Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-08-22T13:28:33Z No. of bitstreams: 1 marinafiqueiralopescançado.pdf: 1089501 bytes, checksum: 825ad490c7a233802c70894b30e9c29a (MD5) / Rejected by Adriana Oliveira (adriana.oliveira@ufjf.edu.br), reason: on 2017-08-24T11:33:27Z (GMT) / Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-08-24T14:06:42Z No. of bitstreams: 0 / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-30T12:39:28Z (GMT) No. of bitstreams: 0 / Made available in DSpace on 2017-08-30T12:39:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-02-03 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Apesar do consumo problemático de álcool ser um problema de saúde pública a busca por tratamento é pequena e a oferta de serviços especializados é insuficiente. Nos últimos anos cresceu o número de ofertas de tratamentos online para diferentes transtornos, incluindo o problemas com o uso de álcool. Este estudo teve como objetivo avaliar a viabilidade e aceitabilidade de uma psicoterapia online para dependentes de álcool e descrever os resultados clínicos iniciais. Para isso foi realizado um estudo piloto com os participantes com uso sugestivo de dependência cadastrados no site www.informalcool.org.br/bebermenos. Os convites foram realizados por e-mail e a psicoterapia proposta foi feita inteiramente por videoconferência. Observamos que entre o cadastramento e a realização da psicoterapia existem algumas etapas de perda. Foi feita a descrição dos participantes em cada etapa para melhor compreensão do perfil dos mesmos. Observou-se que o perfil prevalente para esta intervenção entre todas as etapas do recrutamento e da psicoterapia por internet foi homens, empregados, com alta escolaridade, em estágio de contemplação para mudança do comportamento de beber, com uma média de idade entre 37 e 41,3 anos e pontuação no teste AUDIT entre 22,7 e 26,0. Nenhum dos participantes da psicoterapia online havia se tratado anteriormente para o seu uso de álcool. Encontrou-se que a taxa de resposta aos e-mails convite para a psicoterapia por internet foi de 28,2%, e todos os participantes elegíveis convidados para participar aceitaram iniciar o tratamento, confirmando aceitabilidade. Dos 12 pacientes que iniciaram a psicoterapia 6 finalizaram. Houve redução no número de doses consumidas, de 9,6 doses para 3 doses por ocasião e aumento na quantidade de dias abstinente, de 14 dias para 21,3 dias. Consideramos que a amostra neste estudo apresentou boa aceitabilidade a proposta de psicoterapia por internet, ainda que se apresentem taxas de perda, uma vez que estas existem em estudos clínicos e em psicoterapia. Consideramos viável a realização de um ensaio clínico para avaliar a eficácia e efetividade da psicoterapia por internet. / Although problematic alcohol consumption is a public health problem, the search for treatment is small and the supply of specialized services is insufficient. In recent years there has been an increase in the number of online treatments for different disorders, including alcohol use disorders. This study aimed to evaluate the viability and acceptability of an online psychotherapy for alcohol dependents and to describe the initial clinical results. For this, a pilot study was carried out with the participants with suggestive use of dependence registered in the site www.informalcool.org.br/bebermenos. The invitations were made by e-mail and the proposed psychotherapy was done entirely by videoconference. We observe that between the registration and the accomplishment of the psychotherapy there are some stages of loss. The participants were described at each stage to better understand their profile. It was observed that the prevalent profile for this intervention between all stages of recruitment and internet psychotherapy was men, employed, with high schooling, in contemplation readiness to change drinking behavior, with a mean age between 37 and 41.3 years and AUDIT score between 22.7 and 26.0. None of the participants in online psychotherapy had previously treated themselves for their alcohol use. It was found that the response rate to e-mail invitations to online psychotherapy was 28.2%, and all eligible participants invited to attend agreed to initiate treatment, confirming acceptability. Of the 12 patients who started psychotherapy six finalized. There was a reduction in the number of standard drinks consumed, from 9.6 drinks to 3 drinks per occasion and an increase in the number of days abstinent, from 14 days to 21.3 days. We consider that the sample in this study presented a good acceptability to the proposal of psychotherapy delivered by Internet, even though there are rates of loss, since these exist in clinical studies and in psychotherapy. We consider it feasible to conduct a clinical trial to evaluate the efficacy and effectiveness of online psychotherapy.

