RECALL: Psychotherapy + Personality

Question 1

“115. (Repeat) Patient speaks fondly of his psychiatrist altough not getting better. This is an example of
A) Transference neurosis
B) Resolution of resistance”

Answer 1

A–transference neurosis

Question 2

what is transference neurosis?

Answer 2

“Usually develops in the middle phase of analysis, when the patient, at first eager for improved mental health, no longer consistent displays such motivation, but engages in a continuing battle with the analyst over the desire to ATTAIN SOME KIND OF EMOTIONAL SATISFACTION FROM THE ANALYST so that this becomes the most compelling reason for continuing analysis”” [KS]

WEBSITE (READ IT FOR BETTER UNDERSTANDING):
defined as ““an artificial neurosis into which the manifestations of the transference tend to become organised; is built around the relationship with analyst.”” Freud: analyst and the analysis have become the centre of the patient’s emotional life and the patient’s neurotic conflicts are re-lived in the analytic situation .: TN is this CONSETLLATION OF TRANSFERENCE REACTIONS. TN only undone by the analytic work, takes considerable time, serves as a transition from illness to health.

psychoanalyst uses it deliberately in order to facilitate the access to the patient’s repressed past, most important vehicle to success. BUT can become the most solid resistance to working and to change and, thus, the most frequent cause of therapeutic failure. undoubtedly one of the LENGTHENING FACTORS in open-ended analytic psychotherapies (vs BRIEF PDT, where each transference reaction is confronted and worked through immediately… TN doesn’t have time to develop, assumption is each transference reaction can be fully used to uncover what you need (vs waiting)”

Question 3

“13. A [married] lady presents with panic attacks. She thinks it may be related to a new coworker that she finds attractive. What type of therapy would be most appropriate?
A) IPT
B) Brief dynamic psychotherapy
C) MBCT
D) Marital counselling”

Answer 3

“B) Brief dynamic psychotherapy = best answer.

Panic theorized to have psychodynamic underpinnings in psychodynamic theory. Stem makes it sounds very psychodynamic-y, erotic transference.

Somatic symptoms, no compeling indication for other options.

KSS 11e p. 363: The research indicates that the cause of panic attacks is likely to involve the unconscious meaning of stressful events and that the pathogenesis of the panic attacks may be related to neurophysiological factors triggered by the psychological reactions. Psychodynamic clinicians should always thoroughly investigate possible triggers whenever assessing a patient with panic disorder. The psychodynamics of panic disorder are summarized in Table 9.2-1. Panic-focused psychodynamic psychotherapy has some evidence.

As per staff Michelle van den engh:
- Possible Malan triange of conflict here: unacceptable impulse/feeling for coworker, that is causing anxiety, and comes out as a somatization defense. Plus, she has some psychological mindedness by thinking that it’s related to this coworker

A) FALSE. Not depression, no targets: grief and loss, role transition, intepersonal disupte
B) TRUE.
C) FALSE but 2nd best? it’s mentioned in anxiety guidelines, but not emphasized
D) FALSE. No info on state of marriage. Plus work on self first, then bring that to the couples’ counselling if you need to work on something together.

CANMAT 2016 depression: MBCT for MDD was formally developed as an 8-week group treatment designed to teach patients how to disengage from maladaptive cognitive processes through an integration of mindfulness meditation training and cognitive-behavioural techniques.92 MBCT improves clinical outcomes via changes in mindfulness, rumination, worry, compassion, and metaawareness, consistent with underlying theory

CPG 2014: MBCT adjunctive evidence for panic disorder and GAD”

Question 4

“132. Which of the following lists anxieties in order of immature to most mature?
A) Disintegration, loss of objection, castration, superego anxiety
B) Disintegration, castration, loss of objection, superego anxiety
C) Loss of objection, castration, disintegration, superego anxiety
D) Castration, disintegration, loss of objection, superego anxiety”

Answer 4

“A) Disintegration, loss of object, castration, superego anxiety

KSS 11e p389

Question 5

what is disintegration anxiety

Answer 5

anxiety derives from the fear that the self will fragment because others are not responding with needed affir­mation and validation. Persecutory anxiety can be connected with the perception that the self is being invaded and annihilated by an outside malevolent force.

Question 6

what is loss of object anxiety

Answer 6

fears losing the love or approval of a parent or loved object.

