Quiz — Chapter 32: Anxiety, Depression, and the Spectrum of Distress

Instructions

25 multiple-choice questions covering the core concepts of Chapter 32. Each question has one best answer. After completing the quiz, check your answers against the key at the end.

1. Which three dimensions distinguish an anxiety disorder from normal anxiety according to the chapter?

a) Frequency, origin, and neurochemical basis b) Intensity, duration, and interference c) Severity, chronicity, and biological vulnerability d) Cognitive content, physiological activation, and family history

2. The amygdala's role in anxiety is best described as:

a) The center of conscious threat appraisal, integrating sensory information before generating a response b) The "high road" threat pathway that allows deliberate evaluation before triggering the fear response c) A rapid threat-detection structure that triggers the fear response before conscious processing completes d) The structure responsible for the cognitive distortions that maintain anxiety over time

3. Generalized Anxiety Disorder (GAD) is distinguished from other anxiety presentations primarily by:

a) The presence of unexpected panic attacks without an identifiable trigger b) Excessive, difficult-to-control worry about a wide range of topics across multiple life domains c) Intense fear of specific objects or situations producing immediate avoidance d) Severe anxiety specifically in situations involving social scrutiny or evaluation

4. Safety behaviors in anxiety are problematic because they:

a) Increase physiological arousal, making the anxiety worse in the moment b) Prevent the person from experiencing the disconfirmation that the feared outcome is less probable than believed c) Signal to the amygdala that the situation is genuinely dangerous, increasing future threat sensitivity d) Produce dependence on the safety behavior, making it impossible to engage with any situation without it

5. Interoceptive hypervigilance refers to:

a) Excessive monitoring of other people's emotional states, common in social anxiety b) Heightened self-monitoring of bodily sensations that generates false alarms and amplifies anxiety c) The tendency to attend to threat-relevant information in the environment d) The physiological component of anxiety involving heightened heart rate and breathing

6. The tripartite model (Clark and Watson) proposes that anxiety and depression share which common factor?

a) Low positive affect (anhedonia) b) Physiological hyperarousal c) High negative affect d) Cognitive rumination

7. Anhedonia — a core feature of major depression — is most accurately described as:

a) Persistent sadness and tearfulness in response to perceived losses b) Diminished responsiveness of the reward system, producing loss of capacity for pleasure or interest c) Excessive guilt and self-criticism characteristic of severe depressive episodes d) Cognitive slowing that makes previously easy tasks feel effortful

8. Which of the following best represents the current scientific understanding of the neuroscience of depression?

a) Depression is caused by low serotonin; SSRIs work by restoring serotonin to normal levels b) Depression results from a single neurochemical deficiency that varies by individual c) Depression involves multiple interacting mechanisms including monoamine, inflammatory, neuroplasticity, and default mode network dysfunction d) Depression is primarily a psychological condition; the biological changes are consequences, not causes

9. The inflammatory model of depression proposes that:

a) Depression is primarily an immune disorder triggered by infection b) Elevated inflammatory cytokines reduce serotonin synthesis, disrupt dopamine signaling, and produce depressive features c) Anti-inflammatory medications are the most effective treatment for all forms of depression d) Inflammation is a consequence of depression's behavioral effects (poor sleep, poor diet), not a cause

10. BDNF (Brain-Derived Neurotrophic Factor) is relevant to understanding depression because:

a) It is the primary precursor to serotonin, and its reduction directly causes depressed mood b) Chronic stress reduces BDNF, contributing to hippocampal volume reduction and cognitive and reward system dysfunction in depression c) Antidepressants work primarily by increasing BDNF rather than by modulating monoamine systems d) High BDNF levels are a reliable biological marker for the diagnosis of major depression

11. The default mode network is implicated in depression primarily because:

a) It is deactivated in depression, producing the emotional flatness and motivational blunting characteristic of the disorder b) Hyperactivity of the default mode network mediates the ruminative self-focus that maintains depression c) Default mode network hyperactivity produces the physiological hyperarousal component of depression d) Default mode dysfunction prevents the consolidation of new positive memories that could challenge the depressive narrative

12. Cognitive Behavioral Therapy (CBT) for anxiety emphasizes exposure as a primary intervention. The mechanism of exposure is most accurately described as:

a) Desensitization — the anxiety response is weakened through repeated non-reinforced presentation of the stimulus b) Inhibitory learning — new, non-threatening associations are formed that compete with the original threatening associations c) Extinction — the anxiety response is eliminated through repeated confrontation with the feared stimulus d) Cognitive modification — exposure works primarily by providing evidence that disconfirms catastrophic predictions

13. Behavioral activation for depression is based on which core behavioral insight?

a) Pleasure and mastery are produced by passive activities (rest, relaxation) rather than active engagement b) Motivation is a prerequisite for activity; treatment should focus on restoring motivation before scheduling activities c) Activity precedes motivation in depression; engaging in scheduled activities regardless of motivation gradually reactivates reward circuitry d) Depression is maintained by unrewarding environments; treatment should focus on changing the environment rather than behavior

