Exam 1

Question 1

Generalized Anxiety Disorder (GAD) DSM-5 Diagnostic Criteria

Answer 1

Anxiety + Worry consistently for 6 months.
Difficult to control worry.
3 or more of the following symptoms for 6 months:
Restlessness, Fatigue, Difficulty Concentrating, Irritability, Muscle tension, sleeplessness
Symptoms cause significant distress/impairment
Not caused by substance or medical condition
Not better explained by another disorder

Question 2

GAD Assessment

Answer 2

Penn State Worry Questionnaire (self report)
GAD Questionnaire (self report)
SCID-5 - diagnostic measure

Question 3

GAD Theory for ACT

Answer 3

Excessive worry about future scenarios via catastrophizing and overestimation.
Worry is negatively reinforced since the feared outcome didn’t happen, worry becomes habit.
Worry distracts from deeper emotional experience.
React to internal experiences with distress; view the self as anxious person.
Leads to avoidance.
GAD lends itself to ACT approach.

Question 4

ACT Treatment for GAD (Acceptance and Commitment Therapy)

Answer 4

ACT Goal: Expand Awareness and Compassion towards experience. Accept internal experiences. Engage in value based behaviors.

Question 5

ACT for GAD Sessions 1-7 (First half)

Answer 5

Sessions 1-3:
Overview of treatment and rationale. 
Psychoeducation to explain and validate experience.
Introduce mindfulness breath
Progressive Muscle Relaxation (PMR)
Homework: Raisin Exercise

Session 4:
Mindfulness for awareness of physical sensations.
Remember experiences without altering emotions.
Emphasize values not goals.

Sessions 5-7:
Encourage willingness to experience instead of avoidance.
Use exercises to help client monitor reactions, thoughts, emotions, and physical sensations as transient events.
Identify values.

Question 6

ACT for GAD Sessions 8-16 (second half)

Answer 6

Sessions 8-12:
Personalize concepts in treatment to use in daily life.
Analyze and validate obstacles to willingness.
Have client monitor activities mindfully.

Sessions 13-16:
Treatment reflection and maintenance.
Client more directive in sessions.
Acknowledgement of lapses.
Review coping skills.

Question 7

PTSD DSM-5 Diagnostic Criteria

Answer 7

Direct or indirect exposure to trauma (actual or threatened injury/death/sexual violence).
Re-experiencing the event.
Persistent avoidance (thoughts/memories associated with TE).
Negative alterations in cognition and mood.
Hyperarousal (e.g. fight or flight, irritability, recklessness)
Must occur concurrently for at lest one month.
Disturbance causes impairment of functioning.
Symptoms not due to substance use or medical condition.

Question 8

PTSD Assessment

Answer 8

SCID for DSM-5
Clinician-Administered PTSD Scale (CAPS-5)
PTSD Symptom Scale (PSS-I-5)

Question 9

Information Processing Theory for CPT for PTSD

Answer 9

Rigid schemas about how the world works and traumatic experiences creates a negative view of the world and self.
Trauma leads to cycle of re-experiencing and avoidance.

Question 10

Cognitive Processing Therapy (CPT) for PTSD

Answer 10

Utilizes core CBT techniques specifically for PTSD
Manualized flexible treatment
Focus on stuck points, how trauma impacts life, and how patient relates self to the world.

Question 11

CPT for PTSD sessions 1-3

Answer 11

Session 1:
Psychoeducation
Treatment overview
Discuss role of avoidance to increase commitment
Homework: impact statement
Session 2:
Read impact statement aloud to work through emotions.
Introduce stuck point log.
Introduce activating event-belief-consequence.
HW: Practice ABC worksheets
Session 3:
Review ABC worksheets.
Identify thoughts vs emotions.
HW: Trauma account.

Question 12

CPT for PTSD sessions 4-7

Answer 12

Session 4:
Read trauma account aloud.
Socratic questioning.
HW: Detailed trauma account.
Session 5:
Read 2nd trauma account aloud.
Address stuck points.
Introduce challenging questions sheet.
HW: Daily challenging questions sheet (choose stuck point and challenge).
Session 6:
Review HW and focus on most difficult stuck point.
Teach patterns of problematic thinking.
HW: Identify problematic thinking in everyday life.
Session 7:
Review HW.
Begin safety module.
HW: Challenging beliefs worksheet w/attention to safety.

Question 13

CPT for PTSD sessions 8-12

Answer 13

Sessions 8-11:
Review HW.
Introduce Trust, Intimacy, Power, Esteem modules (TIPE)
HW: Challenging beliefs w/focus on module and final impact statement.
Session 12:
Read final impact statement aloud and compare to initial impact statement.
Review what was learned.
Pt’s goals moving forward.
Relapse prevention.
Schedule follow up for 1 month.