Brief Psychotherapies — MCQs
Freud is known for
Which of the following is not a Cluster A personality disorder?
Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
Best therapy suited to teach daily life skill to a mentally challenged child:
Systematic desensitization is a therapeutic technique used in which of the following conditions?
What are the indications for Electroconvulsive Therapy (ECT)?
A child who wins the first prize in school is given chocolates that he likes. He tends to get high marks in the future. This scenario best illustrates which line of therapy?
All of the following psychotherapy modalities are used to treat anxiety disorders except?
Cognitive therapy for depression was developed by whom?
Deep brain stimulation is used in the treatment of which of the following conditions?
Brief Psychotherapies Indian Medical PG Practice Questions and MCQs
Question 1: Freud is known for
- A. Psychoanalysis (Correct Answer)
- B. Counselling
- C. Flooding
- D. Cognitive therapy
Explanation: ***Psychoanalysis*** - **Sigmund Freud** is widely recognized as the founder of **psychoanalysis**, a school of thought and a set of therapeutic techniques that originated in the late 19th and early 20th centuries. - Psychoanalysis focuses on uncovering **unconscious thoughts**, motivations, and conflicts that influence behavior and emotional states, often through methods like **free association** and dream analysis. *Counselling* - While counseling involves therapeutic conversations, it is a broader term encompassing various approaches to help individuals cope with emotional or psychological issues. - Counseling as a distinct field is not singularly attributed to Freud, but rather includes many different modalities and theorists. *Flooding* - **Flooding** is a specific technique used in **behavioral therapy**, particularly for phobias and anxiety disorders. - It involves exposing an individual to a feared object or situation for a prolonged period to reduce anxiety through extinction and is associated with **behavioral psychology**, not Freud's psychoanalysis. *Cognitive therapy* - **Cognitive therapy** (CT) and **Cognitive Behavioral Therapy (CBT)**, pioneered by figures like **Aaron T. Beck**, focus on identifying and changing distorted thinking patterns and maladaptive behaviors. - This approach evolved significantly later than Freud's work and represents a distinct theoretical and practical orientation in psychotherapy.
Question 2: Which of the following is not a Cluster A personality disorder?
- A. schizoid
- B. schizotypal
- C. paranoid
- D. anankastic (Correct Answer)
Explanation: ***Anankastic*** - **Anankastic personality disorder**, also known as **obsessive-compulsive personality disorder (OCPD)**, is classified under **Cluster C** personality disorders. - Cluster C disorders are characterized by anxious, fearful thinking or behavior, which differentiates them from the odd or eccentric behaviors of Cluster A. *Schizoid* - **Schizoid personality disorder** is a **Cluster A** personality disorder, characterized by a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. - Individuals with schizoid personality disorder typically show no desire for close relationships, including those with family members. *Schizotypal* - **Schizotypal personality disorder** is a **Cluster A** personality disorder, characterized by pervasive patterns of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior. - These individuals may have odd beliefs or magical thinking that is inconsistent with cultural norms. *Paranoid* - **Paranoid personality disorder** is a **Cluster A** personality disorder, characterized by a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent. - Individuals with this disorder often believe that others are exploiting, harming, or deceiving them, even without sufficient basis.
Question 3: Match the following drugs in Column A with their contraindications in Column B. | Column A | Column B | | :-- | :-- | | 1. Morphine | 1. QT prolongation | | 2. Amiodarone | 2. Thromboembolism | | 3. Vigabatrin | 3. Pregnancy | | 4. Estrogen preparations | 4. Head injury |
- A. A-1, B-3, C-2, D-4
- B. A-4, B-1, C-3, D-2 (Correct Answer)
- C. A-3, B-2, C-4, D-1
- D. A-2, B-4, C-1, D-3
Explanation: ***A-4, B-1, C-3, D-2*** - **Morphine** is contraindicated in **head injury** as it can increase intracranial pressure and mask neurological symptoms. - **Amiodarone** is contraindicated in patients with **QT prolongation** due to its risk of inducing more severe arrhythmias like Torsades de Pointes. - **Vigabatrin** is contraindicated during **pregnancy** due to its potential for teratogenicity and adverse effects on fetal development. - **Estrogen preparations** are contraindicated in patients with a history of **thromboembolism** due to their increased risk of blood clot formation. *A-1, B-3, C-2, D-4* - This option incorrectly matches **Morphine** with QT prolongation and **Estrogen preparations** with head injury, which are not their primary contraindications. - It also incorrectly links **Vigabatrin** with thromboembolism and **Amiodarone** with pregnancy. *A-3, B-2, C-4, D-1* - This choice incorrectly associates **Morphine** with pregnancy and **Vigabatrin** with head injury, which are not the most critical or direct contraindications. - It also misaligns **Amiodarone** with thromboembolism and **Estrogen preparations** with QT prolongation. *A-2, B-4, C-1, D-3* - This option incorrectly matches **Morphine** with thromboembolism and **Amiodarone** with head injury, which are not their most significant contraindications. - It also incorrectly links **Vigabatrin** with QT prolongation and **Estrogen preparations** with pregnancy.
