Emotional and mental well-being practice questions for the lifestyle medicine boards
This domain covers screening, the biology of stress, evidence-based self-management and knowing when a patient needs a mental health professional.
ABLM exam domain: Emotional and Mental Well-Being
10%of the ABLM exam
~15of 150 physician questions
~12of 120 health professional questions
160questions on this domain in the bank
What the exam expects you to know
ABLM builds the exam on the lifestyle medicine core competencies. For this domain they include:
Screening tools for stress, depression and anxiety
How emotional and physical health interact, including stress physiology
Stressors such as adverse childhood experiences, and the manageable parts of a stress response
Self-management and resilience-building techniques
The evidence for mindfulness-based stress reduction and related strategies
Lifestyle-related treatment plans for depression and anxiety, and indications for referral
High-yield areas
PHQ-2 and PHQ-9, GAD-7 and how to act on the scores
Adverse childhood experiences and allostatic load
Mindfulness-based stress reduction and mindfulness-based cognitive therapy
Exercise, sleep and other lifestyle treatments for depression and anxiety
Safety: suicide risk and when to refer urgently
Clinician burnout and stress
How to study it
Know the screening instruments well enough to interpret a score in a vignette. Then focus on judgment: when lifestyle treatment is appropriate on its own and when it is an adjunct or a referral.
Free practice questions: Emotional and mental well-being
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · easyEmotional and Mental Well-Being
A 29-year-old cyclist swerves to avoid a car that suddenly pulls out in front of her. Within seconds her heart is pounding, her hands are shaking and she is breathing rapidly. She asks what causes this immediate surge during a sudden scare. Which mediators are principally responsible for this fast phase of the stress response?
Cortisol released into the blood from the adrenal cortex
ACTH released from the anterior pituitary
Corticotropin-releasing hormone from the hypothalamus
Epinephrine and norepinephrine from the adrenal medulla
Aldosterone secreted by the adrenal zona glomerulosa cells
Show answer and rationale
Answer: D. Epinephrine and norepinephrine from the adrenal medulla
A (incorrect): Cortisol is the end product of the HPA cascade, secreted by the adrenal cortex after ACTH stimulation. Its effects, largely mediated through gene transcription, are delayed and long-lasting, so it does not explain a surge within seconds.
B (incorrect): ACTH is the intermediate step of the HPA cascade, released by the anterior pituitary in response to CRH and acting on the adrenal cortex to drive glucocorticoid secretion.
C (incorrect): Corticotropin-releasing hormone from the paraventricular nucleus initiates the HPA cascade that ends in glucocorticoid release; it is not the mediator of the immediate surge.
D (correct): Activation of the sympathetic-adreno-medullary (SAM) axis produces a rapid physiological adaptation mediated mainly by catecholamines: epinephrine and norepinephrine from the adrenal medulla, plus norepinephrine from sympathetic nerves. This produces the racing heart, tremor and rapid breathing within seconds.
E (incorrect): Aldosterone, from the zona glomerulosa, regulates sodium and potassium balance and is not one of the SAM or HPA stress mediators.
Source: Godoy LD, Rossignoli MT, Delfino-Pereira P, Garcia-Cairasco N, de Lima Umeoka EH. A comprehensive overview on stress neurobiology: basic concepts and clinical implications. Front Behav Neurosci. 2018;12:127. Section 'The stress system': SAM axis and HPA axis as the two major components, response starting within seconds; SAM axis section: rapid physiological adaptation mediated mainly by catecholamines, epinephrine and norepinephrine secreted from the adrenal medulla and norepinephrine from sympathetic nerves; section 'HPA Axis and Glucocorticoids': CRH from the PVN stimulates ACTH, which acts on the adrenal cortex (zona fasciculata) to secrete cortisol, with delayed, long-lasting genomic effects. https://pmc.ncbi.nlm.nih.gov/articles/PMC6043787/
Question 2 of 4 · moderateEmotional and Mental Well-Being
A 41-year-old woman has recurrent unexpected panic attacks and avoids brisk walking because a racing heart feels dangerous. Cardiopulmonary evaluation is reassuring. She wants to resume activity and prefers psychological treatment. Which plan best integrates general-health activity with treatment of her disabling fear?
