The incidence of bulimia has been increasingly documented in recent years. Treatments have focused on one behavior in the Binge-Purge chain or have combined several treatment components. This study was designed to assess the effect of teaching bulimics alternative responses for dealing with stressful events.

Clientes com Transtorno de Personalidade Borderline apresentam um alto índice de abandono de terapia. Entender o que ocorre durante as sessões entre terapeuta e cliente com este tipo de transtorno de personalidade pode contribuir para evitar futuros equívocos ou falhas na relação terapêutica, aumentando as chances de continuidade do processo terapêutico e diminuindo a probabilidade de abandono da terapia. O presente estudo teve como objetivo identificar as variáveis que estão relacionadas ao abandono de um caso de Transtorno de Personalidade Borderline. Participou do estudo uma terapeuta de orientação analítico-comportamental, com 12 anos de experiência clínica e uma cliente com 30 anos de idade, casada, sem filhos e com escolaridade superior completo. Um total de 13 sessões foi gravado em áudio, transcrito e categorizado segundo o Sistema Multidimensional para Categorização de Comportamentos da Interação Terapêutica. Foi feita análise sequencial de atraso (Lag sequential analysis). As sessões que compuseram os dados deste estudo foram entre a 9ª e a 22ª sessões, embora a 14ª sessão tenha sido excluída da análise de dados por ter sido uma sessão de casal. Os resultados mostraram que as categorias da terapeuta de maior porcentagem de ocorrência foram Facilitação, Solicitação de Relato e Empatia e as menos frequentes foram, Solicitação de Reflexão\", Aprovação e Recomendação. Reprovação foi a categoria que teve a menor frequência entre as demais categorias da terapeuta. Embora a categoria Interpretação tenha ocorrido em baixa frequência, sua duração foi grande. As categorias de maior porcentagem da cliente foram Relato e Estabelecimento de Relações entre Eventos. E as de menor porcentagem de ocorrência foram: Solicitação, Concordância, Oposição e Melhora. A categoria Metas não ocorreu nenhuma vez. Ao longo das sessões, foi observado um declínio na porcentagem de Estabelecimento de Relações entre Eventos e um aumento em Relato, no que se refere às categorias da cliente. Ao mesmo tempo, foi observada uma diminuição das categorias Empatia, Solicitação de Reflexão e Interpretação da terapeuta. As sequências que mais ocorreram foram Relato\" seguido por Facilitação\" e Facilitação\" seguida por Relato\". O abandono da terapia pareceu estar relacionado a diversos fatores: a) perda de oportunidades de aprovar e solicitar reflexão e interpretar, b) não dar atenção a relatos sobre queixas de doenças, exercendo função de invalidação, c) férias prolongadas da terapeuta e d) não flexibilidade da terapeuta em fazer mais uma sessão domiciliar em um momento de crise, repetindo assim, um comportamento de invalidação / Clients suffering from Borderline Personality Disorder show a high dropout rate in psychotherapy. The understanding of what occurs during the sessions between therapist and client suffering from this type of personality disorder may contribute to prevent future errors and failures, increasing chances of completing the therapeutic process and reducing drop-out probability. The current study had the objective of identifying the variables related to the drop-out in a case of Borderline Personality Disorder. Participated a female behavior-analytic therapist, with 12 years of clinical experience and a female client, 30 years old, married, no children, with a college degree. 13 complete sessions were recorded in video, transcribed and categorized according to the Multidimensional System for Categorization of Behaviors in Therapeutic Interaction. A lag sequential analysis was carried out. Data of this study refer to the 9th through the 22nd sessions, although the 14th session was excluded, since it was a couple session. Outcomes showed that the therapists categories in higher percentages were `Facilitation`, `Request of Report` and `Empathy` and the less frequent percentages were `Request of Reflection`, `Approval` and `Recommendation`. `Disapproval` was the therapists category appearing with lower frequency. Although `Interpretation` occurred in low frequency, it had a long duration. The clients categories with higher percentages were `Report` and `Establishment of Relationship between Events`. The lower percentages of occurrences were: `Request`, `Agreement`, `Opposition` and `Improvement`. The category `Aims` did not occur at any time. Throughout the sessions a decrease in percentage of the client\'s categories `Establishment of Relationship between Events` and an increase in \'Report\' were observed. At the same time a decrease in the therapists categories `Empathy`, `Request for Reflection` and `Interpretation` was noted. Sequences which occurred more frequently were `Report` followed by `Facilitation` and `Facilitation` followed by `Report`. The therapy drop-out seemed to be related to several factors: a) loss of opportunities by the therapist to approve, to request reflection and to interpret; b) lack of attention to reports on complaints of diseases, having an invalidation effect; c) therapists extended vacation and d) therapists refusal to attend an additional home session, in a critical moment, thus repeating the invalidation