Question 4: 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 5: Systematic desensitization is a therapeutic technique used in which of the following conditions?
- A. Dissociation
- B. Phobia (Correct Answer)
- C. Schizoid personality
- D. Psychosis
Explanation: **Explanation:** **Systematic Desensitization** is a behavioral therapy technique developed by **Joseph Wolpe**, based on the principle of **Classical Conditioning** (specifically **Reciprocal Inhibition**). The core concept is that a person cannot be anxious and relaxed at the same time. It involves three steps: training in deep muscle relaxation (Jacobson’s Progressive Muscle Relaxation), constructing a hierarchy of anxiety-provoking stimuli, and gradual exposure to these stimuli while maintaining a relaxed state. * **Why Phobia is Correct:** Systematic desensitization is the treatment of choice for **Specific Phobias** (e.g., fear of heights, spiders). By pairing the feared object with relaxation, the "anxiety response" is replaced by a "relaxation response" (Counter-conditioning). **Analysis of Incorrect Options:** * **Dissociation:** Managed primarily through supportive psychotherapy, hypnosis, or "Amobarbital interviews" to recover repressed memories, rather than behavioral conditioning. * **Schizoid Personality:** This is a personality disorder characterized by social detachment. Treatment focuses on social skills training or supportive therapy; desensitization is ineffective as there is no specific phobic stimulus. * **Psychosis:** Conditions like Schizophrenia require pharmacotherapy (Antipsychotics). Behavioral therapies are used only for social rehabilitation, not for treating core psychotic symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Founder:** Joseph Wolpe. * **Basis:** Reciprocal Inhibition / Counter-conditioning. * **Hierarchy:** Uses the **SUD scale** (Subjective Units of Distress) to rank fears. * **In-vivo vs. Imaginal:** While Wolpe used imaginal exposure, **In-vivo exposure** (real-life) is now considered more effective for most phobias. * **Flooding:** A related technique where the patient is exposed to the maximum intensity of the feared stimulus immediately (preventing the avoidance response).
Question 6: What are the indications for Electroconvulsive Therapy (ECT)?
- A. Paranoid schizophrenia
- B. Depression with suicidal tendency (Correct Answer)
- C. Neurotic depression
- D. All of the above
Explanation: **Explanation:** Electroconvulsive Therapy (ECT) is a biological treatment involving the induction of a generalized seizure through electrical stimulation. In modern psychiatry, the primary indication for ECT is when a **rapid clinical response** is required or when pharmacological treatments have failed. **Why Option B is Correct:** Severe **Depression with suicidal tendency** is the absolute first-line indication for ECT. When a patient is actively suicidal, the 2–4 week lag period of antidepressants is too risky. ECT provides the fastest reduction in depressive symptoms and suicidal ideation, making it a life-saving intervention in emergency psychiatry. Other major indications include severe catatonia and treatment-resistant mania. **Why Other Options are Incorrect:** * **A. Paranoid Schizophrenia:** While ECT can be used as an adjunct in schizophrenia (especially if catatonic or affective symptoms are present), it is not the primary or first-line treatment. Antipsychotics remain the mainstay. * **C. Neurotic Depression:** Also known as Dysthymia or Persistent Depressive Disorder, this condition is characterized by low-grade, chronic symptoms often linked to personality and psychosocial stressors. It responds better to psychotherapy and SSRIs; ECT is generally ineffective for non-psychotic, neurotic-level depression. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves). * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication due to the risk of brain herniation. * **Modified ECT:** Involves the use of an anesthetic (Thiopental/Propofol) and a muscle relaxant (**Succinylcholine**) to prevent bone fractures. * **Electrode Placement:** Bilateral (Gold standard for efficacy) vs. Unilateral (Lower cognitive side effects).