D.Phil. / This thesis presents an intervention programme that aims to facilitate anger-expression and takes psychosocial and immunological variables into account. The present research argues that if the effects of the programme are validated, similar programmes may yield similar benefits for other participants in future intervention programmes in a South African context. The nature, course and effects of the HIV disease are described and include specific processes and mechanisms of influence in physical, mental and social terms. Biological processes that result from immunological deficiencies causing AIDS are analyzed and an explication of disease progression is offered. Psychological and social aspects related to immune-system deterioration carry implications for patients and influence their prognosis. The research was conducted in the context of a biopsychosocial conceptualization and was aimed at reducing levels of anger and helping establish recourses in the patients to manage infection and disease, as well as improve or at least retard decrements in immunological functioning. The goal of this intervention programme was to reduce levels of anger, anxiety, depression and social isolation. This would in turn increase the participant's personal sense of self-control, self-efficacy and self-esteem. Changes in these factors would help retard the overall HIV disease progression. An intervention programme was tailored to address the specific needs of HIV- infected patients. The group intervention was focused in such a way that relevant psychological, behavioural and social aspects were addressed. The programme borrowed and used aspects of different models and reformulated an intervention that would best address the specific needs of the participants. It was possible to isolate specific problems and focus the intervention on these specific areas, such as depression, anger, social isolation and hopelessness. For example, it was possible to take into account the participants' low self-efficacy and problems related to a lack of interpersonal coping skills and develop the participants' confidence and assertiveness (Antoni, 1991)

D.Ed. (Psychology of Education) / Behavioural Emotional and Social Difficulties (BESD) is a significant impediment in the effective learning in secondary schools in England. Legislation includes BESD. within the range of Special Education Needs (SEN). In-schooJLearning Support Units (LSUs) and off-site Pupil Referral Units (PRUs) aim to address BESD through short-term learning programmes, followed by the mandatory, often failed, reintegration of learners into mainstream education. The research focused on the reintegration experiences of these learners in the London Borough of Waltham Forest. A qualitative research approach in two phases through a generic phenomenological enquiry within an interpretivist-constructivist paradigm was pursued. Data collection included participant writing activities; analysis of documents and records; a qualitative parent questionnaire; participant interviews; teacher participant feedback and professionals' interviews. A purposive sample of 13 reintegrated learners with BESD (aged 11 - 14 years) from four secondary schools was used. The findings indicated that learners experienced incongruity between promotive and risk factors within the themes of emotional experiences, relationships and the reintegration process. The contribution of this new understanding to existing knowledge win support practitioners, teachers and education policy makers to adjust their reintegration practices in order to support the sustained .improvement of inclusive education provision to learners with BESD. A new perspective theoretical through the amalgamation of Bioecological Theory and Resilience Theory contributed to Positive Psychology and supported our understanding of the learners' reintegration experiences. From this a resilience-based reintegration programme to provide practitioners and policy makers with a tri-strand programme to develop emotional competence, facilitate skills in promotive relationships and a reintegration route, was developed. The RRP has potential on a wider field as it can be adjusted to be included in the policies that guide practitioners in the way they provide support to enhance inclusive education in similar situations internationally.

Objetivo: Comparar a efetividade da atividade gradual versus programa de exercícios supervisionados em pacientes com dor lombar crônica não específica para os desfechos intensidade da dor, qualidade da dor, incapacidade funcional, qualidade de vida, percepção do efeito global, retorno ao trabalho, atividade física, capacidade física e cinesiofobia. Método: Participaram do estudo 66 indivíduos com idade entre 18 a 65 anos com dor lombar crônica não específica, randomizados em dois grupos: Grupo atividade gradual (n=33) e Grupo fisioterapia (n=33). Os desfechos primários foram: intensidade da dor (Escala Numérica de dor) e incapacidade funcional (Questionário de Incapacidade de Roland Morris) e os defechos secundários: Qualidade da dor (Questionário de dor de McGill) qualidade de vida (Short-Form Health Survey Questionnaire), Percepção do Efeito Global (Escala de Percepção do Efeito Global), retorno ao trabalho, atividade física (Questionário de atividade física habitual de Baecke), capacidade física (Teste sentado para de pé e Teste de Caminhada de 15,2 metros), cinesiofobia (Escala Tampa para Cinesiofobia). As intervenções foram individualizadas, com duração de uma hora, por seis semanas e frequência de duas vezes por semana. Cada indivíduo foi avaliado na linha de base e no follow up de seis semanas, três e seis meses após o tratamento. O nível de significância estabelecido foi de ?=0,05. Resultados: Após seis meses, ambos os grupos melhoraram, porém não houve diferença significante entre os grupos para intensidade da dor (média da diferença de 0,1 pontos; IC a 95% -1,1 a 1,5) e incapacidade funcional (média da diferença de 0,0; IC a 95% -2,9 a 3,0). Não foram encontradas diferenças estatisticamente significante entre os grupos para os demais desfechos. Conclusão: Nossos resultados sugerem que atividade gradual e fisioterapia apresentam efetividade similar na redução da intensidade da dor e melhora da incapacidade funcional em pacientes com dor lombar crônica não específica / Objective: To compare the effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain for pain intensity, quality of pain, disability, quality of life, global perceive effect, return to work, physical capacity and kinesiophobia. Methods: Sixty-six patients between 18 to 65 years old with chronic nonspecific low back pain were randomized into two groups: Graded activity group (n=33) and physiotherapy group (n = 33). The primary outcomes were: Intensity pain (Numerical Pain Scale) and disability (Roland Morris Disability Questionnaire). The secondary outcomes were: Quality of pain (McGill Pain Questionnaire), quality of life (Short-Form Health Survey Questionnaire), Global perceived effect (Global perceived effect scale), return to work, physical activity (Baecke Questionnaire of Habitual Physical Activity), physical capacity (sit-to-stand test and 15.24m walk test) and kinesiophobia (Tampa Scale of Kinesiophobia) The intervention was individualized, twice a week, one hour for six weeks. The participants were assessment for a blind assessor in the baseline and six weeks, three and six month\'s follow-up. The level of significance was established in ?=0.05. Results: After six weeks, both groups improved, but we not observed significance difference between groups (mean difference 0.1 points; CI 95% -1.1 a 1.5) and disability (mean difference 0.0; IC a 95% -2.9 a 3.0). We not observed statistical difference between groups for all outcomes. Conclusion: Our study provide high quality evidence that graded activity and physiotherapy have similar effectiveness reducing intensity pain and disability in patients with chronic nonspecific low back pain

