Lecture 22 and 23

Question 1

As covered in lecture, approximately _______ percent of people treated with Cognitive Behavior Therapy (CBT) for Panic Disorder no longer experience panic attacks at the end of treatment.

A. 0-10%
B. 25-35%
C. 50-60%
D. 70-80%
E. 100%

Answer 1

D. 70-80%

Question 2

CBT for panic disorder includes all of the following EXCEPT:

A. Relaxation
B. Exposure
C. Social skills training
D. Cognitive Restructuring
E. Addressing medication usage

Answer 2

C. Social skills training

Question 3

Which of the following is relatively unique in treatment of panic from a CBT perspective (i.e., would
not exist in CBT for schizophrenia, for example)?

A. Breathing retraining
B. Education
C. Self-monitoring
D. Thinking skills
E. Relapse prevention

Answer 3

A. Breathing retraining

Question 4

What is the rationale for asking clients to self-monitor their symptoms of panic?

A. Self-monitoring increases feelings of predictability and control
B. Self-monitoring helps identify the specific ways the client experiences anxiety
C. Self-monitoring increases the client’s ability to evaluate their success at attempting to
change
D. A and C
E. A, B, and C

Answer 4

E. A, B, and C

Question 5

How often does a client fill out a panic attack record?

A. Every day, regardless of whether they have a panic attack
B. Every time they have a panic attack, regardless of how often they have them
C. Every time they have a panic attack, but only if they happen every day
D. Only in therapy sessions
E. None of the above

Answer 5

B. Every time they have a panic attack, regardless of how often they have them

Question 6

True or False: To determine if treatment is progressing as expected based on the research, the therapist can plot the client’s progress regarding anxiety symptoms and number of panic attacks and then compare the results to those in the treatment manual/literature.

A. True
B. False

Answer 6

A. True

Question 7

Adaptive strategies to interrupt the panic cycle include:

A. Cognitive restructuring
B. Exposure
C. Escape and avoidance
D. A and B
E. A, B, and C

Answer 7

D. A and B

Question 8

True or False: People often hyperventilate during a panic attack.

A. True
B. False

Answer 8

A. True

Question 9

Indicators of overbreathing, or chronic hyperventilation, include which of the following?

A. Chest pain/pressure
B. Slow and steady deep breathing
C. Feeling short of breath
D. A and B
E. A and C

Answer 9

E. A and C

Question 10

Which of the following is TRUE about CBT for panic disorder?

A. Cognitive restructuring targets the underestimation of the likelihood of negative
outcomes of panic attacks
B. Exposure typically begins with the most anxiety-provoking exercise
C. Relapse prevention is completed at the end of treatment
D. Clients learn progressive muscle relaxation and breathing retraining
E. Exposure involves facing physical symptoms of panic attacks but not feared activities or
situations

Answer 10

C. Relapse prevention is completed at the end of treatment

Question 11

In breathing retraining, clients are taught all of the following EXCEPT to

A. Breathe using their diaphragm (to breathe into their belly)
B. Hold their breath at the beginning of the inhale and the end of the exhale
C. Breathe in a normal amount of air
D. Include a meditative component to their breathing
E. Smooth out their breathing

Answer 11

B. Hold their breath at the beginning of the inhale and the end of the exhale

Question 12

According to cognitive-behavioral theorists,

A. Thoughts mediate the links between events and emotions
B. Thoughts and events are unrelated
C. Thoughts and emotions are unrelated
D. A and B
E. A, B, and C

Answer 12

A. Thoughts mediate the links between events and emotions

Question 13

True or False: One of the goals in CBT for panic disorder is to articulate and evaluate negative
automatic thoughts.

A. True
B. False

Answer 13

A. True

Question 14

. In response to chest pain, a person who does not have panic disorder might have which of the
following thoughts?

A. I have indigestion
B. I have strained some chest muscles
C. I am stressed
D. All of the above
E. None of the above

Answer 14

D. All of the above

Question 15

True or False: Exposure is the most critical component of CBT for panic disorder, according to the research literature.

A. True
B. False

Answer 15

A. True

Question 16

In the exposure component of CBT for panic disorder, the client creates a hierarchy of exercises that cause symptoms similar to their panic attacks and then:

A. Starts with the most scary exercise to show themselves that their fears of the less scary
exercises were unfounded
B. Starts in the middle of the hierarchy and then moves up or down depending on whether a
panic attack occurs during the exposure
C. Starts with the least scary exercise and repeats it until the client habituates to the exercise
and then moves up the hierarchy
D. Uses the hierarchy as a guideline for situations to avoid to stop having panic attacks
E. None of the above

Answer 16

C. Starts with the least scary exercise and repeats it until the client habituates to the exercise
and then moves up the hierarchy

Question 17

True or False: After clients with panic disorder complete the agoraphobia hierarchy, they move to the naturally occurring situations hierarchy, and then the physical symptoms hierarchy.

A. True
B. False

Answer 17

B. False

Question 18

True or False: Exposure therapy is assumed to be effective because the client habituates to feared
symptoms, activities, and situations.

A. True
B. False

Answer 18

A. True

Question 19

Relapse prevention involves planning for which of the following circumstances in panic disorder?

A. Anticipating what might trigger significant symptoms
B. Identifying high-risk situations for the client
C. Developing plans for how to cope with significant symptoms
D. All of the above

Answer 19

D. All of the above

Question 20

Why does it require a strong, therapeutic alliance between client and therapist to conduct exposure therapy?

Answer 20

Before even suggesting the idea of an exposure therapy, the relationship between therapist and client must be strong. Exposure therapy is necessarily stressful and anxiety-provoking for the client. Therefore, many clients cannot be convinced to face their fears directly, unless they genuinely trust and believe that their therapist will support and help them.

Question 21

Why are thinking skills taught in CBT for Panic Disorder?

Answer 21

Thinking skills are important to CBT because of the relationship between thoughts, emotions,
and behaviors. According to cognitive theory, how we feel and behave in response to events is
mediated by our thoughts about those events. Thus, learning to identify and challenge maladaptive thoughts in response to events can help to reduce negative emotion and avoidance
behavior.

Question 22

Why are the responses to a number of physical symptoms that are generated during a therapy session assessed in CBT for Panic Disorder?

Answer 22

Responses to a variety of physical symptoms during therapy are assessed during CBT for panic
disorder to allow the client to face these symptoms directly, to recognize that they are not
harmful, and to learn that they can tolerate them. Another reason this is done is to allow the clinician to identify which physical symptoms are most closely related to that client’s panic attacks; these can then be targeted for treatment and used in the creation of an anxiety-provoking hierarchy.

Question 23

After developing a hierarchy of feared agoraphobic situations, how might a client be instructed to pursue exposure to them outside of session?

Answer 23

After the hierarchy is developed, clients may be asked to complete “homework assignments” to
engage in some steps of the hierarchy in between sessions. The client would begin by repeatedly exposing themself to the agoraphobic situation that evokes the least anxiety first, until their anxiety decreases. Then they would do analogous exposure to the situation evoking the second-least anxiety, etc.