Psychotherapies — MCQs

Psychotherapies Indian Medical PG Practice Questions and MCQs

Question 41: A 25-year-old man is seeing a male psychologist for dynamic psychotherapy. He feels very angry with the psychologist, perceiving that the psychologist is exerting his authority similarly to his abusive father. What is this phenomenon known as?

A. Acting out
B. Boundary violation
C. Transference (Correct Answer)
D. Resistance

Explanation: **Explanation:** The correct answer is **C. Transference**. **1. Why Transference is correct:** Transference is a core concept in psychodynamic psychotherapy. It occurs when a patient unconsciously redirects (transfers) feelings, desires, and expectations from significant figures in their past (usually parents) onto the therapist. In this scenario, the patient is projecting the anger and perception of authority associated with his **abusive father** onto the **psychologist**. This is a classic example of **negative transference**. **2. Why the other options are incorrect:** * **A. Acting out:** This refers to the expression of unconscious conflicts through physical actions rather than verbalizing them (e.g., storming out of a session). While the patient feels angry, the question describes a psychological perception/projection, not a specific impulsive action. * **B. Boundary violation:** This occurs when a therapist breaches the professional/ethical limits of the therapeutic relationship (e.g., sexual intimacy or financial dealings). The scenario describes the patient's internal perception, not a breach of professional conduct. * **C. Resistance:** This refers to any unconscious attempt by the patient to block the progress of therapy or avoid bringing repressed material into consciousness (e.g., being late, silence). While transference can lead to resistance, the specific phenomenon of projecting past figures onto the therapist is transference. **Clinical Pearls for NEET-PG:** * **Counter-transference:** When the *therapist* projects their own unconscious feelings onto the patient. * **Positive Transference:** When the patient projects feelings of love, admiration, or idealization onto the therapist. * **Therapeutic Alliance:** The collaborative relationship between therapist and patient; managing transference is key to maintaining this alliance in dynamic therapy. * **Identification:** A defense mechanism where a person patterns themselves after another person (often the "aggressor").

Question 42: Applied tension is used for which of the following conditions?

A. Agoraphobia
B. Blood-injection phobia (Correct Answer)
C. Movement disorders
D. Thanatophobia

Explanation: **Explanation:** **Applied Tension** is a specialized behavioral technique specifically designed for **Blood-Injection-Injury (BII) Phobia**. **Why it is the correct answer:** Unlike most phobias, which are characterized by sympathetic overactivity (tachycardia and hypertension), BII phobia involves a unique **biphasic response**. Initially, there is a brief rise in heart rate, followed by a sudden, dramatic drop in blood pressure and heart rate due to a **vasovagal reflex**. This often leads to fainting (syncope). Applied tension involves tensing the large muscle groups (arms, legs, and trunk) for 10–15 seconds when the patient feels the onset of a faint. This increases peripheral resistance and blood pressure, effectively preventing syncope during exposure to needles or blood. **Why the other options are incorrect:** * **Agoraphobia:** This is treated primarily with **Graded Exposure** or **Systematic Desensitization**. Patients here experience panic, not vasovagal syncope. * **Movement disorders:** These are typically managed pharmacologically (e.g., anticholinergics or dopamine antagonists) or with Habit Reversal Training (for tics). * **Thanatophobia (Fear of death):** This is a specific phobia or a component of anxiety disorders, usually managed with Cognitive Behavioral Therapy (CBT) rather than physical tension techniques. **High-Yield Clinical Pearls for NEET-PG:** * **BII Phobia** is the only phobia where **fainting** is a common symptom. * **Applied Relaxation** is used for Generalized Anxiety Disorder (GAD), whereas **Applied Tension** is specific to BII phobia. * The goal of Applied Tension is to counteract the **vasovagal syncope** by increasing blood pressure.

Question 43: Who pioneered behavioral therapy?