Pair gradual walking with general supportive counseling
Pair gradual walking with a course of applied relaxation
Pair gradual walking with a mindfulness wellness course
Pair gradual walking with therapist-delivered panic CBT
Pair gradual walking with a physical-symptom diary review
Show answer and rationale
Answer: D. Pair gradual walking with therapist-delivered panic CBT
A (incorrect): Supportive counseling may help engagement but does not provide the guideline-recommended structured treatment for panic disorder.
B (incorrect): Applied relaxation is a recommended high-intensity option for GAD; it is not the specified psychological treatment for panic disorder.
C (incorrect): A general mindfulness course is not equivalent to a protocol-based panic CBT intervention.
D (correct): The guideline recommends CBT for panic disorder and discussing exercise for general health. Addressing the disorder while rebuilding activity avoids treating exercise advice as sufficient panic treatment.
E (incorrect): A symptom diary can inform assessment but is not a substitute for treating persistent panic and associated avoidance.
Source: NICE. Generalised anxiety disorder and panic disorder in adults: management. CG113 (2011, updated 2020). Recommendations 1.3.11-1.3.14: exercise for general health, CBT for panic disorder, and trained/supervised protocol-based delivery. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations
Question 3 of 4 · easyEmotional and Mental Well-Being
A 39-year-old receiving depression treatment enjoys walking and regularly walks alone. He misses the clinic exercise group because exercising in front of a crowd evokes shame, not because of time or exertional symptoms. He wants to keep a supported physical-activity component. Which modification best addresses his barrier?
Transfer him to a gym class with a less demanding aerobic pace
Agree on smaller or individual sessions with practitioner support
Replace activity sessions with a behavioral-activation workbook
Add reminders and keep the current group schedule and format
Prescribe shorter vigorous sessions to reduce the attendance burden
Show answer and rationale
Answer: B. Agree on smaller or individual sessions with practitioner support
A (incorrect): Reducing aerobic demand does not address the social exposure that is preventing participation.
B (correct): The guideline recognizes psychological barriers to exercise engagement. Adapting the delivery format with shared decisions can preserve a tolerable, supported activity plan.
C (incorrect): Behavioral activation is a depression treatment, but replacing the activity sessions with written material does not preserve the physical-activity component he wants.
D (incorrect): Reminders address forgetting or scheduling, neither of which is the barrier described.
E (incorrect): Time burden is not the problem, and higher intensity does not address the crowd-related shame.
Source: NICE. Depression in adults: treatment and management. NG222 (2022). Recommendation 1.5.2; Table 1, group exercise: adaptation for anxiety/shame and other psychological barriers to engagement. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations
Question 4 of 4 · easyEmotional and Mental Well-Being
A hospital unit has high emotional-distress scores after staffing shortages led to missed breaks and unpredictable overtime. Staff also request a stress-management course. Which plan best reflects WHO guidance on combining individual and organizational interventions?
Offer stress training, then revisit staffing after course outcomes
Offer time-management coaching, then review staff coping scores
Offer counseling referrals, then await individual clinical diagnoses
Offer stress skills while addressing workload and break coverage
Offer wellness incentives while retaining the current shift pattern
Show answer and rationale
Answer: D. Offer stress skills while addressing workload and break coverage
A (incorrect): A course may help, but waiting for its outcomes delays action on already identified work-related psychosocial risks.
B (incorrect): Coaching targets individual skills; coping scores do not correct the workload and break-coverage hazards described.
C (incorrect): Clinical diagnoses are not prerequisites for addressing workplace risks or making psychosocial support available to distressed workers.
D (correct): WHO supports psychosocial skills interventions for health workers alongside organizational action on psychosocial risks. Individual support is not comprehensive when it substitutes for safer working conditions.
E (incorrect): Incentives may encourage engagement but leave the identified overtime and break-coverage problems unaddressed.
Source: World Health Organization. WHO guidelines on mental health at work (2022). Recommendation 2 (organizational interventions for health, humanitarian and emergency workers: workload reduction, schedule changes; conditional, very low certainty), p. 17; Recommendation 9 (individual interventions for health workers) and implementation remarks, pp. 49-50; Recommendation 8 evidence-to-decision considerations, p. 47 (workers value individual interventions less when not provided alongside organizational interventions). https://iris.who.int/handle/10665/363177
For exam preparation only, not clinical advice.
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