Rapid response is considered the most well-established outcome predictor across treatments of binge-eating disorder (BED), including cognitive-behavioral therapy (CBT). This study sought to identify latent trajectories of early change in CBT and compare them to common rapid response classifications. In a multicenter randomized trial, 86 adults with BED (DSM-IV) or subsyndromal BED provided weekly self-reports of binge eating over the first 4 weeks of CBT, which were analyzed to predict binge eating, depression, and body mass index at posttreatment, 6-, and 18-month follow-up. Using latent growth mixture modeling, three patterns of early change—including moderate and low decreasing—as well as low stable binge eating were identified, which significantly predicted binge-eating remission at 6-month follow-up. Other classifications of rapid response based on Receiver Operating Characteristics curve analyses or on the literature (≥ 10% reduction in binge eating at week 1, ≥ 70% reduction in binge eating at week 4) only predicted posttreatment remission or overall depression, respectively. Latent change trajectories, but not other rapid response classifications, predicted binge-eating frequency over time. A fine-grained analysis of change over the first 4 weeks of CBT for BED revealed different trajectories of early change in binge eating that led to an improved prediction of binge-eating outcome, compared to that of common rapid response classifications. Thorough monitoring of early change trajectories during treatment may have clinical utility.

Introduction: This paper does not aim to predict the future of clinical psychology in Germany. The future of psychology depends on the complex interaction between political, sociological, economic and health-care related factors as well as on the scientific progress in the discipline itself and in neighbour disciplines. However, it is fair to say that clinical psychology continues to gain even stronger influences in health care and will face a number of new challenges over the next years of its expansion. Our paper will present some of these potential fields of development and change based on a brief description of the status quo. The focus of the article will be specific developments in Germany, although there will be an overlap with general tendencies that describe the situation of clinical psychology in the new millenium in general. Furthermore, for research as well as practice, the specific relationship between clinical psychology and psyciatry will be highlighted.

No description available.