A. B.F. Skinner (Correct Answer)
B. Sigmund Freud
C. Konrad Lorenz
D. Aaron Beck

Explanation: **Explanation:** **B.F. Skinner (Option A)** is considered the pioneer of behavioral therapy through his development of **Operant Conditioning**. This psychological principle posits that behavior is determined by its consequences, specifically through reinforcement (increasing behavior) and punishment (decreasing behavior). Behavioral therapy focuses on observable and measurable behaviors rather than unconscious conflicts, utilizing techniques like contingency management and token economies to modify patient actions. **Analysis of Incorrect Options:** * **Sigmund Freud (Option B):** The father of **Psychoanalysis**. His work focused on the unconscious mind, childhood experiences, and defense mechanisms. * **Konrad Lorenz (Option C):** An ethologist famous for his work on **Imprinting** and animal behavior (zoology), rather than clinical psychotherapy. * **Aaron Beck (Option D):** The pioneer of **Cognitive Therapy**. While modern practice often combines the two (Cognitive Behavioral Therapy - CBT), Beck’s specific contribution was identifying "cognitive distortions" and "automatic negative thoughts." **High-Yield Clinical Pearls for NEET-PG:** * **Classical Conditioning:** Pioneered by **Ivan Pavlov** (learning through association; e.g., systematic desensitization). * **Operant Conditioning:** Pioneered by **B.F. Skinner** (learning through consequences). * **Father of Behaviorism:** Often attributed to **John B. Watson**, but Skinner is the key figure for the therapeutic application (Behavioral Therapy). * **Dialectical Behavior Therapy (DBT):** Developed by Marsha Linehan; the gold standard for Borderline Personality Disorder.

Question 44: According to the American Psychiatric Association, what is the maximum cutoff duration for prolonged seizures following electroconvulsive therapy (ECT)?

A. >90 seconds
B. >150 seconds
C. >120 seconds
D. >180 seconds (Correct Answer)

Explanation: **Explanation:** In Electroconvulsive Therapy (ECT), a seizure is considered therapeutic if it lasts at least 20–25 seconds (motor/EEG). However, excessively long seizures can lead to increased post-ictal confusion, cardiovascular stress, and status epilepticus. **1. Why Option D is Correct:** According to the **American Psychiatric Association (APA) Task Force on ECT**, a seizure is defined as **prolonged** if it exceeds **180 seconds (3 minutes)** based on EEG monitoring, or **120 seconds (2 minutes)** based on motor (cuff) manifestations. Since the question asks for the maximum cutoff duration generally cited by the APA, **>180 seconds** is the standard threshold for immediate pharmacological intervention (e.g., intravenous benzodiazepines like Diazepam or Midazolam, or a repeat dose of the induction agent like Propofol). **2. Why Other Options are Incorrect:** * **Option A (>90 seconds):** While a seizure lasting 90 seconds is robustly therapeutic, it does not meet the clinical definition of "prolonged" requiring termination. * **Option B (>150 seconds):** This is an intermediate value not recognized by standard APA guidelines as a specific cutoff. * **Option C (>120 seconds):** This is the cutoff for **motor** seizure duration. However, the APA’s definitive maximum cutoff for EEG-monitored seizures (the gold standard) is 180 seconds. **High-Yield NEET-PG Pearls:** * **Therapeutic Seizure Duration:** Minimum 20–25 seconds. * **Gold Standard Monitoring:** EEG (usually 2-lead). * **Commonest Side Effect:** Retrograde amnesia (most common) and headache. * **Absolute Contraindication:** None (though Increased Intracranial Pressure is the most significant relative contraindication). * **Drug of Choice to terminate prolonged seizure:** IV Diazepam or Midazolam.

Question 45: What are the common side effects of Electroconvulsive Therapy (ECT)?

A. Abortion
B. Stroke
C. Death
D. Body ache (Correct Answer)

Explanation: **Explanation:** Electroconvulsive Therapy (ECT) is a safe and effective biological treatment in psychiatry. Understanding its side-effect profile is crucial for NEET-PG. **Why "Body ache" is the correct answer:** The most common side effects of ECT are **headache, muscle aches (body ache), and nausea**. Body aches occur primarily due to the generalized tonic-clonic seizure induced during the procedure and the use of depolarizing muscle relaxants like **Succinylcholine**, which causes fasciculations before paralysis. While muscle relaxants are used to prevent fractures, residual soreness remains a frequent post-ictal complaint. **Analysis of Incorrect Options:** * **Abortion:** ECT is considered **safe during pregnancy**. It is often the treatment of choice for severe depression or psychosis in pregnant patients when rapid response is needed or to avoid the teratogenic risks of certain medications. * **Stroke:** ECT does not cause strokes. While there is a transient rise in blood pressure and heart rate during the seizure, it is generally well-tolerated. * **Death:** The mortality rate of ECT is extremely low (approximately 2–4 per 100,000 treatments), which is comparable to the risk of general anesthesia for minor surgical procedures. It is not considered a "common" side effect. **Clinical Pearls for NEET-PG:** * **Most Common Side Effect:** Headache/Body ache. * **Most Common Cognitive Side Effect:** Retrograde amnesia (memory of events just before the treatment). * **Absolute Contraindication:** Increased Intracranial Pressure (ICT). * **Drug of Choice for Anesthesia:** Methohexital (Barbiturate). * **Muscle Relaxant of Choice:** Succinylcholine. * **Electrode Placement:** Unilateral (d'Elia placement) is associated with fewer cognitive side effects compared to Bilateral (Bifrontotemporal).

