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Adapted CBT — MRCPsych Paper B MCQ

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ModeratePsychotherapyAdapted CBTMRCPsych Paper B

A 30-year-old man with mild intellectual disability has generalised anxiety disorder with marked functional impairment. After discussing pharmacological and psychological options, he chooses individual high-intensity psychological treatment and wishes to undertake cognitive behavioural therapy. He communicates verbally but has difficulty understanding complex information. Which treatment plan is most appropriate?

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Correct answer: A — CBT delivered with its method and duration adjusted to his needs

The correct answer is A. NICE CG113 recommends offering people with GAD and mild intellectual disability the same evidence-based interventions as other adults, while adjusting the method of delivery or treatment duration when necessary. Because he has marked functional impairment, has chosen high-intensity psychological treatment and wishes to receive CBT, adapted CBT is appropriate. Adjustments may include simpler language, alternative media, repetition, a modified pace and structured support for practising skills. Standard, unadapted CBT may be inaccessible. Behavioural activation is principally a treatment for depression, and psychodynamic therapy is not the NICE-recommended high-intensity treatment for GAD. Medication is an alternative at this stage, but should not replace his informed preference for psychological treatment merely because he has an intellectual disability.

Reference: National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113), recommendations 1.1.1 and 1.2.17–1.2.19. 2011, updated 2020. https://www.nice.org.uk/guidance/cg113/chapter/Recommendations