Psych CASC / OSCE · General adult psychiatry — anxiety disorders
Explain specific phobia and start exposure (not daily diazepam) — CASC communication station
MRCPsych/FRANZCP-style communication station: explain specific phobia types, exposure and OST rationale, applied tension for BII, medication limits, and check understanding.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [4]
Candidate instructions. Explain specific phobia in plain language (including that he may have more than one type), the rationale for graded exposure and the option of an intensive one-session approach for suitable cues, applied tension for needle/blood fear, why daily long-term diazepam is not recommended as the main plan, expected hard work and benefits, and safety-netting. Check understanding and invite questions. The examiner plays the patient. [1][2][4]
Candidate scenario
Your patient meets criteria for situational specific phobia (flying) and blood-injection-injury specific phobia. He cancelled two work trips and avoids blood tests ordered by his GP. He asks for "diazepam every morning so I never feel it" and fears exposure will be "throwing me on a plane cold." You plan collaborative hierarchy work, applied tension training for needles, and discussion of intensive massed exposure where appropriate. [1][3]
Marking domains
- Empathy, structure and agenda-setting
- Accurate plain-language explanation of specific phobia and types
- Clear exposure rationale (not cruelty; graded; skills)
- OST described without jargon overload when offered
- Applied tension explained for BII
- Benzodiazepine stewardship without shaming
- Checks understanding and safety-nets medical avoidance [1][4]
Reveal assessor key
Open and agenda-set. Name time; ask his main worries (being forced on a plane, addiction, fainting). [4]
Explain diagnosis. "Specific phobia means a strong, lasting fear of a particular thing or situation — for you, flying and needles/blood — that comes on quickly, leads you to avoid or white-knuckle through it, and gets in the way of life. It is common and treatable. You can have more than one type." [1]
Explain exposure. "The most effective approach is carefully planned practice facing the fear in steps you help design, while dropping habits that keep the fear stuck. Anxiety usually rises then falls as your brain learns the catastrophe does not happen. We do not dump you on a long-haul flight on day one." [1]
OST option. "For some discrete fears, a longer single therapist-guided session of stepped practice — sometimes a few hours — can work very well. We decide together if that fits." [2]
Applied tension. "With blood and needles, people can feel faint because blood pressure drops. We teach a muscle-tensing skill to steady that, then practice gradually." [3]
Diazepam discussion. "A tablet every morning long-term is not the best main treatment — it can cause dependence and may stop you learning that you can cope. A rare one-off dose for a true unavoidable event is sometimes discussed, but skills and exposure are the plan." [1][4]
Close. Summarise, teach-back, written plan, GP liaison for needed blood tests, crisis contacts if mood worsens, book therapy start. [4]
References
- [1]Choy Y, Fyer AJ, Lipsitz JD Treatment of specific phobia in adults Clin Psychol Rev, 2007.PMID 17112646
- [2]Ost LG One-session treatment for specific phobias Behav Res Ther, 1989.PMID 2914000
- [3]Ost LG, Fellenius J, Sterner U Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia Behav Res Ther, 1991.PMID 1684704
- [4]Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders BMC Psychiatry, 2014.PMID 25081580