PTSD Treatment Planning & Protocols 2 — Questions and Answers
Question 1: Which phase of Prolonged Exposure (PE) therapy involves the therapist and client constructing a hierarchy of avoided situations?
- Psychoeducation phase
- In vivo exposure planning phase (Correct answer)
- Imaginal exposure phase
- Processing phase
Correct answer: In vivo exposure planning phase
The in vivo exposure planning phase involves collaboratively building a hierarchy of avoided situations ranked by subjective units of distress (SUDS).
Question 2: When a PTSD client has comorbid Borderline Personality Disorder, which treatment sequencing approach is most commonly recommended?
- Begin trauma-focused therapy immediately
- Stabilize emotion dysregulation skills before trauma processing (Correct answer)
- Use only supportive therapy and avoid trauma work
- Refer solely to medication management
Correct answer: Stabilize emotion dysregulation skills before trauma processing
Clients with BPD typically benefit from building emotion regulation and distress tolerance skills (e.g., DBT) before engaging in intensive trauma processing.
Question 3: A treatment plan goal states: 'Client will report PTSD Checklist (PCL-5) score reduction of 10+ points within 12 sessions.' This goal is best described as:
- Vague and unmeasurable
- SMART — specific, measurable, achievable, relevant, time-bound (Correct answer)
- Clinician-driven rather than client-centered
- Too ambitious for a realistic treatment goal
Correct answer: SMART — specific, measurable, achievable, relevant, time-bound
This goal meets all SMART criteria: it specifies the measure (PCL-5), the threshold (10 points), and the timeframe (12 sessions).
Question 4: Which of the following best describes the role of cognitive restructuring within Cognitive Processing Therapy (CPT)?
- Replacing traumatic memories with positive ones
- Identifying and challenging stuck points — distorted beliefs about the trauma (Correct answer)
- Teaching relaxation techniques to reduce arousal
- Systematic desensitization through repeated exposure to trauma cues
Correct answer: Identifying and challenging stuck points — distorted beliefs about the trauma
CPT targets 'stuck points' — maladaptive cognitions about safety, trust, power, esteem, and intimacy — through Socratic questioning and thought records.
Question 5: A clinician notices that a veteran client avoids all homework between sessions. The most appropriate treatment planning response is to:
- Discharge the client for non-compliance
- Switch to a non-trauma-focused modality without discussion
- Collaboratively explore barriers and modify assignments to increase engagement (Correct answer)
- Continue the protocol unchanged and document non-adherence
Correct answer: Collaboratively explore barriers and modify assignments to increase engagement
Collaboratively identifying and addressing homework barriers maintains the therapeutic alliance and improves treatment engagement without abandoning the evidence-based protocol.
Question 6: Eye Movement Desensitization and Reprocessing (EMDR) therapy is structured around which processing model?
- Classical conditioning model
- Adaptive Information Processing (AIP) model (Correct answer)
- Cognitive Behavioral Model of PTSD
- Biopsychosocial stress-diathesis model
Correct answer: Adaptive Information Processing (AIP) model
EMDR is grounded in the Adaptive Information Processing model, which holds that trauma symptoms arise from inadequately processed memories stored in isolation.
Question 7: Which standardized protocol component differentiates Trauma-Focused CBT (TF-CBT) from standard CBT when treating PTSD in children?
- Use of exposure hierarchies
- Inclusion of a parallel parent/caregiver treatment component (Correct answer)
- Reliance on medication as a first-line adjunct
- Group-only delivery format
Correct answer: Inclusion of a parallel parent/caregiver treatment component
TF-CBT uniquely includes structured parallel sessions for caregivers, addressing their distress and teaching them skills to support the child's recovery.
PTSD Treatment Planning & Protocols 2
Which phase of Prolonged Exposure (PE) therapy involves the therapist and client constructing a hierarchy of avoided situations?