Question 7

what is castration anxiety

Answer 7

linked to the oedipal phase of development in boys, in which a powerful parental figure, usually the father, may damage the little boy’s genitals or otherwise cause bodily harm.

Question 8

what is superego anxiety

Answer 8

related to guilt feelings about not living up to internalized standards of moral behavior derived from the parents.”

Question 9

why is communication analysis done in IPT and how is it done

Answer 9

Communication Analysis: Communication analysis is used to enhance communication skills and thereby improve interpersonal functioning. In order to dissect in detail the communication between two individuals, the therapist asks for a “movie script” of an exchange between the patient and a significant other, including the setting, content, tone, non-verbal communication, and accompanying emotional experience. The therapist queries the patient about what was intended to be communicated as well as what she thinks was actually communicated. The therapist may then use coaching or role play to help the patient improve her communication skills.

MIDDLE PHASE of IPT

Question 10

what is the rational for behavioural activation in MDD

Answer 10

“Avoidance decreases opportunity for positive reinforcement “

CANMAT 2016 sec 2.17: The rationale for BA is that depression is caused and maintained by escape and avoidance of aversive emotions and stimuli that become self-reinforced and also prevents positive reinforcement of nondepressive behaviour, consequently causing longstanding patterns of inertia, avoidance, and social withdrawal

Question 11

“144. True of group therapy:
a. Patients learn from one another to correct distortions
b. Consensual validation
c. (from French exam) Ventilation is the factor most predictive of success”

Answer 11

“B) Consensual validation = TRUE
BUT A) is describing what consensual validation is

KS table of 20 therapeutic factors (not Yalom). Likely more to the question

A) This is describing what consensual validation is…so it’s true as well
B) TRUE
C) ??. KS table says ““cohesion”” is most important therapeutic factor for positive therapeutic effect”

Question 12

“145.Typical aspects of an agreement that may be required of patients entering psychodynamic group therapy include all of the following EXCEPT:
a. be present regularly, on time, and remain throughout the session
b. work actively on problems that brought the patient to the group
c. free associate whenever possible
d. put feelings into words, and not actions”

Answer 12

C) free associate whenever possible

Question 13

what is abreaction

Answer 13

A process by which repressed material, particularly a painful experience or conflict, is brought back to consciousness. In the process, the person not only recalls but relives the material, which is accompanied by the appropriate emotional response; insight usually results from the experience.

Question 14

what is catharsis

Answer 14

The expression of ideas, thoughts, and suppressed material that is accompanied by an emotional response that produces a state of relief in the patient.

Question 15

The expression of ideas, thoughts, and suppressed material that is accompanied by an emotional response that produces a state of relief in the patient.

Answer 15

“B) Being late = true

https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/

A) is life-threatening behaviour
B) best answer
C) is quality of life interfering behaviour. If you are showing up intoxicated, that would be therapy-interfering behaviour
D) you are allowed to express emotions during therapy

The treatment targets in order of priority are:
1) Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including suicide communications, suicidal ideation, and all forms of suicidal and non-suicidal self-injury.
2) Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
3) Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as disorders, relationship problems, and financial or housing crises.
4) Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.”

Question 16

IPT has evidence for all except:
a. Bulimia
b. Social anxiety
c. Delusional disorder
d. Anorexia”

Answer 16

“C) Delusional disorder

Mood disorders, SAD, PTSD, AN, BN
MDD, PDD, Binge-Eating Disorder, Anorexia, Bulimia, Bipolar Disorder

KS FULL 10e P.2783
- Lists SAD, BN
- AN is ““under investigation””
- Psychosis is contraindication, ““Contraindications: Interpersonal psychotherapy was not developed to treat psychotic depression or other forms of psychosis, such as schizophrenia.”””

Question 17

what are some of the roles of the therapist in group therapy

Answer 17

“In terms of specific leadership technique, the leader has to be proficient in tolerating as well as containing intense affect, managing his/her own countertransference engendered by the group, performing a teaching function for members in which the leader clarifies misperceptions and provides factual information, and uses interpretation in a timely manner.”

