The child-therapist alliance is believed to be a critical ingredient of successful psychotherapy for youth depression. However, only a few studies have examined the association between the alliance and clinical outcomes in the treatment of youth depression. The present thesis examined the alliance-outcome association in two treatments for youth depression: cognitive-behavioral therapy (CBT) and usual clinical care (UC). Data were from an effectiveness trial conducted in six community clinics (see Weisz et al., 2009). Forty-one youth were randomly assigned to receive CBT or UC from community clinicians. The observed early alliance, alliance shifts, and self-reported alliance did not significantly predict child- or parent-reported depression outcome. However, the direction and strength of the alliance-outcome associations differed across alliance methodology (self- and observer-report) and condition (CBT and UC). Early child alliance did significantly predict treatment satisfaction. Implications and limitations of the results are discussed.

Combat and war zone veterans are particularly vulnerable to developing Posttraumatic Stress Disorder (PTSD) due to the increased risk of experiencing trauma inherent in military service. Insomnia and nightmares are core symptoms of PTSD and can be factors in the development, maintenance, and exacerbation of PTSD. However, sleep disturbance has received relatively little attention from a treatment point of view until recently. Recent research has demonstrated that cognitive behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares are effective stand alone and combination treatments for sleep disturbance in civilian and veteran populations. Although group interventions are lower in cost and more efficient to deliver in a VA setting, studies have yet to test the feasibility and efficacy of group CBT-I/IRT combination treatment for veterans with PTSD. The current pilot study investigated the feasibility and efficacy of a combined CBT-I and IRT protocol intervention for insomnia and nightmares delivered in a group format to a sample of mixed theater veterans with PTSD. Participants (n = 34) were randomly assigned to either a treatment (n = 17) or waitlist control condition (n = 17). After baseline assessment, participants assigned to the treatment condition participated in six weekly group sessions of combined CBT-I and IRT and completed posttreatment and two month follow-up assessments. Those in the waitlist condition completed a six week waiting period. After completing post-waitlist assessment, they were given the opportunity to receive the treatment. Authors hypothesized that those in the treatment condition would experience significant improvement on self-report measures of sleep, nightmare frequency, PTSD-related sleep disturbance, beliefs about sleep, and overall PTSD and depression severity compared to the waitlist condition at posttreatment and two-month follow-up. These hypotheses were largely supported by the study results with some notable exceptions. Significant condition by time interactions were found on measures of sleep and nightmares, beliefs about sleep, and depression at posttreatment. Treatment gains were maintained at two month follow-up for sleep variables but not nightmare frequency or depression. There were no condition by time interactions for measures of PTSD or PTSD-related sleep disturbance at posttreatment. In sum, the findings of this study indicate that a combined CBT-I and IRT delivered in a group format was effective in reducing insomnia symptoms, nightmare frequency, and depression in a sample of mixed theater veterans with PTSD. The study also demonstrated the feasibility of this treatment approach with this population suggesting that a larger randomized controlled study is warranted.

The field has developed many evidence-based treatments (EBTs); the integrity of EBTs being delivered, however, has been studied less than rigorously. Because many treatment manuals are developed to be delivered session-by-session, one way to assess treatment adherence, specifically, is across the course of the case: do therapists deliver treatment components in the order prescribed? The goals of this study were to characterize how therapists deviate from prescribed order and how adherence to order relates to child characteristics. Therapy process data were collected from a subsample of children (N = 33, aged 7-15) that received cognitive behavioral therapy (CBT) to address primary symptoms of anxiety. Adherence to CBT was measured by the CBT Adherence Scale for Youth Anxiety (Southam-Gerow & McLeod, 2011). Four methods to assess order were developed. Analyses include descriptive and correlative statistics that characterize the delivery of CBT and the relation between adherence to order and pretreatment characteristics.

Insomnia is defined as difficulty initiating or maintaining sleep, or nonrestorative sleep that lasts for at least one month and is accompanied by significant impairment in daytime functioning including fatigue, irritability, and/or difficulty concentrating. It is one of the most common complaints reported by individuals with cancer, especially around the time of cancer diagnosis and treatment. Yet it is often unrecognized and untreated, leading to adverse health consequences and increased healthcare costs. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recommended as the gold standard for treating insomnia among individuals with cancer. Multiple studies have tested and proven the efficacy and effectiveness of CBT-I among individuals with cancer. However, only one study has investigated the efficacy of CBT-I in individuals newly diagnosed with cancer who are undergoing cancer treatment. Moreover, previous studies have been limited by their focus on largely homogenous samples of White, well-educated women with breast cancer. The dissemination of CBT-I among individuals with cancer is greatly limited by the lack of available providers and resources needed to implement the standard face-to-face treatment. One strategy to address this shortage has been to abbreviate standard CBT-I into low-intensity modalities that require fewer resources and can be self-administered on the Internet. The current study sought to examine the feasibility and acceptability, as well as the efficacy of one such program, an online low-intensity CBT-I intervention, Sleeping Healthy Using the Internet (SHUTi), supplemented with clinician support, in a sample of individuals newly diagnosed with heterogeneous malignancies who were undergoing chemotherapy and/or radiation. Results yielded support for the feasibility and acceptability of addressing individuals’ insomnia with a low-intensity CBT-I intervention while they are undergoing cancer treatment. With regard to sleep, there were significant treatment effects observed on a global measure of insomnia severity and on subjective sleep consolidation. There were also significant treatment effects for depressive symptoms. Findings are discussed in the context of study limitations and for the purpose of expanding the literature on disseminating CBT-I early in the cancer care trajectory.

Psicoterapia Analítica Funcional (FAP) tem como proposta a análise e intervenção de comportamentos que ocorrem durante a sessão, através de modelagem direta dos comportamentos do cliente. Para realizar a FAP de forma sistemática, alguns repertórios são requeridos do terapeuta, que o conhecimento teórico em si pode não ser capaz de produzir. Por isso, tem-se estudado formas de treino ao terapeuta FAP e sua eficácia. Além de leituras, a maneira mais comum de treino é por meio de supervisões, mas uma forma adicional tem sido utilizada mais recentemente, a de workshops experienciais, com objetivo maior de desenvolver as habilidades desejáveis ao terapeuta FAP. O objetivo do presente estudo foi investigar se esta forma de treino é capaz de produzir aquisições no repertório do terapeuta e se estas mudanças são mantidas três meses após a intervenção. Para isso, dois terapeutas participaram de delineamento experimental de linha de base múltipla, e passaram por um workshop (variável independente - VI). Foram utilizados para análise dos dados os instrumentos Functional Analytic Psychotherapy Rating Scale (FAPRS) e a Escala de Impacto da FAP (FAPIS). A análise dos dados mostrou que, após o workshop, ambos os terapeutas passaram a prover consequências (TRB2) aos comportamentos de melhora do cliente (CCR2) com maior eficiência, e um dos terapeutas passou a evocar mais comportamentos problema (CCR1) após o treino. A Cliente 1 emitiu mais CCR1 na fase experimental, enquanto o Cliente 2 passou a emitir mais CCR2 após a introdução da VI. Os dados da FAPIS mostraram que ambos os terapeutas relataram ter adquirido habilidades relacionadas à aplicação principalmente das Regras 2 e 3 da FAPA / Functional Analytic Psychotherapy proposes to analyze and do interventions in behaviors that occur during sessions, through direct shaping of clients behaviors. To do FAP in a systematic way, some repertoires are required of the therapist that theoretical knowledge may not be able to provide. Therefore, studies have been carried out on training methods for FAP therapists and its efficacy. Besides readings, the most common form of training is through supervisions, but a new additional way is through experiential workshops, whose goal is to develop desirable skills in FAP therapists. The aim of this study was to investigate if this form of training is capable of producing repertoire acquisitions to therapists and if these changes maintain three months after the intervention. For this, two therapists participated in a multiple-baseline experimental design, and did a workshop (independent variable IV). To analyze the data, two instruments were used: the Functional Analytic Psychotherapy Rating Scale (FAPRS) and the FAP Impact Scale (FAPIS). Results show that, after the workshop, both therapists provided consequences (TRB2) to clients improvement behaviors (CRB2) more effectively, and one of the therapists evoked more problem behaviors (CRB1). Client 1 emitted more CRB1 in experimental phase, whereas C2 emitted more CRB2. FAPIS data showed that therapists reported that they have acquired more FAP-related skills, especially the ones related to Rules 2 and 3

