A large body of empirical research has accumulated, suggesting that stress plays a direct and indirect role in both somatic and psychological disorder. Impaired job performances have also been attributed to the deleterious effects of stress. Most of the occupational stress management literature, however, has been focused on non-handicapped populations. Negative reactions to anger and stress have been identified as factors contributing to the poor transition from school to work for handicapped youth. The present study was one of the first efforts to evaluate and compare the efficacy of cognitive-behavioral therapy and relaxation coping techniques for the management of stress-related anger in handicapped work adjustment youth using a controlled group design. Forty work adjustment students identified as emotionally handicapped or mentally retarded were randomly assigned to a stress inoculation condition, progressive relaxation condition, or a waiting-list control condition. Subjects ranged in age from 16 to 22. Subjects in the two treatment conditions met with a male therapist for 10 one-hour group sessions. Physiological, psychological, and behavioral measures were administered at pre-treatment, post-treatment, and 4-week follow-up intervals to all subjects. Results of a 3x2x3 multivariate analysis of variance with repeated measures indicated no significant main or interaction effects. It was concluded that the interaction of treatment with time, and treatment with time accounting for disability did not significantly affect the work adjustment students' stress and anger scores for the selected dependent measures. Possible explanations for the absence of significant differences on these measures were presented, and the utility of the study as a whole was discussed. / Ph. D.

There are a great number of people whose suggestions and encouragement have contributed to the preparation and completion of this study. Special recognition is due to the committee of faculty evaluating this study through the various stages from inception. I appreciate the patience plus clear arid precise guidance of Tom Hohenshil, and Dennis Hinkle's counsel and completion of the computer analyses of the results of this study, I am grateful for the inspiration Dean Hummel provided especially during the early stages of this project. I wish also to express my thanks to Cherry Houck who’s door was always open and was also instrumental in the inception of this study, I also appreciate Harriett Cobb's perceptiveness and special efforts in dissipating my committee meeting jitters. Finally, I consider myself fortunate to have had exposure to these individual's expertise and vast experiences. I wish also to acknowledge the assistance and financial support, I received from Charlotte McNulty, SYEP Project Director, and from the Board of Directors of People Places Inc. in Staunton, Virginia. I am indebted to the patience and trust Ms. McNulty repeatedly afforded me throughout the various stages of carrying out this project. The generous offer of the use of equipment .and office space of People Places Inc. is also greatly appreciated. And finally, I consider myself fortunate to have a wife supportive of my efforts in achieving an advanced degree in education. Her genuine interest in the topic of this study and willingness to listen, proofread, type, and many other supportive actions deserve a special "thank you". / Ed. D.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Separation anxiety disorder (SAD) is the most common and impairing childhood anxiety disorder. Left untreated, SAD is associated with heightened risk for the development of additional internalizing disorders as well as impairments in educational attainment and social functioning. Numerous clinical trials have demonstrated the efficacy of cognitive-behavior therapy (CBT) for the treatment of childhood anxiety disorders, including SAD. However, additional research is needed to enhance the compatibility (e.g., fit of the treatment to the patient population) and ultimate uptake of evidence-based interventions for anxious youth. The current research evaluates the feasibility and preliminary efficacy of an intensive, cognitive-behavioral intervention for school-aged girls with SAD provided within the novel context of a one-week camp-like setting. This alternative treatment format was predicated on evidence supporting the need for treatments that allow for creative and developmentally-sensitive applications of intervention components, incorporate a child's social context, target relevant parenting variables, and provide additional models for treatment delivery. Twenty-nine female children aged 7 to 12 with a principal or co-principal diagnosis of SAD were randomized to an immediate treatment (n = 15) or waitlist (i.e., delayed treatment; n = 14) condition during the course of this randomized-controlled trial. Measures were administered at pretreatment/ pre-waitlist, post-treatment/post-waitlist, and six weeks following treatment to assess changes in symptom reports, functional