**in the MCQ, the answer was “tolerate and contain strong affects”

Question 18

“27- Child who adopted recently. 3 years old. Doesn’t want the mother. Distress when she is away. Not functional. But when she comes back angry. Can’t be reassured.
a. Insecure attachement – ambivalent type
b. Insecure attachement – disorganized
c. Secure attachment with separation anxiety
d. Insecure - avoidant”

Answer 18

“A) Ambivalent - Distressed when caregiver leaves, not reassured when comes back.

Disorganized is more unpredictable”

Question 19

“30. What is the fourth stage of the Kubler-Ross stages of grief:
a. Bargaining
b. Depression
c. Anger
d. Acceptance”

Answer 19

“B) Depression

DABDA
Denial (avoidance, fear, shock)
Anger (frustration, anxiety, anger)
Bargaining (reaching out to others, telling story, struggling to accept)
Depression (overwhelmed, helpless)
Acceptance (new plan, moving on)

critisims- overly simplistic, grief is not linear, not rooted in any sound theories

accepted as a valubale simple overview. “

Question 20

list the anxieties from most primitive to least primitive

superego anxiety
castration anxiety
persecutory/disintegration anxiety
separation anxiety/fear of loss of object
stranger anxiety
fear of loss of love

Answer 20

most primitive–> persecutory/disintegration anxiety–> stranger anxiety–> separation anxiety/fear of loss of object–> fear of loss of love–> castration anxiety–> superego anxiety–> least primitive

Question 21

“31- Therapy with patient. Patient is anxious and avoiding eye contact. You ask how he feels about him and he gives a vague answer. What is part of the triangle of conflict is the vague answer?
a. Transference
b. Defense
c. Anxious
d. Impulse”

Answer 21

“B) Defense

confirmed by staff michelle van den engh

This is referring to Malan’s brief psychodynamic psychotherapy

Triangle of conflict: Feelings/impulses, Anxiey, Defense
Triangle of person: Current, Past, Transference

Defences– minimizing, ignoring, avoiding the question.
Anxiety –Worry, panic, fear, anxiety, guilt, shame
Feeling/Impulse – joy, anger, grief, love pride

Two Triangles - the Triangle of Conflict (Defence, Anxiety and Hidden Feeling) and the Triangle of Persons (Current, Transference/Present and Past). The Triangle of Conflict illustrates the relation between anxiety, defences and the underlying impulses or feelings. The Triangle of Persons shows the links between the relationship with the therapist, with current people in the patient’s life, and with people from their past.

That is, Defenses (D) and Anxieties (A) can block the expression of true Feelings (F). These patterns began with Past persons (P), are maintained with Current persons (C), and are often enacted with the Therapist (T).”

Question 22

what are the goals of IPT

Answer 22

-alleviate suffering
-remite symptom, improve function
-resolve current interpersonal problems
-improve communication and relationships

Question 23

“38) Which is true about establishing interpersonal inventory in IPT?
a. Part can be done as homework
b. Challenges the sick role
c. Includes past and present relationships
d. Helps to establish goals of therapy”

Answer 23

“C) Includes past and present relationships = TRUE

A) FALSE. Done with therapist in session.
B) FALSE. Does NOT challenge the sick role.
C) TRUE. ““includes a review of the patient’s past and current social functioning and close relationships””. Also from our IPT course, also KS Full
D) LESS TRUE. Is true lol, but probably a stem recall issue. not the MOST true, given C is here. This is also substantiated by the IPT textbook. sigh”

Question 24

what is core to Freuds structural theory of the mind

Answer 24

superego, ego, id

Question 25

what is core to Freuds topographical theory of the mind

Answer 25

conscious, preconscious, unconscious

Question 26

“39. What is at the core of Freud’s structural theory of the mind?
a. Psychosexual development stages
b. Oedipal conflict
c. The division between id, ego and superego
d. conscious, unconscious, preconscious”

Answer 26

“C) The division between id, ego, and superego = TRUE

Structural = id, ego, superego
Topographical = conscious, preconscious, unconscious

A) FALSE. Oral, anal, phallic, latent, genital.
B) FALSE. Part of phallic.
C) TRUE
D) FALSE. Topographical model”

Question 27

what are the flexibility categories in the FACES-III Family adaptation and cohesion scale

Answer 27

Rigid–somewhat flexible–flexible–very flexible–chaotic

Question 28

what are the cohesion categories in the FACES-III Family adaptation and cohesion scale

Answer 28

Disengaged–somewhat connected–connected–very connected–enmeshed

Question 29

“4. Which of the following combination about the FACES-III Family Adaptation and Cohesion Scale is correct?
a. Low cohesion corresponds to a separated family
b. High cohesion corresponds to rigid family
c. High flexibility corresponds to a chaotic family
d. Low flexibility corresponds to ???”

