Orientadores: Miriam Dambros, Luis Alberto Magna / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T00:26:33Z (GMT). No. of bitstreams: 1 Perchon_LygiaFerreiraGomes_M.pdf: 1294691 bytes, checksum: a72c898a6ea9573ee2b6576eed28d447 (MD5) Previous issue date: 2006 / Resumo: O presente trabalho, com duração de 24 semanas, avaliou a eficácia da terapia comportamental em grupo em promover mudanças positivas no padrão de qualidade de vida (Qol) de pacientes com incontinência urinária (IU) e disfunção erétil (DE), após prostatectomia radical. Participaram da pesquisa 30 pacientes. A intervenção foi desenhada visando melhorar a QoL, através de técnicas específicas para ensinar os participantes a identificarem e a administrarem situações estressantes e teve como foco as queixas de IU e DE, pós prostatectomia radical. A diferença entre o início e o final do estudo, para cada variável, foi comparada pelo teste t de Student para dados pareados. Análise múltipla, realizada com regressão linear múltipla escalonada, foi precedida de análise de correlação simples de Pearson. Consideraram-se variáveis dependentes: percepção geral da saúde, disfunção erétil e impacto da incontinência urinária e as variáveis independentes: idade, status profissional, alcoolismo, atitude frente ao câncer e frente à cirurgia, satisfação sexual anterior à cirurgia e planos para o futuro. A média de tempo entre a data da cirurgia e o início da terapia comportamental de grupo foi de 14,8 meses (desvio padrão=6,2; mediana=16,5). Para 63,3% dos pacientes, esse intervalo foi maior que 12 meses. Não foi encontrada correlação significativa entre esse tempo e as variáveis dependentes. O escore do domínio percepção geral da saúde diminuiu ao final do estudo (p=0,000), assim como o escore referente ao impacto da incontinência urinária (p=0,023), o que significa melhora dos dois fatores. A diferença entre os escores do impacto da incontinência correlacionou-se negativamente com a idade (p=0,04) e status profissional (p=0,05). A regressão múltipla mostrou que a idade foi a variável mais importante (r2 = 26,0%); considerados simultaneamente, idade e status profissional, há um aumento de 10,3% (r2 = 36,3%). O escore de disfunção erétil aumentou no final do estudo (p=0,000), e as diferenças entre os escores dessa variável correlacionaram-se positivamente e significantemente somente com os de satisfação sexual anterior à cirurgia (p=0,029), o que demonstrou a influência da satisfação sexual anterior à cirurgia sobre a disfunção erétil (r2 = 15,8%). A terapia de grupo mostrou-se efetiva em melhorar a percepção da qualidade de vida de homens submetidos à prostatectomia radical, particularmente em relação à IU e DE / Abstract: The current study evaluated the efficacy of a 24-week, group based, behavioral therapy in improving quality of life (QoL) among men who were treated for localized prostate carcinoma (PC) with radical prostatectomy (RP), and had treatment related dysfunctions: Urinary Incontinence (UI) and Erectile Dysfunction (ED). Thirty men were assigned to a 24-week group therapy. The intervention was designed to improve QoL by helping participants to identify and effectively manage stressful experiences and was focused on treatment-related sequelae of PC. The difference of all variables was compared between the beginning and the end of the study by means of Student¿s t test for paired samples. Multiple analysis was carried out by stepwise multiple linear regression following bivariate Pearson¿s correlation analysis. This was achieved with all predictors (i.e. general health perception, ED and the impact of UI) and relevant covariates (i.e. age, work/retirement status, alcohol addiction, attitude before cancer and before surgery, sexual satisfaction, and plans for the future). The mean time from surgery to attending the behavioral group intervention was 14.8 months (sd = 6.2; median = 16.5), and for 63.3% of the patients, this time was over 12 months. There was no significant correlation between that time and the predictor variables. General health perception scores decreased at the end of the study (p = 0.000), as well as urinary incontinence impact (UI) score (p=0.023), thus denoting improvement of both factors. The difference between the scores of the latter correlated negatively and significantly with both age (p = 0.04) and work/retirement (p = 0.05). Multiple stepwise regression showed that age was the most important variable (r2 = 26.0%); considering simultaneously age and work/retirement, there is an increase of 10.3% (r2 = 36.3%). Erectile dysfunction (ED) showed an increase at the end of the study (p = 0.000), and the difference between the scores of this variable correlated positively and significantly with sexual satisfaction only (p = 0.029), which means the positive influence of previous sexual satisfaction over erectile dysfunction (r2 = 15.8%). In conclusion, a 24-week behavioral group therapy was effective in improving the perceived QoL among men treated for PC. There were changes associated with the therapy, particularly the improvement in UI and ED / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

The present study examined the efficacy of a cognitive-behavioral therapy package and a highly credible attention-placebo in the treatment of male heterosocial anxiety. Previous research provided evidence that cognitive factors are important in the etiology and maintenance of heterosocial anxiety, and suggested that a cognitive-behavioral approach should be effective in the treatment of this problem. Despite such evidence, relatively few therapy outcome studies have been conducted using cognitive-behavioral procedures.

