CBT Diagnosis, and Treatment Planning 2 — Questions and Answers
Question 1: Which DSM-5 specifier is used when a major depressive episode co-occurs with full manic criteria?
- With mixed features (Correct answer)
- With melancholic features
- With anxious distress
- With psychotic features
Correct answer: With mixed features
The 'with mixed features' specifier applies when manic symptoms are present during a depressive episode but don't meet full criteria for a manic episode.
Question 2: In CBT case conceptualization, what does the 'maintenance' component of a formulation primarily explain?
- Why current symptoms persist despite the client's wish to recover (Correct answer)
- The historical origins of core beliefs
- The client's diagnosis and comorbidities
- Which CBT protocol to select
Correct answer: Why current symptoms persist despite the client's wish to recover
The maintenance component identifies cognitive and behavioral cycles—such as avoidance and safety behaviors—that keep symptoms going in the present.
Question 3: A therapist notes that a client's GAD is best explained by intolerance of uncertainty. Which treatment target does this suggest as primary?
- Reducing uncertainty-avoidance behaviors and building tolerance for ambiguity (Correct answer)
- Scheduled worry time only
- Thought stopping for intrusive worries
- Relaxation training as the sole intervention
Correct answer: Reducing uncertainty-avoidance behaviors and building tolerance for ambiguity
When intolerance of uncertainty drives GAD, treatment focuses on exposing clients to ambiguous situations and reducing reassurance-seeking behaviors.
Question 4: Which assessment measure is specifically designed to evaluate dysfunctional attitudes consistent with Beck's cognitive model of depression?
- Dysfunctional Attitude Scale (DAS) (Correct answer)
- Penn State Worry Questionnaire
- Anxiety Sensitivity Index
- Trauma Symptom Inventory
Correct answer: Dysfunctional Attitude Scale (DAS)
The DAS measures rigid, maladaptive beliefs about performance and approval that are central to Beck's cognitive theory of depression.
Question 5: When creating a treatment plan for a client with comorbid OCD and major depression, which condition should typically be addressed first?
- OCD, because depression often improves as compulsions decrease
- Depression first, because low motivation prevents ERP engagement (Correct answer)
- Both simultaneously with equal priority
- Whichever the client prefers, regardless of severity
Correct answer: Depression first, because low motivation prevents ERP engagement
Severe depression can undermine the motivation and energy needed for exposure and response prevention, so it is often prioritized to create a foundation for OCD treatment.
Question 6: The Situational Formulation (ABC model) used in CBT maps Antecedents, Beliefs, and Consequences. What does 'C' most accurately represent?
- Emotional, behavioral, and physiological consequences (Correct answer)
- Cognitive consequences only
- Context in which the problem occurs
- Coping strategies employed
Correct answer: Emotional, behavioral, and physiological consequences
In the ABC model, Consequences include the full emotional, behavioral, and physiological responses that follow activation of a belief in a given situation.
Question 7: Which principle guides the sequencing of treatment goals in a CBT treatment plan when safety and symptom reduction are both needed?
- Address safety and crisis first, then symptom-focused interventions (Correct answer)
- Start with symptom reduction to build therapeutic alliance before safety work
- Follow the client's stated priorities regardless of risk level
- Begin with the least distressing goal to build momentum
Correct answer: Address safety and crisis first, then symptom-focused interventions
CBT treatment planning follows a hierarchical approach where safety concerns (suicidality, self-harm) are addressed before moving to symptom-reduction goals.
CBT Diagnosis, and Treatment Planning 2
Which DSM-5 specifier is used when a major depressive episode co-occurs with full manic criteria?