Supportive Psychotherapy — MCQs
In which of the following conditions is behavioral therapy most commonly utilized?
In which of the following conditions is behavior therapy considered most effective?
Cognitive behavior therapy deals with:
Best therapy suited to teach daily life skills to a child with intellectual disability:
In which of the following patients would supportive therapy be most challenging to implement effectively?
A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
Which of the following is the most prevalent psychiatric disorder in the general population?
A 25-year-old medical student who failed his exam tells his friends, "I didn't want to pass anyway. The exam was poorly designed and doesn't test real clinical knowledge." This is an example of which defense mechanism?
Which among the following are defence mechanisms adopted when an individual is faced with problems or failures? I. Rationalization II. Regression III. Projection IV. Replacement Select the correct answer using the code given below :
Systematic desensitization is a therapeutic technique used in which of the following conditions?
Supportive Psychotherapy 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: 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 3: Cognitive behavior therapy deals with:
- A. Only maladaptive thoughts
- B. Thoughts and behaviors (Correct Answer)
- C. Only problematic behaviors
- D. Unconscious conflicts and past experiences
Explanation: ***Thoughts and behaviors*** - **Cognitive Behavioral Therapy (CBT)** specifically targets and modifies both **maladaptive thought patterns** and **unhelpful behaviors**. - The core principle is that feelings and behaviors are significantly influenced by how an individual thinks about themselves, others, and the world. *Only maladaptive thoughts* - While CBT heavily focuses on **maladaptive thoughts** (cognitions), it also directly addresses **behaviors**. - Changing thoughts alone without addressing associated behaviors would be an incomplete therapeutic approach within CBT. *Only problematic behaviors* - Focusing solely on **problematic behaviors** would align more with traditional behavioral therapy. - CBT integrates cognitive restructuring with behavioral techniques, recognizing the interplay between thoughts and actions. *Unconscious conflicts and past experiences* - This description is characteristic of **psychodynamic therapy** or psychoanalysis, which delve into **unconscious conflicts** and the impact of past experiences on current functioning. - CBT is primarily present-focused and deals with conscious thought processes and current behaviors, rather than deep exploration of the unconscious.
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: 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.
Question 6: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
- A. Schizophrenia
- B. Major depressive disorder plus psychosis (Correct Answer)
- C. Schizoaffective disorder
- D. Schizotypal personality disorder
Explanation: ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern 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. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.
Question 7: Which of the following is the most prevalent psychiatric disorder in the general population?
- A. Schizophrenia
- B. Mania
- C. Anxiety disorder (Correct Answer)
- D. Depression
Explanation: ***Anxiety disorder*** - **Anxiety disorders** are collectively the most prevalent psychiatric disorders in the general population, affecting approximately **10-30% of individuals** during their lifetime. - This category includes **specific phobias, social anxiety disorder, panic disorder, generalized anxiety disorder, and others**, which together have the highest prevalence among all psychiatric conditions. - Epidemiological studies consistently show that **anxiety disorders surpass depression** in terms of overall prevalence in community samples. *Depression* - **Major depressive disorder** is highly prevalent (lifetime prevalence approximately 10-15%) and is the **leading cause of disability worldwide**. - While extremely common and clinically significant, it is slightly less prevalent than anxiety disorders when considering community-based epidemiological data. - Depression often occurs **co-morbidly with anxiety disorders**, further emphasizing the importance of both conditions. *Schizophrenia* - **Schizophrenia** is a severe chronic mental illness with a much lower prevalence, affecting approximately **0.3-0.7%** of the general population. - Despite its significant impact on affected individuals and families, its overall prevalence is relatively low compared to mood and anxiety disorders. *Mania* - **Mania** is a mood state characteristic of **bipolar disorder**, which has a prevalence of approximately **1-2%** of the population. - This is considerably lower than the prevalence of both anxiety disorders and major depressive disorder.
Question 8: A 25-year-old medical student who failed his exam tells his friends, "I didn't want to pass anyway. The exam was poorly designed and doesn't test real clinical knowledge." This is an example of which defense mechanism?
- A. Denial
- B. Projection
- C. Displacement
- D. Rationalization (Correct Answer)
Explanation: ***Rationalization*** - **Rationalization** involves constructing a logical justification for actions or attitudes that otherwise would be unacceptable, thereby avoiding feelings of guilt or shame. - The man in the scenario uses logical reasons to explain his actions, preventing him from feeling guilty about them. *Denial* - **Denial** is a defense mechanism where a person refuses to accept or acknowledge a reality or facts of a situation, usually a painful or threatening one. - In this case, the man is not denying his actions but rather finding reasons to excuse them. *Projection* - **Projection** is when an individual attributes their own unacceptable thoughts, feelings, or qualities to another person. - The man is creating excuses for his own behavior, not attributing his feelings or actions to someone else. *Displacement* - **Displacement** involves redirecting unacceptable urges or feelings from their original target to a less threatening one. - The man is not shifting his emotions to a different object or person; instead, he is justifying his own actions.
Question 9: Which among the following are defence mechanisms adopted when an individual is faced with problems or failures? I. Rationalization II. Regression III. Projection IV. Replacement Select the correct answer using the code given below :
- A. I, III and IV
- B. I, II and III (Correct Answer)
- C. I, II and IV
- D. II, III and IV
Explanation: ***I, II and III*** - **Rationalization**, **Regression**, and **Projection** are all classic defense mechanisms described in psychoanalytic theory. - These mechanisms are unconscious strategies used by the **ego** to reduce anxiety and protect the self from unacceptable thoughts or feelings, particularly when an individual faces problems or failures. *I, III and IV* - This option correctly identifies Rationalization and Projection, but incorrectly includes **Replacement**. - While "replacement" might refer to a form of **displacement** in some contexts, it is not a standard, recognized defense mechanism in the classic psychoanalytic framework. *I, II and IV* - This option correctly identifies Rationalization and Regression, but incorrectly includes **Replacement**. - **Replacement** is not a standard defense mechanism; instead, individuals might experience **displacement** where feelings are redirected to a safer target. *II, III and IV* - This option includes Regression and Projection, but misses **Rationalization** while incorrectly including **Replacement**. - **Rationalization** is a very common defense mechanism involving creating logical but false justifications for actions or beliefs.
Question 10: 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).
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