Depression i samband med graviditet förekommer hos ungefär 10% av gravida och medför risker för den gravida och barnet. Många erhåller inte behandling. IKBT kan öka behandlingstillgängligheten och har visat sig effektivt jämfört med sedvanlig mödravård. Utvärderingens syfte var att undersöka skillnader i depressionssymtom före och efter fyra veckor i en IKBT-behandling mot antenatal depression och att jämföra skillnaderna med en tidigare RCT på en snarlik behandling. Huvudfrågeställningen var huruvida depressionssymtom minskar hos patienter med antenatal depression efter fyra veckor i en IKBT-behandling. 26 personer deltog i behandlingen. Förmätning jämfördes med senast kända mätningen efter fyra veckor. Dessa och de veckovisa mätningarna fram till vecka fyra, jämfördes med två icke-randomiserade kontrollgrupper. Skillnad mellan förmätning och senaste mätningen avseende grad av depressionssymtom var signifikant i genomfört t-test och symtomreduktionen tycks vara i nivå med resultat från den tidigare RCT-studien. IKBT skulle således kunna utgöra ett behandlingsalternativ för gravida med depression. Slutsatser bör dras med försiktighet. Framtida forskning inom fältet är av vikt för att validera resultat och för att ge underlag till utvecklingen av behandling vid antenatal depression. / Pregnancy related depression exists in approximately 10% of pregnant people and adds risks for the pregnant individual and the baby. Many are not treated. ICBT may increase the treatment availability and appears to be more effective than conventional maternal health care. The purpose of this evaluation was to examine differences in symptoms of depression before and after four weeks of ICBT-treatment for antenatal depression and to compare the differences with a prior RCT of a similar treatment. The main research question was whether symptom of depression decreases in patients with antenatal depression after four weeks when being treated with an ICBT-treatment. 26 persons participated in the treatment. Pre-measures was compared to the most recent measurement after four weeks. These, and the weekly done measurements up to week four, was compared with two non-randomized control groups. The difference between pre-measures and the most recent measurement regarding degree of depressive symptoms was significant in completed t-test and the reduction of symptoms appears to be on a par with results from the prior RCT. ICBT could be a treatment alternative for pregnant people with depression. Conclusions should be done with caution. Further studies in this field are of importance for validating results and to provide knowledge for the development of treatment for antenatal depression.

The improvement of data acquisition and computer heavy methods in recentyears has paved the way for completely digital healthcare solutions. Digitaltherapeutics (DTx) are such solutions and are often provided as mobileapplications that must undergo clinical trials. A common method for suchapplications is to utilize cognitive behavioral-therapy (CBT), in order toprovide their patients with tools for self-improvement. The Swedish-basedcompany Alex Therapeutics is such a provider. They develop state-of-theartapplications that utilize CBT to help patients. Among their applications,they have one that aims to help users quit smoking. From this app, they havecollected user data with the goal of continuously improving their servicesthrough machine learning (ML). In their current application, they utilizemultiple ML methods to personalize the care, but have opened up possibilitiesfor the usage of reinforcement learning (RL). Often the wanted behavior isknown, such as to quitting smoking, but the optimal path, within the app, forhow to reach such a goal is not. By formalizing the problem as a Markovdecision process, where the transition probabilities have to be inferred fromuser data, such an optimal policy can be found. Standard methods of RL arereliant on direct access of an environment for sampling of data, whereas theuser data sampled from the application are to be treated as such. This thesisthus explores the possibilities of using RL on a static dataset in order to inferan optimal policy. A double deep Q-network (DDQN) was chosen as the reinforcement learningagent. The agent was trained on two different datasets and showed goodconvergence for both, using a custom metric for the task. Using SHAPvaluesthe strategy of the agent is visualized and discussed, together with themethodological challenges. Lastly, future work for the proposed methods arediscussed. / Förbättringar av datainsamling och datortunga metoder har på senare år banatväg för helt digitala vårdlösningar. Digitala terapier (DTx) är sådana lösningaroch tillhandahålls ofta som mobila applikationer. Till skillnad från andrahälsoappar måste DTx-applikationer genomgå klinisk prövning. En vanligmetod för sådana applikationer är att använda kognitiv beteendeterapi (KBT)för att ge patienter verktyg för självförbättring. Det svenskbaserade företagetAlex Therapeutics är en sådan leverantör. De utvecklar moderna applikationersom använder KBT för att hjälpa patienter. Bland deras appar har de förrökavvänjning. Från denna har de samlat in användardata med målet attkontinuerligt förbättra tjänsten via maskininlärning (ML). I sina nuvarandetillämpning använder de flera ML metoder för att personifiera vården, menhar öppnat möjligheter för användningen av Reinforcement learning (RL)(förstärkningsinlärning). Ofta är det önskade beteendet känt, t.ex att slutaröka, men den optimala vägen, inom appen, för hur man når ett sådant mål ärinte känt. Genom att formalisera problemet som en Markovsk beslutsprocess(Markov decision process), där övergångssannolikheterna måste härledas frånanvändardata, kan en sådan optimal väg hittas. Standardmetoder för RLär beroende av direktåtkomst till en miljö för att samla data. Dock skulleanvändardatan som samlats in från appen kunna behandlas på samma sätt.Detta examensarbete undersöker möjligheten att använda RL på statisk dataför att dra slutsatser om en optimal policy. Ett double deep Q-network (DDQN) (dubbelt djupt Q-nätverk) valdes somagent. Agenten tränades på 2 olika datasets och visar bra konvergens förbåda, med hjälp av ett anpassat mått för evaluering. SHAP-värden beräknadesför att visualisera agentens strategi. Detta diskuteas tillsammans med demetodologiska utmaningarna. Till sist behandlas framtida arbete för de föreslagnametoderna.

No description available.