Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-18T18:37:37Z No. of bitstreams: 1 RandolfodosSantosJunior_tese.pdf: 1610909 bytes, checksum: 28fc3685f524eb861999084083484f4a (MD5) / Made available in DSpace on 2018-10-18T18:37:37Z (GMT). No. of bitstreams: 1 RandolfodosSantosJunior_tese.pdf: 1610909 bytes, checksum: 28fc3685f524eb861999084083484f4a (MD5) Previous issue date: 2017-11-13 / The assessment and management of chronic pain are an important focus of attention, since these are pointed out as a major cause of disability and demand for health care.Objective: To evaluate the self-efficacy and indicators of anxiety and depression in patients diagnosed with chronic pain in two forms of treatment: a) structured program of Cognitive-Behavioral Therapy in group; B) control group who undergone the usual treatment of the institution.Materials and Methods: Adult patients of both genders at the beginning of care in the Pain Clinics. Those who met the inclusion criteria and agreed to participate in the study were randomized to allocation in the Experimental Group (EG) or Control Group (CG). All participants were evaluated in three moments: initial evaluation, reassessment and follow-up. They answered the following instruments: Questionnaire on clinical and sociodemographic data; Self-Efficacy Scale for Chronic Pain; Hospital Anxiety and Depression Scale; Numeric Pain Rating Scale; Inventory of Attitudes and Beliefs Facing Chronic Pain. The experimental group received, besides the habitual treatment provided by the institution, 10 sessions of Cognitive-Behavioral intervention in group. The control group received the usual treatment provided by the Pain Clinics. Results:A total of 114 adult patients undergoing chronic pain treatment participated in the first part of this study. Data pointed out high indicators of anxiety (53%) and depression (55%), in addition to low self-efficacy (63%). Low self-efficacy was associated with beliefs and dysfunctional attitudes towards pain and to higher indicators of anxiety and depression were observed. In the second part of the study, all participants were randomized into two groups: Experimental Group (EG) and Control Group (CG) . Fifty-seven patients participated in all the stages of this part of the study, 31 in EG and 26 in CG. Comparing the two groups according to the follow-up, the results showed that the experimental group had significantly higher self-efficacy scores (p <0.026) and. significantly lower anxiety scores (p < 0 , 01) and depression (p <0.023).Conclusion: In this study, the cognitive-behavioral therapy in group has improved important benefits for patients with chronic pain, playing on their beliefs and attitudes toward pain, anxiety management and reduction on depression indicators. / A avaliação e o manejo da dor crônica constituem importante foco de atenção, uma vez que são apontadas como uma das principais causas de incapacidade e de procura por cuidados de saúde. Objetivo: Avaliar autoeficácia e indicadores de ansiedade e depressão em pacientes com diagnóstico de dor crônica alocados em duas modalidades de tratamento: a) programa estruturado de Terapia Cognitivo Comportamental em grupo; b) grupo controle, que recebeu o tratamento habitual fornecido pela instituição. Materiais e Métodos: Participaram pacientes adultos de ambos os sexos, em início de atendimento na Clínica da Dor. Aqueles que atenderam aos critérios de inclusão e concordaram em participar do estudo foram randomizados para alocação no Grupo Experimental (GE) ou no Grupo Controle (GC). Todos os participantes foram avaliados em três momentos: avaliação inicial, reavaliação e seguimento. Responderam aos seguintes instrumentos: Questionário de dados clínicos e sociodemográficos; Escala de Autoeficácia para Dor Crônica; Escala Hospitalar de Ansiedade e Depressão; Escala Numérica de Dor; Inventário de Atitudes e Crenças Diante da Dor Crônica. O grupo experimental recebeu, além do tratamento habitual fornecido pela instituição, 10 sessões de intervenção Cognitivo Comportamental em grupo. O grupo controle recebeu o tratamento habitual, oferecido pela Clínica da Dor. Resultados: Participaram da primeira parte deste estudo 114 pacientes adultos em tratamento de dor crônica. Os dados apontaram indicadores elevados de ansiedade (53%) e depressão (55%), além de baixa autoeficácia (63%). Observou-se que a baixa autoeficácia está associada às crenças e atitudes disfuncionais diante da dor e a indicadores mais elevados de ansiedade e depressão. Na segunda parte do estudo, todos os participantes foram distribuídos por meio de randomização em dois grupos: Grupo Experimental (GE) e Grupo Controle (GC). Participaram de todas as etapas desta parte do estudo 57 participantes, sendo 31 no GE e 26 no GC. Comparando-se os dois grupos no que se refere ao seguimento, os resultados apontaram que o grupo experimental apresentou em relação ao grupo controle, escores significativamente maiores de autoeficácia (p < 0,026) e, significativamente,menores de ansiedade (p < 0,01) e depressão (p < 0,023). Conclusão: Neste estudo, a Terapia Cognitivo Comportamental em grupo promoveu benefícios importantes aos pacientes com dor crônica, atuando em suas crenças e atitudes diante da dor, manejo de ansiedade e redução nos indicadores de depressão.

