Clinical focus, 29% of today's outline

Which intervention has the strongest evidence base for teaching communication and adaptive skills to young children with autism spectrum disorder?

1. Facilitated communication
   Facilitated communication has been discredited: controlled tests show the messages come from the facilitator, not the child.
2. Applied behavior analysis
   Early intensive behavioral intervention based on applied behavior analysis has the strongest evidence for building communication and adaptive skills in young autistic children.
3. Sensory integration therapy
   Sensory integration therapy is widely used, but its evidence for improving communication and adaptive skills is weak.
4. Nondirective play therapy
   Nondirective play therapy may support emotional expression but lacks evidence for teaching communication and adaptive skills in autism.

In Dugas's cognitive model of generalized anxiety disorder, which factor is the central process that keeps chronic worry going?

1. Intolerance of uncertainty
   Dugas's model holds that people with GAD find uncertainty unacceptable and worry to prepare for every outcome, so treatment builds tolerance of uncertainty.
2. Anxiety sensitivity
   Anxiety sensitivity, fear of anxiety symptoms themselves, is the core process in models of panic disorder rather than GAD.
3. Thought-action fusion
   Thought-action fusion, the belief that thinking something makes it likelier or morally equal to doing it, is central to OCD models.
4. Fear of negative evaluation
   Fear of negative evaluation drives social anxiety disorder, not the broad, multi-topic worry of GAD.

A married man with many coworkers and friends feels deeply lonely because he and his wife have grown emotionally distant and no longer confide in each other. In Weiss's model, which type of loneliness is this?

1. Emotional cutoff
   Emotional cutoff is Bowen's term for managing family anxiety by distancing from family of origin, not a type of loneliness in Weiss's model.
2. Social loneliness
   Social loneliness means lacking friends or a community network, which this man has in abundance.
3. Emotional loneliness
   Weiss's emotional loneliness comes from lacking a close, intimate attachment, even when a wide social network is present.
4. Existential isolation
   Existential isolation (Yalom) is the unbridgeable gap between any person and others, a philosophical given rather than distance in one relationship.

In Clark's cognitive model of panic disorder, what is the central mechanism that sets off a panic attack?

1. Unconscious conflict breaking through defenses
   Unconscious conflict is a psychodynamic explanation of anxiety, not the cognitive mechanism in Clark's model.
2. Chronic worry spread across many life areas
   Widespread chronic worry is the hallmark of generalized anxiety disorder, not the sudden spiral of a panic attack.
3. A conditioned fear of crowded public places
   Fear of crowded places describes agoraphobic avoidance, which can follow panic attacks but does not explain how they start.
4. Catastrophic misreading of normal body sensations
   Clark proposed that panic arises when normal sensations such as a racing heart are misread as signs of disaster, which raises anxiety and the sensations in a spiral.

Which explanation of depression is MOST associated with Lewinsohn's behavioral model?

1. A learned expectation that outcomes are uncontrollable
   Learned helplessness (Seligman) explains depression through expected uncontrollability, a different model.
2. Negative automatic thoughts about self, world, and future
   The negative cognitive triad is Beck's cognitive model of depression, not Lewinsohn's behavioral one.
3. Anger turned inward against the self
   Anger turned inward is the classic psychoanalytic account of depression, associated with Freud.
4. Too little response-contingent positive reinforcement
   Lewinsohn proposed that depression grows when behavior earns too little positive reinforcement, which lowers activity further; behavioral activation grew from this idea.

A client with years of heavy daily drinking stops abruptly. When are delirium tremens MOST likely to begin?

1. About 7 to 10 days later
   By 7 to 10 days acute withdrawal has usually passed its peak; this timing is too late for the usual onset of delirium tremens.
2. Within 6 to 12 hours
   Tremor, anxiety, sweating, and nausea within 6 to 12 hours are early, minor withdrawal signs, not delirium tremens.
3. 48 to 72 hours later
   Delirium tremens, with confusion, hallucinations, and autonomic instability, usually begins 48 to 72 hours after the last drink and can be fatal.
4. Within the first hour
   Within an hour of stopping, blood alcohol is still present and withdrawal has not begun.

