Cognitive-Behavioral Therapy for Anxiety — MCQs
In which of the following conditions is behavioral therapy most commonly utilized?
Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
Best therapy suited to teach daily life skill to a mentally challenged child:
A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
Management of a violent patient in psychiatry includes all except:
Which of the following is NOT a characteristic feature of delirium tremens?
At what age does stranger anxiety typically develop in infants?
A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes. He passes his examination with poor marks. However, his mathematical ability and social adjustment are appropriate for his age. Which of the following is the most likely diagnosis?
A 65-year-old man with severe Alzheimer's disease is experiencing agitation and aggression. What is the most appropriate management for this condition?
In which of the following patients would supportive therapy be most challenging to implement effectively?
Cognitive-Behavioral Therapy for Anxiety Indian Medical PG Practice Questions and MCQs
Question 1: In which of the following conditions is behavioral therapy most commonly utilized?
- A. Schizophrenia
- B. Agoraphobia (Correct Answer)
- C. Delirium
- D. Neurotic depression
Explanation: ***Agoraphobia*** - **Behavioral therapy**, particularly **exposure therapy**, is the **gold standard and first-line treatment** for agoraphobia. - It involves **systematic desensitization** and gradual exposure to feared situations (e.g., crowded places, public transport, open spaces). - This approach directly reduces **avoidance behaviors** and anxiety responses, making it the most commonly utilized behavioral intervention among these conditions. *Schizophrenia* - While behavioral interventions can be part of a comprehensive treatment plan, **pharmacotherapy** (antipsychotics) is the cornerstone for managing positive and negative symptoms. - Behavioral approaches often focus on **social skills training** and vocational rehabilitation, not primary symptom reduction. *Delirium* - The primary management for delirium involves identifying and treating the **underlying medical cause** and providing supportive care. - Behavioral therapy is generally not indicated as this condition is an **acute organic brain syndrome** requiring medical management. *Neurotic depression* - This term is largely outdated; current diagnostic manuals use terms like **persistent depressive disorder (dysthymia)** or **major depressive disorder**. - While behavioral activation is a component of CBT for depression, the primary treatments are **cognitive behavioral therapy (CBT)** and/or **pharmacotherapy** (antidepressants), rather than purely behavioral therapy.
Question 2: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
- A. Fluoxetine
- B. Carbamazepine (Correct Answer)
- C. Cognitive Behaviour Therapy
- D. Clomipramine
Explanation: ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder. - It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**. *Fluoxetine* - **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD. - SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**. *Cognitive Behaviour Therapy* - **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD. - It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**. - It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.
Question 3: Best therapy suited to teach daily life skill to a mentally challenged child:
- A. Contingency management (Correct Answer)
- B. Cognitive reconstruction
- C. Self instruction
- D. CBT (Cognitive behavior therapy)
Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.
Question 4: A 45-year-old male presents with recurrent episodes of palpitations, sweating, and a fear of losing control. He has been experiencing these episodes for the past six months. What is the most likely diagnosis?
- A. Generalized anxiety disorder
- B. Panic disorder (Correct Answer)
- C. Social anxiety disorder
- D. Obsessive-compulsive disorder
Explanation: ***Panic disorder*** - The presentation of recurrent, unexpected **panic attacks** characterized by sudden episodes of intense fear, palpitations, sweating, and a fear of losing control is classic for **panic disorder**. - These episodes often manifest with physical symptoms that mimic a medical emergency, leading to significant distress and avoidance behaviors. *Generalized anxiety disorder* - This condition involves **persistent and excessive worry** about various life circumstances for at least six months, rather than discrete, intense episodes of fear. - While physical symptoms like restlessness and fatigue can occur, they are generally less acute and not as severe as the sudden "fight-or-flight" response seen in panic attacks. *Social anxiety disorder* - This disorder is characterized by marked fear or anxiety about **social situations** where the individual might be scrutinized by others. - While it can involve symptoms like palpitations and sweating in social contexts, it doesn't typically present with unexpected attacks unrelated to social performance. *Obsessive-compulsive disorder* - This disorder is defined by the presence of **obsessions** (recurrent and persistent thoughts, urges, or images) and/or **compulsions** (repetitive behaviors or mental acts) that the individual feels driven to perform. - The symptoms described—palpitations, sweating, and fear of losing control—are not typical primary manifestations of OCD, which focuses on specific obsessions and compulsions.
