Psychotherapies — MCQs

Psychotherapies Indian Medical PG Practice Questions and MCQs

Question 21: Psychoanalysis was founded by which of the following scientists?

A. Eysenck
B. Sigmund Freud (Correct Answer)
C. Carl Jung
D. Alfred Alder

Explanation: **Explanation:** **Sigmund Freud (Option B)** is the founder of **Psychoanalysis**, a clinical method for treating psychopathology through dialogue between a patient and a psychoanalyst. Freud introduced revolutionary concepts such as the **unconscious mind**, the structure of personality (**Id, Ego, and Superego**), and the stages of **psychosexual development**. His work emphasizes that adult personality and psychological conflicts are largely determined by repressed childhood experiences and unconscious drives. **Analysis of Incorrect Options:** * **Eysenck (Option A):** Hans Eysenck was a personality theorist known for the **PEN model** (Psychoticism, Extraversion, and Neuroticism). He was famously critical of psychoanalysis, arguing it lacked scientific empirical evidence. * **Carl Jung (Option C):** A former associate of Freud, Jung broke away to found **Analytical Psychology**. He introduced concepts like the **collective unconscious**, archetypes, and the distinction between introversion and extroversion. * **Alfred Adler (Option D):** Another former associate of Freud, Adler founded **Individual Psychology**. He shifted the focus from sexual drives to the **"Inferiority Complex"** and the drive for superiority/social belonging. **High-Yield Clinical Pearls for NEET-PG:** * **Free Association:** The primary technique in psychoanalysis where the patient speaks whatever comes to mind. * **Transference:** A phenomenon where the patient redirects feelings for significant others onto the therapist (a key tool in psychoanalytic treatment). * **Defense Mechanisms:** Freud’s daughter, Anna Freud, further codified these (e.g., Projection, Sublimation, Reaction Formation), which are frequently tested in NEET-PG. * **Father of Behaviorism:** John B. Watson (often confused with founders of psychotherapy).

Question 22: Which condition is typically associated with the 'semen squeeze' technique?

A. Erectile dysfunction
B. Premature ejaculation (Correct Answer)
C. Retrograde ejaculation
D. Antegrade ejaculation

Explanation: **Explanation:** The **'Semen Squeeze' technique** (developed by Masters and Johnson) is a behavioral therapy specifically designed for the management of **Premature Ejaculation (PE)**. The underlying medical concept is to increase the patient's awareness of the sensations preceding ejaculation and to improve voluntary control over the ejaculatory reflex. During sexual activity, when the patient feels the urge to ejaculate, the partner applies firm pressure to the glans penis for several seconds. This pressure causes a temporary loss of the urge to ejaculate and a slight decrease in erection, allowing the couple to resume activity and prolong the duration of intercourse. **Analysis of Incorrect Options:** * **Erectile Dysfunction (A):** This refers to the inability to achieve or maintain an erection. It is primarily managed with PDE-5 inhibitors (e.g., Sildenafil) or vacuum devices, not techniques meant to delay ejaculation. * **Retrograde Ejaculation (C):** This is a physiological condition where semen enters the bladder instead of exiting through the urethra. It is often caused by surgery (TURP) or medications (Alpha-blockers) and cannot be corrected by behavioral squeeze techniques. * **Antegrade Ejaculation (D):** This is the normal physiological process of ejaculation. It is not a clinical condition requiring therapeutic intervention. **High-Yield Clinical Pearls for NEET-PG:** * **Stop-Start Technique (Semans Technique):** Another common behavioral therapy for PE where stimulation is stopped just before the "point of ejaculatory inevitability." * **Pharmacotherapy for PE:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line medical treatment. **Dapoxetine** is specifically approved for PE due to its rapid onset and short half-life. * **Sensate Focus:** A broader behavioral technique used for various sexual dysfunctions (including ED and PE) focusing on non-genital touching to reduce performance anxiety.

Question 23: Providing 'limited information' as part of the therapy process is part of which of the following therapies?

