CBT Anxiety Disorders & CBT Protocols 3 — Questions and Answers
Question 1: The 'fear hierarchy' (SUDS ladder) used in systematic desensitization and exposure therapy is primarily used to:
- Diagnose the severity of a specific phobia
- Rank feared situations from least to most anxiety-provoking for graduated exposure (Correct answer)
- Identify the cognitive distortions underlying each feared situation
- Measure treatment progress through weekly therapist ratings
Correct answer: Rank feared situations from least to most anxiety-provoking for graduated exposure
A fear hierarchy orders feared stimuli by distress level (0–100 SUDS), guiding graduated exposure from least to most threatening.
Question 2: Which CBT technique for GAD directly targets the 'intolerance of uncertainty' maintaining excessive worry?
- Thought records challenging catastrophic appraisals
- Scheduled worry time to contain rumination
- Uncertainty exposure and behavioral experiments with ambiguous outcomes (Correct answer)
- Progressive muscle relaxation to reduce somatic tension
Correct answer: Uncertainty exposure and behavioral experiments with ambiguous outcomes
Intolerance of uncertainty exposure involves deliberately engaging with ambiguous situations without seeking reassurance, directly targeting the core mechanism of GAD.
Question 3: In CBT for Social Anxiety Disorder, 'safety behaviors' are targeted because they:
- Increase the likelihood of panic attacks in social situations
- Prevent disconfirmation of feared social catastrophes and maintain anxiety (Correct answer)
- Signal to others that the client is anxious, worsening embarrassment
- Reduce self-efficacy by creating dependence on external supports
Correct answer: Prevent disconfirmation of feared social catastrophes and maintain anxiety
Safety behaviors (e.g., avoiding eye contact, rehearsing speech) prevent the client from learning that feared outcomes are unlikely, thereby maintaining social anxiety.
Question 4: A client with Specific Phobia of blood-injection-injury (BII) type requires a modified exposure protocol because:
- BII phobia does not respond to standard CBT techniques
- These clients typically have a diphasic response (initial rise then drop in blood pressure/heart rate) requiring applied tension (Correct answer)
- Imaginal exposure must precede in vivo exposure for all BII phobias
- Cognitive restructuring must be completed before any exposure begins
Correct answer: These clients typically have a diphasic response (initial rise then drop in blood pressure/heart rate) requiring applied tension
BII phobias involve a unique vasovagal fainting response, so applied tension technique is added to exposure to prevent syncope.
Question 5: The 'worry postponement' technique used in GAD treatment involves:
- Eliminating all worry by challenging each anxious thought as it arises
- Scheduling a specific daily period for worry and deferring worry thoughts to that time (Correct answer)
- Distracting oneself from worry with pleasant activities
- Accepting worry as harmless and allowing it to pass without engagement
Correct answer: Scheduling a specific daily period for worry and deferring worry thoughts to that time
Worry postponement (scheduled worry time) reduces pervasive worry by containing it to a designated 20–30 minute window, breaking the habitual worry pattern.
Question 6: Which statement best describes the role of avoidance in the maintenance of anxiety disorders?
- Avoidance reduces anxiety in the long term by lowering baseline arousal
- Avoidance provides short-term relief but prevents extinction learning, maintaining fear (Correct answer)
- Avoidance is only problematic when it generalizes to unrelated situations
- Avoidance is adaptive unless it results in functional impairment
Correct answer: Avoidance provides short-term relief but prevents extinction learning, maintaining fear
Avoidance provides immediate anxiety relief but prevents the corrective learning experience that exposure would provide, keeping the fear intact.
Question 7: The DSM-5 requires that anxiety in anxiety disorders be distinguished from normal fear primarily by its:
- Neurobiological markers and biomarkers in blood panels
- Proportionality relative to the actual threat and degree of impairment caused (Correct answer)
- Age of onset, with adult-onset anxiety being considered more pathological
- The specific content of feared thoughts or situations
Correct answer: Proportionality relative to the actual threat and degree of impairment caused
DSM-5 criteria require anxiety to be out of proportion to the actual danger posed by the situation and to cause clinically significant distress or impairment.
CBT Anxiety Disorders & CBT Protocols 3
The 'fear hierarchy' (SUDS ladder) used in systematic desensitization and exposure therapy is primarily used to: