Cognitive-behavioral therapy for anxiety US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Cognitive-behavioral therapy for anxiety. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Cognitive-behavioral therapy for anxiety US Medical PG Question 1: A 35-year-old man presents to the psychiatry OPD with an intense fear of spiders (arachnophobia) that significantly interferes with his daily activities. He reports avoiding certain areas of his house and experiencing panic attacks when encountering spiders. What is the most appropriate first-line treatment for this patient?
- A. Benzodiazepines
- B. Antidepressants
- C. Cognitive behavioral therapy (Correct Answer)
- D. Beta-blockers
- E. Anxiolytics
Cognitive-behavioral therapy for anxiety Explanation: ***Cognitive behavioral therapy***
- **Cognitive Behavioral Therapy (CBT)**, specifically exposure therapy, is the **first-line treatment** for specific phobias due to its high efficacy in reducing fear and avoidance.
- The patient's significant interference with daily activities and panic attacks necessitate a direct and effective intervention like CBT.
*Benzodiazepines*
- **Benzodiazepines** can provide short-term relief for acute anxiety, but they do not address the underlying phobia and have a **risk of dependence** and withdrawal symptoms.
- They are generally not recommended as a first-line or monotherapy for specific phobias because they can interfere with the learning process of exposure therapy.
*Antidepressants*
- **Antidepressants**, particularly SSRIs, are effective for generalized anxiety disorder or panic disorder but are **not typically first-line for specific phobias** unless there are co-occurring conditions.
- Their action mechanism is slower, and they are less effective than exposure therapy for specific phobias.
*Beta-blockers*
- **Beta-blockers** help manage the **physical symptoms of anxiety** (e.g., palpitations, tremors) but do not address the psychological component of specific phobias.
- They are used symptomatically and are not a cure for the phobia itself.
*Anxiolytics*
- **Anxiolytics** is a broad term that includes benzodiazepines; while they can reduce anxiety, they are **not a primary treatment** for specific phobias and carry risks.
- For specific phobias, the goal is not just symptom reduction but overcoming the fear through behavioral changes, which anxiolytics do not facilitate.
Cognitive-behavioral therapy for anxiety US Medical PG Question 2: A 45-year-old woman presents to her primary care physician with complaints of muscle pains, poor sleep, and daytime fatigue. When asked about stressors she states that she "panics" about her job, marriage, children, and finances. When asked to clarify what the "panics" entail, she states that it involves severe worrying. She has had these symptoms since she last saw you one year ago. What is the most likely diagnosis?
- A. Generalized anxiety disorder (Correct Answer)
- B. Social phobia
- C. Adjustment disorder
- D. Obsessive-compulsive disorder
- E. Panic disorder
Cognitive-behavioral therapy for anxiety Explanation: ***Generalized anxiety disorder***
- This patient presents with **chronic, excessive, and uncontrollable worry** about multiple life circumstances (job, marriage, children, finances), fulfilling the core diagnostic criterion for GAD.
- The associated symptoms of **muscle pains**, **poor sleep**, and **daytime fatigue** are common physical manifestations of GAD, and the duration of symptoms for over a year supports the diagnosis.
*Social phobia*
- **Social phobia**, or social anxiety disorder, involves intense fear and anxiety in **social situations** where one might be scrutinized or judged.
- The patient's reported worries are broad and not limited to social interactions, making social phobia less likely.
*Adjustment disorder*
- **Adjustment disorder** is characterized by emotional or behavioral symptoms developing within **three months of an identifiable stressor**, not diffuse chronic worry.
- The symptoms in adjustment disorder typically resolve within **six months** after the stressor or its consequences have ended, whereas this patient's symptoms are chronic and pervasive.
*Obsessive-compulsive disorder*
- **Obsessive-compulsive disorder (OCD)** involves recurrent, intrusive **obsessions** (thoughts, urges, images) and/or **compulsions** (repetitive behaviors or mental acts) performed to reduce anxiety.
- While the patient experiences severe worrying, there's no mention of specific obsessions or compulsive behaviors aimed at neutralizing those anxieties.