Change-talk (CT), or self-arguments for change, has been associated with favorable patient outcomes, while counter change-talk (CCT), or self-arguments against change, has been associated with poorer outcomes. Most studies on change language have focused on the prediction of distal posttreatment outcomes, while the prediction of more proximal outcomes has remained largely untested. Addressing this gap, we examined early treatment CT and CCT as predictors of worry change trajectories, “hazard” of clinically significant response, and time to response (i.e., outcome efficiency) in CBT and CBT integrated with MI (MI-CBT) for generalized anxiety disorder (GAD). We also explored whether treatment type moderated these associations. Data derived from a randomized controlled trial comparing CBT (n = 43) and MI-CBT (n = 42) for GAD. Independent observers reliably coded CT/CCT during session 1. Patients rated their worry after every session. Multilevel modeling revealed that, across both treatments, more CT associated with lower midtreatment worry level (p = .03), whereas more CCT associated with a slower rate of worry reduction at midtreatment (p = .04). However, treatment moderated the associations between CT and both midtreatment worry level (p = .004) and rate of change (p = .03). In CBT, patients with higher vs. lower CT had less worry and a faster rate of worry reduction; in MI-CBT, CT was unrelated to midtreatment worry level and the rate of worry change. Treatment did not moderate the CCT-worry relations. Survival analyses revealed that, across both treatments, more CT associated with a greater hazard of response (p = .004) and approached a faster time to response (p = .05), and more CCT associated with a lower hazard of response (p = .002) and approached a slower time to response (p = .06). Patient motivational language predicts proximal outcomes, and may be useful in differential treatment selection.

Aim: A randomized clinical trial demonstrated that responsively adding motivational interviewing (MI) to cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) outperformed CBT alone on long-term worry reduction (Westra et al., 2016). Consistent with MI’s additive aim, this effect was mediated by less patient midtreatment resistance in the integrative treatment (Constantino et al., 2019). Insofar as GAD is marked by interpersonal styles of excessive nonassertiveness and over accommodation, I tested here whether MI-CBT also outperformed CBT, across acute treatment and long-term follow up, on reducing these characteristic interpersonal problems. Moreover, as patient resistance is an interpersonal event for which person-centered MI should, according to theory, be more helpful than directive CBT, I tested if resistance also mediated the expected effect of treatment on the long-term interpersonal outcomes. Method: Eighty-five patients with severe GAD were randomly assigned to 15 sessions of MI-CBT or CBT. Patients completed a measure of interpersonal problems repeatedly through treatment and 12 months of follow up. Independent observers rated patient resistance at a midtreatment session. Results: As expected, structural equation models revealed comparable reductions in nonassertiveness and over accommodation across acute MI-CBT and CBT. Also as predicted, MI-CBT vs. CBT promoted significantly greater reduction in over accommodation problems over long-term follow up; however, this differential effect was only marginally significant for nonassertiveness problems. Finally, as predicted, the treatment effect on the level of both interpersonal problems at 12-month follow up was mediated by less midtreatment resistance in MI-CBT vs. CBT. Discussion: Results support that the benefit of adding MI to CBT for GAD extends to long-term interpersonal change, and they implicate resistance management as a candidate mechanism of this additive effect.

Background: Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT. Aims: This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression. Methods: A parallel randomized controlled trial design (n = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken. Results: Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes d = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group d = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group. Conclusion: Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.

Decreasing the impact of stressors on the body remains an important area of study for the affected population. While there is evidence showing that cognitive behavior therapy (CBT), a psychotherapy approach, results in decreased stress, little was found about the effects of chiropractic treatment (CC) on stress. The purpose of this quantitative archival study was to determine whether the combination therapy of CC and CBT was more effective in decreasing stress than CBT independently. Cognitive neuropsychology served as the theoretical lens. Client data from a mental health and chiropractic care center on the West coast (N = 112) were divided into 2 treatment groups, CBT and CC and CBT alone. Pre and posttreatment data were collected on stress, anxiety, and nerve conduction. ANOVA test results indicated that there were no statistically significant differences in the mean change scores between the 2 groups in terms of individual participants' stress, anxiety, and nerve interference. Although there was no significant interaction effect, results showed that both the combination therapy and CBT alone led to a decrease in stress and anxiety and an increase in the nerve conduction of participant's posttreatment. While this archival study did not yield evidence of the benefits of CC for stress-related disorders, its results suggest that future researchers should pursue more direct efforts to evaluate the effects of combination therapies. Considering the high number of people who experience stress-related challenges, the incorporation of CC along with a psychological treatment might engender positive social change for individuals and healthcare practitioners through the potential reduction of stress.

No description available.

No description available.

Background: Exposure tasks—where an individual confronts a feared stimulus or situation—are known to be a key element of the treatment for youth anxiety. However, optimal therapist behaviors during these exposure tasks and the specifics of how therapist should conduct exposure tasks have not been determined. The current study examined the relationship between therapist behaviors that (a) increased, (b) decreased or (c) maintained the youth’s anxiety during exposures and treatment outcomes. Methods: Participants were youth (N = 107) ages 7 to 17 who received cognitive behavioral therapy for anxiety. Youth and their primary caregiver(s) completed a diagnostic interview and self- and parent-report measures pre- and post-treatment. Exposure session videos were rated by observers trained to reliability on a coding system evaluating therapist behaviors. Hierarchical regression analyses examined the role of therapist behaviors in predicting treatment outcomes. Logistic regression assessed the ability of therapist behaviors to predict treatment responder status (i.e., being a treatment responder versus a non-responder). Exploratory analyses examined the relationship between the individual therapist behaviors (within the three overall categories of behaviors) and treatment outcomes. Results: Youth showed significant improvement over the course of treatment. The three categories of therapist behaviors used during exposure tasks (increase, decrease and maintain the youth’s anxiety) were not associated with treatment outcomes. Discussion: Findings indicate that so long as exposure tasks are conducted, the therapist behaviors during the exposures may not be as important for predicting outcomes. Clinical implications, study limitations, and future directions are discussed. / Psychology

No description available.