outcomes, and overall program satisfaction. Analyses of covariance were conducted to assess effects of treatment condition and repeated measures analyses of variance were conducted to evaluate change over the three data collection time points. Relative to waitlist, children in the immediate treatment group evidenced significant reductions in SAD severity by clinician report on a diagnostic interview measure. Moreover, treatment gains strengthened over time. Contrary to hypotheses, children receiving the intervention did not display significantly greater improvements relative to waitlist on parent-rated fear and avoidance scores or on parent or child self-report measures. Potential explanations for non-significant findings are discussed. Overall, the intervention's positive therapeutic response on SAD diagnostic status and severity suggests one possible delivery model for surmounting difficulties faced in the dissemination of standard, weekly treatments for this condition. / 2999-01-01

M.A. / Attention Deficit Hyperactivity Disorder (ADHD) affects between 1% and 20% of school-aged children. Many aspects of the disorder remain largely speculative including the treatment of it, and often these children experience significant learning, social and emotional difficulties from their childhood years through to adulthood. Pharmacological treatment of the disorder has gained wide acceptance and it has achieved much success in bringing about positive short-term changes in the behaviours of such children. However the long-term efficacy of medication still remains questionable and many children do not respond well to or do not tolerate such treatment. The use of psychological interventions for this condition has not received as much support as that of medication. While research shows that some psychological approaches have virtually no effect others have shown limited benefits. Taking into account the previous research conducted into the benefits of the psychological treatment of ADHD and through examining the limitations of these approaches, the present research aims to establish an effective psychological intervention in the treatment of this condition. This intervention follows the format of a Parent-training based Cognitive-Behavioural programme making use of Barkley's theory that Behavioural Inhibition is the central impairment in Attention Deficit Hyperactivity Disorder. Therefore the hypotheses of this research are twofold. Firstly, that psychological interventions can make a positive contribution to the treatment of this condition and secondly, that this parent-training based cognitive-behavioural progra

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The fields of psychology and rhetoric share the goal of improving human mental health and behavior through persuasion. This thesis traces the history of rhetoric and psychology theory, focusing on the parallel theories of Nienkamp's internal rhetoric and Herman's dialogical self. Both theories model the human mind as having multiple psyches that actively interact to interpret human experience and project human behavior. I conclude with a case study of anorexic patients using ethos, pathos, and logos in dialectical behavior therapy (DBT), arguing that principles of rhetoric can help patients with mental disorders cognitively realign their thinking more effectively than drug treatments can.

This double-blind placebo-controlled study investigated the relative efficacy of Homoeopathic similimum treatment as compared to psychological counselling (Cognitive therapy combined with Behavioural therapy), in the management of Generalized Anxiety Disorder (GAD). / Thesis (M.Tech.: Homoeopathy)-Dept. of Homoeopathy, Durban Institute of Technology, 2006 xli, 201 leaves

Há debates sobre quais são os mecanismos responsáveis por mudanças ocorridas em psicoterapias. Pergunta-se se são as técnicas específicas ou as variáveis da relação terapêutica que propiciam os efeitos da terapia. Também tem sido questionado se mudanças comportamentais produzidas pela terapia são modeladas por contingências da relação terapêutica ou são governadas por novas regras produzidas na terapia. Nas pesquisas sobre emissão de regras (orientação) e autorregras (auto-orientação) anteriores a esta pesquisa não foram encontradas variáveis responsáveis por sua emissão. A determinação da utilização da estratégia de orientação ora parecia ser o cliente, ora o terapeuta, ora nenhum deles, ora o tema abordado, e possivelmente uma complexa combinação destas e de outras variáveis. O estudo detalhado das orientações e auto-orientações de 81 sessões de terapia analítico-comportamental foi realizado nesta pesquisa com o objetivo de verificar quais as variáveis responsáveis pela emissão de orientação e auto-orientação em intervenções clínicas comportamentais. Os resultados indicaram que a maioria dos terapeutas emitiu de 40 a 60 orientações nas nove sessões analisadas. Os clientes dos terapeutas independente da experiência apresentaram poucas auto-orientações. O número de orientações diminuiu para