Psychological Treatments

Question 1

GAD

Answer 1

• CBT
• CBT as effective as meds so consider it first line.
• No evidence for combo.
• If the person doesn’t respond to therapy or meds, can consider switching or combo (as there is limited harm).

Question 2

Panic Disorder

Answer 2

• CBT with ERP is first line.
• In the acute phase, can consider combo treatment to help the pt tolerate ERP.
• In the recovery phase, want combo or CBT alone as they are better than meds alone. (CBT = combo > meds alone).
• Can use benzos for agitation/hasten response at the beginning but evidence that it may worsen therapy over time.

Question 3

Social Anxiety Disorder

Answer 3

• CBT, online CBT, CBT with ERP is 1st line.
• CBT benefits are more long lasting.

Question 4

Specific Phobia

Answer 4

CBT (exposure)

Question 5

OCD

Answer 5

• CBT (ERP), online CBT guided, computer-based CBT guided are 1st line.
• CBT with ERP > meds as therapy is more efficacious, safer, and longer lasting.
• ERP > meds and NO evidence that combo (ERP + meds) is better than ERP alone.

Question 6

PTSD

Answer 6

• Trauma-focused CBT, EMDR, prolonged exposure, and cognitive processing therapy all have evidence.
• No role for psychological debriefing.
• Meds or therapy can be used, no evidence that one is superior.
• Trauma-focused CBT has evidence in both PTSD and acute stress disorder.

Question 7

BPD

Answer 7

DBT, psychodynamic therapy, schema therapy

Question 8

Depression, acute

Answer 8

1st line: CBT, IPT, BA

2nd line: MBSCT, CBASP, short-term psychodynamic

Question 9

Depression, maintenance

Answer 9

1st line: CBT, mindfulness-based CBT

2nd line: IPT, BA, CBASP

Question 10

Bipolar Disorder, maintenance 1st/2nd line

Answer 10

1st line: Psychoeducation (level 2)

2nd line: CBT, family-focused therapy (both level 2)

Question 11

Bipolar Disorder, depression 1st/2nd line

Answer 11

No first line

2nd line: CBT, family-focused therapy (level 2)

Question 12

Scz - family intervention

Answer 12

• Strong evidence for decreased sx, decreased hospitalization
• Some evidence on improving fxn

Question 13

Scz - employment

Answer 13

• Supported employment if interested
• Prevocational training if cannot find employment
• Evidence of financial benefit, benefits for sx, benefit for well-being

Question 14

Scz - CBT for psychosis

Answer 14

• Offer to all who have not adequately responded to antipsychotic
• Effective for reducing sx, hospitalizations, and relapses

Question 15

Scz - cognitive remediation

Answer 15

• May improve cognitive domains that could translate to improved social and fxnal outcomes

Question 16

Scz - social skills training

Answer 16

• Offer to those who are having difficulty or anxiety with social interactions
• Routine use not strongly recommended
• May have some effects on negative sx/social fxn but limited improvement on positive sx

Question 17

Scz - life skills training

Answer 17

• Little evidence for effectiveness
• For pts who are having trouble with self-care, practical aspects of life

Question 18

Scz - pt education

Answer 18

• Integral part of treatment
• Does not have robust effects on treatment outcome

Question 19

Scz - new interventions

Answer 19

• Mindfulness, avatar, ACT, peer support
• Need further studies

Question 20

Substance Use Disorder

Answer 20

• Psychotherapy is superior to control for SUD (utility of meds for SUD may be limited unless delivered with psychotherapy; meds can enhance therapy ie lower drop-out rate)
• No particular therapy has been found to be consistently superior
• CBT
• Behavioural therapies (contingency management, community reinforcement, cue exposure and relaxation training, aversion therapy)
• Motivational enhancement therapy
• Group therapy
• Family therapies
• Self-help groups and 12-step oriented approaches
• Brief therapies
• Hypnosis (little evidence for Nic UD)