Question 5: Management of a violent patient in psychiatry includes all except:
- A. CBT (Correct Answer)
- B. Haloperidol
- C. ECT
- D. BZD
Explanation: ***CBT*** - **Cognitive Behavioral Therapy (CBT)** is a long-term psychological intervention aimed at changing maladaptive thought patterns and behaviors. It is **not suitable for immediate management** of an acutely violent patient. - While CBT can be beneficial for aggression management in a stable patient, it requires patient cooperation, cognitive engagement, and time, which are not available during a **violent psychiatric emergency**. *Haloperidol* - **Haloperidol** is a potent typical antipsychotic frequently used in acute settings for rapid tranquilization of violent or severely agitated patients. - It is effective in reducing **psychosis-related agitation** and can be administered **intramuscularly** for quick onset of action. - Often used in combination with benzodiazepines for optimal control of acute violence. *ECT* - **Electroconvulsive Therapy (ECT)** may be considered in **severe, treatment-resistant cases** of violence associated with conditions like uncontrolled mania, catatonic excitement, or psychotic depression when pharmacological interventions have failed. - While not used for immediate acute management due to logistical requirements (consent, anesthesia, specialized setup), it can be an effective option for severe psychiatric conditions with persistent violence. - It works by inducing a brief controlled seizure, which can rapidly alleviate severe symptoms. *BZD* - **Benzodiazepines (BZDs)** like lorazepam or diazepam are **first-line agents** in the acute management of violent or agitated patients due to their rapid anxiolytic, sedative, and muscle relaxant properties. - They are particularly useful for **calming acute agitation** and are often combined with antipsychotics for rapid tranquilization. - Can be administered intramuscularly or intravenously for quick action in psychiatric emergencies.
Question 6: Which of the following is NOT a characteristic feature of delirium tremens?
- A. Severe depression (Correct Answer)
- B. Extreme anxiety
- C. Delusion
- D. Hallucination
Explanation: ***Severe depression*** - While mood disturbances can occur with alcohol withdrawal, **severe depression** is not a hallmark or defining feature of **delirium tremens (DTs)** itself. - DTs primarily manifest as severe autonomic hyperactivity, altered mental status, and perceptual disturbances. *Hallucination* - **Hallucinations**, particularly **visual** (e.g., seeing insects or small animals), are a classic and common feature of delirium tremens. - These perceptual disturbances contribute significantly to the agitated and disoriented state of patients experiencing DTs. *Extreme anxiety* - **Extreme anxiety**, agitation, and fear are very common in delirium tremens due to the heightened state of arousal and terrifying hallucinations. - This **hyperarousal** is a direct result of the severe autonomic dysregulation. *Delusion* - **Delusions**, often **paranoid** or referring to being persecuted, are frequently observed in patients with delirium tremens. - These fixed, false beliefs contribute to the patient's confusion, fear, and sometimes aggressive behavior.
Question 7: At what age does stranger anxiety typically develop in infants?
- A. 3 months
- B. 4 months
- C. 7 months (Correct Answer)
- D. 11 months
Explanation: ***7 months*** - **Stranger anxiety** typically emerges around **6-8 months** of age, peaking around 9-12 months. - This developmental stage reflects the infant's growing ability to distinguish between familiar and unfamiliar faces and their developing **attachment to primary caregivers**. *3 months* - At 3 months, infants are typically in an earlier stage of social development, primarily focusing on **recognizing primary caregivers** and showing social smiles. - They generally do not exhibit stranger anxiety, as their cognitive and emotional development has not yet reached that milestone. *4 months* - While 4-month-olds are becoming more socially aware and responsive, their **object permanence** and ability to differentiate strangers from familiar faces is still developing. - Therefore, definitive stranger anxiety is typically not observed at this age. *11 months* - By 11 months, stranger anxiety has already developed and is usually **at its peak**, as infants at this age have a well-established sense of who their primary caregivers are. - While stranger anxiety is very prominent at this age, it is not when it typically **develops** (initial emergence), but rather when it is most pronounced.
Question 8: A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes. He passes his examination with poor marks. However, his mathematical ability and social adjustment are appropriate for his age. Which of the following is the most likely diagnosis?