Answer 29

“C) High flexibility corresponds to a chaotic family = TRUE

Flexibility categories:
Rigid – somewhat flexible – flexible – very flexible - chaotic

Cohesion categories:
Disengaged – somewhat connected – connected – very connected – enmeshed

A) FALSE. Low cohesion = disengaged family. Separated isn’t a term.
B) FALSE. High cohesion = enmeshed
C) TRUE
D) FALSE. Low flexibility = rigid
“

Question 30

“41- Lady sees glass half empty, instead of half full. What cognitive distortion?
a. Dichotomous thinking
b. Selective abstration
c. Overgeneralization
d. Catastrophizing”

Answer 30

B selective abstraction

Question 31

“43. Which is true about family therapy:
a. Free association is desired
b. Symptom resolution is the goal of treatment
c. Therapy is considered complete when family members are able to see how others see them
d. Splits and alliances are addressed in the Bowen model”

Answer 31

C–therapy is considered complete when family members are able to see how others see them

(splits and alliances are addressed in the STRUCTURAL not bowen models which is why that one is not true)

Question 32

“49. Davanloo short-term dynamic therapy includes all of the following except?
a. Resolves Oedipal problems
b. Does not have a set date of termination
c. Splitting, projection and denial are not a barrier to treatment”

Answer 32

“C) Splitting, projection, denial are not a barrier to treatment = FALSE

A) TRUE. Can resolve Oedipal problems. [specifically says this]
B) TRUE. Does not have a set date of termination. [TR2020]
C) FALSE. They are a barrier

C - need to be able to TOELRATE interpretations and connect well with therapist. so this is best answer.
KS: selection criteria = the establishment of a psychotherapeutic focus; the psychodynamic formulation of the patient’s psychological problems; the ability
to interact emotionally with evaluators; a history of give-and take relationships with a significant person in the patient’s life; the patient’s ability to experience and tolerate anxiety, guilt, and depression; the patient’s motivations for change, psychological mindedness, and an ability to respond to interpretation and to link evaluators with persons in the present and past”

Question 33

“53. All of the following are defense mechanisms involved in Kernberg’s concept of borderline personality organization except?
a. Projective identification
b. Splitting
c. Reaction formation
d. Denial”

Answer 33

“C) Reaction formation = NOT

A) YES [KS p.180]
B) YES [KS p.180]
C) NOT [TR 2020, slide 68)
D) SURE”

Question 34

“56. All of the following are potential dynamic explanation of pseudocyesis except?
a. Ambivalence about gender identity and having children
b. A reaction to a miscarriage
c. Wish for vs. fear of pregnancy
d. A defense against dyspareunia”

Answer 34

“D) A defense against dyspareunia = NOT

A) YES
B) YES
C) YES
D) NOT listed in KS”

“predisposing psychological processes are thought to include:
1. a pathological wish for, and fear of, pregnancy
2. ambivalence or conflict regarding gender, sexuality or childbearing
3. a grief reaction to loss following a miscarriage, tubal ligation or hysterectomy
–> may have a true somatic delusion but often negative pregnancy test or pelvic U/S will resolve the issue
–> psychotherapy is recommended during or after a presentation of pseudocyesis to evaluate and treat the underlying psychological dysfunction”

Question 35

what defense mechanism is more common in paranoid PD

Answer 35

projection

Question 36

what defense mechanism is common in Borderline

Answer 36

splitting

Question 37

“57. You are seeing a 16 year old girl in the ER who is there with her mother after a tylenol and SSRI overdose and suicide attempt. They have been cleared by medicine. When you see them you notice a lot of tension and fighting between the mother and daughter. What family therapy intervention would be helpful?
a) Tell the daughter that her mother is trying and that she needs to be less angry with her
b) Work with the daughter to help her develop additional problem solving skills
c) Work with the mother to express positive emotions towards her daughter
d) Try to establish clear boundaries in the family”

