Review Question - QID 210803

A 32-year-old man arrives to his primary care physician to discuss his fear of flying. The patient reports that he has had a fear of flying since being a teenager. He went on a family vacation 15 years ago, and during the flight there was turbulence and a “rough landing.” Since then he has avoided flying. He did not go to his cousin’s wedding because it was out of the country. He also was unable to visit his grandmother for her 80th birthday. The last time his job asked him to meet a client out of state, he drove 18 hours instead of flying. Several years ago he promised his fiancée they could fly to Florida. Upon arrival at the airport, he began to feel dizzy, lightheaded, and refused to go through security. During the clinic visit, the patient appears anxious and distressed. He recognizes that his fear is irrational. He is upset that it is affecting his relationship with his wife. His current job may soon require employees in his sales position to fly to meet potential clients. He is embarrassed to have a conversation with his manager about his fear of flying. His temperature is 98.6°F (37°C), blood pressure is 115/74 mmHg, pulse is 71/min, and respirations are 12/min. Which of the following is the most appropriate first-line therapy?