*Panic disorder*
- **Panic disorder** is characterized by recurrent, unexpected **panic attacks**—sudden surges of intense fear or discomfort accompanied by physical and cognitive symptoms.
- While the patient uses the term "panics," she clarifies it involves "severe worrying," not discrete, intense, and short-lived panic attacks.
Cognitive-behavioral therapy for anxiety US Medical PG Question 3: A 42-year-old man comes to the emergency department complaining of chest pain. He states that he was at the grocery store when he developed severe, burning chest pain along with palpitations and nausea. He screamed for someone to call an ambulance. He says this has happened before, including at least 4 episodes in the past month that were all in different locations including once at home. He is worried that it could happen at work and affect his employment status. He has no significant past medical history, and reports that he does not like taking medications. He has had trouble in the past with compliance due to side effects. The patient’s temperature is 98.9°F (37.2°C), blood pressure is 133/74 mmHg, pulse is 110/min, and respirations are 20/min with an oxygen saturation of 99% on room air. On physical examination, the patient is tremulous and diaphoretic. He continually asks to be put on oxygen and something for his pain. An electrocardiogram is obtained that shows tachycardia. Initial troponin level is negative. A urine drug screen is negative. Thyroid stimulating hormone and free T4 levels are normal. Which of the following is first line therapy for the patient for long-term management?
- A. Cognitive behavioral therapy (Correct Answer)
- B. Alprazolam
- C. Imipramine
- D. Fluoxetine
- E. Buspirone
Cognitive-behavioral therapy for anxiety Explanation: ***Cognitive behavioral therapy***
- This patient's symptoms are highly suggestive of **panic disorder**, characterized by recurrent, unexpected panic attacks and persistent worry about future attacks. **Cognitive behavioral therapy (CBT)** is considered **first-line treatment** for panic disorder, especially for long-term management, as it addresses the underlying thought patterns and behaviors.
- CBT, particularly exposure therapy, helps patients **reframe their catastrophic thoughts** and directly confront situations that trigger anxiety, leading to a significant reduction in panic attack frequency and severity. It is a good choice for this patient since he has had problems with medication compliance.
*Alprazolam*
- **Alprazolam** is a **benzodiazepine** that provides rapid symptom relief during acute panic attacks but is generally not recommended as first-line for long-term management due to its **potential for dependence**, tolerance, and withdrawal symptoms.
- Its short half-life can lead to rebound anxiety, and it does not address the underlying cognitive distortions common in panic disorder.
*Imipramine*
- **Imipramine** is a **tricyclic antidepressant (TCA)** that can be effective for panic disorder, but it is **not generally a first-line pharmacotherapy** due to its more significant side effect profile (e.g., anticholinergic effects, cardiac toxicity in overdose) compared to SSRIs.
- The patient's history of medication non-compliance due to side effects makes this a less suitable long-term option compared to CBT.
*Fluoxetine*
- **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)**, which is often considered first-line pharmacotherapy for panic disorder due to its efficacy and generally favorable side effect profile. However, given the patient's strong preference against medication and history of non-compliance, CBT would be the preferred initial long-term strategy.
- While effective, SSRIs generally take several weeks to reach full therapeutic effect, and the patient may still experience initial side effects, further contributing to potential non-compliance.
*Buspirone*
- **Buspirone** is an **anxiolytic** that is effective for generalized anxiety disorder but is **not considered first-line for panic disorder**.
- It has a slower onset of action and is typically less effective in treating the acute, intense symptoms of panic attacks compared to other agents.
Cognitive-behavioral therapy for anxiety US Medical PG Question 4: A 10-year-old child is sent to the school psychologist in May because he refuses to comply with the class rules. His teacher says this has been going on since school started back in August. He gets upset at the teacher regularly when he is told to complete a homework assignment in class. Sometimes he refuses to complete them altogether. Several of his teachers have reported that he intentionally creates noises in class to interrupt the class. He tells the psychologist that the teacher and his classmates are at fault. What is the most appropriate treatment?
