A nurse in an acute care mental health facility is caring for a client who has major depressive disorder. Which of the following actions by the client indicates that the treatment has been effective?

A. Expressing feelings demonstrates improved communication, emotional processing, and engagement in therapy. Clients with major depressive disorder often withdraw and internalize emotions; therefore, verbalizing feelings indicates therapeutic progress. B. Difficulty sleeping is a common symptom of depression and does not indicate improvement. C. Excessive reassurance-seeking reflects continued anxiety and low self-esteem rather than effective treatment. D. Preoccupation with one’s own thoughts suggests ongoing withdrawal and rumination, which are common in depression and do not indicate improvement.