A. ERP
B. PLISSIT (Correct Answer)
C. DBT
D. BEBT

Explanation: **Explanation:** The correct answer is **PLISSIT (Option B)**. The **PLISSIT model**, developed by Jack Annon in 1974, is a stepped-care framework used in **Sexual Therapy** to address sexual dysfunction. It consists of four levels of intervention: 1. **P (Permission):** Giving the patient permission to talk about their concerns and reassuring them that their feelings/actions are normal. 2. **LI (Limited Information):** Providing specific factual information directly related to the patient’s concern (e.g., explaining normal anatomy or the effects of aging on arousal) to dispel myths. 3. **SS (Specific Suggestions):** Giving direct instructions or "homework" to solve a specific problem (e.g., Sensate Focus exercises). 4. **IT (Intensive Therapy):** Referral for specialized psychiatric or medical treatment for complex underlying issues. **Why other options are incorrect:** * **A. ERP (Exposure and Response Prevention):** The gold standard behavioral therapy for **OCD**. It involves exposing the patient to anxiety-provoking stimuli while preventing the ritualistic behavior. * **C. DBT (Dialectical Behavior Therapy):** A specialized form of CBT used primarily for **Borderline Personality Disorder**. It focuses on mindfulness, emotional regulation, and distress tolerance. * **D. BEBT:** This is not a standard psychiatric acronym; it may be a distractor for CBT (Cognitive Behavioral Therapy) or REBT (Rational Emotive Behavior Therapy). **High-Yield Clinical Pearls for NEET-PG:** * The first three stages of PLISSIT (P, LI, SS) can be performed by general practitioners; only **IT** requires a specialist. * **Sensate Focus** (developed by Masters and Johnson) is the most common "Specific Suggestion" used in sexual therapy. * **ERP** is the treatment of choice for OCD, while **DBT** is the treatment of choice for BPD and chronic suicidality.

Question 24: Memory disturbance following Electroconvulsive Therapy (ECT) typically resolves within what timeframe?

A. A few days to a few weeks
B. A few weeks to a few months (Correct Answer)
C. A few months to a year
D. Permanent

Explanation: **Explanation:** Memory disturbance is the most common side effect of Electroconvulsive Therapy (ECT). It typically manifests in two forms: **Anterograde amnesia** (difficulty forming new memories), which resolves rapidly after treatment, and **Retrograde amnesia** (difficulty recalling past events), which is more persistent. **Why Option B is Correct:** While the acute confusion (post-ictal state) clears within hours, the formal memory deficits—specifically retrograde amnesia—typically follow a recovery curve where the most significant improvement occurs within **a few weeks to a few months** (usually 1–6 months). Most patients eventually return to their cognitive baseline, though some may have "spotty" permanent gaps for events occurring right around the time of treatment. **Analysis of Incorrect Options:** * **Option A:** A few days is too short for the resolution of retrograde amnesia, though it may be sufficient for the resolution of acute post-ictal delirium. * **Option C:** While some patients report subjective deficits for longer, objective neuropsychological testing usually shows recovery much earlier than a year. * **Option D:** ECT does not cause permanent global intellectual impairment or dementia. Permanent memory loss is usually limited to the specific period surrounding the course of ECT. **High-Yield Clinical Pearls for NEET-PG:** * **Type of ECT:** Bilateral ECT causes more memory impairment than Unilateral ECT. * **Brief Pulse vs. Sine Wave:** Brief pulse stimulation (modern standard) is associated with fewer cognitive side effects than the older sine wave stimulation. * **Electrode Placement:** Right unilateral (d'Elia placement) is the preferred method to minimize verbal memory deficits. * **Mortality:** The mortality rate of ECT is approximately 0.01% (similar to minor general anesthesia). * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication.

Question 25: Which of the following is a contraindication for electroconvulsive therapy?

A. First-trimester pregnancy
B. Elderly
C. Raised intracranial pressure (Correct Answer)
D. Catatonia

Explanation: ### Explanation **Correct Option: C. Raised intracranial pressure (ICP)** Electroconvulsive therapy (ECT) involves the induction of a generalized seizure, which leads to a significant physiological surge in blood pressure and cerebral blood flow. In patients with **raised intracranial pressure** (e.g., due to a brain tumor or hemorrhage), this surge can lead to **uncal herniation** or brainstem compression, making it the only absolute contraindication (though many modern texts now classify it as a "high-risk" relative contraindication). **Analysis of Incorrect Options:** * **A. First-trimester pregnancy:** ECT is considered safe and effective during all trimesters of pregnancy. It is often preferred over pharmacotherapy for severe depression or psychosis to avoid potential teratogenic effects of medications. * **B. Elderly:** Age is not a contraindication. In fact, ECT is highly effective in the elderly, especially for "melancholic depression" or patients who cannot tolerate the side effects of tricyclic antidepressants or SSRIs. * **C. Catatonia:** This is actually a **prime indication** for ECT. ECT is the treatment of choice for life-threatening catatonia (Lethal Catatonia) if there is a poor response to benzodiazepines (Lorazepam). **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** Classically, there are **no absolute contraindications** to ECT, but raised ICP is the most dangerous condition. * **Recent Myocardial Infarction (MI):** A recent MI (within the last 3 months) is the most common **cardiovascular** high-risk factor. * **Mechanism of Action:** The therapeutic effect of ECT is derived from the **seizure activity** itself, not the electrical current. * **Most Common Side Effect:** Retrograde and anterograde amnesia (usually transient). * **Mortality Rate:** Approximately 2 per 100,000 treatments (similar to minor surgical procedures involving general anesthesia).

Question 26: Sigmund Freud is associated with which of the following?