O futebol é um esporte coletivo, em que desempenhos individuais podem definir o resultado de um jogo ou de um campeonato. Especialmente em cobranças de pênalti, o destino da partida encontra-se nos pés do cobrador. A ansiedade no momento das cobranças de pênalti em jogos de futebol de campo é um dos motivos que podem fazer com que um jogador de futebol não converta a cobrança em gol. Neste estudo experimental controlado foi testado um protocolo de biofeedback e psicologia cognitivo-comportamental com o objetivo de reduzir o estado de ansiedade em atletas de futebol amadores de futebol de campo de 15 e 16 anos de idade. Os participantes do grupo experimental foram avaliados antes de duas competições de pênaltis, que aconteceram antes e depois de quatro encontros de intervenção com o protocolo de biofeedback e psicologia cognitivo-comportamental para a redução de ansiedade dos jogadores de futebol que participaram do grupo ativo, em relação ao grupo controle / Soccer is a collective sport in which individual performances can define the outcome of a game or a championship. Especially at penalties shootouts, the destination of the match is at the feet of the penalty taker. Anxiety at the time of penalty kicks at soccer matches is one of the reasons why a soccer player may not score the goal. In this controlled experimental study, a protocol of biofeedback and cognitive-behavioral psychology was tested with the objective of reducing the state anxiety in 15 and 16 year old amateur soccer athletes. Participants in the experimental group were assessed before two penalty shoot-outs, which took place before and after four intervention sessions with a biofeedback and cognitive-behavioral psychology protocol. The results showed that the protocol was efficient as a method and effective in reducing the anxiety state of soccer players who participated in the experimental group, in comparison to the control group

A Teoria Cognitiva Comportamental (TCC) tem sido utilizada nos programas de cessação do tabagismo e tem apresentado resultados satisfatórios na sua aplicação. A abordagem telefônica também tem sido utilizada no tratamento dos fumantes, seu uso é recente e sua efetividade ainda não é consolidada. No Brasil, não existe um protocolo para a abordagem telefônica do fumante estruturado na TCC, assim este estudo teve como objetivo verificar a efetividade de um protocolo para cessação do tabagismo baseado na utilização de ambos. Para isso o perfil tabagístico e a dependência a nicotina foram avaliadas através da aplicação de questionário após o tempo controle, a intervenção e após seis meses do término da abordagem. Foram incluídos 101 indivíduos integrantes de uma UBS no estado de São Paulo. Cada indivíduo recebeu oito contatos com duração média de quarenta minutos, onde foi abordada a identificação e análise dos pensamentos automáticos, crenças disfuncionais, análise funcional do comportamental e emprego de técnicas para mudança de comportamento. Obteve-se uma abstinência imediata de 67,3% (p=0,001) e após seis meses, 37,6% de abstinência. Observou-se diminuição significativa dos cigarros fumados por dia (p=0,001) e diminuição da dependência à nicotina avaliado através do teste de dependência à nicotina, teste Fargeström, (p=0,001). Houve associação entre o sexo dos participantes e o resultado do estudo. Estes resultados sugerem uma efetividade do uso do protocolo baseado na Teoria Cognitiva Comportamental na intervenção telefônica para cessação do tabagismo na amostra estudada. / Cognitive Behavioral Theory (CBT) has been used in programs for stopping smoking and has shown satisfactory results in their application. The telephone approach has also been used in the access to smokers, this use is recent and its effectiveness is not yet consolidated. In Brazil, there is no record for dealing in telephone approach to smoker (CBT), so this study is aimed to verify the effectiveness for stopping smoking based on the use of both. Therefore, the profile of the tobacco user and nicotine dependence were assessed using a questionnaire after the time control, intervention and six months after the end of the approach. 101 members of UBS in the state of Sao Paulo were enrolled in the program. Each person received eight contacts with an average duration of forty minutes, which dealt with the identification and analysis of automatic thoughts, dysfunctional beliefs, functional behavior analysis and use of techniques to change behavior. Results showed an immediate withdrawal of 67.3% (p = 0.001) and 37.6% after six months of abstinence. We observed a significant reduction in cigarettes smoked per day (p = 0.001) and decreased nicotine dependence measured by the test of nicotine dependence, Fargeström test (p = 0.001). There has been an association between sex of participants and the study\'s outcome. These results suggest effectiveness of using a protocol based on Cognitive Behavioral Theory in telephone intervention for stopping smoking in this population

A partir do estudo e consolidação empírica da Psicoterapia Analítica Funcional (FAP) tem-se explorado cada vez mais a relação estabelecida entre terapeuta e cliente, no intuito de se compreender e aprimorar os processos de mudança clínica ocorridos em terapia. A literatura enfatiza que respostas emitidas por parte do terapeuta no decorrer do processo de autorrevelação do cliente podem impactar seu desfecho, facilitando ou dificultando exposições e verbalizações. Considerando que a FAP tem se ajustado bem a casos clínicos que apresentam dificuldades no estabelecimento de relações de intimidade, o objetivo central desta pesquisa foi investigar se o responder contingente do terapeuta às respostas de esquivas emocionais emitidas pelo cliente, aumenta a emissão de relatos sobre sentimentos, assim como o de autorrevelações em sessão e em seus relacionamentos extra consultório. Para isso, uma cliente com queixa de dificuldade em estabelecer relações interpessoais e uma terapeuta (com experiência clínica no manejo da FAP) foram selecionadas. O delineamento experimental de caso único apresentou o formato: A1-B1-A2-B2. As sessões foram filmadas e transcritas e os dados coletados foram analisados pela Escala de Classificação da Psicoterapia Analítica Funcional (FAPRS) adaptada. Doze sessões foram categorizadas e 4.094 (quatro mil e noventa e quatro) unidades de análises foram avaliadas. Os resultados indicaram que a variável independente (FAP) foi a responsável pela diminuição na emissão de comportamentos problema (CRBs1) e, principalmente, pelo aumento na emissão de comportamentos de melhora (CRBs2). Em outras palavras, durante a fase FAP, após a evocação da terapeuta, a cliente passou a entrar em contato com seus sentimentos e se autorrevelar mais efetivamente em terapia, de modo que seus comportamentos de esquiva emocional diminuíram. De maneira geral, as diferenças entre as fases FAP e não-FAP ficaram evidentes com os dados dos CRBs2 e não com os dos CRBs1. Os resultados corroboram a hipótese do estudo, fortalecem as evidências clínicas promovidas pela Psicoterapia Analítica Funcional e replicam os dados apresentados pelas pesquisas realizadas no Programa de Psicologia Clínica da USP com o uso da FAP e com delineamento experimental de caso único / Based on studies and empirical consolidation of Functional Analytic Psychotherapy (FAP), the relationship between therapist and client has been extensively explored in order to understand and enhance the process of clinical change that occurs during therapy sessions. The literature emphasizes that feedback provided by the therapist to the process of clients self-disclosure might affect and impact outcome by facilitating or hindering interpersonal exposure and verbalizations. Considering that FAP presents satisfactory results with clinical cases characterized by difficulties to establish intimate relationships, the aim of this research was to investigate whether the therapist contingent responding to clients emotional avoidance increases clients report of feelings, self-disclosure in therapy and in out-of-session relationships. For this study, a client with problems to establish interpersonal relationships and a therapist with clinical expertise on FAP were chosen. The single-case experimental design had the format: A1-B1-A2-B2. The sessions were recorded and transcribed and the data collected were coded using an adaptation of the Functional Analytic Psychotherapy Rating Scale (FAPRS). Twelve sessions were coded and 4.094 (four thousand and ninetyfour) units of analysis were analyzed. Results indicated that the independent variable (FAP) was responsible for decreasing the emission of problem behaviors (CRBs1) and above all for increasing the emission of improvements (CRBs2). In other words, during FAPs phase, after the therapist evoking, the client began to get in touch with her feelings and to self-disclose more effectively in therapy. As a result, her emotional avoidance behaviors decreased. In general, the differences between FAP and non-FAP phases were clearly showed in the data of the CBRs2 and not in the data of the CRBs1. The results corroborate the hypothesis of the study, strengthen clinical evidence of FAP and replicate the data presented in other research studies conducted in the Clinical Psychology Program at University of São Paulo using FAP and single-case designs

