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9990 · 1.4.3

Treatment and management of anxiety disorders and fear-related disorders — practice questions

Practice and worked examples for 9990 Treatment and management of anxiety disorders and fear-related disorders. Short previews only — attempt the full question in MarkScheme against the official scheme.

Worked example 1

A patient with a spider phobia avoids gardens and has catastrophised thoughts ('It will attack me').

(a) Outline systematic desensitisation and CBT for this patient. [4 marks] (b) Compare systematic desensitisation with flooding. Evaluate the use of benzodiazepines for anxiety. [6 marks]

Show solution outline

(a) AO1 — Systematic desensitisation:

  • Train relaxation (e.g. breathing).
  • Build hierarchy: spider picture → video → jar at distance → closer exposure.
  • Pair each step with relaxation — counter-conditioning replaces fear with calm.

AO1 — CBT:

  • Identify catastrophic thoughts ('It will attack me').
  • Evidence testing — challenge probability and coping ability.
  • Behavioural experiments during graded exposure.

(b) AO3 — SD vs flooding:

SDFlooding
ProcessGradual hierarchyImmediate full exposure
---------
DistressLow–moderateVery high initially
EthicsMore acceptableRisk of dropout, retraumatisation
EffectivenessStrong evidenceCan work if patient persists

AO3 — Benzodiazepines evaluation:

  • Strengths: Rapid relief of acute anxiety; useful short-term for crisis.
  • Limitations: Tolerance, dependence, withdrawal rebound anxiety; do not address maintaining avoidance cognitively.
  • Comparison: SSRIs preferred long-term; CBT/SD produce durable effects without dependency.

Judgement: SD + CBT is first-line for this phobia; benzodiazepines at most short-term adjunct, not primary treatment.

Worked example 2

A clinical trial compares Cognitive Behavioural Therapy (CBT) with a waitlist control group for patients with Generalised Anxiety Disorder (GAD). The severity of GAD is measured using the GAD-7 scale (scores range from 0-21). The CBT group (n=40) had a mean pre-treatment score of 16. After 14 weeks of therapy, their mean score was 7. The control group (n=40) had a mean score of 15.5 at the start and 14.5 after 14 weeks.

(a) Calculate the percentage reduction in symptom severity for the CBT group. [2 marks] (b) Using the data, evaluate the effectiveness of CBT for GAD. [4 marks]

Show solution outline

(a) AO2 — Calculation:

  1. Find the absolute reduction: Initial Score (16) - Final Score (7) = 9 points.
  2. Calculate the percentage reduction: (Absolute Reduction / Initial Score) * 100 (9 / 16) * 100 = 56.25% The percentage reduction in symptom severity for the CBT group is 56.25%.

(b) AO3 — Evaluation:

  • Effectiveness: The 56.25% reduction in GAD-7 scores for the CBT group indicates a large and clinically significant improvement. A final score of 7 is in the 'mild anxiety' range, down from 'severe' (15+).
  • Comparison with Control: The control group only showed a small reduction of 1 point (15.5 to 14.5), which is a (1 / 15.5) * 100 = 6.5% reduction. This minimal change suggests that GAD symptoms do not significantly improve without intervention over this time period.
  • Causality: The large difference in improvement between the CBT group (56.25%) and the control group (6.5%) strongly suggests that the CBT was the causal factor in reducing anxiety symptoms, rather than just the passage of time or placebo effects.
  • Conclusion: This evidence supports the conclusion that CBT is a highly effective treatment for GAD, leading to substantial and meaningful reductions in symptoms compared to no treatment.
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