menos da metade quando se contaram apenas orientações com conteúdos e funções diferentes, indicando que os terapeutas tendem a \'repetir\' funcionalmente a orientação. Para as auto-orientações houve diminuição de um quarto ao se contarem aquelas com conteúdo e função diferente. O conjunto de terapeutas emitiu mais orientações para ação específica e genérica; e de forma similar os clientes estes terapeutas emitiram mais auto- orientações para ação específica e auto-orientações para ação genérica. Episódios de orientação/auto-orientação foram identificados nas 81 sessões, ocupando em média um terço das sessões dos terapeutas experientes e um quarto das sessões dos terapeutas pouco experientes. E nesses episódios havia diversos tipos de intervenção do terapeuta além da orientação. Orientações são emitidas de modo geral no seguinte contexto: clientes relatam uma situação vivenciada e algumas intervenções do terapeuta ocorrem. Quando clientes mostram dificuldade em assumir responsabilidade, enfrentar e avaliar seus comportamentos há fornecimento de regras pelo terapeuta. Os clientes na maioria das vezes concordam com as orientações recebidas, em um quarto das ocasiões se opõem a ela e em um sexto recebem novas orientações. Dois terços das auto-orientações foram seguidos de aprovação do terapeuta, mas ocorreram também reprovações. As variáveis intervenientes \"temas\", \"motivação\" e \"escolaridade\" foram consideradas e correlacionadas: existe pouca relação entre tema abordado e presença de orientação/auto-orientação; clientes motivados receberam mais orientações que os desmotivados e resistentes; quanto maior a escolaridade do cliente maior o número de auto-orientações. 10% da amostra foram avaliados por um juiz, com índices de concordância juiz-pesquisador satisfatórios indicando validade externa. Futuras pesquisas devem ser realizadas para correlacionar o uso de regras e os resultados das intervenções clínicas comportamentais. / Mechanisms responsible for changes that occur in psychotherapy are subject to debate. The question is whether specific techniques or variables of the therapeutic relationship promote the effects of the therapy. Another question is whether behavioral changesproduced by therapy are shaped by contingencies of the therapeutic relationship or ifthey are governed by new rules produced in therapy. In researches about emission of rules (orientation) and self emitted rules (self-orientation) prior to this research, novariables responsible for their emission were found. The use of the orientation strategy seemed to be determined either by the client, or by the therapist, sometimes by neither, and at times by the theme, and possibly by a complex combination of these and other variables. A detailed study of orientations and self-orientations in 81 sessions of behavior analytic therapy was carried out in this research to ascertain which variables were responsible for the emission of orientation and self-orientation in behavioralclinical interventions. The findings indicated that each therapist issued an average of 40to 60 orientations during their nine sessions. The clients of both experienced and inexperienced therapists presented few self-orientations. The number of orientationsdecreased to less than half when only rules with different contents and functions were counted, indicating that therapists tend to functionally \'repeat\' the rule. The self-orientations decreased one quarter when those with different content and function were considered. The group of therapists issued more orientations for specific and generic action; similarly, the clients of these therapists issued more self-orientations for specific and generic action. Episodes of orientation/self-orientation were identified in the 81 sessions, occupying an average of one third of the sessions of experienced therapists, and one quarter of the sessions of inexperienced therapists. These episodes involved several types of intervention by the therapist besides orientation. Orientations were generally issued within the following context: clients report a situation they have experienced and the therapist makes some interventions. When clients show difficulty in assuming responsibility, facing and evaluating their behavior, the therapist providesrules. Clients usually agree with the rules they receive, but on one quarter of occasions they oppose them and, and in one sixth of occasions they receive new orientations. Two thirds of self-orientations were approved by the therapist, but there were alsodisapprovals. There was little correlation between the theme and the presence of orientation/self-orientation. Motivated clients received more orientation than unmotivated and resistant clients; the higher the client\'s level of education the greaterthe number of self-orientation. Ten percent of the sessions were evaluated by a judge, with satisfactory indices of judge-researcher agreement indicating external validity. Future researches should be conducted to correlate the use of rules and the results of behavioral clinical interventions.

