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Generalized anxiety disorder — MCCQE Part 1 MCQ

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HardAnxietyGeneralized anxiety disorderMCCQE Part 1

A 24-year-old student has intense fear of scrutiny during seminars, avoids eating in public, and has stopped attending classes because she expects humiliation. The fear has persisted for 18 months, is disproportionate to the situations, and is not due to substances, psychosis, or a medical disorder. She prefers psychotherapy. Which treatment should be offered first?

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Correct answer: C — Cognitive-behavioural therapy with graduated exposure to feared social situations

The persistent, disproportionate fear of negative evaluation, broad social avoidance, and functional impairment establish social anxiety disorder rather than normal shyness or a circumscribed performance concern. Cognitive-behavioural therapy is the first-line psychotherapy and should include disorder-focused cognitive work and graduated exposure, with progress monitored over an adequate course. Exposure allows corrective learning; endorsing avoidance maintains the fear cycle. Benzodiazepines are not a durable core treatment and create sedation, dependence, and interference with exposure learning. Nondirective therapy without behavioural work has a weaker evidence base for this objective. Inpatient care is reserved for an acute safety, diagnostic, or functional crisis that cannot be managed safely as an outpatient. An SSRI or SNRI is also a first-line medication option when preferred or when psychotherapy alone is insufficient, but this patient specifically requests psychotherapy.

Reference: Centre for Addiction and Mental Health, Anxiety—Psychotherapy: https://www.camh.ca/en/professionals/treating-conditions-and-disorders/anxiety-disorders/anxiety---treatment/anxiety---psychotherapy