A. Group Psychotherapy
B. Psychoanalysis (Correct Answer)
C. Sociogram
D. Cognitive Behavior Therapy

Explanation: **Explanation:** **Sigmund Freud** is universally recognized as the father of **Psychoanalysis**. This therapeutic approach is based on the theory that unconscious conflicts, often rooted in childhood experiences, drive human behavior and psychiatric symptoms. The goal of psychoanalysis is to bring these unconscious thoughts into the conscious mind through techniques like free association, dream analysis, and the exploration of transference. **Analysis of Options:** * **A. Group Psychotherapy:** While many contributed to this field, **Joseph Pratt** is credited with its earliest use, and **Irvin Yalom** is a key modern figure. Freud focused primarily on the individual psyche. * **C. Sociogram:** This is a graphic representation of social links and relationships within a group, developed by **Jacob L. Moreno** (who also pioneered Psychodrama). * **D. Cognitive Behavior Therapy (CBT):** This is a structured, short-term therapy focusing on the "here and now." It was developed by **Aaron T. Beck** (Cognitive Therapy) and **Albert Ellis** (REBT), moving away from the long-term, past-oriented focus of Freud’s psychoanalysis. **High-Yield Clinical Pearls for NEET-PG:** * **Freud’s Structural Model:** Id (pleasure principle), Ego (reality principle), and Superego (morality principle). * **Topographical Model:** Conscious, Preconscious, and Unconscious. * **Defense Mechanisms:** Freud’s daughter, **Anna Freud**, significantly expanded the study of ego defense mechanisms (e.g., Projection, Sublimation, Reaction Formation). * **Transference:** The patient’s unconscious displacement of feelings for a significant person onto the therapist—a cornerstone of psychoanalytic treatment.

Question 27: Which of the following statements is true regarding transcranial magnetic stimulation (TMS)?

A. Does not require general anesthesia.
B. Seizures are not required for therapeutic effects.
C. It is a non-invasive central nervous system stimulant.
D. All of the above (Correct Answer)

Explanation: **Explanation:** Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation technique used primarily in treatment-resistant depression. It works on the principle of **electromagnetic induction**, where a coil placed against the scalp generates rapidly changing magnetic fields. these fields pass through the skull and induce electrical currents in specific cortical regions (usually the dorsolateral prefrontal cortex). **Why Option D is correct:** * **Option A (No General Anesthesia):** Unlike Electroconvulsive Therapy (ECT), TMS does not cause systemic convulsions or loss of consciousness. Therefore, it is an outpatient procedure that requires no anesthesia or muscle relaxants. * **Option B (Seizures not required):** The therapeutic mechanism of TMS is the modulation of neuronal firing and neuroplasticity, not the induction of a generalized seizure. In fact, a seizure is considered a rare adverse effect of TMS, not a goal. * **Option C (Non-invasive CNS stimulant):** TMS is non-invasive as it does not require surgery or electrode implantation. High-frequency TMS (>5 Hz) typically acts as a stimulant to the underlying cortical neurons. **High-Yield Clinical Pearls for NEET-PG:** * **FDA Approval:** Major Depressive Disorder (MDD), OCD, Migraine with aura, and Smoking Cessation. * **Most Common Side Effect:** Headache and scalp discomfort at the site of stimulation. * **Most Serious Side Effect:** Accidental induction of a seizure (rare). * **Contraindication:** Presence of metallic implants in or near the head (e.g., cochlear implants, aneurysm clips, or pacemakers) due to the magnetic field. * **Comparison with ECT:** TMS is less effective than ECT for severe/psychotic depression but has a superior cognitive safety profile (no memory loss).

Question 28: Electroconvulsive therapy is indicated in:

A. Psychotic symptoms (Correct Answer)
B. Neurotic symptoms
C. Dissociative symptoms
D. Affective symptoms

Explanation: **Explanation:** Electroconvulsive Therapy (ECT) is a biological treatment that involves inducing a generalized seizure through an electrical stimulus. It is primarily indicated for severe psychiatric conditions where a rapid response is required or medications have failed. **1. Why Psychotic Symptoms is Correct:** ECT is highly effective for severe **psychotic symptoms**, particularly those associated with **Schizophrenia** (especially the catatonic subtype) and **Schizoaffective disorder**. In the context of this question, "Psychotic symptoms" represents a core indication, as ECT is a first-line treatment for **Catatonia** (regardless of etiology) and is used for treatment-resistant psychosis. **2. Why the other options are incorrect:** * **Neurotic symptoms (B):** These include mild anxiety and phobias. ECT is not indicated for neuroses; these are managed with psychotherapy (CBT) or anxiolytics. * **Dissociative symptoms (C):** These are typically rooted in psychological trauma. The mainstay of treatment is psychotherapy (e.g., hypnosis or abreaction), not biological brain stimulation. * **Affective symptoms (D):** While ECT is excellent for *Major Depressive Disorder* (a specific affective disorder), the term "affective symptoms" is too broad. It can include mild mood swings or dysthymia, which do not warrant ECT. Between A and D, "Psychotic symptoms" (specifically Catatonia/Severe Psychosis) is often prioritized in standardized exams as a definitive indication. **Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** Increased Intracranial Pressure (ICP). * **Most Common Side Effect:** Retrograde amnesia. * **Drug of Choice for Anesthesia:** Methohexital (Barbiturate). * **Muscle Relaxant used:** Succinylcholine. * **Mortality Rate:** Approximately 0.01% (similar to minor surgical procedures).