Esta pesquisa teve como objetivo estudar a relação entre mudanças na competência social e no peso em dois adolescentes obesos. Os casos foram atendidos individualmente dentro do modelo de terapia comportamental e os dados obtidos foram descritos em forma de estudo de caso. Os clientes foram avaliados em relação às mudanças ocorridas através de diferentes escalas e inventários e de categorias de comportamento criadas pela pesquisadora para observação e análise do processo terapêutico. Para os dois clientes ocorreram ganhos referentes à competência social. Em relação ao peso, um cliente apresentou uma forte relação inversa com competência social no decorrer do tratamento e perdeu peso. O outro cliente precisou de um tratamento mais longo mas apresentou no final do tratamento (últimas 10 sessões) uma tendência semelhante. Os resultados também indicaram que ambos desenvolveram estratégias de comportamento para lidar com os aspectos aversivos do ambiente relacionados à obesidade, apontando para a necessidade de associar essa modalidade de tratamento que enfoca o desenvolvimento da competência social a outros procedimentos utilizados nos tratamentos de perda de peso. / This research evaluated the relationship between changes in social competence and weight loss in two obese adolescents. Both cases were treated with individual behavioral therapy and the results were presented as a case report. The clients were evaluated by changes obtained on different scales and inventories, as well as by the analysis of behavioral categories created by the therapist. In this analysis, both clients were observed to improve in terms of social competence. One of the clients demonstrated a significant inverse correlation between improvement of social competence and weight loss during treatment (16 sessions) and lost weight. The other client required longer treatment (40 sessions), but also demonstrated at the end of intervention, the same tendency of results. Based on this evaluation, it was postulated that behavioral therapy targeted to issues of social competence should be an integral part of treatment for weight loss, and should be combined with other therapeutic modalities.

A enurese é uma condição caracterizada pela perda de urina durante o sono, em crianças com mais de cinco anos sem outra condição clínica que explique os episódios. A enurese pode ser primária, no caso das crianças que nunca obtiveram controle prévio, ou secundária, em que a enurese cessou por pelo menos seis meses. Também é classificada como monossintomática, na ausência de sintomas diurnos do trato urinário inferior ou não-monossintomática, quando está associada a tais sintomas, como a urgência miccional. A enurese, cujas causas apresentam componentes hereditários ainda pouco claros, tem sua etiologia baseada na combinação de três fatores: a poliúria noturna ou a hiperatividade detrusora ligada á incapacidade de despertar em resposta aos sinais da bexiga cheia. Há tratamentos medicamentosos e psicológicos, sendo que a desmopressina, análogo sintético da vasopressina, que atua na poliúria noturna e o alarme, que atua na incapacidade de despertar, apresentam os níveis mais altos de recomendação e evidência. Embora tais tratamentos estejam consolidados, ainda não há total clareza sobre seus mecanismos de funcionamento e o porquê de não alcançarem todos os casos. Este trabalho teve como objetivo verificar se um conjunto de variáveis atuaria como moderador do resultado do tratamento com alarme, ou seja, em que medida influenciava, positiva ou negativamente, o desempenho dos participantes atendidos. As variáveis avaliadas foram: tipo de acompanhamento (presencial e à distância), frequência inicial de episódios, nível de problemas de comportamento, escolaridade dos pais, sexo e idade. Foram incluídos na amostra 61 crianças e adolescentes de 6 a 17 anos que receberam tratamento com alarme, sendo que 34 foram acompanhados à distância e 27 presencialmente. No total, 37 participantes obtiveram sucesso, caracterizado por 14 noites consecutivas sem episódios, num período de 28 semanas. Doze participantes não obtiveram sucesso e outros 12 desistiram. Caracterizaram-se como moderadoras do resultado do tratamento as seguintes variáveis: tipo de acompanhamento (grupo acompanhado à distância obteve mais sucessos), frequência inicial de episódios (participantes que obtiveram sucesso tinham menos episódios, em média, no início do tratamento) e nível de problemas de comportamento (participantes que não obtiveram sucesso tinham escores maiores de problemas de comportamento externalizantes). Os resultados indicam a efetividade do alarme e apontam para os aspectos que devem receber atenção do clínico ao administrar esse tipo de tratamento / Enuresis is a condition in which children of at least five years of age lose urine during sleep, without another clinical condition that could explain the wetting episodes. Enuresis may be primary, when the child has not obtained previous bladder control, or secondary, when such control was achieved for at least six months. It is also classified as monosymptomatic, when it is not associated with other lower urinary tract symptoms or non monosymptomatic, when these symptoms, such as urgency, are present. Enuresis etiology has unclear hereditary aspects. Its physiology is based on a combination of at least two of three malfunctioning systems: incapacity to wake in response to the full bladder signals plus nocturnal polyuria or detrusor hyperactivity. There are evidence based pharmacological and psychological treatments. Desmopressin, a synthetic version of hormone vasopressin that reduces nocturnal polyuria is the first line pharmacological treatment, whereas the alarm, which acts in the incapacity to wake is the first line psychological treatment. Both have the higher levels of evidence and recommendation by the specialized literature. However, the mechanisms underlying these treatments results and the reasons they are not successful with every enuretic children are not entirely clear. The objective of this work was to verify to what stand a series of variables are moderators of alarm treatment outcome. These variables were: type of support (face-to-face versus long distance), initial bedwetting frequency, behavior problems scores, level of parents education, gender and age. Sixty-one children with ages from 6 to 17 were included. All received full spectrum home training. Thirty-four received long distance support during treatment and 27 received face-to-face support. Success was defined by 14 consecutive dry nights within a 28 weeks treatment period. Success was obtained by 37 children, while 12 did not succeed and other 12 dropped out. Three variables were observed as moderators of treatment outcome: type of support (long distance had better results), initial bedwetting frequency (participants who succeeded had fewer initial wet nights) and behavior problem scores (participants who did not succeed had higher externalizing problems scores). Results indicate alarm effectiveness and aspects that should be focuses of attention when this kind of treatment is administered

