. Trial evidence shows that CBT and sertraline each help and work best together. A sixteen-week CBT plan built around graded exposure and active parent involvement, with sertraline started at a low dose and careful monitoring, offers her the strongest chance of sleeping in her own room and speaking up in class by the end of the school year.
References
James, A. C., Reardon, T., Soler, A., James, G., & Creswell, C. (2020). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, 2020(11), Article CD013162. https://doi.org/10.1002/14651858.CD013162.pub2
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., Ginsburg, G. S., Rynn, M. A., McCracken, J., Waslick, B., Iyengar, S., March, J. S., & Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753-2766. https://doi.org/10.1056/NEJMoa0804633
Wang, Z., Whiteside, S. P. H., Sim, L., Farah, W., Morrow, A. S., Alsawas, M., Barrionuevo, P., Tello, M., Asi, N., Beuschel, B., Daraz, L., Almasri, J., Zaiem, F., Larrea-Mantilla, L., Ponce, O. J., LeBlanc, A., Prokop, L. J., & Murad, M. H. (2017). Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: A systematic review and meta-analysis. JAMA Pediatrics, 171(11), 1049-1056. https://doi.org/10.1001/jamapediatrics.2017.3036
Reading the NUR 7620 Module 3 assignment instructions
Therapy across the lifespan is the phrase in TESU's NUR-7620 catalog text that this third module answers, using a child case because no public syllabus fixes the sequence. Directions for a child case usually ask for an assessment that uses parent and teacher information, a choice of treatment backed by pediatric evidence, a therapy plan that involves the family and the school, and safety monitoring if medication is used. Some sections ask for an adolescent with depression or a child with behavior problems instead. Confirm the age group your case must cover. Use evidence from children, not adults, and explain the plan at a level a parent could follow. Plan how the school will help and when boosters will happen.
Inside the NUR 7620 Module 3 example
Ana is introduced through her nights in her mother's bed, her mornings at the classroom door and her silence when called on. Her diagnoses rest on parent, teacher and child information. The CAMS trial results for each arm, a Cochrane review and a comparative meta-analysis make the case for therapy, medication and their combination. A section on choosing with her parents explains their decision to start CBT and add sertraline. The CBT plan describes skills, cognitive work and a graded exposure ladder in a six-row table, with parent and teacher roles. Medication dosing and suicidal-thinking monitoring follow, then outcome measures and a conclusion. Booster sessions are set for the start of fifth grade.
Reading the NUR 7620 Module 3 grading rubric
Child therapy papers are judged on developmentally appropriate assessment, pediatric evidence, a therapy plan that a child and parents could follow and safety planning around any medication. Graded exposure should be concrete, with steps that fit the child's actual fears. Parents and school should have defined roles. Mentors look for the boxed warning handled accurately and for measures from more than one informant. Language matters: the plan should be explained in terms the family would understand. Reviews and trials should be described with their populations, and APA formatting should be complete. A booster plan for school transitions shows foresight that mentors notice.
NUR 7620 Module 3 help: mistakes that cost marks
Students often borrow adult CBT techniques without adapting them for a child's age. Use simple language, concrete rewards and visible steps. Another common gap is leaving parents out, when parental behavior, such as constant reassurance, keeps anxiety going. Build exposure steps from the child's real fears, not a generic list. If medication is used, give the starting dose for a child and the monitoring schedule. Gather information from parents and teachers as well as the child, and schedule boosters before the next big change in her life. Ask a desk writer for a first draft on your own NUR-7620 child case, at no cost the first time.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7620 Module 3 questions, answered
Where can I find a free NUR 7620 Module 3 sample paper?
Ana's whole case, from diagnosis to exposure ladder, is printed above with notes on each sheet.
What did the CAMS trial find for childhood anxiety?
Combined CBT and sertraline helped about 81 percent of children, compared with about 60 percent for CBT alone, 55 percent for sertraline alone and 24 percent for placebo.
Is CBT effective for anxiety in children?
Yes. A Cochrane review of 87 studies found that CBT probably increases remission of a child's main anxiety disorder compared with waiting list, with about three children treated per additional remission.
What is graded exposure in child anxiety treatment?
A planned series of steps from mildly to strongly feared situations, practiced one at a time with rewards, so the child learns that anxiety falls and feared outcomes do not happen.
Why are parents involved in CBT for child anxiety?
Parents often keep anxiety going by reassuring or allowing avoidance. Learning to praise brave behavior and reduce accommodation supports the child's progress.