- A. Cognitive-behavioral therapy (Correct Answer)
- B. Interpersonal therapy
- C. Administration of lithium
- D. Motivational interviewing
- E. Administration of clozapine
Cognitive-behavioral therapy for anxiety Explanation: ***Cognitive-behavioral therapy***
- This child exhibits symptoms consistent with **Oppositional Defiant Disorder (ODD)**, including persistent refusal to comply with rules, anger outbursts, and blaming others. **CBT** is a highly effective treatment for ODD, teaching children coping skills, anger management, and problem-solving.
- CBT helps children identify and change **maladaptive thought patterns** and behaviors, which is crucial for managing the defiant and argumentative behaviors seen in ODD.
*Interpersonal therapy*
- **Interpersonal therapy (IPT)** primarily focuses on improving interpersonal relationships and communication patterns, often used for depression or eating disorders.
- While improved relationships might be a secondary benefit, IPT does not directly target the core **defiant behaviors** and **anger management** issues central to ODD.
*Administration of lithium*
- **Lithium** is a mood stabilizer primarily used in the treatment of **bipolar disorder** and severe mood dysregulation.
- There is no indication from the provided symptoms (defiance, anger, blaming others) that the child is experiencing a mood disorder that would warrant lithium.
*Motivational interviewing*
- **Motivational interviewing** is a counseling approach that helps individuals resolve ambivalence to change, often used in substance abuse or health behavior change.
- While it can be useful in encouraging willingness to engage in therapy, it is not a direct therapeutic modality for addressing the specific **behavioral challenges** and **underlying cognitive distortions** of ODD.
*Administration of clozapine*
- **Clozapine** is an antipsychotic medication reserved for severe mental illnesses like **treatment-resistant schizophrenia** due to its significant side effects.
- The child's symptoms of defiance and rule-breaking are not indicative of a psychotic disorder requiring antipsychotic medication.
Cognitive-behavioral therapy for anxiety US Medical PG Question 5: A 25-year-old man comes to the physician because of palpitations, sweating, and flushing. Since he was promoted to a manager in a large software company 6 months ago, he has had several episodes of these symptoms when he has to give presentations in front of a large group of people. During these episodes, his thoughts start racing and he fears that his face will “turn red” and everyone will laugh at him. He has tried to avoid the presentations but fears that he might lose his job if he continues to do so. He is healthy except for mild-persistent asthma. He frequently smokes marijuana to calm his nerves. He does not drink alcohol. His only medication is an albuterol inhaler. His pulse is 78/min, respirations are 14/min, and blood pressure is 120/75 mm Hg. Cardiopulmonary examination shows no abnormalities. On mental status examination, the patient appears worried and has a flattened affect. Which of the following is the most appropriate next step in management?
- A. Buspirone therapy
- B. Lorazepam therapy
- C. Duloxetine therapy
- D. Cognitive behavioral therapy (Correct Answer)
- E. Olanzapine therapy
Cognitive-behavioral therapy for anxiety Explanation: ***Cognitive behavioral therapy***
- The patient exhibits classic symptoms of **social anxiety disorder (social phobia)**, including anxiety in social situations, fear of judgment, and avoidance behavior, which is a key indication for **CBT**.
- **CBT** is an effective first-line treatment for social anxiety, helping individuals identify and challenge distorted thoughts, and gradually expose themselves to feared social situations.
*Buspirone therapy*
- **Buspirone** is an anxiolytic that can be used for **generalized anxiety disorder**, but it is generally less effective for specific phobias like social anxiety or for acute anxiety attacks.
- Its therapeutic effects can take several weeks to manifest, making it unsuitable for immediate symptom management in highly specific, performance-related anxiety.
*Lorazepam therapy*
- **Lorazepam**, a **benzodiazepine**, can acutely reduce anxiety symptoms but carries risks of **tolerance, dependence, and withdrawal**, especially with frequent use.
- Its potential for abuse, combined with the patient's marijuana use for nerves, makes it a less appropriate first-line choice for long-term management.
*Duloxetine therapy*
- **Duloxetine**, a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, is a pharmacological option for social anxiety disorder, particularly when CBT alone is insufficient.
