Evidence-Based Psychotherapy Practices — MCQs
For which condition is behaviour therapy helpful?
Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
In which of the following conditions is behavior therapy considered most effective?
Best therapy suited to teach daily life skills to a child with intellectual disability:
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?
Which conditioning principle can be used to remove many of our day-to-day bad habits?
All of the following psychotherapy modalities are used to treat anxiety disorders except?
Evidence-Based Psychotherapy Practices Indian Medical PG Practice Questions and MCQs
Question 1: For which condition is behaviour therapy helpful?
- A. Schizophrenia
- B. Personality Disorder
- C. Agoraphobia (Correct Answer)
- D. Neurotic depression
Explanation: ***Agoraphobia*** - **Behavior therapy**, especially **exposure therapy**, is highly effective for agoraphobia by gradually exposing individuals to feared situations. - It helps patients learn new coping mechanisms and reduce avoidance behaviors associated with anxiety. *Schizophrenia* - While supportive and skills-based therapies can be beneficial, **behavior therapy alone is not the primary or most effective treatment** for core psychotic symptoms. - Treatment typically involves **antipsychotic medication** combined with psychotherapy. *Personality Disorder* - **Dialectical behavior therapy (DBT)**, a specific type of cognitive-behavioral therapy, is effective for some personality disorders, particularly **borderline personality disorder**, but general behavior therapy alone is not comprehensive enough for the broad spectrum of personality disorders. - These conditions often require a **multi-modal approach** addressing deep-seated thought patterns and relationship issues. *Neurotic depression* - **Cognitive-behavioral therapy (CBT)** is an effective treatment for depression, but it is a broader approach that includes cognitive restructuring in addition to behavioral techniques. - Purely behavioral interventions may address some symptoms but often don't tackle the underlying cognitive distortions common in depression.
Question 2: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
- A. Cognitive behavioral therapy
- B. SSRIs
- C. Clomipramine
- D. Systematic desensitisation (Correct Answer)
Explanation: ***Systematic desensitisation*** - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where avoidance is a key feature and a clear, single trigger can be identified. - While it involves exposure, the gradual hierarchy and relaxation training are less effective for the complex, intrusive thoughts and compulsive rituals characteristic of **OCD**. *Cognitive behavioral therapy* - **CBT, particularly Exposure and Response Prevention (ERP)**, is considered the gold standard psychotherapy for OCD. - It directly addresses the **obsessions** by exposing the individual to feared thoughts or situations and then preventing the ritualistic responses. *SSRIs* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the availability of **serotonin** in the brain. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant (TCA) with potent **serotonergic effects**, making it highly effective in treating OCD, often when SSRIs are partially effective or not tolerated. - It is specifically approved for OCD and is sometimes considered a second-line or augmentation strategy.
Question 3: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Question 4: Best therapy suited to teach daily life skills to a child with intellectual disability:
- A. Applied Behavior Analysis (ABA) (Correct Answer)
- B. Cognitive Behavioral Therapy (CBT)
- C. Social skills training
- D. Self-instructional training
Explanation: **Applied Behavior Analysis (ABA)** - **ABA** is a highly structured, evidence-based therapy that focuses on teaching specific skills by breaking them down into smaller steps and using **positive reinforcement**. - It is particularly effective for children with intellectual disabilities in acquiring **adaptive daily living skills**, communication, and social behaviors. *Cognitive Behavioral Therapy (CBT)* - **CBT** primarily targets changing negative thought patterns and behaviors, requiring a level of abstract reasoning that may be challenging for children with significant intellectual disabilities. - While it can be adapted, its core methods rely on cognitive processes that might not be the most direct approach for teaching basic daily life skills to a mentally challenged child. *Social skills training* - **Social skills training** focuses specifically on improving social interactions and communication within social contexts. - While important for overall development, it is a subcomponent of broader skill development and may not directly address all aspects of **daily living skills** in a comprehensive manner. *Self-instructional training* - **Self-instructional training** involves teaching individuals to guide themselves through tasks using internal speech or self-talk, which relies on a child's ability to internalize and follow complex verbal instructions. - This approach might be too cognitively demanding for a child with significant developmental delays when the primary goal is mastering basic, functional daily life skills.
Question 5: 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 6: 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 7: 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 8: 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 9: Which conditioning principle can be used to remove many of our day-to-day bad habits?
- A. Positive conditioning
- B. Negative conditioning (Correct Answer)
- C. Biofeedback
- D. Generalization
Explanation: **Explanation:** The correct answer is **Negative Conditioning** (often referred to in behavioral therapy as **Aversion Therapy**). **1. Why Negative Conditioning is Correct:** Negative conditioning involves the association of an undesirable habit with an unpleasant or painful stimulus. In the context of behavioral modification, this is based on **Classical Conditioning** principles. When a "bad habit" (the conditioned stimulus) is repeatedly paired with an aversive stimulus (like a mild electric shock, a bitter taste, or an emetic drug), the individual develops an association between the habit and the unpleasant sensation. Eventually, the habit itself triggers a feeling of aversion, leading to its cessation. This is a standard technique used to treat habits like nail-biting, smoking, or alcohol dependence (e.g., using Disulfiram). **2. Why Other Options are Incorrect:** * **Positive Conditioning:** This involves reinforcing a behavior by providing a reward. While useful for building *new* healthy habits, it is generally less effective than aversion for rapidly *removing* deep-seated maladaptive behaviors. * **Biofeedback:** This is a technique where patients learn to control involuntary physiological functions (like heart rate or muscle tension) using visual or auditory feedback. It is primarily used for stress, migraine, and hypertension, not for breaking general bad habits. * **Generalization:** This is a learning phenomenon where a response conditioned to one stimulus is elicited by similar stimuli. It is a process of learning, not a therapeutic technique for habit reversal. **Clinical Pearls for NEET-PG:** * **Aversion Therapy** is a classic example of **Counter-conditioning**. * **Disulfiram (Antabuse)** therapy for alcohol use disorder is the most common clinical application of aversion conditioning. * **Covert Sensitization** is a variation where the aversive stimulus is merely imagined (e.g., imagining vomiting while thinking of a cigarette).
Question 10: 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.
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