M.A. (Psychology) / Human suffering and death are an intrinsic part of the work of emergency response personnel. Emergency workers are not immune to the stresses of emergency situations, and it is therefore understandable that those dealing with the critically ill or injured will experience feelings like anger, anxiety and sadness. Gibbs, Drummond and Lachenmeyer (1993) cite some characteristic responses ofemergency workers in their reaction to the daily experience oftrauma. These responses include increased anxiety, tension and feelings of distress, and cognitive deficiencies. Physical symptoms and the abuse of alcohol are also common. Despite the considerable body of knowledge regarding stress in emergency workers, most intervention strategies to alleviate the long-term consequences of mental trauma on these workers have been prophylactic in terms of future service. Little has been done to validate such efforts (Dunning, 1990). Within the South African context research in this field is also scant, yet the overwhelming evidence ofthe reactions cited in research (Hetherington, 1993a; Gibbs et al, 1993; Mitchell, 1985, 1982, 1984b; Sparrius, 1992 and Mitchell and Bray, 1990), both local and international, would indicate that such reactions exist in South Africa and should therefore be extensively investigated. It would therefore be necessary to implement an intervention programme for this group and systematically evaluate it. However, the nature of PTSD on its own, and how it relates to the emergency worker needs to be discussed...

M.A. (Clinical Psychology) / The purpose of this study was to determine whether a behavioural intervention could reduce scratching behaviour in atopic dermatitis. The literature dealing with the psychological aspects, and existing approaches to the treatment of atopic dermatitis and related dermatoses was reviewed. It was hypothesized that if subjects with atopic dermatitis were able to reduce their scratching behaviour they would show a corresponding reduction in size of identified lesions. In order to test these hypotheses, SUbjects with atopic dermatitis participated in a self-control programme lasting between eight and ten weeks. Of the seven subj ects that originally started the programme, four completed it. SUbjects' self-monitoring details reflected changes in scratching behaviour, and a specially designed grid was used to measure changes in lesion size. Inspection of the data showed that two SUbjects eliminated their scratching behaviour and lesions entirely; the other two showed marked reduction. The results of this study indicate that self-control procedures could be usefully applied as adjuncts to the conventional dermatological management of atopic dermatitis.