14. Acceptance and Commitment Therapy (ACT) differs from traditional CBT primarily in that:

a) ACT targets the content of thoughts for change, while CBT targets the behavioral consequences of thoughts b) ACT shifts focus from changing thought content to changing one's relationship to thoughts, reducing cognitive fusion and experiential avoidance c) ACT is most effective for anxiety disorders, while CBT is most effective for depression d) ACT does not include behavioral elements, focusing exclusively on acceptance and values

15. Cognitive fusion, as described in ACT, refers to:

a) The tendency for anxiety and depression to occur together, sharing cognitive mechanisms b) Treating thoughts as literal truths about reality rather than as mental events that come and go c) The process by which two competing cognitive schemas merge into a single, integrated belief d) The cognitive style in which information from different domains is inappropriately combined

16. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed for which population?

a) People experiencing their first episode of major depression b) People with anxiety disorders not responding to standard CBT c) People with recurrent depression who have recovered and are at high risk for relapse d) People with treatment-resistant depression who have not responded to two or more antidepressant trials

17. Research on SSRIs and SNRIs for depression shows that:

a) Response rates are approximately 80–90%, making them highly effective first-line treatments b) Response rates (50% symptom reduction) are approximately 50–60%, with remission in approximately 30–40% of patients c) SSRIs are primarily effective for anxiety rather than depression; SNRIs are preferred for depression d) Antidepressants are effective only for severe depression and do not outperform placebo for mild-to-moderate cases

18. The chapter describes rumination as distinct from constructive reflection. Which of the following is most characteristic of rumination?

a) Time-limited, purposeful analysis of a problem leading to a resolution or action b) Repetitive, passive focus on symptoms of distress and their causes without productive resolution c) Future-oriented worry about potential negative outcomes, characteristic of anxiety d) Systematic analysis of evidence for and against a belief, as practiced in CBT

19. Barlow's Unified Protocol for Transdiagnostic Treatment of Emotional Disorders is designed to address:

a) Pure anxiety disorders without comorbid depression b) The common maintaining mechanisms (emotion avoidance, negative appraisal, behavioral avoidance) across anxiety and depression presentations c) Treatment-resistant cases that have not responded to disorder-specific protocols d) Anxiety disorders in medical settings where psychiatric diagnosis is less relevant

20. Which of the following best explains why asking directly about suicidal ideation does not increase suicidal risk?

a) Direct questioning triggers denial, which temporarily suppresses suicidal ideation b) Direct inquiry signals that the topic is speakable, reduces shame and isolation, and creates space for intervention c) Most suicidal ideation is fleeting; naming it gives the person permission to acknowledge and then dismiss it d) Suicidal ideation that cannot be acknowledged directly is unlikely to lead to action

21. The chapter argues that understanding the biological mechanisms of anxiety and depression is functionally destigmatizing. What is the core argument?

a) Biological etiology requires medical treatment, removing the personal choice dimension from the disorder b) Understanding that the physiological cascade begins before conscious thought, and that reward system changes are involuntary, establishes these as conditions, not character failures c) Biological framing allows insurance coverage, making treatment more financially accessible d) Understanding the mechanisms empowers individuals to target specific biological processes through lifestyle changes

22. The average time between first symptoms and first treatment for anxiety disorders is approximately:

a) Two to three years b) Five to six years c) Eleven years d) Fifteen to twenty years

23. Which of the following describes "distress tolerance" as used in the chapter?

a) The capacity to experience high levels of positive emotion, offsetting negative emotional states b) A cognitive skill involving reappraisal of stressors as less threatening c) The capacity to experience difficult emotional states without resorting to maladaptive regulation strategies d) Physiological resilience — the speed with which the body returns to homeostasis after stress activation

24. Persistent Depressive Disorder (dysthymia) is distinguished from major depression primarily by:

a) The presence of psychotic features, including delusions and hallucinations b) Lower intensity but longer duration (at least two years) — often described as "depression you forget you have" c) Exclusively seasonal patterns of onset, occurring in fall/winter months d) Exclusive occurrence in the context of bereavement, with no prior depressive history

25. The chapter presents three "core insights" for practice. Which of the following best represents all three?

a) Medication is more effective than therapy; self-care is adequate for subclinical distress; diagnosis is required for treatment b) Avoidance worsens anxiety; action precedes motivation in depression; thoughts are not facts c) Exercise is the primary treatment for anxiety; behavioral activation is the primary treatment for depression; social connection prevents both d) The biological causes of anxiety and depression can be targeted directly; cognitive work is secondary; recovery is primarily physiological

Short-Answer Extensions

Choose two of the following:

Extension 1: A friend tells you: "I've been anxious my whole life — I've just learned to manage it by being very prepared and never putting myself in situations where things can go wrong." Using the chapter's framework of avoidance and safety behaviors, explain why this "management strategy" might actually be maintaining the anxiety, and what a different approach might look like.

Extension 2: The chapter describes depression as involving multiple interacting neurobiological mechanisms (monoamine, inflammatory, neuroplasticity, default mode network). Why does this multi-mechanism understanding matter for treatment? What would it predict about why some depressed patients don't respond to SSRIs, and what it might suggest about treatment alternatives?

Extension 3: Explain the difference between ACT's cognitive defusion and CBT's cognitive restructuring. Why might defusion be particularly useful for someone with chronic negative self-beliefs (e.g., "I'm fundamentally broken") that are resistant to evidence-based challenge?

Answer Key