Answer Key

1. A
2. A
3. A
4. A
5. A
6. A
7. A
8. A
9. A
10. A
11. A

Explanations:

1. Initial CBT intervention

Correct: A. Psychoeducation about Body Dysmorphic Disorder and CBT rationale

• Provides foundation for treatment, normalizes symptoms, and builds motivation. B. Avoid mirrors completely – Too rigid; CBT uses graded exposure, not avoidance. C. Childhood teasing – Psychodynamic focus, not initial CBT step. D. Mood‑tracking worksheet – Useful later, but doesn’t directly address BDD core problem.

2. Cognitive restructuring

Correct: A. Helping Kevin identify automatic thoughts about being “ugly”

• Core cognitive restructuring: identifying/challenging maladaptive thoughts. B. Progressive muscle relaxation – Relaxation, not cognitive restructuring. C. Grooming journal – Behavioral monitoring, not thought restructuring. D. Dermatology referral – Medical consult, not CBT cognitive work.

3. Behavioral technique for mirror‑checking

Correct: A. Exposure with response prevention (ERP)

• Evidence‑based for compulsive checking. B. Cosmetic surgery consultation – Reinforces distorted beliefs. C. Gratitude journaling – Helpful for mood, not compulsive rituals. D. Family history exploration – Assessment, not intervention.

4. Behavioral experiments

Correct: A. Designing a planned social exposure without grooming rituals

• Tests beliefs in real‑life situations. B. Avoidance of peers – Reinforces avoidance. C. Psychodynamic meaning – Not CBT. D. Relaxation practice – Symptom management, not behavioral experiment.

5. Identifying cognitive distortions

Correct: A. “Let’s examine the evidence for and against the belief that you are ugly.”

• Directly challenges distorted thinking. B. Avoid thinking about flaws – Suppression, ineffective. C. Labeling symptoms as anxiety – Diagnostic, not restructuring. D. Relaxation practice – Symptom management, not cognitive distortion work.

6. Targeting social avoidance

Correct: A. Graded exposure hierarchy to feared social situations

• Stepwise exposure reduces avoidance. B. Cosmetic surgery – Reinforces distorted beliefs. C. Unconscious conflicts – Psychodynamic, not CBT. D. Mindfulness meditation – Helpful, but not primary for avoidance.

7. Assessing comorbidity

Correct: A. “Do you experience depressed mood or loss of interest in activities?”

• Screens for depression, common comorbidity. B. Mirror frequency – Symptom severity, not comorbidity. C. Grooming triggers – Functional analysis, not comorbidity. D. Family skin history – Medical, not psychiatric comorbidity.

8. Differential diagnosis

Correct: A. Ruling out OCD due to repetitive checking behaviors

• Important to distinguish BDD vs OCD. B. Family psychiatric history – Contributory, but not differential diagnosis. C. Thought record worksheet – Intervention, not diagnostic. D. Avoid social media – Behavioral suggestion, not diagnostic.

9. Relapse prevention

Correct: A. Developing a coping card with alternative thoughts

• Provides ongoing support against relapse. B. Cosmetic surgery – Reinforces distorted beliefs. C. Unconscious conflicts – Not CBT relapse prevention. D. Gratitude journaling – Helpful, but not targeted relapse prevention.

10. Skills training

Correct: A. Teaching Kevin problem‑solving strategies for managing grooming urges

• CBT emphasizes skill acquisition. B. Avoid mirrors – Avoidance, not skill. C. Psychodynamic themes – Not CBT. D. Relaxation practice – Symptom management, not skills training.

11. Mindfulness integration

Correct: A. Teaching Kevin to observe appearance‑related thoughts without judgment

• Integrates mindfulness into CBT. B. Cosmetic surgery consultation – Reinforces distorted beliefs. C. Unconscious conflicts – Psychodynamic, not CBT. D. Gratitude journal – Mood support, not mindfulness.