A client with many years of heavy drinking arrives confused and unsteady on his feet, with abnormal eye movements. Which condition, treated urgently with thiamine, is MOST likely?

1. Korsakoff syndrome
   Korsakoff syndrome has the same cause but is the chronic memory disorder with confabulation that can follow, not an acute state with ataxia and eye signs.
2. Wernicke encephalopathy
   Wernicke encephalopathy is an acute brain disorder from thiamine deficiency, classically confusion, ataxia, and eye-movement problems, and it is a medical emergency.
3. Alcohol withdrawal delirium
   Withdrawal delirium brings agitation, hallucinations, and autonomic instability after drinking stops; thiamine is not its specific treatment.
4. Alcohol intoxication
   Intoxication can cause unsteadiness, but it resolves as alcohol clears and does not call for urgent thiamine.

After learning that his cancer has spread, a client lashes out at his doctors and family, saying, "Why me? I did everything right, and it isn't fair." Which Kübler-Ross stage does this BEST illustrate?

1. Anger
   In Kübler-Ross's model, anger often appears as 'Why me?' protests and resentment aimed at caregivers, family, or God.
2. Depression
   Depression is sadness and withdrawal as the loss sinks in, not outward protest at doctors and family.
3. Bargaining
   Bargaining tries to postpone the outcome with a deal, such as promising to change in exchange for more time.
4. Denial
   Denial refuses to believe the news; he accepts that the cancer has spread and is protesting its unfairness.

A counselor gives a client who injects opioids a naloxone kit, information on syringe services, and fentanyl test strips, without requiring abstinence. Which approach is this?

1. Motivational interviewing
   Motivational interviewing also meets clients where they are, but it is a conversation style for resolving ambivalence, not handing out naloxone and test strips.
2. Abstinence-based recovery
   Abstinence-based approaches make stopping use the goal and condition of treatment, the opposite of what this counselor does.
3. Harm reduction
   Harm reduction lowers the dangers of continued use, such as overdose and infection, without making abstinence a condition of help.
4. Contingency management
   Contingency management rewards verified behavior such as drug-free urine tests; nothing here is contingent on the client's behavior.

A 15-year-old whose father has a severe alcohol use disorder wants a peer support group for teens affected by a family member's drinking. Which group fits BEST?

1. Alcoholics Anonymous
   Alcoholics Anonymous is for people who want to stop their own drinking, not for family members affected by someone else's.
2. Alateen
   Alateen is the branch of Al-Anon for young people affected by someone else's drinking.
3. Al-Anon
   Al-Anon serves family members and friends of people who drink, mostly adults; Alateen is its group for teens.
4. SMART Recovery
   SMART Recovery helps people change their own addictive behavior using cognitive-behavioral tools; it is not a group for affected teens.

A 78-year-old client tells her counselor that her nephew has been using her bank card for his own purchases without her permission. Which type of elder abuse does this describe?

1. Financial exploitation
   Using an older adult's money or property without permission for someone else's benefit is financial exploitation; reporting duties for counselors vary by state.
2. Psychological abuse
   Psychological abuse is causing distress through threats, insults, or intimidation; misuse of her bank card is a financial harm.
3. Self-neglect
   Self-neglect is an older adult's own failure to meet her basic needs, with no one else causing the harm.
4. Passive neglect by a caregiver
   Neglect is a caregiver's failure to provide needed care; the nephew is taking her money, not failing to care for her.

Which finding is MOST associated with the Adverse Childhood Experiences (ACE) study?

1. Effects vanished once family income was taken into account
   The effects did not vanish when other factors were considered; the graded links held after adjusting for demographic factors such as education.
2. More types of adversity predicted greater adult health risk
   Felitti and Anda found a dose-response pattern: the more categories of childhood adversity, the higher the risk of later physical and mental health problems.
3. Only childhood sexual abuse predicted adult health problems
   The study counted several categories of abuse, neglect, and household dysfunction, and the risk rose with the total, not with one type alone.
4. Most adult participants reported no childhood adversity
   About two-thirds of the mostly middle-class participants reported at least one adverse experience.