Question 46: Desensitization form of behavior therapy is used for:

A. Phobic disorder (Correct Answer)
B. Anxiety neurosis
C. Mania
D. Depression

Explanation: **Explanation:** **Systematic Desensitization**, a behavior therapy technique developed by **Joseph Wolpe**, is based on the principle of **Reciprocal Inhibition**. This concept posits that if a response incompatible with anxiety (such as relaxation) can be made to occur in the presence of anxiety-provoking stimuli, it will weaken the bond between those stimuli and the anxiety response. 1. **Why Phobic Disorder is Correct:** Phobias are characterized by irrational, intense fear triggered by specific objects or situations. Systematic Desensitization works by gradually exposing the patient to the feared stimulus (using a hierarchy of fears) while they are in a state of deep muscle relaxation (**Jacobson’s Progressive Muscle Relaxation**). This replaces the fear response with a relaxation response, making it the gold-standard behavioral treatment for **Specific Phobias** and **Agoraphobia**. 2. **Why Other Options are Incorrect:** * **Anxiety Neurosis (GAD):** While relaxation techniques help, Generalized Anxiety Disorder involves pervasive, non-specific worry rather than a specific trigger that can be "desensitized" through a hierarchy. * **Mania & Depression:** These are **Mood Disorders** primarily managed with pharmacotherapy (Mood stabilizers, Antidepressants) or ECT. Behavior therapy for depression usually focuses on "Behavioral Activation" rather than desensitization. **High-Yield Clinical Pearls for NEET-PG:** * **Three Steps of Desensitization:** 1. Relaxation training, 2. Hierarchy construction, 3. Desensitization (pairing the two). * **In-vivo vs. Imaginal:** Desensitization can be done in real life (*in-vivo*) or through imagination. * **Flooding:** A related behavior therapy where the patient is exposed to the maximum intensity of the feared stimulus immediately (preventing the avoidance response). * **Aversion Therapy:** Another behavioral technique used primarily for **Alcoholism** and **Paraphilias** (based on Classical Conditioning).

Question 47: A 14-year-old girl presenting with depressive symptoms is seen in the OPD. The treating physician experiences extreme sadness and pity, leading to a decision to adopt her. This scenario exemplifies:

A. Positive transference
B. Negative transference
C. Positive counter transference (Correct Answer)
D. Negative counter transference

Explanation: ### Explanation **1. Why "Positive Counter Transference" is Correct:** In psychotherapy, **Counter-transference** refers to the emotional reaction of the therapist toward the patient, often based on the therapist’s own unconscious needs or past conflicts. * **Positive Counter-transference** occurs when the therapist experiences overly warm, protective, or affectionate feelings toward the patient. * In this scenario, the physician’s "extreme sadness and pity" and the unprofessional urge to "adopt" the patient represent an extreme form of protective/nurturing counter-transference. It indicates a loss of professional boundaries due to the therapist's emotional response. **2. Analysis of Incorrect Options:** * **A & B (Transference):** Transference refers to the **patient’s** unconscious redirection of feelings (from a significant person in their past) toward the **therapist**. Since the question describes the *physician's* feelings, these options are incorrect. * **D (Negative Counter-transference):** This involves the therapist experiencing feelings of dislike, anger, resentment, or annoyance toward the patient. While still a boundary issue, it is the opposite of the protective/pitying behavior described here. **3. High-Yield Clinical Pearls for NEET-PG:** * **Transference:** Patient $\rightarrow$ Doctor. * **Counter-transference:** Doctor $\rightarrow$ Patient. * **Management:** Counter-transference is not always a "mistake," but it must be recognized. The best management is **regular supervision** and **self-analysis/personal therapy** for the clinician to maintain professional neutrality. * **Acting Out:** When a patient or therapist translates unconscious impulses into action (like the decision to adopt) rather than reflecting on them in therapy.

Question 48: A patient can be taught to control their involuntary physiological responses by which of the following therapies?

A. Breathing therapy
B. Stress modification
C. Bio-feedback (Correct Answer)
D. Rational-emotive therapy

Explanation: ### Explanation **Correct Option: C. Bio-feedback** **Bio-feedback** is a therapeutic technique that utilizes electronic or electromechanical instruments to monitor and provide real-time information (feedback) to a patient about their **involuntary physiological processes**. By observing visual or auditory signals representing functions like heart rate, blood pressure, skin temperature, or muscle tension (EMG), the patient learns to exert **voluntary control** over these typically autonomic responses. It is based on the principle of **operant conditioning**. **Analysis of Incorrect Options:** * **A. Breathing therapy:** While deep breathing can influence the autonomic nervous system, it is a specific relaxation technique rather than a comprehensive system for monitoring and controlling multiple involuntary physiological parameters via instrumentation. * **B. Stress modification:** This is a broad term encompassing various lifestyle changes and coping strategies. It does not specifically refer to the technological process of controlling involuntary responses. * **D. Rational-emotive therapy (RET/REBT):** Developed by Albert Ellis, this is a form of **Cognitive Behavioral Therapy (CBT)**. It focuses on identifying and changing irrational beliefs and thought patterns rather than physiological responses. **Clinical Pearls for NEET-PG:** * **Indications for Bio-feedback:** Tension headaches, Migraines (thermal bio-feedback), Raynaud’s disease, Hypertension, and Fecal/Urinary incontinence. * **Mechanism:** It converts "covert" physiological signals into "overt" signals. * **High-Yield Association:** Bio-feedback is often used in conjunction with **Progressive Muscle Relaxation (PMR)** to manage anxiety disorders. * **Key Concept:** Remember that Bio-feedback bridges the gap between the autonomic nervous system and conscious control.

Question 49: Flooding is a type of?

A. Behaviour therapy (Correct Answer)
B. Psychoanalytically-oriented psychotherapy
C. Group therapy
D. Social speech

Explanation: **Explanation:** **Flooding** is a core technique in **Behaviour Therapy** based on the principles of **Classical Conditioning** (specifically, extinction). It involves the rapid and prolonged exposure of a patient to their most feared stimulus or situation at maximum intensity, either in imagination (*implosion*) or in real life (*in vivo*). Unlike systematic desensitization, which uses a graded hierarchy, flooding prevents the patient from using avoidance behaviors, eventually leading to the exhaustion of the anxiety response and the extinction of the conditioned fear. **Analysis of Options:** * **Option A (Correct):** Behaviour therapy focuses on modifying maladaptive behaviors through conditioning. Flooding is a classic "exposure therapy" used primarily for phobias and PTSD. * **Option B:** Psychoanalytically-oriented psychotherapy focuses on unconscious conflicts, childhood experiences, and techniques like free association or dream analysis, rather than direct behavioral modification. * **Option C:** Group therapy involves treating multiple patients simultaneously to utilize group dynamics for emotional support and interpersonal learning. * **Option D:** Social speech is a linguistic/developmental term referring to communication intended for others, unrelated to psychotherapeutic modalities. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Flooding works on the principle of **extinction** (repeated exposure without the unconditioned stimulus leads to a decrease in the conditioned response). * **Contrast:** **Systematic Desensitization** (Wolpe) is "graded" and uses relaxation; **Flooding** is "abrupt" and induces high anxiety. * **Contraindications:** Flooding should be avoided in patients with severe heart disease or intense psychosis due to the extreme physiological stress it induces. * **Implosion Therapy:** This is a variant of flooding conducted entirely in the patient's imagination.

Question 50: Who is the founder of the school of psychoanalysis?

A. Bleuler
B. Freud (Correct Answer)
C. Kraeplin
D. Melanie Klein

Explanation: **Explanation:** **Sigmund Freud** is the undisputed 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 **Id, Ego, and Superego** (structural model), and the stages of **psychosexual development**. His work shifted the focus of psychiatry from purely biological descriptions to the exploration of childhood experiences and repressed emotions. **Analysis of Incorrect Options:** * **A. Eugen Bleuler:** A Swiss psychiatrist best known for coining the term **"Schizophrenia"** (replacing Dementia Praecox) and defining the **"4 As"** (Association, Affect, Ambivalence, and Autism). * **C. Emil Kraepelin:** Often called the founder of modern scientific psychiatry. He is famous for the **"Kraepelinian Dichotomy,"** which distinguished between Dementia Praecox (Schizophrenia) and Manic-Depressive Psychosis (Bipolar Disorder). * **D. Melanie Klein:** A post-Freudian psychoanalyst known as the pioneer of **Object Relations Theory** and **Play Therapy**. While she expanded psychoanalysis, she did not found the school. **High-Yield Clinical Pearls for NEET-PG:** * **Free Association:** The "gold standard" technique in psychoanalysis where patients speak thoughts without censorship. * **Transference:** When a patient redirects feelings for a significant person in their life 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). * **Father of American Psychiatry:** Benjamin Rush (often confused with the founders mentioned above).

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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