- A. Specific learning disability (Correct Answer)
- B. Intellectual disability
- C. Examination anxiety
- D. Lack of interest in studies
Explanation: ***Specific learning disability*** - The boy's difficulties specifically in **writing** and **spelling** despite age-appropriate mathematical ability and social adjustment are characteristic of a **specific learning disorder**. - These disorders affect specific academic skills like **dysgraphia** (writing) or **dysorthographia** (spelling) while other cognitive functions remain intact. *Intellectual disability* - This condition involves significant limitations in **both intellectual functioning** (e.g., reasoning, problem-solving) and **adaptive behavior** (e.g., conceptual, social, practical skills). - The boy's appropriate **mathematical ability** and **social adjustment** argue against a diagnosis of intellectual disability. *Examination anxiety* - While examination anxiety can lead to poor test performance, it typically affects performance across various subjects due to **stress** and **panic**, rather than specific difficulties in writing or spelling. - It would not explain a fundamental difficulty in **expressing himself in writing** regardless of the context. *Lack of interest in studies* - Lack of interest might lead to poor academic performance, but it doesn't typically manifest as specific difficulties with **writing and spelling mechanics** while other cognitive abilities are preserved. - A student lacking interest might simply not try, but usually wouldn't have a fundamental inability to perform the task if motivated.
Question 9: A 65-year-old man with severe Alzheimer's disease is experiencing agitation and aggression. What is the most appropriate management for this condition?
- A. Increase the dose of donepezil
- B. Add a benzodiazepine for agitation
- C. Initiate treatment with an antipsychotic medication
- D. Implement non-pharmacological behavioral interventions (Correct Answer)
Explanation: ***Implement non-pharmacological behavioral interventions*** - Non-pharmacological approaches are the **first-line treatment** for agitation and aggression in Alzheimer's disease due to fewer side effects and potential effectiveness. - These interventions include identifying and addressing triggers, providing a **calm environment**, routine activities, and redirection. *Increase the dose of donepezil* - Donepezil is a **cholinesterase inhibitor** used to improve cognitive symptoms in Alzheimer's disease, but it does not directly treat agitation or aggression. - Increasing its dose is unlikely to resolve behavioral disturbances and might exacerbate issues like **gastrointestinal side effects**. *Add a benzodiazepine for agitation* - Benzodiazepines are generally avoided in older adults, especially those with dementia, due to risks of **sedation**, cognitive impairment, falls, and paradoxical agitation. - They offer short-term relief but can worsen long-term behavioral and cognitive outcomes. *Initiate treatment with an antipsychotic medication* - While antipsychotics can be effective for severe agitation and aggression, they carry significant risks in elderly dementia patients, including increased **mortality**, cardiovascular events, and cerebrovascular adverse events. - They should be reserved for cases where non-pharmacological interventions have failed and the patient poses a significant risk to themselves or others.
Question 10: In which of the following patients would supportive therapy be most challenging to implement effectively?
- A. Patient who is severely ill and has significant ego dysfunction
- B. Person who is motivated and has good self-control
- C. Person with good cognitive and functional abilities
- D. Patient who is severely ill and uncooperative (Correct Answer)
Explanation: ***Patient who is severely ill and uncooperative*** - A **severely ill** patient who is **uncooperative** presents the most **immediate and direct barrier** to implementing supportive therapy effectively. Their **active resistance** to therapeutic interventions (refusing medication, declining to engage, missing appointments) makes it practically impossible to deliver care. - **Uncooperativeness** represents active opposition to treatment, requiring resolution before any therapeutic work can proceed. Without patient engagement, even the most basic supportive interventions cannot be implemented. - While other patients may have limitations, an uncooperative patient fundamentally blocks the therapeutic alliance necessary for any psychotherapy. *Patient who is severely ill and has significant ego dysfunction* - **Ego dysfunction** (impaired reality testing, poor impulse control, weak sense of self) is indeed challenging and represents a relative contraindication to insight-oriented therapies. - However, patients with ego dysfunction may still **passively participate** in supportive therapy, especially when the therapy is structured and focused on basic stabilization rather than insight. - The key difference: ego dysfunction is a **structural limitation** requiring adaptation of technique, whereas uncooperativeness is an **active barrier** preventing any intervention. A patient with ego dysfunction can still potentially benefit from modified supportive approaches, but an uncooperative patient cannot be engaged at all. *Person who is motivated and has good self-control* - This patient would be the **easiest to treat** with supportive therapy due to their intrinsic motivation and ability to manage their own behavior. - Their **motivation** and **self-control** would facilitate adherence to treatment plans and active participation in their care, making implementation straightforward. *Person with good cognitive and functional abilities* - This patient would be **highly amenable to supportive therapy** as their cognitive and functional capacities allow them to understand and participate in treatment. - Good cognitive and functional abilities enable them to comprehend instructions, manage their own care, and engage effectively with healthcare providers, presenting minimal implementation challenges.
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