- While an antidepressant, it is not considered the initial treatment of choice over CBT, which addresses the underlying cognitive and behavioral patterns.
*Olanzapine therapy*
- **Olanzapine** is an **atypical antipsychotic** primarily used for conditions like **schizophrenia** and **bipolar disorder**.
- It is not indicated for social anxiety disorder as a standalone treatment and carries significant side effects, including metabolic disturbances.
Cognitive-behavioral therapy for anxiety US Medical PG Question 6: A 35-year-old man comes to the Veterans Affairs hospital because of a 2-month history of anxiety. He recently returned from his third deployment to Iraq, where he served as a combat medic. He has had difficulty readjusting to civilian life. He works as a taxi driver but had to take a leave of absence because of difficulties with driving. Last week, he hit a stop sign because he swerved out of the way of a grocery bag that was in the street. He has difficulty sleeping because of nightmares about the deaths of some of the other soldiers in his unit and states, “it's my fault, I could have saved them. Please help me.” Mental status examination shows a depressed mood and a restricted affect. There is no evidence of suicidal ideation. Which of the following is the most appropriate initial step in treatment?
- A. Dialectical behavioral therapy
- B. Venlafaxine therapy
- C. Cognitive behavioral therapy (Correct Answer)
- D. Motivational interviewing
- E. Prazosin therapy
Cognitive-behavioral therapy for anxiety Explanation: ***Cognitive behavioral therapy***
- **Cognitive Behavioral Therapy (CBT)** is considered a first-line psychological treatment for **Post-Traumatic Stress Disorder (PTSD)**, which the patient's symptoms (deployments, intrusive thoughts, nightmares, avoidance, guilt) strongly suggest.
- CBT helps individuals identify and challenge **maladaptive thought patterns** and behaviors related to the trauma, fostering new coping mechanisms.
*Dialectical behavioral therapy*
- **Dialectical Behavioral Therapy (DBT)** is primarily used for individuals with **Borderline Personality Disorder** or severe emotional dysregulation.
- While it can help with emotional regulation, it is not the **first-line therapy** specifically targeting trauma-related cognitive distortions and avoidance behaviors seen in PTSD.
*Venlafaxine therapy*
- **Venlafaxine**, an SNRI, is an antidepressant that can be effective for PTSD symptoms. However, current guidelines recommend **psychotherapy (like CBT)** as the initial step, especially when feasible.
- While pharmacotherapy can be used, it's typically considered **adjunctive** or for cases where psychotherapy alone is insufficient or not preferred.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style used to address ambivalence and enhance a person's **intrinsic motivation** for change.
- It is often utilized in substance abuse treatment or when patients are resistant to treatment, but it is not a primary, standalone treatment for the core symptoms of PTSD.
*Prazosin therapy*
- **Prazosin** is an alpha-1 antagonist used off-label to treat **PTSD-related nightmares** and sleep disturbances.
- While it can be helpful for a specific symptom, it does not address the broader spectrum of PTSD symptoms, such as intrusive thoughts, avoidance, or negative cognitions.
Cognitive-behavioral therapy for anxiety US Medical PG Question 7: A 20-year-old man comes to the physician because of decreasing academic performance at his college for the past 6 months. He reports a persistent fear of “catching germs” from his fellow students and of contracting a deadly disease. He finds it increasingly difficult to attend classes. He avoids handshakes and close contact with other people. He states that when he tries to think of something else, the fears “keep returning” and that he has to wash himself for at least an hour when he returns home after going outside. Afterwards he cleans the shower and has to apply disinfectant to his body and to the bathroom. He does not drink alcohol. He used to smoke cannabis but stopped one year ago. His vital signs are within normal limits. He appears anxious. On mental status examination, he is oriented to person, place, and time. In addition to starting an SSRI, which of the following is the most appropriate next step in management?
- A. Cognitive-behavioral therapy (Correct Answer)
- B. Psychodynamic psychotherapy
- C. Motivational interviewing
- D. Interpersonal therapy
- E. Group therapy
Cognitive-behavioral therapy for anxiety Explanation: **Cognitive-behavioral therapy**
- **Cognitive-behavioral therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the most effective psychotherapy for **obsessive-compulsive disorder (OCD)**, which this patient's symptoms strongly suggest.
