CARN Counseling and Therapeutic Modalities 4 — Questions and Answers
Question 1: A patient with alcohol use disorder is receiving Cognitive Processing Therapy (CPT). Which 'stuck point' is MOST commonly addressed in patients with co-occurring PTSD and addiction?
- 'I need alcohol to feel normal'
- 'I deserved what happened to me' (Correct answer)
- 'AA meetings are not helpful'
- 'My doctor doesn't understand me'
Correct answer: 'I deserved what happened to me'
CPT targets stuck points — maladaptive beliefs like self-blame ('I deserved it') that maintain PTSD symptoms and often drive substance use as coping.
Question 2: Which motivational interviewing spirit component emphasizes collaborative decision-making rather than the counselor directing the patient?
- Evocation
- Partnership (Correct answer)
- Acceptance
- Compassion
Correct answer: Partnership
Partnership (formerly 'collaboration') in MI means the counselor and patient work together as equals rather than the counselor acting as the expert directing change.
Question 3: During group therapy, a patient with opioid use disorder idealizes the counselor and devalues peers. A psychodynamically-informed nurse would MOST likely interpret this as:
- Countertransference
- Transference (Correct answer)
- Resistance
- Projection
Correct answer: Transference
Transference occurs when a patient projects feelings and attitudes from past relationships onto the therapist or group leader.
Question 4: A nurse co-facilitating a process group notices that new members are unusually silent. According to Yalom's group therapy principles, which therapeutic factor is MOST impaired by this dynamic?
- Universality
- Altruism
- Interpersonal learning (Correct answer)
- Catharsis
Correct answer: Interpersonal learning
Interpersonal learning — gaining insight through feedback and interaction with others — is most impaired when members are silent and not engaging with each other.
Question 5: Acceptance and Commitment Therapy (ACT) uses 'defusion' techniques in addiction treatment to help patients:
- Suppress or eliminate craving thoughts
- Observe thoughts without being controlled by them (Correct answer)
- Replace negative thoughts with positive affirmations
- Analyze the origins of craving thoughts
Correct answer: Observe thoughts without being controlled by them
Defusion in ACT helps patients create distance from their thoughts, viewing them as just thoughts rather than truths that must be acted upon.
Question 6: A CARN is applying Motivational Enhancement Therapy (MET) with a patient who is ambivalent about stopping cannabis use. The MOST appropriate nurse response to ambivalence is:
- Confront the patient directly about the consequences of use
- Explore both sides of the ambivalence without judgment (Correct answer)
- Refer the patient to a more intensive program immediately
- Educate the patient on cannabis withdrawal symptoms
Correct answer: Explore both sides of the ambivalence without judgment
MET guides nurses to explore ambivalence without confrontation, helping the patient articulate their own reasons for and against change.
Question 7: Eye Movement Desensitization and Reprocessing (EMDR) is used with SUD patients PRIMARILY because:
- It directly reduces withdrawal symptoms
- It processes traumatic memories that often underlie or trigger substance use (Correct answer)
- It eliminates cravings through bilateral stimulation
- It replaces the need for medication-assisted treatment
Correct answer: It processes traumatic memories that often underlie or trigger substance use
EMDR targets the unprocessed traumatic memories that frequently contribute to the development and maintenance of substance use disorders.
CARN Counseling and Therapeutic Modalities 4
A patient with alcohol use disorder is receiving Cognitive Processing Therapy (CPT).
Which 'stuck point' is MOST commonly addressed in patients with co-occurring PTSD and addiction?