Psychotherapy and Psychosocial Interventions
This domain tests whether you can match a model to a disorder, describe its mechanism and structure, and justify the choice. Examiners ask what you would do first, what the evidence base is, and how the therapy is delivered in a resource-limited service.
Core models and their targets
- Cognitive behavioural therapy: Beck's model holds that emotional distress is mediated by biased appraisals. Therapy uses formulation, Socratic questioning, thought records, behavioural experiments and homework, typically over 12-20 sessions. Strongest evidence in depression, panic disorder, social anxiety, generalised anxiety and OCD (as exposure and response prevention).
- Behavioural activation: simpler than full CBT, deliverable by trained non-specialists, and effective in depression.
- Exposure and response prevention: the psychological treatment of choice in OCD; exposure must be graded, repeated and prolonged, with strict prevention of the neutralising ritual.
- Psychodynamic therapy: works with transference, countertransference, defence mechanisms and interpretation; brief models have evidence in depression and personality disorder.
- Dialectical behaviour therapy: biosocial model of emotional dysregulation, four skills modules (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness), evidence for repeated self-harm and borderline personality disorder.
- Family intervention in schizophrenia: reduces expressed emotion and relapse; psychoeducation, communication training and problem solving.
- Motivational interviewing: collaborative, uses open questions, affirmation, reflection and summary, and rolls with resistance rather than confronting it.
Worked example
A 29-year-old woman washes her hands until they bleed, fearing contamination, and believes that if she stops her mother will die. Reasoning: this is OCD with poor insight, not a psychotic illness, because the belief is embedded in a recognisable obsession-compulsion loop. First-line treatment is ERP plus an SSRI at a higher dose for 8-12 weeks. Adding an antipsychotic is justified only for poor insight or comorbidity, and reassurance from relatives would feed the ritual.
Traps that cost marks
Offering insight-oriented therapy during acute psychosis. Confusing motivational interviewing with advice-giving or confrontation. Assuming longer therapy is always better than brief structured therapy. Forgetting that therapy and medication combined outperform either alone in moderate to severe depression. Ignoring the therapeutic alliance and rupture repair, which predict outcome across all models.