Answer 37

“D) Try to establish clear boundaries in the family

C a less good option
Staff michelle van den engh’s voted for D

note the actual stem in real life and consider the principles below

D)
- PRO: minuchin structural model talks about boundaries. boundaries important for containment. common intervention for dysregulation.
- CON: not clear this is the underlying issue, possibly a longer term strategy than acute crisis

C)
CON:
- staff said: some say might be true if it didn’t have the word ““positive.”” in family therapy, you want to get family to express all emotions, not just positive.
PRO:
- in some family therapy models, you need to bring the interpersonal pattern and you’d like work on expressing positive emotions as a first step (e.g. EFFT, selective praise, reducing expressed emotion, etc). you’re not forcing mother to express positive emotions that are not genuine or invalidating. you’re working with her to express them, ie interrupt the criticism-acting out cycle.

–
A) is too directive/invalidating
B) ?is a bit counter to family therapy philosophy because it labels the daughter the problematic family member. not a bad idea though, but not ““family therapy intervention”””

Question 38

“64. All of the following are considered positive therapeutic factors in group therapy except?
a. Universality
b. Psychoeducation
c. Consensual validation
d. Imitation”

Answer 38

psychoeducation (not a therapeutic factor in group therapy)

Question 39

“65. Reciprocal inhibition is used for the following therapies except:
a. Systematic desensitization
b. Aversive
c. Token economy “

Answer 39

“C) Token economy

A) Relaxation + exposure to fear (obvious reference to ““recipricol inhibition””)
B) Noxious stimuli + paraphilia (seems related intellectually, e.g. https://www.researchgate.net/publication/304579470_Aversion_Therapy)”

Question 40

“77. While in family therapy, you suggest that the child’s defiant behavior is just a representation of the conflict between the two parents. What is this an example of?

Another version: Family therapy, you ask the parents to view the child’s defiant behaviour as child’s way of distracting them from their fighting/shitty marriage, what is this called?

A) Reframing
B) Interpretation
C) Paradoxical injunction
D) Triangulation”

Answer 40

“A) reframing = true.

almost verbatim from K&S:
Reframing, also known as positive connotation,
is a relabeling of all negatively expressed feelings or behavior
as positive. When the therapist attempts to get family members to view behavior from a new frame of reference, ““This child is impossible”” becomes ““This child is desperately trying to distract and protect you from what he or she perceives as an unhappy mar­ riage.”” Reframing is an important process that allows family mem­ bers to view themselves in new ways that can produce change.

But, others not clearly wrong, so an annoying question

A) TRUE
B) FALSE, LESS TRUE. Could be, but not how the stems describes it.
C) FALSE. An instruction to do something that is rendered impossible by the instruction itself, as in ““Do not think of a giraffe!””
D) FALSE, LESS TRUE. Could be, eg the 2 parents are fighting, and their child is being pulled into this dynamic to make a triangle.”

Question 41

what are the 5 skills of stress management training

Answer 41

self observation

cognitive restructuring

releaxation exercises

time management

problem solving

Question 42

“78. Which is not a component of evidence-based Stress Management (same in French exam)
a. cognitive reframing
b. relaxation
c. problem solving
d. peer support group”

Answer 42

“D) Peer support group = FALSE

KSS 11e p.488
STRESS MANAGEMENT TRAINING: 5 skills
1) Self-observation
2) Cognitive restructuring
3) Relaxation exercises
4) Time-management
5) Problem-solving”

Question 43

“85- Panic focused psychodynamic psychotherapy
a. No evidence for psychodynamic in panic
b. Psychodynamic equal CBT
c. Psychodynamic focused on panicogens

other version:
d. the therapy is transference focused”

Answer 43

“D) the therapy is transference focused = TRUE.