Introdução: A Terapia Cognitivo-Comportamental (TCC) e os inibidores seletivos de recaptação de serotonina (ISRS) são considerados os tratamentos de primeira linha para o Transtorno Obsessivo-Compulsivo (TOC) nos ensaios clínicos randomizados (ECR). No entanto, a maior parte destes estudos exclui grande parte dos pacientes (em torno de 50%) por apresentarem comorbidades psiquiátricas. Ensaios clínicos pragmáticos e de efetividade, que costumam simular ambientes clínicos naturalísticos ao estudar amostras que representam melhor a população real comparando tratamentos ativos, são de grande importância para as decisões tomadas por um sistema de saúde e poucos têm sido feitos para avaliar a efetividade dos tratamentos para o TOC. O objetivo do presente estudo foi comparar os tratamentos de primeira linha para o TOC em uma amostra mais próxima da população que procura atendimento e avaliar características clínicas associadas às respostas aos tratamentos. Metodologia: Pacientes de 18 a 65 anos de idade, com escore de linha de base da YBOCS de pelo menos 16 para obsessões e compulsões, ou pelo menos 10 apenas para obsessões ou compulsões e com possíveis comorbidades psiquiátricas adicionais foram alocados seqüencialmente para tratamento de TCC em grupo (TCCG; n = 70) ou para tratamento medicamentoso (ISRS; n = 88). A TCCG consistiu em doze sessões semanais de duas horas cada com grupos de 6 a 8 pacientes, baseadas em um manual validado (Cordioli, 2002). O medicamento utilizado foi a fluoxetina com dosagem máxima de 80mg/dia. Foram analisadas respostas aos tratamentos como variáveis contínua (redução percentual na YBOCS) e categórica (redução de pelo menos 35% na YBOCS e ICG 1 muito melhor ou 2 melhor. Resultados: Os escores da YBOCS reduziram 23,13% no grupo tratado com TCCG e 21,54% no grupo tratado com ISRS, sem diferença estatística entre os grupos de tratamento (p = 0,875). Foi encontrada em 33,3% dos pacientes de TCCG e 27,7% dos pacientes de ISRS a redução de pelo menos 35% no escore da YBOCS e resposta à ICG 1 ou 2 (p = 0,463). O número médio de comorbidades psiquiátricas por paciente foi 2,7; e 81,4% da amostra apresentou pelo menos uma comorbidade. A redução na YBOCS foi significativamente menor entre os pacientes com uma ou mais comorbidade psiquiátrica (21,15% e 18,73%, respectivamente) do que entre os pacientes com TOC puro (34,62%) (p = 0,034). Sexo masculino, apresentar um escore inicial mais alto na Beck-A, ter abandonado o tratamento e apresentar comorbidade com Transtorno Depressivo Maior ou Distimia foram associados com taxas mais baixas de resposta ao tratamento, independente do tratamento recebido. Os resultados sugeriram que em uma população mais heterogênea os tratamentos de primeira linha para o TOC são menos efetivos. É necessário o desenvolvimento de intervenções que sejam efetivas para uma população da prática clínica / Introduction: Cognitive-Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors (SSRI) are considered the first line treatments for Obsessive-Compulsive Disorder (OCD) in randomized controlled trials (RCT). However, most of these trials exclude a great amount of patients (around 50%) for presenting psychiatric comorbidities. Pragmatical and effectiveness clinical trials simulate natural clinical environments and compare active treatments in samples that represent the real population. These trials are of great importance for decision makers of the health public system, and only a few trials have investigated the effectiveness of treatments to OCD. The aim of this study was to compare the first line OCD treatments in a sample closer to the OCD real population, and to evaluate clinical characteristics associated to responses to treatments. Methodoly: Patients (1865 years; baseline Yale-Brown Obsessive-Compulsive Scale (YBOCS) scores 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with group CBT (GCBT; n=70) or pharmacological treatment (SSRI; n=88). GCBT consisted in twelve two hours weekly sessions with groups of 6 to 8 patients, based in a validated manual (Cordioli, 2002). Medication utilized in SSRI group was fluoxetine, 80mg/day. Response to treatment was analyzed as continuous variable (percent reduction on YBOCS) and as categorical variable (reduction of at least 35% on YBOCS and CGI 1 much better or 2 better. Results: Mean Y-BOCS scores fell