Question 1

Which of the following best defines the basis of cognitive behavior therapy?&#10;A) Cognitive behavior therapy is based on the concept that distorted thoughts are the foundation of many emotional, mental, and behavioral disorders.&#10;B) Cognitive behavior therapy is based on the concept that higher education can prevent emotional, mental, and behavioral disorders.&#10;C) Cognitive behavior therapy is based on the concept that a contingency contract can help a client develop adaptive behaviors.&#10;D) Cognitive behavior therapy is based on a reward system of positive reinforcement of positive self-statements.&#10;

Accepted Answer

1.This is correct. Cognitive behavior therapy is based on the theory that distorted perceptions, or cognition, are the foundation of many emotional, mental, and behavioral disorders.
2.This is incorrect. There is no correlation with education level and mental health.
3.This is incorrect. A contract for improved behavior is a component of behavioral therapy, not cognitive behavior therapy.
4.This is incorrect. This type of positive reward as a form of positive reinforcement is a component of behavioral therapy, not cognitive behavior therapy.

Question 2

An advanced practice nurse recommends that a client participate in cognitive behavior therapy. The client asks, "What's cognitive behavior therapy, and how can it help me?" Which is the nurse's best reply?

A) "It is a system of techniques in which you use positive thinking to improve your mood."
B) "It is a long-term interpersonal approach that emphasizes the role of early childhood experiences."
C) "It is an interpersonal treatment approach that specifically targets magical thinking."
D) "It is a focused treatment for the modification of distorted thinking and maladaptive behaviors."

"It is a focused treatment for the modification of distorted thinking and maladaptive behaviors."

Accepted Answer

1.This is incorrect. This does not answer the client's question on cognitive behavior therapy. Cognitive behavior therapy utilizes interventions to modify the client's perceptions and responses to stressors.
2.This is incorrect. Although principle 1 states that the therapist identifies current thinking patterns that may have developed early in life, cognitive behavior therapy is often a time-limited approach.
3.This is incorrect. The goal of cognitive behavior therapy is to substitute more-realistic interpretations for the client's biased cognitions, not recommend "magical thinking."
4.This is correct. Cognitive behavior therapy is a time-limited intervention in which the therapist works in collaboration with the client to modify thinking to eliminate cognitive errors that reinforce emotional disturbances.

Question 3

The student comes in to the instructor's office and reports that they wish to drop out of nursing school due to the overwhelming work. The instructor advises the student to write assignments and due dates on a calendar to help break down what needs to be done and when. What technique is the instructor using?

A) Activity scheduling
B) Distraction
C) Graded task assignments
D) Behavioral rehearsal

Graded task assignments

Accepted Answer

1.This is incorrect. Activity scheduling identifies important areas needing concentration during therapy, where the client is asked to keep a daily log of their activities on an hourly basis.
2.This is incorrect. Distraction redirects the client's thinking and diverts from intrusive thoughts or depressive ruminations that are contributing to maladaptive responses.
3.This is correct. Graded task assignments are used to break down the task into subtasks that the client can complete one step at a time. Using a calendar with the assignments and due dates may help the student/client increase self-esteem and decrease feeling of helplessness.
4.This is incorrect. Behavioral rehearsal would include miscellaneous techniques such as role-modeling, social skills training, and other behavioral interventions.

Question 4

Beck's original concept for cognitive behavior therapy has been expanded by many theorists, but the foundation remains. Which of the following best describes the historical foundation of cognitive behavior therapy?

A) Rejection of passive listening used in psychoanalysis in favor of active, direct dialogues with clients.
B) Utilization of the psychoanalytic view of seeing depression as "anger turned inward."
C) Recognition that cognitive behavior therapy works for depression but not for other emotional disorders.
D) Cognitive behavior therapy has been the forefront of the Freudian framework of psychoanalysis.

Accepted Answer

1. This is correct. Beck was trained in the Freudian psychoanalytic view of depression but began to observe a common theme of negative cognitive processing in thoughts and dreams of his depressed clients.
2.This is incorrect. This is the Freudian psychoanalytic view of depression and encourages passive listening of therapists.
3.This is incorrect. Indications for cognitive behavioral therapy have been recognized as effective for several clinical conditions, such as post-traumatic stress disorder, panic disorder, and substance abuse.
4.This is incorrect. Beck, the originator of cognitive behavior therapy, was trained in Freudian psychoanalysis.

Question 5

A nurse practitioner uses cognitive behavior therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts (DRDT). Which of the following are appropriate nursing replies to a client asking about the purpose of this exercise? Select all that apply.

A) "The purpose of this exercise is to identify automatic thoughts."
B) "The purpose of this exercise is to identify rational alternatives."
C) "The purpose of this exercise is to modify cognitive errors."
D) "The purpose of this exercise is to eliminate irrational beliefs."
E) "The purpose of this exercise is to monitor thoughts related to self-esteem."

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Accepted Answer

1.This is correct. The DRDT is a tool commonly used in cognitive behavior therapy to help clients identify automatic thoughts.
2.This is correct. The DRDT is a tool commonly used in cognitive behavior therapy to help clients generate rational alternatives.
3.This is correct. The DRDT is a tool commonly used in cognitive behavior therapy to help clients modify thinking.
4.This is incorrect. The DRDT does not help eliminate irrational beliefs.
5.This is incorrect. The DRDT does not monitor a client's thoughts related to self-esteem.

