Case (cont.): Betty decides to start with some integrative approaches to treat her vasomotor symptoms. She starts with CBT and hypnosis and adds black cohosh. You discuss the use of an SSRI (other than paroxetine since she is on tamoxifen) if these interventions do not help with her symptoms. Betty comes back to see you 3 months later and reports that CBT, hypnosis and black cohosh have been partially effective for her VMS, but she is still not sleeping well and has increased anxiety. You start her on venlafaxine and suggest that she discontinue black cohosh, but continue with CBT and hypnosis. You see her back in 2 months and she states that the venlafaxine is working very well. You continue on the same dose and schedule a follow up in 6 months.