Several weeks after her husband's death, a widow keeps scanning crowds for his face and feels intense pining for him. In Bowlby's phases of mourning, she is in which phase?

1. Disorganization and despair
   Disorganization and despair comes when the loss is accepted as permanent and searching gives way to hopelessness and withdrawal.
2. Shock and numbness
   Shock and numbness is the first phase, right after the death, marked by disbelief and feeling unreal rather than active searching.
3. Reorganization
   Reorganization is the final phase of rebuilding life and identity, with the loss integrated.
4. Yearning and searching
   Bowlby's second phase, yearning and searching, brings intense pining and searching for the lost person, such as scanning crowds for his face.

Batterer intervention programs based on the Duluth model view intimate partner violence MAINLY as

1. mutual conflict between partners
   Framing violence as mutual conflict hides who holds power and who is in danger, which the model explicitly rejects.
2. a result of alcohol or drug use
   Substance use can make violence more severe, but the Duluth model does not treat it as the cause.
3. a deliberate pattern of power and control
   The Duluth model's power and control wheel treats battering as a deliberate pattern of coercion used to dominate a partner, so programs challenge beliefs of entitlement.
4. a loss of anger control under stress
   Duluth programs reject the anger-management framing: abusers often control their anger elsewhere and choose whom to target.

Which treatment is a first-line, trauma-focused psychotherapy for PTSD?

1. Cognitive processing therapy
   Cognitive processing therapy, like prolonged exposure, is a first-line trauma-focused psychotherapy for PTSD in current guidelines.
2. Critical incident stress debriefing
   Single-session debriefing after trauma is not recommended; studies found no benefit and some increase in symptoms.
3. Supportive counseling alone
   Supportive counseling is often a comparison condition in trials and is less effective than trauma-focused therapy.
4. Psychological first aid
   Psychological first aid supports people in the immediate aftermath of disaster; it is not a treatment for diagnosed PTSD.

A high-achieving graduate student attributes her awards to luck and fears that her professors will discover she is "a fraud." This pattern is BEST described as

1. self-handicapping
   Self-handicapping is creating obstacles, such as not studying, so failure can be blamed on them; she discounts her own successes instead.
2. learned helplessness
   Learned helplessness is giving up after expecting outcomes to be uncontrollable; she keeps achieving and wins awards.
3. stereotype threat
   Stereotype threat is anxiety about confirming a negative stereotype about one's group; her fear is about being personally found out.
4. impostor phenomenon
   The impostor phenomenon (Clance and Imes) describes capable people who credit their success to luck and fear being exposed as frauds.

A client taking phenelzine eats aged cheese and cured salami at a party and soon has a severe, pounding headache, a stiff neck, and a racing heart. What should the counselor recognize?

1. A tension headache from stress
   Stress is the tempting explanation, but the timing, right after tyramine-rich foods while taking an MAOI, points to a medical emergency rather than an ordinary headache.
2. Expected side effects that will pass
   These are not routine side effects to wait out. A sudden pounding headache after tyramine on an MAOI is a warning sign that needs urgent care.
3. Signs of a hypertensive crisis
   Phenelzine is an MAO inhibitor, and MAOIs block the breakdown of tyramine in aged cheese and cured meats; a severe headache, stiff neck, and racing heart after such foods signal a blood-pressure surge that needs emergency care.
4. Antidepressant discontinuation symptoms
   Discontinuation symptoms follow stopping or sharply cutting an antidepressant. This client is still taking phenelzine.

A counselor asks a client to write about her deepest thoughts and feelings about a traumatic event for about 20 minutes on four consecutive days. Which intervention is this?

1. Expressive writing
   Pennebaker's expressive writing has people write about an emotional upheaval for about 15 to 20 minutes on several consecutive days.
2. Therapeutic letters
   Therapeutic letters are written to someone, often unsent, or by the counselor in narrative work, not timed private writing sessions about a trauma.
3. The trauma narrative
   The trauma narrative is a TF-CBT component built gradually with the therapist across sessions, not brief writing on four days in a row.
4. Bibliotherapy
   Bibliotherapy assigns reading, such as self-help books, rather than writing about one's own experience.