Question 6

Which of the following statements regarding role-playing is correct? Select all that apply.&#10;A) Role-playing is a type of distractor from negative thinking.&#10;B) The client assumes the role of the antagonist that produces the maladaptive response.&#10;C) The situation is played out to help the client recognize their automatic thinking.&#10;D) Role-play is limited to strong relationships between client and therapist.&#10;E) Role-play teaching increases awareness of controlled breathing.&#10;

Accepted Answer

1.This is incorrect. Role-play is a technique to allow the client to practice a new way of responding to distressing situations.
2.This is incorrect. The therapist assumes the role of the antagonist that produces the maladaptive response in the client.
3.This is correct. The situation is played out to elicit recognition of automatic thinking on the part of the client.
4.This is correct. Role-play is a technique that should be used only when the relationship between client and therapist is strong and there is little likelihood of maladaptive transference.
5.This is incorrect. Guided relaxation is aimed at reducing autonomic responses to anxiety, which also increases awareness of conscious control over breathing, anxiety symptoms, and thoughts.

Question 7

A client is diagnosed with an anxiety disorder. The nurse counselor recommends the behavioral technique of reciprocal inhibition. The client asks, &#34;What's that?&#34; Which is the best nursing reply?&#10;A) &#34;At the beginning of this intervention, a contract will be drawn up explicitly stating the behavior change agreed upon.&#34;&#10;B) &#34;By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve.&#34;&#10;C) &#34;Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety.&#34;&#10;D) &#34;In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate.&#34;&#10;

Accepted Answer

1.This is incorrect. This is contingency contracting, which has specifics on how reinforces and punishment will be presented.
2.This is correct. Reciprocal inhibition decreases or eliminates an undesired behavior by introducing a more adaptive behavior that is incompatible with the undesired behavior.
3.This is incorrect. This is systematic desensitization where the client is exposed to a hierarchy of anxiety-producing events through which the individual progresses during therapy.
4.This is incorrect. This is "flooding" where the client is exposed to a continuous presentation (through mental imagery) of the phobic stimulus until it no longer elicits anxiety.

Question 8

The spouse of an alcoholic comes to the clinic and asks for some medication to help the client stop drinking. The spouse states that there is a drug given to help stop drinking by making them sick after ingesting alcohol. Which of the following is the most appropriate response to this request?

A) "This may work, as it has been a form of eliminating behavior with a more-adaptive behavior."
B) "This would be a discussion with the individual who wishes to stop drinking by replacing the euphoric feeling with a severe punishment."
C) "I am sure that the therapist can prescribe this and you can add it to your spouse's food."
D) "Have you tried to use a written contract with your spouse first? The side effects of the medication are dangerous."

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Accepted Answer

1.This is incorrect. This describes reciprocal inhibition, where the client with a more adaptive behavior for the unacceptable behavior
2.This is correct This is a form of overt sensitization, or aversion therapy, that produces unpleasant consequences. This disulfiram (Antabuse) is given to individuals who wish to stop drinking. Further discussion is necessary, as the client must agree to this treatment.
3.This is incorrect. This would be ethically incorrect, as the client must be willing to use the medication and wish to stop drinking.
4.This is incorrect. This is an example of contingency contracting. A contract is drawn up among all parties involved. The desired behavior change and specified reinforcers for performing this behavior are stated explicitly in writing.

Question 9

The parents of a 10-year-old child come to the office to discuss the issues raised during the most recent parent-teacher conference. One parent states that the child is able to act age appropriately unless given a task to complete, such as making their bed. In this case, the child crawls on the floor and begins to speak "baby talk" until the other parent relents and does the task for the child. What is the most appropriate reason for this maladaptive behavior?

A) This is an example of extinction technique.
B) This is an example of overt sensitization.
C) This is an example of systematic desensitization.
D) This is an example of classical conditioning.

Accepted Answer

1.This is incorrect. Extinction behavioral modification is the gradual decrease in frequency or disappearance of a response when the positive reinforcement is withheld.
2.This is incorrect. Overt sensitization is a type of aversion therapy that produces unpleasant consequences for undesirable behavior.
3.This is incorrect. Systematic desensitization is a technique used for assisting individuals to overcome their fear of a phobic stimulus.
4.This is correct. The father has been conditioned by the child to perform the tasks for the child's maladaptive behavior.

Question 10

Per behavioral theory, the treatment of phobic symptoms involves which action?&#10;A) Decrease the environmental stimuli in the room.&#10;B) Progressive exposure of the phobia to the actual experience.&#10;C) Request the family participate in the care planning.&#10;D) Discovery of previous noxious experiences via hypnosis.&#10;

Accepted Answer

1.This is incorrect. Manipulating the environment, such as dimming the lights and sounds, may decrease the client's overall anxiety but does not address the phobias.
2.This is correct. This is an example of systematic desensitization, which is used to assist an individual overcome fear of a phobic stimulus. It is systematic in that there is a hierarchy of anxiety-producing events through which the individual progresses during therapy.
3.This is incorrect. Family inclusion is not a component of behavior theory.
4.This is incorrect. Hypnosis or revisiting incidents that produced the phobia is not a component of behavior theory.

Deck 7: Cognitive Behavior Therapy