Question 7: A child who wins the first prize in school is given chocolates that he likes. He tends to get high marks in the future. This scenario best illustrates which line of therapy?
- A. Interpersonal therapy
- B. Behavior therapy (Correct Answer)
- C. Dialectic therapy
- D. Dynamic therapy
Explanation: ### Explanation The scenario described is a classic example of **Operant Conditioning**, a core principle of **Behavior Therapy**. **Why Behavior Therapy is Correct:** The child’s behavior (studying hard/winning a prize) is followed by a rewarding stimulus (chocolates). This is known as **Positive Reinforcement**. According to B.F. Skinner’s theory of Operant Conditioning, when a behavior is followed by a desirable consequence, the probability of that behavior being repeated in the future increases. Behavior therapy focuses on modifying observable actions through reinforcement, punishment, or extinction. **Analysis of Incorrect Options:** * **A. Interpersonal Therapy (IPT):** Focuses on improving current interpersonal relationships and social functioning to resolve symptoms (commonly used in depression). It does not use reward-based conditioning. * **C. Dialectical Behavior Therapy (DBT):** A specific type of CBT used primarily for Borderline Personality Disorder. it focuses on emotional regulation, distress tolerance, and mindfulness. * **D. Dynamic Therapy:** Based on Psychoanalysis (Freud), it explores unconscious conflicts, childhood experiences, and defense mechanisms rather than focusing on immediate behavioral modification through rewards. **High-Yield Clinical Pearls for NEET-PG:** * **Positive Reinforcement:** Adding a pleasant stimulus to increase behavior (e.g., chocolates for high marks). * **Negative Reinforcement:** Removing an unpleasant stimulus to increase behavior (e.g., taking an aspirin to remove a headache). * **Token Economy:** A specialized form of behavior therapy often used in psychiatric wards where patients earn "tokens" (secondary reinforcers) for desired behaviors, which can be exchanged for rewards. * **Systematic Desensitization:** Another behavior therapy technique based on *Classical Conditioning* (Wolpe) used for phobias.
Question 8: All of the following psychotherapy modalities are used to treat anxiety disorders except?
- A. Systemic desensitization
- B. Relaxation techniques
- C. Flooding
- D. Sensate focus therapy (Correct Answer)
Explanation: ### Explanation The correct answer is **D. Sensate focus therapy**. **1. Why Sensate Focus Therapy is the correct answer:** Sensate focus therapy is a specific behavioral technique developed by **Masters and Johnson**. It is primarily used to treat **sexual dysfunctions** (such as erectile dysfunction, premature ejaculation, and female orgasmic disorder) by reducing "spectatoring" and performance anxiety during intimacy. It involves a series of graduated touching exercises where the focus is on physical sensation rather than sexual arousal or intercourse. It is **not** a primary modality for generalized or phobic anxiety disorders. **2. Analysis of Incorrect Options (Used in Anxiety Disorders):** * **A. Systematic Desensitization:** Developed by **Joseph Wolpe**, this is a classic behavioral therapy for **Phobias**. It involves pairing a relaxation response with a hierarchy of anxiety-provoking stimuli (counter-conditioning). * **B. Relaxation Techniques:** Methods like Jacobson’s Progressive Muscle Relaxation (JPMR) and deep breathing are core components in managing **Generalized Anxiety Disorder (GAD)** and Panic Disorder to physiological arousal. * **C. Flooding:** This is a form of exposure therapy where the patient is directly exposed to their maximum feared stimulus for a prolonged period until the anxiety response extinguishes. It is used for **Specific Phobias** and **PTSD**. **3. Clinical Pearls for NEET-PG:** * **Reciprocal Inhibition:** The underlying principle of Systematic Desensitization (one cannot be relaxed and anxious simultaneously). * **Spectatoring:** A key concept in Sensate Focus where the individual monitors their own sexual performance from a third-person perspective, leading to dysfunction. * **First-line Psychotherapy:** For most anxiety disorders (OCD, Panic, Phobias), **Cognitive Behavioral Therapy (CBT)** is considered the gold standard.
