You are a family doctor in Thunder Bay. On your day schedule you note that Lan Chen is booked to see you about "fatigue". She is a devout, hardworking nurse who has in the past year developed hypertension, hypercholesterolemia and Type II Diabetes. She is 45, has been married for 18 years and has three healthy sons, ages 10, 8, and 6. The patient presents as tense, tired, and clearly distressed. Ms. Chen complains of feeling "wiped out", constantly fatigued despite sleeping up to 12 hours at a time. She describes herself as feeling "useless" because she is falling behind on her work at home and is worried about her work at the hospital because she is having trouble focusing: "my thoughts keep jumping around and I'm never really sure what I've done. I keep checking things over and over to make sure I'm not making mistakes". She feels overwhelmed by the many decisions she has to make every day in the hospital, and the demands on her at home. She used to love her work, her family, and coaching soccer. Now she describes feeling intense dread driving to work, at times crying in the car, knowing how busy and intense the day will be. She likewise dreads coaching her soccer team: "This year's group is different, they're a bunch of lazy little brats". She is very upset because she yelled at two of the girls at the last game, and is even more upset because she is yelling at her own sons "all the time".