- CBT helps patients challenge distorted thoughts and gradually expose themselves to feared situations while preventing compulsive rituals, thus breaking the cycle of obsessions and compulsions.
*Psychodynamic psychotherapy*
- This therapy focuses on **unconscious conflicts** and **past experiences** to understand current symptoms.
- While it can be helpful for some mental health conditions, it is generally **less effective** than CBT for the specific, highly ritualized symptoms of OCD.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style designed to address **ambivalence about change** and enhance intrinsic motivation.
- It is often used in substance abuse or lifestyle changes, but it does not directly teach coping skills for OCD symptoms or address the underlying thought patterns.
*Interpersonal therapy*
- **Interpersonal therapy (IPT)** focuses on the patient's **current interpersonal relationships** and social functioning.
- While social difficulties can arise from OCD, IPT does not directly target the obsessions and compulsions that are central to the disorder.
*Group therapy*
- **Group therapy** can provide support and a sense of community, but for a severe condition like OCD, **individual therapy** (especially CBT/ERP) is typically recommended first due to the highly individualized nature of obsessions and compulsions.
- It may be a complementary approach, but usually not the most appropriate initial next step given the intensity of the patient's symptoms.
Cognitive-behavioral therapy for anxiety US Medical PG Question 8: An 8-year-old girl is brought to the physician by her parents because of difficulty sleeping. One to two times per week for the past 2 months, she has woken up frightened in the middle of the night, yelling and crying. She has not seemed confused after waking up, and she is consolable and able to fall back asleep in her parents' bed. The following day, she seems more tired than usual at school. She recalls that she had a bad dream and looks for ways to delay bedtime in the evenings. She has met all her developmental milestones to date. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Normal development
- B. Sleep terror disorder
- C. Nightmare disorder (Correct Answer)
- D. Post-traumatic stress disorder
- E. Separation anxiety disorder
Cognitive-behavioral therapy for anxiety Explanation: ***Nightmare disorder***
- The key features supporting **nightmare disorder** are vivid, frightening dreams that lead to waking up, the ability to recall the dream content, being easily consolable, and attempts to avoid bedtime.
- Sleep disturbances, daytime fatigue, and negative emotional responses centered around sleep are characteristic of this disorder.
*Normal development*
- While occasional bad dreams are part of normal development, a frequency of one to two times per week over 2 months, leading to daytime tiredness and bedtime avoidance, suggests a **clinical disorder** exceeding typical developmental experiences.
- The distress caused and impact on daily functioning (tiredness at school) differentiate it from normal, transient nightmares.
*Sleep terror disorder*
- **Sleep terrors** typically involve abrupt awakening with intense fear, screaming, and autonomic arousal, but the individual is usually disoriented, inconsolable, and has no recall of the event upon waking or the next day.
- In this case, the child is consolable and *recalls* having a bad dream, distinguishing it from sleep terrors.
*Post-traumatic stress disorder*
- **PTSD** requires exposure to a traumatic event, which is not mentioned in the vignette.
- While nightmares can be a symptom of PTSD, they are usually accompanied by other symptoms like flashbacks, avoidance behavior, negative alterations in cognition/mood, and hypervigilance related to the trauma.
*Separation anxiety disorder*
- **Separation anxiety disorder** is characterized by excessive fear or anxiety concerning separation from attachment figures.
- Although the child sleeps in her parents' bed, the primary issue is frightening dreams and difficulty sleeping, not anxiety specifically related to separation from her parents.