Directly from KS Full 10e p2679

A) FALSE. panic-focused psychoanalytic psychotherapy (PFPP) is a thing (see KS Full)
B) FALSE? LESS TRUE
- https://journals.sagepub.com/doi/abs/10.1177/070674371305800604
- CPG2014 p22 says ““mixed”” and some evidence of equivalency.
C) FALSE. Does not focus on panicogens. If question says psychodynamic is focused on ““triggers”” then that would be perhaps right answer, because K&S says ““Psychodynamic clinicians should always thoroughly investigate possible triggers whenever assessing a patient with panic disorder.””
Panicogen only mentioned in KSS 11e as a biological trigger (p 392)
D) TRUE

”

Question 44

name 3 defense mechanisms that are part of dream work per Freud

Answer 44

repression

condensation

displacement

Question 45

“91. Which is NOT one of the defense mechanisms in dreams described by Freud?
a) Regression
b) Repression
c) Condensation
d) Displacement”

Answer 45

regression

Question 46

how does condensation appear in dream work

Answer 46

Condensation is the mechanism by which several unconscious
wishes, impulses, or attitudes can be combined into a single
image in the manifest dream content. Thus, in a child’s night­
mare, an attacking monster may come to represent not only
the dreamer’s father but may also represent some aspects of
the mother and even some of the child’s own primitive hostile
impulses as well.

Question 47

how does repression appear in dream work

Answer 47

The analysis of dreams elicits material that has been repressed.

Question 48

how does displacement appear in dream work

Answer 48

The mechanism of displacement refers to the transfer of
amounts of energy (cathexis) from an original object to a sub­
stitute or symbolic representation of the object. For example, in a
dream, the mother may be represented visually by an unknown
female figure (at least one who has less emotional significance
for the dreamer), but the naked content of the dream nonetheless
continues to derive from the dreamer’s unconscious instinctual
impulses toward the mother.

Question 49

“93) Girl thinks that her team at work got a bad review all because of her performance? What defence mechanism used?
a) personalization
b) generalization
c) catastrophization”

Answer 49

“A) Personalization = TRUE

Likely asking about DISTORTIONS, not defense mechanisms.

A) TRUE
B) FALSE
C) FALSE”

Question 50

“94. Young woman with recurrent SI has always lived with her mother. Mother falls ill and is admitted to hospital. Daughter is not coping, presenting to ER every day demanding admission. Defense mechanism?
a. Reaction formation
b. Identification
c. Acting out”

Answer 50

“B) Identification

"”Identification. Patients with conversion disorder may unconsciously model their symptoms on those of someone important to them. For example, a parent or a person who has recently died may serve as a model for conversion disorder. During pathological grief reaction, bereaved persons commonly have symptoms of the deceased.”” [KS]

A) FALSE
B) TRUE
C) FALSE
“

Question 51

“104. 29 y/o guy is dumped by his girlfriend of 18 months. Seen in crisis. Feels worthless and “never does anything right.” Envious of friends in happy marriages and fantasizes about bad things happening to them. Most likely PD?
a. Borderline
b. Narcissistic
c. Dependent
d. Antisocial
“

Answer 51

**NOTE: other versions of this question are more clearly narcissistic, including mentions of patient being disappointed he is not a “famous author” as he dreamed.

“Narci? Male, narcissistic injury, envy, fantasies
^slightly better.

BPD? But envy is not typical per criteria

Other years more clearly Narci
Recognize the criteria, stem should be better on the exam

C) FALSE
D) FALSE

NARCI:
Grandiose sense of self-importance
Fantasies of unlimited success, power, brilliance, beauty, ideal love
Believes self as “special” + unique, should only assoc with high-status
Needs excessive admiration
Sense of entitlement
Interpersonally exploitative
Lacks empathy
Often jealous/envious of others, believes others envious of him/her
Arrogant, haughty behaviors or attitudes

BPD:
Frantic efforts to avoid abandonment (real/imagined)
Unstable + intense interpersonal relationships (idealize, devalue)
Identity disturbance
Impulsivity, 2 areas, potentially self-damaging
Recurrent suicidality or self-harm
Affective instability (due to marked mood reactivity)
Chronic emptiness
Inappropriate anger or difficulty controlling
Transient, stress-related paranoid ideation or severe dissociative sx
“

Question 52

“2. A guy has fight with boss and then shows up at ER with panic attack sxs. Says he doesn’t blame boss “I understand why she was upset, she was under a lot of pressure”. What is occurring?
a. Histrionic
b. Narcissistic
c. OCPD
d. Panic Attack”

Answer 52

“C) OCDP = true

this is reaction formation defense, used by OCPD.

"”Individuals with this disorder are rigidly deferential to authority and rules and insist on quite literal compliance, with no rule bending for extenuating circumstances.”” page 679 of DSM5

A) FALSE
B) FALSE
C) FALSE
D) FALSE. I mean he probably had a panic attack, but OCPD is best answer here. HOWEVER, we should read what the real stem says, and perhaps choose this answer, especially if the Royal College wants us to not diagnose a PD in the ER.

