In the treatment of borderline personality disorder, which of the following does Stage 2 of dialectical behaviour therapy target?
B. Treatment of borderline personality disorder is organized around the level of the disorder, with each level corresponding to one of four stages of treatment with specific goals that are targeted towards core deficits seen in these patients.
Reference:
Rachel is a 35-year-old woman who was recently involved in a lifethreatening road traffic accident. She developed symptoms suggestive of post-traumatic stress disorder (PTSD) over a period of a month following the accident. The symptoms interfered with her daily activities. She refused to drive to work and started missing her work. She also stopped taking her children to the nursery.
According to NICE guidelines, what treatment is recommended?
A. The NICE recommends ‘Watchful waiting’ when symptoms are mild and have been present for less than 4 weeks after the trauma, with a follow-up contact within 1 month. NICE specifically asks therapists and clinicians not to routinely offer brief, single-session interventions (debriefing) that focus on the traumatic incident to that individual alone. Where symptoms are present for less than 3 months (as in the case with Rachel), NICE specifically recommends trauma-focused CBT (usually on an individual outpatient basis. Trauma-focused CBT is also recommended for people with ‘severe’ symptoms or ‘severe’ PTSD within 1 month. NICE recommends 8–12 weekly sessions of trauma-focused CBT, each session delivered by the same person and lasting around 90 minutes during which trauma is discussed. NICE advises against the use of non-directed therapies such as relaxation training. Where symptoms are milder and have lasted for more than 3 months, NICE recommends either trauma-focused CBT or EMDR. In addition to psychological treatments, NICE also recommends specific pharmacological interventions.
During a biofeedback session, which of the following denotes a stage of relaxation?
B. Biofeedback is the process where certain physiological parameters of an individual are recorded and displayed. It is usually used in combination with relaxation. This involves the recording of small changes in the physiological levels (induced by relaxation) of the feedback parameter. The display can be visual or auditory. Patients are instructed to change the levels of the physiological parameter, using the feedback from the display. It is based on the idea that the autonomic nervous system can come under voluntary control through operant conditioning. The feedback instrument used depends on the patient and the specific problem. The most effective instruments are the electromyogram (EMG), which measures the electrical potentials of muscle fibers; the electroencephalogram (EEG), which measures alpha waves that occur in relaxed states; the galvanic skin response (GSR) gauge, which shows decreased skin conductivity during a relaxed state; and the thermistor, which measures skin temperature (which drops during tension because of peripheral vasoconstriction). For example, in the treatment of bruxism, an EMG electrode is attached to the masseter muscle. The EMG emits a loud tone when the muscle is contracted and a low tone when at rest. Patients can learn to alter the tone to indicate relaxation. Patients receive feedback about the masseter muscle, the tone reinforces the learning, and the condition ameliorates.
Cognitive therapy aims to modify the schemas that perpetuate depression or anxiety.
Which of the following is least likely with respect to schemas?
B. Schemas determine our perceptions, assimilations, and actions upon the externally received information. These are developed through early experiences in childhood and formative influences thereafter. According to Beck, these are deeper cognitive structures than the negative automatic thoughts that are readily observable in clients undergoing cognitive behavioural therapy. Everyone interacts with the external world by utilizing his/her set of schemas. Most of these are simple schemas that do not contribute to any psychopathology. So schemas are conditional rules (‘if–then statements’) while the others are core beliefs about oneself (‘I am good-looking’, ‘I cannot write a poem’, etc). Clients requiring CBT often have a cluster of maladaptive schemas that perpetuate depression or anxiety state.
On the basis of cognitive theory, certain cognitive distortions are formulated to explain both behavioural features and bodily symptoms of various psychiatric disorders.
Which of the following themes is correctly matched with the disorder?
C. Clients with generalized anxiety often have an attentional bias that sensitizes them to respond to potentially threatening stimuli in the environment. Such attentional biases towards threatening information are also noted in individuals with high trait anxiety and may play an important role in the development of clinical anxiety disorders and maintenance of anxiety. Experimentally, dot probe tasks have been used to demonstrate such biases. Clients with depression often underestimate positive aspects of life, e.g. downplaying positive feedback but continuing with a sense of failure and hopelessness. They might also exhibit absolute thinking favouring negative themes – this is termed as black and white thinking.
Click to expand