This examination consists of three Cases with open questions. Case 1 has two open questions,
and Case 2 and 3 each have three open questions; so 8 open questions in total for the exam.
The maximum number of points that can be obtained for each case is 10. The number of points
per open question is indicated in the exam.
Please write your answers in English in the space provided below each question (in the
box). You are allowed to use books, papers, videos, etc. to answer the questions. You are not
allowed to discuss the questions and answers with others including your fellow students. Your
total mark for this examination must at least be a ‘pass’ mark [minimum 5,5]. Good luck!
➔ Please put your name and student number on this first page.
If you have technical problems or any other questions, you can contact me via email:
E.Salemink@uu.nl or via MS Teams.
Course: Cognitive Behavioural Therapy
Examination, 1 November 2021
, 2
Case 1
Sue is a 30-year-old woman and referred to a psychologist given her general physical tension
symptoms, emotionality, difficulty sleeping and physical and mental fatigue. During the case
conceptualization, the psychologist learned that social situations are difficult for Sue and that she can
experience intense fear of rejection. Problems at work made Sue decide to take action, but the fear
manifests itself in all kinds of social situations, including informal contacts, such as during a
conversation at a party. When Sue is asked what a prototypical rejection looks like in her case, she
mentions that the other person then shows clear signs of disapproval in his look or words. She will
then have the tendency to make herself as small as possible and take a humble body posture. She’ll
start blushing and look into another direction. There will be all kinds of thoughts such as 'I am not
good enough’, ‘I am a failure’.
Sue told the psychologist that she used to be a shy and good girl. She had many social contacts,
had hobbies and got good grades at school. Her (only) older brother had some behavioral problems, to
which her parents devoted a lot of time and attention. She was expected to behave in a problem-free
manner and she followed her parents' rules and (perceived) expectations. In high school, her brother
had a critical and disapproving role towards her. His comments focused on her (otherwise good)
performance in school or her (otherwise almost always impeccable) behavior. What has remained with
her from this period is that she began to feel insecure in more and more situations. She was not only
constantly afraid that others would reject her and think she was 'not good enough', but especially that
they were right.
Sue tries to avoid social situations (she might skip a meeting a work, and cancel attending a
party as she is too busy) and - if this is not possible - to behave in a way that is as impeccable and
socially desirable as possible (agree with the opinion of the majority, say yes to any request). This is
accompanied by feelings of tension and insecurity.
Question 1 (6 points).
Clark and Wells (1995) describe a cognitive model that explains social anxiety, see below for the
model. Describe Sue's symptoms, the relationships between symptoms and the maintaining
mechanisms using this cognitive model (use the empty box on the next page for your answer).
Course: Cognitive Behavioural Therapy
Examination, 1 November 2021
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