”

Question 53

what does the MMPI measure

Answer 53

MMPI has 10 subscales. One is ““Social Introversion”” which measures introversion and extroversion.

Others are: hypochondriasis, depression, hysteria, psychopathic deviate, masculinity/femininity, psychasthenia, schizophrenia, hypomania.
https://psychcentral.com/lib/minnesota-multiphasic-personality-inventory-mmpi/

NOT projective, which means ambiguous stimuli upon which they project and then you deduce (e.g. Rorschach), https://link.springer.com/referenceworkentry/10.1007%2F978-0-387-79948-3_2096

Doesn’t measure IQ

Not great internal consistency, alpha coefficient for internal consistency should be 90%, generously 70+%, this one found 27% and 29% for women and men respectively [https://journals-sagepub-com.ezproxy.library.ubc.ca/doi/pdf/10.1177/0748175609354594]”

Question 54

“26. The MMPI:
a. Measures social inhibition (other version had “introversion”)
b. Has high internal consistency
c. Uses a projective approach
d. Measures IQ”

Answer 54

“A) Measures social inhibition

MMPI has 10 subscales. One is ““Social Introversion”” which measures introversion and extroversion. Others are: hypochondriasis, depression, hysteria, psychopathic deviate, masculinity/femininity, psychasthenia, schizophrenia, hypomania.
https://psychcentral.com/lib/minnesota-multiphasic-personality-inventory-mmpi/

NOT projective, which means ambiguous stimuli upon which they project and then you deduce (e.g. Rorschach), https://link.springer.com/referenceworkentry/10.1007%2F978-0-387-79948-3_2096

Doesn’t measure IQ

Not great internal consistency, alpha coefficient for internal consistency should be 90%, generously 70+%, this one found 27% and 29% for women and men respectively [https://journals-sagepub-com.ezproxy.library.ubc.ca/doi/pdf/10.1177/0748175609354594]”

Question 55

what type of therapy can be offered to someone with ASPD, especially if incarcerated

Answer 55

Group CBT or mindfulness based stress reduction–++ lack of clarity around this. depends on presentation–Group CBT is better if person has insight and wants to change. Mindfulness likely better if severe ASPD/psychopathy as psychotherapy may be more harmful

Question 56

“42. 28 year old man in prison presents. He has a history of multiple charges for assault. He presents in an upbeat and engaging manner. He says ““they caught the wrong guy””. What intervention is most appropriate?
A) Mindfulness-based stress reduction
B) Group CBT
C) Group problem solving therapy
D) Insight oriented therapy”

Answer 56

“B) Group therapy CBT = TRUE
vs
C) Group problem solving therapy

GROUP CBT = MORE EVIDENCE?
Per 2013 NICE guidelines, group-based cognitive behavioral interventions are recommended for ASPD. The stem has some features of psychopathy (superficial charm), but same NICE guidelines state limited evidence around treatment for psychopathy and still recommend group-based cognitive behavioral interventions.

Antisocial patients generally do poorly in a heterogeneous group setting because they cannot adhere to group standards; but if the group is composed of other antisocial patients, they may respond better to peers than to perceived authority figures. [KS].

PROBLEM SOLVING CITED IN TR2020?
TR2020 personality disorder lec slide 78, tx for ASPD ““Groups, including support and problem solving, can help with relapse prevention”” (assuming for recidivism maybe?)

A) FALSE. Some evidence, but not mentioned in NICE guidelines.
B) TRUE? If in prison and with other inmates :) (not with general population)
C) TRUE?
D) FALSE - Can be negative outcome – hekping them to manipulate even further

staff michelle van den engh’s thoughts: mindfulness-based stress reduction = best. it’s done individually, so doesn’t hurt anyone else, unlike the group setting (B and C). MBSR encourages compassion. so she thinks this is best.”