by 23.13% in the GCBT and 21.54% in the SSRI group. Symptom reduction did not differ between groups (p = 0.875). A reduction of at least 35% in baseline Y-BOCS score and a CGI rating of 1 (much better) or 2 (better) was achieved by 33.3% of patients in the GCBT and 27.7% in the SSRI group (p=0.463). Patients presented 2.7 mean number of psychiatric comorbidity, and 81.4% showed at least one additional disorder. The YBOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than those with pure OCD (34.62%) (p = 0.034). Low responses to treatments were found to be associated to: being male, presenting a high initial Beck-A score, comorbid major depression, dysthymia and abandoning treatment, independently of the treatment received. The development of effective interventions to a real population is necessary

Made available in DSpace on 2016-07-27T14:21:36Z (GMT). No. of bitstreams: 1 Maria de Fatima Jose de Almeida Vieira.pdf: 373804 bytes, checksum: 84d28c42b1ebdddf5664bf29dd85c935 (MD5) Previous issue date: 2007-02-28 / In the therapist-client relationship, here conceptualized as an encounter of subjectivities in an interpersonal context, self-disclosure (SD) by the therapist to the client is not rare. Here SD is defined as the act of the therapist to disclose verbally something about him or her self during the session. The literature presents controversial positions concerning the use of SD as a therapeutic intervention. At the one hand there are practices that promote it enthusiastically. On the other, we observe strong opposition. The aim of the present study is to seek support for the use or not of SD and to investigate the therapist s goals, as well as his or her vision concerning the impact of SD on him or herself, on the client and on the process. A qualitative, exploratory method is used including 10 therapists with behavioral training, and who work from a contextualist point of view. The data collection occurred through semi-structured interviews, recorded and transcribed verbatim for analysis. A Grounded theory approach was used, which consists of an inductive process of analysis, organization, categorization and interpretation with the aim to elaborate a theory that explains contexts. The results suggest that SD is frequently used, mainly by therapists whose training includes contact with the ideas of the third wave . The use of SD to intensify the therapist-client relationship, to demonstrate comprehension, and to offer models was observed to be quite general. A sub-group considered that SD does not have to be genuine to be valid. It is suggest that experience and training may be variables that influence the use of AR. / No relacionamento terapêutico, aqui considerado como um encontro de subjetividades no contexto interpessoal, não é raro a Auto-Revelação (AR) pelo terapeuta frente ao seu cliente, doravante definida como o ato do terapeuta de revelar verbalmente algo de si durante a sessão. A literatura traz posições controversas sobre a utilização de AR como intervenção terapêutica. De um lado existem práticas que a promovem de forma entusiasta, e do outro, observa forte oposição. O objetivo do presente estudo é buscar amparo para utilização ou não da auto-revelação e investigar a intenção, assim como a visão do terapeuta do impacto da AR sobre si, sobre o cliente e sobre o processo. Trata-se de um estudo qualitativo e de caráter exploratório com 10 terapeutas de formação behaviorista e que atuam dentro de uma visão contextualista. Para a coleta de dados foram realizadas entrevistas simi-estruturadas, que foram gravadas e posteriormente transcritas para efeito de análise. A abordagem utilizada para análise dos dados, foi a Grounded Theory que consiste num processo indutivo de análise, organização, categorização e interpretação no intuito de elaborar uma teoria que explique o contexto. Os resultados indicam, que AR é freqüentemente usada, principalmente por terapeutas cuja formação inclui exposição às idéias da terceira onda da terapia comportamental. O uso de AR para intensificar o relacionamento terapêutico, para evidenciar compreensão, normalizar experiência do cliente e para oferecer modelos foi constatado ser bem geral. Um sub-grupo considera que AR não precisa ser genuína para ser válida. Sugere que a experiência e a formação podem ser variáveis que influenciam o uso de AR.