Question 9: Cognitive therapy for depression was developed by whom?
- A. Ellis
- B. Beck (Correct Answer)
- C. Godfrey
- D. Meicheinbanon
Explanation: **Explanation:** **Correct Answer: B. Beck** Cognitive Therapy (CT) was developed by **Aaron T. Beck** in the 1960s. The core concept is that depression is maintained by distorted thinking patterns. Beck identified the **"Cognitive Triad"** of depression, which consists of negative views about: 1. **The Self** (e.g., "I am worthless") 2. **The World/Environment** (e.g., "Everything is unfair") 3. **The Future** (e.g., "Things will never get better") The therapy aims to identify and challenge these "automatic negative thoughts" and underlying maladaptive schemas. **Incorrect Options:** * **A. Ellis:** Albert Ellis developed **Rational Emotive Behavior Therapy (REBT)**. While it is a form of CBT, it focuses on the "ABC" model (Activating event, Beliefs, Consequences) and uses more confrontational techniques to dispute irrational beliefs. * **C. Godfrey:** This is a distractor and is not associated with a major school of psychotherapy relevant to NEET-PG. * **D. Meichenbaum:** Donald Meichenbaum is known for **Cognitive Behavior Modification** and **Stress Inoculation Training (SIT)**, which helps patients prepare for stressful events using self-instructional training. **High-Yield Clinical Pearls for NEET-PG:** * **Cognitive Distortions:** Common examples include *Arbitrary Inference* (jumping to conclusions) and *All-or-nothing thinking*. * **Indication:** CBT is the first-line non-pharmacological treatment for mild-to-moderate depression and anxiety disorders. * **Dialectical Behavior Therapy (DBT):** Developed by **Marsha Linehan**, specifically for Borderline Personality Disorder. * **Interpersonal Therapy (IPT):** Developed by **Klerman and Weissman**, focusing on social roles and relationships.
Question 10: Deep brain stimulation is used in the treatment of which of the following conditions?
- A. Depression
- B. Parkinsonism (Correct Answer)
- C. Dementia
- D. Delirium
Explanation: **Explanation:** **Deep Brain Stimulation (DBS)** is a neurosurgical procedure involving the implantation of electrodes into specific brain targets, which are connected to an implanted pulse generator (IPG). It acts as a "brain pacemaker" to modulate abnormal neural activity. **Why Parkinsonism is Correct:** DBS is a well-established, FDA-approved treatment for advanced **Parkinson’s disease**, particularly when motor fluctuations (like dyskinesia) become refractory to medical therapy (Levodopa). The most common targets are the **Subthalamic Nucleus (STN)** and the **Globus Pallidus interna (GPi)**. By delivering high-frequency electrical stimulation, DBS suppresses the overactive inhibitory output of these nuclei, thereby improving tremors, rigidity, and bradykinesia. **Why Other Options are Incorrect:** * **Depression:** While DBS is being researched for treatment-resistant depression (targeting the Subgenual Cingulate Cortex/Area 25), it is **not** a standard or first-line treatment. Electroconvulsive Therapy (ECT) remains the gold standard for refractory depression. * **Dementia & Delirium:** These are characterized by diffuse cortical dysfunction or acute metabolic/toxic insults. DBS is a focal neuromodulation technique and is not indicated for the global cognitive decline of dementia or the acute fluctuating sensorium of delirium. **High-Yield Clinical Pearls for NEET-PG:** * **Psychiatric Indications:** In psychiatry, the only FDA-approved use for DBS (under a Humanitarian Device Exemption) is for **Refractory Obsessive-Compulsive Disorder (OCD)**. The target is the **Ventral Striatum/Internal Capsule**. * **Other Targets:** * Essential Tremor: Ventral Intermediate Nucleus (Vim) of the Thalamus. * Dystonia: Globus Pallidus interna (GPi). * **Contraindication:** DBS is generally avoided in patients with significant cognitive impairment or active psychosis.
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