The present dissertation consists of three empirical studies on social anxiety disorder (SAD) in a sample of Swedish children and adolescents. Based on findings made in a large behavior treatment study, the thesis contributes to the field of research on childhood SAD by investigating a factor that maintains the disorder, ways to measure and screen for diagnosis, and the treatment of the disorder. Study I investigated whether giving an educational course to the parents of socially anxious children would lead to a better outcome of a behavior-treatment study consisting of individual and group treatment components such as exposure in-vivo and social skills training, compared to a condition where only children were treated and the parents received no educational course.  Another purpose of Study I was to investigate what influence, if any, co-morbidity has on treatment outcome. The results showed that there was no significant difference between the two treatment groups on any of the primary or secondary outcome measures. Further, the comorbid disorders did not impair the SAD treatment but was rather associated with further improvement, and despite the sole focus on SAD, there was significant improvement in the comorbid disorders. Study II tested the psychometric properties of the Social Phobia and Anxiety Inventory for Children in a sample of children with SAD. The results indicated that the instrument is a both valid and reliable measure. Further, a three-factor solution represented the three areas of SAD commonly found in adult studies, i.e. fear of performance, observation, and interaction situations. Study III explored threat perception and interpretation bias by means of an ambiguous stories task. The results showed that children with SAD deviated significantly from a non-anxious control peer group with regard to their interpretations. Post treatment the threat perception bias was altered in a normal direction, and one year after treatment termination, the SAD sample ratings were comparable to those of the non-anxious children. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 1: Manuscript.</p>

The present study investigated the efficacies of Individual CBT (ICBT), Parent Relationship Skill Training (RLST, which targets increasing parental acceptance of youth and increasing autonomy granting) and Parent Reinforcement Skills Training (RLST, which targets increasing parental positive reinforcement and decreasing negative reinforcement). The specific aims were to examine treatment specificity and mediation effects of parenting variables. ICBT was used as a baseline comparison condition. The sample consisted of 253 youth (ages 5-16 years; M = 9.38; SD = 2.42) and their parents. To examine treatment outcome and specificity, the data were analyzed using analysis of variance within a structural equation modeling framework. Mediation was analyzed via structural equation modeling using MPlus. Results indicated that ICBT, RLST, and RFST produced positive treatment outcomes across all indices of change (i.e., clinically significant improvement, anxiety symptom reduction) and across all informants (i.e., youths and parents). RLST was associated with incremental reduction in youth anxiety symptoms beyond ICBT, as per youth report. Treatment specificity effects were found for participants in RFST in terms of parental reinforcement, as per parent report only. Treatment mediation was not found for any of the hypothesized parenting variables (i.e., parental acceptance, parental autonomy granting, parental reinforcement). The results support the use of CBT involving only the youth and the parent and youth together for treating youth anxiety. The findings’ implications are further discussed in terms of the need to conduct further meditational treatment outcome designs in order to continue to advance theory and research in youth anxiety treatment.

M.A. / The approach of psychology to sport has over the century been ambivalent. The relationship between the field of psychology and matters on the sports field has tended to favour one type of understanding, namely cognitive-behavioural psychology. The theoretical underpinnings of this conception are seen to be directly connected to a set of philosophical, ethical and aesthetic ideas known as Modernism, which have dominated this century. It is suggested herein that with the renewed interest of psychology in matters sporting, some of the current theoretical perspectives in the general field of psychology might be applied to sports. The approach adopted here explores how the narratives of professional golfers, looked at through a social constructionist lens, could assist them in re-evaluating and enriching their experiences. Social constructionism aims to change the traditional agenda of psychological research, which might lead to new ways of talking about ourselves and our surroundings. Social constructionism is situated inside a different set of theoretical premises, which are known as Postmodern, which challenge the Modern way of knowing.

The efficacy of multidisciplinary inpatient and outpatient treatment for transitioning children with severe pediatric feeding disorders from gastrostomy tube dependency to oral nutrition was investigated utilizing caloric and fluid intakes as an outcome measure. The study involved 29 children ages 12 months to 5 years of age with gastrostomy tube dependency. Treatments were provided by speech therapists, occupational therapist, dietician and psychologist for a 30 day period. Four treatment groups were evaluated and average intakes compared at 4 observation periods including pretreatment, initiation of treatment, completion of treatment at 30 days and 4 month follow-up. Children receiving inpatient treatment for feeding disorders evidenced significant differences in oral caloric intake from pretreatment to discharge than outpatient treatment (p < .01) and wait list control group (p = .04). Oral caloric intake from discharge to 4 month follow up yielded no significant differences indicating treatment gains were maintained. Change in environment and caretaker showed a significant effect for the inpatient group (d = 1.89). Effects of treatment by age and weight at 4 month follow up were also analyzed.