A 35-year-old woman presents to the clinic with a 3-month history of poor sleep, vivid nightmares, and constantly feeling “on edge”. Seven months ago, she was involved in a severe motor vehicle collision that resulted in acute respiratory distress syndrome and a prolonged intensive care unit stay. During her hospitalization, she experienced a documented episode of acute delirium with frightening hallucinations. Since returning home, she actively avoids driving or riding in cars. She reports feeling emotionally numb, describes a pervasive sense of sadness, and has lost interest in her previously enjoyed hobbies. She denies any substance abuse or previous psychiatric history.

She appears anxious and fidgety in the examination chair. She is afebrile with a blood pressure of 122/78 mmHg, a heart rate of 88 bpm, and a respiratory rate of 14 breaths per minute.