Question 57

“43. All of the following include paranoia in their diagnostic criteria EXCEPT
a) Schizotypal PD
b) Schizophreniform D/O
c) Paranoid PD
d) Schizoid PD”

Answer 57

“D) Schizoid PD

Cluster A- schizotypal and Paranoid have paranoia. Schizoid only one that doesn’t”

Question 58

“86. 28 year old man in prison presents. He has a history of multiple charges for assault. He presents in an upbeat and engaging manner. He says ““they caught the wrong guy””. What intervention is most appropriate?
A) Mindfulness-based stress reduction
B) Group CBT
C) Group problem solving
D) Insight oriented therapy”

Answer 58

“B) Group therapy CBT = TRUE

NICE guidelines (2010): https://www.ncbi.nlm.nih.gov/books/NBK55350/#ch7.s3

For people with antisocial personality disorder, including those with substance misuse problems, in community and mental health services, consider offering group-based cognitive and behavioural interventions, in order to address problems such as impulsivity, interpersonal difficulties and antisocial behaviour.

7.2.18.2.
For people with antisocial personality disorder with a history of offending behaviour who are in community and institutional care, consider offering group-based cognitive and behavioural interventions (for example, programmes such as ‘Reasoning and Rehabilitation’) focused on reducing offending and other antisocial behaviour.

______

From UTD– all choices appear false–> of all I may go for mindfulness given that there seems to be equivocal or negative evidence for other forms. They say that CBT may work for milder forms with insight– which is not the case in the vignette and that psychotherapy may be ineffective or harmul to persons with psychopathy or severe ASPD (which is the case here)– may go through the motion and learn skills that help them better manipulate, especially in group therapy–most evidence/ rationale for trt comorbidity (other PD or SUD):

"”Clinical trials of the best studied psychotherapy, cognitive-behavioral therapy (CBT) for persons with ASPD have been negative. It is possible, however, that CBT may benefit those with milder forms of the disorder (eg, not physically dangerous) and who possess some insight and reason to improve. Examples of the latter would be patients who risk losing a spouse or job if their behavior were not controlled. Psychoanalysis or psychodynamic therapy were historically preferred approaches to treating ASPD, but these gradually have given way to CBT, which has been adapted from models developed for depression and anxiety disorders. (See ‘Efficacy’ below.)

Antisocial persons often possess traits that actively interfere with the process of psychotherapy and make working with them difficult (eg, impulsivity, blaming others) [4]. No matter how determined the therapist may be to help an antisocial patient, it is possible that the patient’s criminal past, irresponsibility, and tendency toward violence may render him thoroughly unlikable. For that reason, many therapists will find it difficult, if not impossible to work with such a patient. Therapists must be aware of their own feelings and remain vigilant to prevent countertransference from disrupting therapy [25]. The best prospects for treatment come with mental health professionals experienced in treating ASPD who are able to anticipate their emotions and to present an attitude of acceptance tempered with the need to set limits and confront manipulative behaviors without moralizing [26].

Psychotherapy may be ineffective or even harmful when provided to persons with psychopathy or severe ASPD [27,28]. One perspective is that the rigid personality structure of these individuals generally resists outside influence [27], observing that in therapy, many often simply go through the motions, and may even learn skills that help them better manipulate others. This concern is particularly pronounced for group therapy. (See ““Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis””, section on ‘Psychopathy’.)””

Per 2013 NICE guidelines, group-based cognitive behavioral interventions are recommended for ASPD. The stem has some features of psychopathy (superficial charm), but same NICE guidelines state limited evidence around treatment for psychopathy and still recommend group-based cognitive behavioral interventions.
Interestingly, Hart and Hare (1997) reviewed the treatment literature on psychopaths and suggested it was possible that “group therapy and insight-oriented programs help psychopaths to develop better ways of manipulating, deceiving, and using people but do little to help them to understand themselves” (p. 31).
Antisocial patients generally do poorly in a heterogeneous group setting because they cannot adhere to group standards; but if the group is composed of other antisocial patients, they may respond better to peers than to perceived authority figures. [KS]. Some evidence psychopaths do worse in groups, manipulate others, worse recidivism [UTD].
“

Question 59

“89.BPD. Self-mutilation. Behavioral chain analysis. Reflects back behavior and the resulting symptoms. What is that?
a. Reciprocal communication
b. Dialectical technique
c. Validation”

Answer 59

“C) validation = true

Read the 6 levels of validation

1) Listening
2) Reflecting back
3) What’s unsaid
4) Validate given past
5) Validate given current
6) Radical genuineness”