Question 29: Flooding is a method of treatment in which condition?

A. Phobia (Correct Answer)
B. Depression
C. Schizophrenia
D. Organic brain syndrome

Explanation: **Explanation:** **Flooding** is a behavioral therapy technique based on the principle of **classical conditioning (extinction)**. It is primarily used to treat **Phobias** and certain anxiety disorders. 1. **Why Option A is Correct:** In flooding, the patient is exposed directly and immediately to their most feared stimulus (e.g., being in a room full of spiders) for a prolonged period. Unlike systematic desensitization, which uses a gradual hierarchy, flooding prevents the patient from using avoidance behaviors. Eventually, the anxiety response "exhausts" itself, and the patient realizes the feared outcome does not occur, leading to the extinction of the conditioned fear response. 2. **Why Incorrect Options are Wrong:** * **Depression:** Treated primarily with Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, or pharmacotherapy (SSRIs). Flooding would be ineffective and potentially distressing. * **Schizophrenia:** A psychotic disorder requiring antipsychotics and social skills training. Behavioral exposure therapies have no role in treating core psychotic symptoms. * **Organic Brain Syndrome:** These are physical/medical causes of mental impairment (e.g., delirium, dementia). Treatment focuses on addressing the underlying medical etiology. **High-Yield Clinical Pearls for NEET-PG:** * **Implosion Therapy:** Similar to flooding but uses **imagination** rather than real-life (in-vivo) exposure. * **Systematic Desensitization:** Developed by **Joseph Wolpe**; uses reciprocal inhibition (relaxation) and a graded hierarchy. * **Contraindications for Flooding:** Patients with cardiovascular disease or intense panic disorders, as the extreme anxiety induced can be physically taxing. * **Key Mechanism:** Extinction of the conditioned response.

Question 30: ECT is advocated in all of the following conditions except?

A. Chronic Schizophrenia (Correct Answer)
B. Catatonic Schizophrenia
C. Severe depression
D. Severe psychosis

Explanation: **Explanation:** Electroconvulsive Therapy (ECT) is a biological treatment primarily used for rapid symptom relief in severe psychiatric conditions. The core principle for its use is **acuity and severity**, rather than chronicity. **1. Why Chronic Schizophrenia is the Correct Answer:** ECT is generally **ineffective** for chronic schizophrenia, especially when negative symptoms (apathy, withdrawal) or cognitive deficits predominate. In chronic cases, the pathology is often structural or long-standing, making it less responsive to the seizure-induced neurotransmitter modulation of ECT. Antipsychotic maintenance and psychosocial rehabilitation are the mainstays of treatment here. **2. Why the other options are incorrect (Indications for ECT):** * **Catatonic Schizophrenia:** This is a **prime indication**. ECT is highly effective and often life-saving for catatonic stupor or excitement, especially when the patient is not eating or drinking. * **Severe Depression:** ECT is the "Gold Standard" for severe depression, particularly when accompanied by **suicidal ideation**, psychotic features, or treatment resistance. It works faster than antidepressants. * **Severe Psychosis:** Acute psychotic episodes that are refractory to medications or where rapid stabilization is needed (e.g., acute mania or schizoaffective disorder) respond well to ECT. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** Increased Intracranial Pressure (ICT) – due to risk of brain herniation. * **Most Common Side Effect:** Retrograde amnesia (usually transient). * **Mortality Rate:** Approximately 0.01% (similar to general anesthesia). * **Mechanism:** It involves the induction of a generalized tonic-clonic seizure lasting at least 25–30 seconds. * **Electrode Placement:** Bilateral (more effective) vs. Unilateral (fewer cognitive side effects).

Practice by Chapter

Principles of Psychotherapy

Practice Questions

Psychodynamic Psychotherapy

Practice Questions

Cognitive-Behavioral Therapy

Practice Questions

Interpersonal Psychotherapy

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Supportive Psychotherapy

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Group Psychotherapy

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Family Therapy

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Couple Therapy

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Brief Psychotherapies

Practice Questions

Mindfulness-Based Therapies

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Integration of Psychotherapy and Pharmacotherapy

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Evidence-Based Psychotherapy Practices

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