CBT Diagnosis, and Treatment Planning 3 â Questions and Answers
Question 1: A client endorses recurrent intrusive thoughts about harming her infant but finds them deeply distressing and ego-dystonic. The most accurate DSM-5 diagnosis is:
- OCD with harm obsessions (Correct answer)
- Postpartum psychosis
- Impulse control disorder
- Generalized anxiety disorder
Correct answer: OCD with harm obsessions
Ego-dystonic intrusive thoughts about harm that cause distress without intent to act are classic OCD harm obsessions, not psychosis or impulse control problems.
Question 2: Which CBT model uses the concept of 'negative automatic thoughts' as the primary entry point for treatment planning?
- Beck's cognitive therapy (Correct answer)
- Acceptance and Commitment Therapy
- Dialectical Behavior Therapy
- Metacognitive therapy
Correct answer: Beck's cognitive therapy
Beck's cognitive therapy identifies negative automatic thoughts as the most accessible level of cognition and uses them to uncover deeper schemas.
Question 3: In differential diagnosis, what distinguishes social anxiety disorder from avoidant personality disorder?
- Severity and pervasiveness of avoidance and self-view as socially inept (Correct answer)
- The type of social situations feared
- Age of onset
- Response to pharmacotherapy
Correct answer: Severity and pervasiveness of avoidance and self-view as socially inept
Avoidant personality disorder involves a more pervasive pattern of social inhibition and deep belief of being fundamentally inadequate, whereas social anxiety disorder may be situation-specific.
Question 4: SMART goals in CBT treatment planning require that goals be Specific, Measurable, Achievable, Relevant, and Time-bound. Which example best meets all criteria?
- Client will reduce panic attack frequency from 5/week to 1/week within 8 weeks (Correct answer)
- Client will feel less anxious
- Client will work on avoidance behaviors
- Client will learn relaxation techniques
Correct answer: Client will reduce panic attack frequency from 5/week to 1/week within 8 weeks
Only the first option includes a specific behavior, a measurable baseline and target, a realistic reduction, relevance to panic disorder, and a defined timeframe.
Question 5: Which assessment approach helps identify behavioral avoidance patterns that maintain anxiety in CBT case formulation?
- Functional behavioral analysis (Correct answer)
- Structural clinical interview only
- Projective testing
- Neuropsychological evaluation
Correct answer: Functional behavioral analysis
Functional behavioral analysis examines antecedents, behaviors, and consequences to reveal how avoidance is triggered and reinforced.
Question 6: A therapist suspects a client's depressive disorder has a bipolar component. Which historical feature would most support upgrading the diagnosis to Bipolar II?
- At least one past hypomanic episode lasting 4+ days with elevated or irritable mood (Correct answer)
- A single episode of insomnia and energy increase during finals week
- Family history of schizophrenia
- Rapid cycling during an antidepressant trial
Correct answer: At least one past hypomanic episode lasting 4+ days with elevated or irritable mood
Bipolar II requires at least one hypomanic episode (4+ days) distinct from normal mood, not explained by substances or medical conditions.
Question 7: In CBT for PTSD using the CPT model, what is the primary diagnostic target addressed in the treatment plan?
- Stuck pointsâdistorted beliefs about the trauma and its meaning (Correct answer)
- Trauma memory consolidation through medication
- Relaxation deficits and arousal management
- Social skills impaired by avoidance
Correct answer: Stuck pointsâdistorted beliefs about the trauma and its meaning
CPT targets 'stuck points,' which are maladaptive beliefs about safety, trust, power, esteem, and intimacy that developed from or were disrupted by the trauma.
CBT Diagnosis, and Treatment Planning 3
A client endorses recurrent intrusive thoughts about harming her infant but finds them deeply distressing and ego-dystonic.
The most accurate DSM-5 diagnosis is: