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Die vorliegende kumulative Promotion umfasst drei veröffentlichte Publikationen, die im Rahmen der Berliner Borderline Versorgungsstudie (BBV-Studie) durchgeführt wurden. In Studie 1 wurde die effectiveness der ambulanten Dialektisch-Behavioralen Therapie (DBT) an N = 47 Patienten mit einer Borderline Persönlichkeitsstörung (BPS), die das DBT-Behandlungsjahr vollständig durchlaufen haben, untersucht. Im Prä-Post-Vergleich zeigten sich für die untersuchten Symptombereiche signifikante Veränderungen und die Effektstärken lagen überwiegend im mittleren Bereich. 77% der Patienten erfüllten nach einem Jahr DBT nicht mehr die diagnostischen Kriterien für eine BPS. In Studie 2 wurden die Krankheitskosten von N = 55 BPS-Patienten in dem Jahr vor der ambulanten DBT umfassend aus einer gesellschaftlichen Perspektive erhoben. Die durchschnittlichen Kosten lagen bei €26.882 (SD = €32.275). Davon gingen mit €17.976 (SD = €23.867) etwa 66% auf die direkten, mit €8.906 (SD = €15.518) knapp 34% auf die indirekten Kosten zurück. In Studie 3 wurden für die N = 47 DBT- compleater die Krankheitskosten im Jahr vor der Therapie mit denen während des DBT-Behandlungsjahres und mit denen während des ersten Katamnesejahres (N = 33) verglichen. Die durchschnittlichen Krankheitskosten lagen im Jahr vor der DBT bei €28.026 (SD = €33.081), während des DBT-Jahres bei €18.758 (SD = €19.450) und sanken innerhalb des Katamnesejahres weiter auf €14.750 (SD = €18.592). Die deutlichsten Kostenreduktionen zeigten sich im stationären Bereich. Hingegen konnten die indirekten Kosten kaum gesenkt werden. Insgesamt weist die vorliegende Promotion darauf hin, dass die ambulante DBT auch unter Versorgungsbedingungen in Berlin wirksam ist. Zudem besitzt die BPS auch in Deutschland eine hohe gesellschaftliche Relevanz. Die Krankheitskosten können deutlich gesenkt werden, wenn BPS-Patienten in einem DBT-Netzwerk behandelt werden. Hieraus ergeben sich erste Hinweise auf die Effizienz der ambulanten DBT. / This thesis includes three publications that were conducted as part of a Berlin wide treatment study (“Berliner Borderline Versorgungsstudie“). In study 1, we examined the effectiveness of dialectical behavior therapy (DBT) for borderline personality disorder (BPD) under the routine health care situation in Berlin. N = 47 patients completed the one-year treatment and provided data. Our findings demonstrate significant improvements on all measures with medium effect sizes. Moreover, at the end of the first treatment year, 77% of the patients no longer met the criteria for a BPD diagnosis. In Study 2, BPD-related cost-of-illness 12 months prior to outpatient DBT was assessed in a sample of N = 55 BPD-patients from a societal perspective. Total cost-of-illness was €26882 (SD = €32275) per patient. €17976 (SD = €23867; 66%) were direct costs and €8906 (SD = €15518; 34%) were calculated as indirect costs. In study 3, societal cost-of-illness of the N = 47 DBT completers was calculated for 12 months prior to DBT and further investigated during DBT-treatment year and during the following year. Total mean annual cost-of-illness was €28026 (SD = €33081) during pre-treatment, €18758 (SD = €19450) during the DBT treatment year and €14750 (SD = €18592) during the follow-up year for the N = 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions of inpatient treatment costs, while indirect costs barely decreased. In sum, the present thesis shows that outpatient DBT under routine mental health care conditions in Berlin leads to positive results. Furthermore, mean annual cost-of-illness of German BPD-patients exceed those of many other mental disorders meaning that BPD poses a high economic burden. Importantly, treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Correspondingly, outpatient DBT has the potential to be an efficient treatment.

Reinforcer assessments have largely relied on the use of progressive ratio (PR) schedules to identify stimuli that function as reinforcers. PR schedules evaluate the reinforcing efficacy of a stimulus by measuring the number of responses produced in order to access a stimulus as the number of required responses increases. The current evaluation extends the literature on reinforcer assessments by measuring responding under a progressive force (PF) schedule, in addition to progressive ratio requirements. We compared responding under PR and PF schedules with two children with autism using a multielement design embedded within a reversal experimental design. Results were mixed and implications for further development of reinforcer assessment methods (particularly PF schedules) are discussed.

Text in Afrikaans / Students who study part time find themselves in a situation, with much pressure, which causes stress. The reason for this study was therefore to investigate the effectiveness of Rational Emotive Therapy as a coping technique for students in order to handle stress. A qualitative analysis was conducted and data was gathered primarily through group therapy and interviewing. The results of the research led to the conclusion that Rational Emotive Therapy could be effectively applied by students as a stresscoping mechanism / Educational Studies / M.Ed.

Historically the trend in health care has been the domain of health care professionals such as doctors, nurses and other professionals from the medical fraternity. This created the separation between the mind and body, due to the diagnostic and treatment origins being segregated. This thesis addresses the idea that psychological processes have significant impacts on our physical health {and visa versa). It establishes the notion that health care needs to be understood holistically, from a broader systemic perspective, expanding the working model of health. The second chapter of this thesis addresses the power of the mind and the connection between the mind and body. It establishes the importance of beliefs and perceptions and the huge effect this has on people and their lives. How we choose to perceive a situation will give that situation meaning. The meanings that we give to events usually depict how we will see and respond to that event, sometimes more than the actual event itself. It explains the importance of the mind (psychological issues) as well as the body (physiological issues) when understanding and dealing with health and wellbeing. The following chapter discusses the historical developments of physical and mental health; from Hippocrates and Descartes to a modern holistic approach and attitude. Behaviour Medicine6, explicitly recognises that mind and body are intimately interconnected and that an appreciation of these interconnections and their scientific study is an interdisciplinary field, uniting the behavioural sciences with the biomedical sciences; in the hope that the cross fertilization will yield a more comprehensive picture of health and illness. The 'biopsychosocial model'7 provides a theoretical framework, explaining how an awareness of biological, psychological and social process are all important in understanding disease and recovery, supported by systemic principles. The scientific research and practical implications of psychoneuroimmunology8 (PNI) takes this biopsychosocial model one-step further. It describes how thoughts, perceptions and emotions have interchangeable influences with brain chemistry, which in turn influences the body and neurological systems1 particularly immune system functioning. The concept that we all have an inner ability /intelligence to heal ourselves is also detailed. Miller (1997: 350) discusses this notion, stating that we all have "a healer within." He states that this inner healer can be awakened in order to participate in "our deep healing.11 He claims, "This vital essence has been with us since birth ... Its function is to maintain homeostasis (internal balance). As humans, we can1 through our ability to change our images and beliefs, enhance, or inhibit the power of this inner healer." The concepts discussed thus far in the thesis are then demonstrated practically. The relationship between stress and health is examined and practical ways to maintain a healthier lifestyle is detailed. The researcher then introduces a South African company that is currently working in the field with the concepts of mindbody medicine and psychoneuroimmunology. This led the researcher to find a philosophical container in which to hold the holistic mind body theories and concepts. Anderson & Carter (2003: 222) states, "Social work distinguishes itself by exploring the 'person-environment fit'. This is an area in social work where constructivism may prove supportive. Such an emphasis increases the likelihood that diverse voices and points of view are integrated in social work theory and practice." Therefore/ a constructive epistemology/ philosophy in which meaning is intimately connected with experience, is expanded upon. The mind/body theory and concepts are then linked to Constructivism and Personal Construct Theory (by George Kelly). Constructivism postulates that we all create and interpret our own meaning systems, which become our subjective realities. The link to mind body medicine is pertinent in that both constructivism and mind body medicine share similar ideologies about how realities are construed, and how this in turn effects treatment of disease and maintenance of wellbeing. Cybernetic complementarities then expand our understanding of the mind and body connection in a monolistic framework, where mind and body are recursive partial arcs of a holistic health care system. Constructivism therefore integrates eastern and western concepts, cementing all the concepts used in this thesis, in a holistic manner. It also helps us to understand how some of the mind body techniques may be working within the mind body realm. Given the unique needs of a changing and developing society, as found in South Africa, there is a need to be creative and find alternative ways to cope with our societal stresses and daily occurrences. This is where the researcher feels that the social work profession needs to be involved in working and contributing to our health care services. The development of medical social work is detailed and the latest social work definition discussed. It is reveals how contents of the definition of social work are relevant and are a pertinent fit with mind-body approaches to health and wellbeing. The researcher debates the role of social workers in this field of health care. It is then proposed, in the detailed discussion, that social workers practising in this field should be known as Health Care Social Workers. This field of holistic health care has many proposed strengths and implication, for both Health Care Social Workers and other health care professionals. It will naturally also present challenges that need to be considered and contemplated. The final chapter of this thesis examine these strengths and challenges and their therapeutic implications. The researcher concludes by demonstrating that the literature study on holistic mind and body approaches matches her objectives from the first chapter. / Social work / M.A. (Social Science with specialisation in Mental Health)

Thesis (MEd)--Stellenbosch University, 2012. / Bibliography / ENGLISH ABSTRACT: As a grade R teacher in South Africa, the researcher was disturbed by the extent of aggressive behaviour amongst children (aged 4 years to 6 years). Other teachers involved with the same class were of the opinion that the aggressive behaviour had a detrimental effect on their instructional time and motivation. Schools, teachers and other support personnel of staff have developed many cognitive and social support programmes to encourage positive behaviour, including reducing aggressiveness. Some programmes are in individual format and others in group format. However, the problem with these types of support programmes is that they are hard to come by due to cost and lack of knowledge among personnel. A child's full development is influenced negatively when in a negative atmosphere or situation (which includes abuse, aggression or discouragement). During 2011, the researcher took her dog to visit her class informally. It started when the class was having a discussion on pets and the researcher wanted to show the class how to groom and take care of a pet dog. The school’s staff and the researcher noticed a calmer and friendlier atmosphere amongst the children after the visits. This positive experience led to reading related literature and the researcher found substantial recent literature that increased her interest in the subject. The literature review suggested that the positive effects of animals in classrooms and on children should be explored and shared with teachers and schools, hence this study. The question arose whether this method could possibly provide the type of support South African children need to become caring, empathic and understanding of the world around them and each other. This research study was undertaken to explore the influence of the visits of a dog on the learners’ aggressive behaviour and teachers' opinions, which were of great value. This qualitative study took place within an interpretive paradigm. A case study design was used, as the focus was on an in-depth explanation of how a dog influenced the aggressive behaviour in the grade R class as a single bounded system. The study took place over a period of eight successive weeks. The data collection methods employed were questionnaires to gather biographical data, individual semi-structured interviews and observation during free play. Data were analysed by means of content analysis. Research findings indicated a positive influence on the learners' aggressive behaviour after eight weeks of the P.A.T. (Pet Assisted Therapy) dog visits. Positive behaviour in general was also witnessed and, most importantly, the participating teachers were of the opinion that the class was easier to manage and more time could be spent on instruction. The participating teachers provided different perspectives as they were involved in the class in different ways. However, the conclusion was that the positive influence of PAA on the learners' aggressive behaviour was mainly due to how some individual learners were influenced, which changed the interaction among all the learners. It is recommended that further studies be done on the time available to teachers to address aggressive behaviour to achieve a long-term result compared to just solving the problem at the occurrence of aggressive behaviour, and how PAA influences the learners in their other microsystems as well. / AFRIKAANSE OPSOMMING: Die navorser, 'n graad R opvoeder, vind die intensiteit en die hoeveelheid van aggressiewe gedrag onder graad R leerders kommerwekkend. Ander onderwysers betrokke by dieselfde klas se opinie was dat die aggressiewe gedrag onder die leerders 'n uiters negatiewe impak op die opvoeding van die leerders het. Verskeie kognitiewe en sosiale ondersteunings- programme vir die aanmoediging van positiewe gedrag in die klaskamer is reeds deur opvoeders, skole en ondersteunende personeel ontwikkel. Die navorser is egter van mening dat die finansiële omstandighede van verskeie skole en die kennis van die onderwysers wat moontlik die strategieë moet implementeer, die gebruik van sulke programme beperk . Leerders wat in negatiewe opvoedingsomstandighede (wat misbruik, aggressiwiteit of ontmoediging insluit) geplaas is, word negatief beïnvloed. Die navorser het gedurende 2011 haar eie hond skool toe geneem om by die weeklikse tema oor 'diere' aan te sluit. Die doel was om aspekte van hoe 'n mens na jou hond omsien met die leerders te bespreek. Die skoolpersoneel en die navorser (as opvoeder) het opgelet dat 'n kalmer atmosfeer onder die leerders geheers het nadat die navorser se troeteldier die klas besoek het. Dit het daartoe gelei dat die navorser leeswerk oor die onderwerp onderneem het. Vele onlangse bevindinge wat die onderwerp nog meer interessant gemaak het, is opgespoor. Een van die klasse in die betrokke skool het aggressiewe gedrag onder die leerders ervaar wat die onderwyser se motivering om te onderrig negatief beïnvloed het. Dit het gelei tot die gevallestudie wat die gebruik van 'n hond in die klaskamer as 'n moontlike metode om Suid-Afrikaanse kinders te motiveer om ‘n gevoel van omgee, empatie en begrip van die wêreld om hulle en ander te ontwikkel. Die navorsing het die moontlike invloed van gestruktureerde besoeke deur 'n hond op die gevallestudieklas ondersoek. Omdat die aggressiewe gedrag ook deur die onderwysers ondervind word en dit hul opvoedingstaak affekteer, was hulle opinies van groot belang. Die kwalitatiewe studie is onder die interpretatiewe paradigma onderneem. 'n Gevallestudieformaat is gebruik en was daarop gerig om die invloed van die hond op die leerders se aggressiewe gedrag grondig te verstaan. Die studie het oor 'n tydperk van agt opeenvolgende weke plaasgevind. Kwalitatiewe navorsingsmetodologie is gebruik. Dit het ’n doelbewuste streekproef van deelnemers, vraelyste vir biografiese data, individuele semi-gestruktureerde onderhoude, observasies om die informasie wat uit die onderhoude verkry is, te ondersteun en inhoudsanalise vir die ontleding van die data (veldwerknotas) omvat. Die navorsingsbevindinge het ‘n afname in aggressiewe gedrag onder die leerders na die agt weke van die intervensie (hond se besoeke) getoon. Algemene positiewe gedrag is waargeneem en die belangrikste bevinding was dat die deelnemende onderwysers van mening was dat die klas meer hanteerbaar was en meer tyd tot hul beskikking vir die opvoeding van leerders toegelaat het. Die onderwysers kon verskeie perspektiewe uitlig aangesien elk op 'n ander manier by die klas betrokke was. Daar was 'n duidelike kommentaar dat PAA 'n invloed op individuele leerders uitgeoefen het en dit het die interaksie onder die leerders in die klas beïnvloed. Die navorser stel voor dat verdere studies onderneem word om te bepaal hoeveel tyd onderwysers benodig om 'n langdurige positiewe effek op leerders se aggressiewe gedrag te bewerkstellig, eerder as om telkens wanneer ‘n probleem opduik ‘n oplossing te vind wat moontlik nie op die lang duur effektief sal wees nie. Verder kan ondersoek ingestel word na hoe PAA die leerders se gedrag buite die klas beïnvloed.

Tradicionalmente, a escolha pelo tipo de intervenção psicoterápica para diferentes quadros clínicos depende fundamentalmente da experiência profissional do terapeuta e de sua predileção por determinadas estratégias clínicas. Esse cenário, entretanto, tem se modificado no contexto da prática baseada em evidências, definida pela American Psychological Association como o processo individualizado de tomada de decisão clínica que ocorre por meio da integração da melhor evidência disponível com a perícia clínica no contexto das características, cultura e preferências do cliente. O paradigma de prática baseada em evidências está em perfeita harmonia com a ideologia da análise do comportamento aplicada, que, desde a sua origem, apresenta um forte comprometimento com a sustentação empírica de seus procedimentos terapêuticos. Apesar desse comprometimento, é de fundamental importância avaliar em que medida a área está ou não produzindo evidências de eficácia. Em vista disso, o presente trabalho teve por objetivo analisar a produção de evidências empíricas da terapia analítico-comportamental (TAC) e da psicoterapia analítica-funcional (FAP), na literatura nacional e internacional, de modo a complementar as revisões sistemáticas já realizadas sobre outras modalidades de análise do comportamento clínica terapia de aceitação e compromisso (ACT), terapia comportamental dialética (DBT) e ativação comportamental (BA). Para cumprir esse objetivo, foi realizada uma revisão da literatura conduzida de forma a localizar o maior número possível de estudos empíricos sobre TAC e FAP, publicados ou não, que abarcou onze bases de dados globais e três bases de dados específicas da análise do comportamento. A seleção dos estudos obedeceu aos seguintes critérios de inclusão: ser relato de caso, experimento de caso único ou pesquisa de grupo que descreve os resultados obtidos num processo de terapia individual; ter participantes com desenvolvimento típico e idade igual ou superior a 18 anos; ter ocorrido exclusivamente no ambiente de consultório; ser fundamentado no behaviorismo radical e utilizar conceitos da análise do comportamento na descrição do processo terapêutico. No total, foram selecionados 54 trabalhos que apresentaram 72 casos. As informações de cada um dos casos foram organizadas numa planilha do Microsoft Excel e diferentes categorias de análise foram construídas de modo a possibilitar dois tipos de análise. A primeira, descritiva, abarcou a denominação dada à terapia, idade, gênero e diagnóstico dos clientes, método de pesquisa, número de sessões, avaliação da fidelidade ao procedimento, apresentação de análise de contingências, alvos da intervenção, procedimentos utilizados, eficácia, medidas de resultado e follow-up. A segunda análise consistiu em diversos cruzamentos entre esses dados. Os resultados obtidos permitem concluir que a TAC e a FAP carecem de evidências empíricas que comprovem ou rejeitem sua eficácia. À luz desses dados e das revisões sistemáticas sobre ACT, DBT e BA, argumenta-se que terapeutas e pesquisadores brasileiros têm três opções: (1) utilizar apenas os princípios comportamentais básicos, isto é, a teoria, para guiar sua prática clínica, o que é insuficiente para garantir a eficácia da intervenção; (2) adotar um dos modelos internacionais de análise do comportamento clínica; (3) sistematizar a TAC para, posteriormente, pesquisá-la experimentalmente. Espera-se que, além de oferecer o estado da arte da pesquisa clínica sobre TAC e sobre FAP, este trabalho contribua para o desenvolvimento científico das terapias comportamentais e para o fortalecimento da análise do comportamento como ciência e profissão / Traditionally, the choice of the type of psychotherapeutic intervention for various clinical conditions fundamentally depends on the professional experience of the therapist and his/her predilection for certain clinical strategies. However, this scenario has been changing in the context of evidence-based practice, defined by the American Psychological Association as the individualized process of clinical decision-making that takes place through the integration of the best available evidence with clinical expertise in the context of the characteristics, culture and preferences of the client. The paradigm of evidence-based practice is in perfect harmony with the applied behavior analysis ideology, which, since its inception, has a strong commitment to the empirical support of its therapeutic procedures. Despite this commitment, it is of fundamental importance to assess to what extent the area is or is not producing evidence of efficacy. In view of this, this thesis aimed to analyze the production of empirical evidence of behavioral-analytic therapy (TAC) and functional-analytic psychotherapy (FAP), in national and international literature, in order to complement the systematic reviews already conducted on other modalities of clinical behavior analysis acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and behavioral activation (BA). To achieve this goal, a review of the literature was conducted in order to find the largest possible number of empirical studies of TAC and FAP, published or not, which covered eleven global databases and three specific databases of behavior analysis. The selection of studies followed the following inclusion criteria: to be a case report, single-case experiment or group research that describes the results obtained in an individual therapy process; to have participants with typical development and age up to 18 years of age; to have taken place exclusively in the office environment; to be based on radical behaviorism and to use behavior analysis concepts in the description of the therapeutic process. In total, 54 works that presented 72 cases were selected. The information regarding each one of the cases has been organized in a Microsoft Excel worksheet and different analysis categories have been designed so as to enable two kinds of analysis. The first kind was a descriptive one, and embraced the name given to the therapy, age, gender and diagnosis of clients, research method, number of sessions, evaluation of procedure fidelity, description of analysis of contingencies, targets of intervention, procedures used, efficacy, outcome measures and follow-up. The second kind consisted of the analysis of different combinations of these data. The results lead to the conclusion that TAC and FAP lack empirical evidence to support or reject their efficacy. In light of these data and the systematic reviews on ACT, DBT and BA, it is argued that Brazilian therapists and researchers have three options: (1) use only the basic behavioral principles, i.e. the theory, to guide their clinical practice, which is insufficient to ensure the efficacy of the intervention; (2) adopt one of the international models of clinical behavior analysis; (3) systematize TAC so that it can be researched experimentally afterwards. It is expected that, in addition to offering the state of the art of clinical research on TAC and on FAP, this work will contribute to the scientific development of behavioral therapies and to the strengthening of behavior analysis as a science and profession

Objetivou-se verificar a viabilidade de uma proposta de aperfeiçoamento a distância para a prática psicológica no atendimento à Enurese (EN) em Serviços-escola, Unidades Básicas de Saúde e consultórios particulares, situados em diferentes regiões do país e se o tempo de experiência dos psicólogos participantes da proposta estava relacionado com algumas variáveis como: o número de contatos de supervisão, o tempo para alta dos clientes, as variações nos escores de problemas de comportamento dos clientes e da intolerância dos pais deles. Foram participantes (N=40) psicólogos de diferentes regiões do país, de ambos os sexos, divididos em dois grupos conforme sua experiência, sendo G1: menos de 10 anos (n=27) e G2: mais de 10 anos (n=13). Os participantes receberam treinamento e supervisão num programa de Educação a Distância (EAD) e atenderam crianças ou adolescentes com queixa de EN. As informações e as questões relativas ao atendimento foram comunicadas ao participante, através da internet, pela qual ele também ofereceu respostas e subsídios para sua prática. Os participantes tiveram total liberdade de consultar o supervisor quantas vezes desejassem para solucionar questões ou buscar orientação. O atendimento que desenvolveram se deu através de intervenção comportamental com uso de aparelho nacional de alarme. A Escala de Intolerância foi utilizada para avaliação dos pais, e para avaliar os filhos utilizou-se o Inventário de Comportamentos da Infância e Adolescência CBCL e o Registro simples de \"molhadas\" (descontrole enurético) ao longo do atendimento. Os resultados foram de dois tipos: dos participantes psicólogos e de seus clientes e pais. Foram comparados os números médios de contatos entre os psicólogos e o supervisor, dos dois diferentes grupos de experiência, e os escores obtidos nos instrumentos de avaliação dos clientes aplicados antes e após a intervenção, a fim de verificar a efetividade do tratamento, além do decréscimo do número de molhadas durante este. Do total de participantes, 15 concluíram o tratamento de seus clientes tendo eles atingido os critérios de sucesso e alta, dois tiveram clientes que concluíram sem sucesso, 13 descontinuaram o tratamento, quatro não conseguiram clientes e seis permanecem atendendo seus clientes que não finalizaram o tratamento ao final da coleta dessa pesquisa. O G1 atingiu alta no tratamento com uma média de 20,1 (dp=9,96) contatos para supervisão ix em 20,4 semanas(dp=5,27). O G2 alcançou alta com média de 10,0 contatos (dp=5,30) em 20,4 semanas (dp=7,13). Observou-se, nos clientes, significativa redução nos escores na escala total de problemas de comportamento dos clientes e de intolerância de seus pais em ambos os grupos de participantes após o tratamento. Os resultados deste estudo são inferiores aos obtidos no atendimento com supervisão presencial realizados no país, mas aproximam-se deles, justificando portanto o seu uso. Esses dados demonstram a viabilidade dessa modalidade de atendimento / The objective was to examine feasibility of a distance improvement program of psychological practice in treating Enuresis (EN) in School-services, Basic Health Units, and private offices, located in different areas of the country and if the amount of experience time of the participating psychologists was in any way related to variables such as: the number of supervision contacts, time for client discharge, and intolerance of their parents. Participants were (N=40) psychologists from different regions of the country, from both genders, divided into two groups according to their experience, where G1: under 10 years (N=27), and G2: over 10 years (N=13). Participants received training and supervision in a Distance Learning program (EAD) and treated children or adolescents complaining about EN. Treatment information and related questions were made known to the participant through the internet, where answers and practice aid were also offered. Participants were totally free to consult with supervisor as many times as desired to solve issues or seek guidance. Developed treatment was performed by behavioral intervention with the use of national alarm device. Throughout treatment, the Intolerance Scale was used for parent evaluation, and the Child Behavior Checklist CBCL, as well as bedwetting Record for evaluating the children. Results were of two kinds: of participating psychologists and their clients and parents. The average number of contacts between participating psychologists and their supervisors, of the two experience groups, and pre and post treatment scores obtained in client evaluation instruments were compared in order to check treatment effectiveness, as well as the decrease in bedwetting throughout it. Of the total number of participants, 15 concluded treatment with client achieving success criteria and discharge, two had clients concluding without success, 13 discontinued treatment, four did not obtain clients, and six remained treating clients who had not finish treatment at the end of data collection for this research. G1 obtained treatment discharge with an average of 20.1 (SD=9.96) contacts for supervision in 20.4 weeks (SD=5.27). G2 obtained treatment discharge with an average of 10.0 contacts (SD=5.30) in 20.4 weeks (SD=7.13). Clients were observed to have a significant decrease in total behavior problems scale scores and parent intolerance in both groups of participants xi after treatment. Results of this study are inferior to the ones obtained in treatment with face to face supervision performed in the country, but are close, therefore justifying their use. Such data demonstrates feasibility for this treatment modality

O entendimento do comportamento verbal (ou simbólico) e sua aplicação aos problemas comportamentais é importante para a análise clínica do comportamento pelo fato de o comportamento verbal humano ser pervasivo. Ou seja, humanos, ao serem verbalmente capazes, interagem com o ambiente, e processos verbais se tornam uma fonte de regulação comportamental. Considerando a psicoterapia como eminentemente verbal, entende-se como necessário a condução de pesquisas que abordem a complexidade do comportamento verbal no ambiente terapêutico. Embora metáforas, uma forma de intervenção verbal, tenham sido utilizadas por terapeutas analítico-comportamentais, nem sempre são claras as vantagens ou elucidados os efeitos que tal manejo traria. Esta pesquisa investigou, num delineamento experimental de caso único A-B-A-B na clínica, os efeitos do manejo de metáforas orientadas para valores na psicoterapia analítico-comportamental em um cliente com queixas ligadas à ansiedade. Os resultados foram comparados e correlacionados da categorização das sessões segundo o SiMCCIT - Sistema Multidimensional para a Categorização de Comportamentos na Interação Terapêutica e a qualidade das relações estabelecidas pelo cliente, com os resultados do EAS-40 e do BAI. Sugere-se que o manejo de metáforas evocou um estabelecimento de relações maior por parte da cliente no momento em que metáforas eram manejadas, embora os dados sejam pouco conclusivos. O uso de observações repetidas e contínuas, a avaliação da linha de base e o critério de estabilidade nesta e para as mudanças nas fases, assim como a replicação direta, permitiram demonstrar confiabilidade e contribuíram para a validade interna da pesquisa / The understanding of verbal (or symbolic) behavior and its application to behavioral problems is important for the clinical behavior analysis due to verbal behavior pervasiveness. While being able to verbally interact with the environment, humans verbal and cognitive processes become a source of behavioral regulation. As psychotherapy is considered eminently verbal, it is understood as necessary conduct researches that address the complexity of verbal behavior in this context. Although metaphors, a form of verbal intervention, are being used by behavioral therapists, advantages or effects of the management of them would bring are not always clear. This research investigated, in a single case ABAB experimental design, the effects of the management of oriented values metaphors in a behavior therapy on a client with complaints related to anxiety. The results were compared and correlated with the categorization of sessions using the SiMCCIT, the quality of the relations established by the client on then, and the results of the EAS-40 and BAI. It is suggested that the management of metaphors evoked a greater establishment of relations by the client at the time that metaphors were handled, although the data are still inconclusive. The use of repeated and continuous observations, the evaluation of the baseline and the stability criteria on this and in the changes of the phases, as well as direct replication, have demonstrated reliability and contributed to internal validity

Made available in DSpace on 2016-04-29T13:17:50Z (GMT). No. of bitstreams: 1 Fernando Albregard Cassas.pdf: 984002 bytes, checksum: 787a62ba52704b0b87c54e523fbb452a (MD5) Previous issue date: 2013-07-05 / The work presented here is motivated by a clinical intervention that began to be practiced by behavior analysts in Brazil in the early 1990s. This form prioritizes the work in the natural environment and, therefore, more likely to act directly on controlling contingencies of client behavior. This type of control seems to have established in the literature, a polarization between Therapeutic Accompaniment (TA) and the clinical based on the greater or lesser ability to control to be undertaken on the client behavior. The research presented here aims to resume and analyze the therapeutic practices of radical behaviorist base in order to establish a comparison between them and the TA, thus define whether it is possible to assert the existence of this polarization. Four sets of papers were analyzed: bases of behavior therapy: publications Skinner and Ferster about therapy, the Behavior Modification; literature on the following therapeutic approaches: Functional Analytic Therapy, Acceptance and Commitment Therapy, Behavioral Activation, the literature on the brasilian therapeutic proposals: Analytical Behavioral Therapy, Therapy of Contingencies of Reinforcement, Pragmatic Behavioral Psychotherapy and Molar and Self Therapy, beyond literature about the TA. To compose this analysis, four analytical categories were developed: core concepts for the diagnosis, intervention strategies, effectiveness and generality. The analysis of the studies cited showed that the polarization in the terms formulated above, is not true because all proposed schedule forms to ensure the generalizability of the results. Could be defined, however, the existence of a "minimum repertoire client". This concerns the modeling repertoire of verbal behavior that will allow the client to modify alone, the environment itself. And that is the reason for this study in a natural environment where the client does not have the repertoire to modify their own environment independently, the therapist operates the changing client environment in order to build a better learning condition for that client. From this, suggestions for future research are made at the end of the work / A tese aqui apresentada é motivada por um trabalho de intervenção clínica que começou a ser praticado por analistas do comportamento brasileiros no início da década de 1990. Essa forma prioriza o trabalho em ambiente natural e, com isso, maior chance de atuar diretamente nas contingências controladoras do comportamento do cliente. Esse tipo de controle parece ter estabelecido, na literatura da área, uma polarização entre o Acompanhamento Terapêutico (AT) e o consultório com base na maior ou menor possibilidade de controle a ser assumido sobre o comportamento do cliente. A pesquisa aqui apresentada se propõe a resgatar e analisar as práticas terapêuticas de base behaviorista radical com vistas a estabelecer uma comparação entre elas e o AT para, assim, definir se é possível afirmar a existência dessa polarização. Para isso, quatro conjuntos de trabalhos foram analisados: bases da terapia comportamental: publicações de Skinner e de Ferster respeito da terapia, e sobre a Modificação de Comportamento; a literatura sobre as seguintes propostas terapêuticas: Functional Analytic Therapy, Acceptance and Commitment Therapy, Behavioral Activation; a literatura sobre as propostas terapêuticas nacionais: Terapia Analítico‐ comportamental, Terapia por Contingências de Reforçamento, Psicoterapia Comportamental Pragmática e Terapia Molar e de Autoconhecimento, além da literatura acerca do Acompanhamento Terapêutico. Para compor essa análise, foram desenvolvidas quatro categorias analíticas: conceitos centrais para o diagnóstico, estratégias de intervenção, efetividade e generalidade. A análise dos trabalhos citados apontou que a polarização, nos termos formulados acima, não acontece, pois todas as propostas programam formas garantir a generalização dos resultados. Foi possível definir, no entanto, a existência de um repertório mínimo de cliente . Esse repertório diz respeito a modelagem de comportamento verbal que permitirá ao cliente modificar, sozinho, o próprio ambiente. E essa é a justificativa do trabalho em ambiente natural, quando o cliente não tem repertório para modificar o seu próprio ambiente de forma independente, o terapeuta opera mudando o ambiente do cliente de maneira a construir uma condição de aprendizagem melhor para esse cliente. A partir disso, sugestões para pesquisas futuras são feitas ao final do trabalho