Cognitive-behavioral therapy for anxiety US Medical PG Question 9: A 5-year-old boy is brought to the physician by his mother because he does not “listen to her” anymore. The mother also reports that her son cannot concentrate on any tasks lasting longer than just a few minutes. Teachers at his preschool report that the patient is more active compared to other preschoolers, frequently interrupts or bothers other children, and is very forgetful. Last year the patient was expelled from another preschool for hitting his teacher and his classmates when he did not get what he wanted and for being disruptive during classes. He was born at term via vaginal delivery and has been healthy except for 3 episodes of acute otitis media at the age of 2 years. He has met all developmental milestones. His mother has major depressive disorder and his father has Graves' disease. He appears healthy and well nourished. Examination shows that the patient does not seem to listen when spoken to directly. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in treatment?
- A. Methylphenidate
- B. Methimazole
- C. Behavior therapy (Correct Answer)
- D. Fluoxetine
- E. Hearing aids
Cognitive-behavioral therapy for anxiety Explanation: ***Behavior therapy***
- For **preschool-aged children (ages 4-5 years)** with ADHD symptoms, **behavior therapy** is recommended as the **first-line treatment**.
- This approach focuses on teaching parents and caregivers strategies to manage challenging behaviors and improve communication, promoting positive behavioral changes in the child.
*Methylphenidate*
- **Stimulant medications** like methylphenidate are generally considered **second-line treatment** for ADHD in preschool-aged children.
- While effective, their use in this age group is typically reserved for cases where behavior therapy alone has not yielded sufficient improvement.
*Methimazole*
- **Methimazole** is an **antithyroid medication** used to treat **hyperthyroidism**, such as **Graves' disease**.
- This medication is irrelevant to the child's behavioral symptoms and is used for the father's condition.
*Fluoxetine*
- **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** primarily used to treat **depression** and **anxiety disorders**.
- While the mother has major depressive disorder, fluoxetine is not indicated for the child's ADHD-like symptoms.
*Hearing aids*
- Although the child has a history of recurrent **otitis media**, there is **no current evidence** of hearing impairment affecting his development or behavior.
- Furthermore, his developmental milestones were met, suggesting that any past hearing issues were transient or did not significantly impact his overall development.
Cognitive-behavioral therapy for anxiety US Medical PG Question 10: A 35-year-old man presents to his primary care physician for a routine visit. He is in good health but has a 15 pack-year smoking history. He has tried to quit multiple times and expresses frustration in his inability to do so. He states that he has a 6-year-old son that was recently diagnosed with asthma and that he is ready to quit smoking. What is the most effective method of smoking cessation?
- A. Nicotine replacement therapy alone
- B. Quitting cold turkey
- C. Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy (Correct Answer)
- D. Participating in a smoking-cessation support group
- E. Bupropion alone
Cognitive-behavioral therapy for anxiety Explanation: ***Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy***
- The combination of **pharmacological therapies** (Bupropion and NRT) with **behavioral support** (CBT) is consistently shown to be the most effective strategy for smoking cessation. This approach addresses both the physiological addiction and the psychological habits associated with smoking.
- **Bupropion** helps reduce cravings and withdrawal symptoms, while **nicotine replacement therapy (NRT)** manages nicotine withdrawal. **Cognitive behavioral therapy (CBT)** provides coping mechanisms and strategies to deal with triggers and prevent relapse.
*Nicotine replacement therapy alone*
- While **nicotine replacement therapy (NRT)** is an effective treatment, its efficacy significantly increases when combined with behavioral therapy or other pharmacotherapies.
- NRT alone primarily addresses the **physical dependence** on nicotine but may not fully address the psychological and behavioral aspects of addiction.
*Quitting 'cold-turkey'*
- **Quitting cold turkey** has a very low success rate, with only about 3-5% of individuals managing to quit long-term using this method.
- This method provides no support for severe **withdrawal symptoms** or cravings, making relapse highly likely, especially for heavy smokers.
*Participating in a smoking-cessation support group*
- **Support groups** provide valuable behavioral and social support, which is an important component of successful cessation.
- However, behavioral support alone is often less effective than when combined with **pharmacological interventions** that address the physiological addiction.
*Bupropion alone*
- **Bupropion** is an effective pharmacotherapy that helps reduce cravings and withdrawal symptoms and has been shown to improve cessation rates.
- While effective, its success rate is typically lower than when used in combination with **nicotine replacement therapy** and comprehensive behavioral support.
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