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Treatment for child abusers was evaluated using two methods: reviewing three areas of literature and surveying practitioners.

Dual diagnosis clients continue to have low treatment completion rates. The purpose of the current study was to understand if motivational interviewing helped to increase completion rates for clients receiving cognitive behavioral therapy (CBT). Studying the problem was necessary for identifying an evidenced-based model for mental health counselors to help clients with dual diagnoses complete CBT treatment. There were no studies available for understanding the effectiveness of motivational interviewing as a tool for improving treatment completion rates for dual diagnoses clients in intensive outpatient programs. The research question examined if motivational interviewing was effective for improving treatment completion rates for the dual diagnosis population. A quantitative methodology with a quasi-experimental design used for this study and included a paired samples t test, a chi-square test, and a logistic regression analysis. The results showed a statistically significant association between receiving the motivational interviewing techniques and completing CBT. Clients who received motivational interviewing were 4 times more likely to complete CBT treatment compared to clients who did not receive the technique. Clients with increased self-efficacy levels were 2 times more likely to complete treatment, thus addressing the problem of dual diagnosis clients having low treatment completion rates. The overall results demonstrated that clients reduced substance use relapse and recidivism improved. Completing treatment helped to reduce crimes related to drug use; it also prepared substance users for return to society as productive citizens, which promoted positive social change.

Evidence-Based Alternative Therapy to Reduce Anxiety in Ambulatory Mental Health Patients by Renee Denobrega MS, Widener University, 2013 BS, Alvernia University, 2007 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University January 2016

Although it is suggested that a dysfunctional stress response system may be associated with posttraumatic stress disorder (PTSD) the neurobiological underpinnings are not well established, especially in children. There is also limited research on how treatment for PTSD may impact associated physiology. Respiratory sinus arrhythmia (RSA) is a reliable measure of parasympathetic stress reactivity, and both resting RSA and RSA reactivity are physiological indicators related to children’s emotion functioning and regulation. The present study examined if pretreatment resting RSA levels predicted RSA reactivity at pretreatment and the trajectory of resting RSA, RSA reactivity, resting heart period (HP) and HP reactivity after Cognitive Behavioral Therapy (CBT). Forty-nine children who experienced at least 1 traumatic event and presented with PTSD symptoms were assessed for psychological measures, RSA and HP at pretreatment, post treatment and a 3-month follow up. At pretreatment, lower resting RSA was associated with increased RSA withdrawal. Analysis with repeated measures mixed models indicated that lower resting pretreatment RSA and lower RSA withdrawal increased during CBT, and individuals with higher resting RSA and RSA withdrawal decreased during CBT, so that those at the extreme ends of higher and lower indices converged in the middle by the end of treatment. These data suggest an optimal moderate range for resting RSA and RSA reactivity. There were also significant gender differences on RSA reactivity after CBT. Lower pretreatment resting RSA predicted lower resting heart period (higher heart rate) across all time points but did not change with CBT. Pretreatment resting RSA did not predict HP reactivity. Post hoc analysis also revealed that PTSD symptoms were significantly reduced after CBT but this change was not associated with pretreatment resting RSA levels. Overall, these results suggest that children may change physiologically after CBT and the direction of the changes may depend on initial resting RSA levels. / acase@tulane.edu