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

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 família é um componente fundamental para o desenvolvimento e socialização infantil. Práticas educativas parentais adequadas e consistentes influenciam positivamente o repertório comportamental e emocional da criança, além do relacionamento intrafamiliar. No entanto, apesar da necessidade de orientar pais ser amplamente mencionada na literatura, há poucas intervenções estruturadas descritas que visem esse objetivo, sobretudo anteriores ao surgimento de queixas clínicas infantis. Mais escassas ainda são as modalidades de orientação de pais que incorporam aspectos cognitivos e emocionais. Este estudo visa contribuir com a aquisição e aprimoramento de práticas educativas parentais adequadas e investir em uma melhor interação familiar, ao propor e investigar o PROPAIS II, um programa de orientação de pais Cognitivo-Comportamental de duração breve. Este se volta para pais de crianças em idade escolar e finalização da educação infantil e enquadra-se no contexto de promoção de saúde, sendo realizada em instituições não governamentais de educação e fortalecimento de vínculos. Participaram do estudo 25 pais ou cuidadores de crianças, de duas instituições não governamentais de grande porte do Interior de São Paulo. Os instrumentos utilizados foram: Child Behavior Checklist (CBCL 6/18 anos), Escalas de Qualidade na Interação Familiar (EQIF-versão pais) e Critério de Classificação Econômica Brasil (CCEB). Os participantes foram submetidos às seis sessões do Programa e duas sessões de testagem, uma anterior e uma posterior ao grupo interventivo. O Programa foi aplicado em grupos, com média de cinco participantes cada, sendo oferecido em seis grupos independentes. Para verificar a efetividade do Programa para os participantes foram realizadas análises quantitativa dos dados comparando os escores pré e pós-intervenção e análise qualitativas dos relatos dos pais nas sessões e na avaliação final, coletadas por registro das falas durante as sessões. O intervalo de confiança adotado para o estudo foi de 95%. Os resultados indicam que os participantes obtiveram melhoras significativas na Interação Familiar, adotando práticas educativas mais positivas e adequadas, ganhando também maior consciência acerca de seus sentimentos, comportamentos e emoções. Sugerem também ampliação da compreensão do comportamento de seus filhos e dos próprios, relacionados ao educar, sinalizando a importância da inserção do Modelo Cognitivo na orientação de pais. As queixas comportamentais infantis, na percepção dos pais, mostraram modificações quanto a problemas externalizantes, sobretudo agressividade. Os resultados obtidos após as seis sessões apontam para a importância de se investir no treinamento para aquisição de melhores práticas educativas parentais e interação familiar mais saudável. O estudo sinalizou também dificuldades na adesão dos pais para formação dos grupos, justificando novos investimentos para compreensão de fatores relacionados à baixa adesão e para que abarque mais participantes. / Family is a key to child\'s development and socialization. Appropriate and consistent parenting practices positively influence the behavioral and emotional repertoire of the child and the intrafamily relationship. However, despite the need to counsel parents be widely reported in the literature, structured interventions aimed at this goal are scarcely represented in the literature, especially prior to the emergence of children\'s clinical complaints. Rarer still are the modalities of parents\' guiding incorporating cognitive and emotional aspects. This study aims to contribute to the acquisition and improvement of appropriate parenting practices and invest in a better family interaction, while proposing to investigate the PROPAIS II, a brief Cognitive-Behavioral program of parents\' guiding. This program aims to parents of school- age children and completion of early childhood education and fits in the context of health promotion, being performed in non-governmental educational institutions and strengthening of bonds. Study participants were 25 parents or caregivers of children, two non-governmental institutions of Ribeirão Preto - SP. The instruments employed were the Child Behavior Checklist (CBCL 6/18 years), Scales of Quality Family Interaction (EQIF-parent version) and Brazil Economic Classification Criterion (CCEB). Participants underwent six sessions of the program and two testing sessions, one before and one after the interventive group. The program was applied in groups, averaging five participants each, being offered in six independent groups. To assess the effectiveness of the program for participants, quantitative data analysis were employed, comparing pre and post intervention, and qualitative analysis using parental reports at sessions and final assessment scores collected by recording the speeches during the sessions were made. The confidence interval for the study was 95%. The results indicate that participants experienced significant improvements in Family Interaction, adopting more positive and appropriate educational practices, also gaining greater awareness of feelings, behaviors and emotions. Results also suggest expanding the understanding of the behavior of their children and themselves, related to education, signaling the importance of inserting the Cognitive Model in parental guiding. Child behavioral complaints and parents\' perception showed changes as externalizing problems, particularly aggression. Results after six sessions point out to the importance of investing in training to acquire better parenting practices and healthy family interaction. The study also signaled difficulties in adhering to parent guiding groups, justifying new investments for understanding factors related to poor adherence and encompassing more participants.

Made available in DSpace on 2015-03-05T19:35:31Z (GMT). No. of bitstreams: 0 Previous issue date: 22 / Nenhuma / A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma patologia frequentemente acompanhada de um aumento dos sintomas de ansiedade e depressão. O objetivo desta dissertação foi investigar o efeito de uma intervenção psicológica cognitivo-comportamental associada à Psicoeducação nos sintomas de ansiedade, depressão e qualidade de vida em pacientes com DPOC. Participaram da pesquisa 22 pacientes divididos aleatoriamente em três grupos. Os pacientes do primeiro grupo (n=7) receberam o atendimento padrão do hospital. O segundo (n=8), o atendimento padrão e sessões de Terapia Cognitivo-Comportamental (TCC) e, para o terceiro (n=7), todo o procedimento anterior acrescido de uma sessão de Psicoeducação. Os participantes foram avaliados antes e após o atendimento com o Inventário Beck de Ansiedade e Depressão e o Saint George’s Respiratory Questionnaire (SGRQ), para a Qualidade de vida. Os dados foram analisados com técnicas estatísticas não-paramétricas para medidas repetidas. Os resultados indicaram que os participante / The Chronic Obstructive Pulmonary Disease (COPD) is a pathology often accompanied by an increase of anxiety and depression symptoms. The goal of this dissertation was the inquiry on the effects of a cognitive-behavioral psychological intervention associated to a psychoeducation of anxiety and depression symptoms, as well as quality of life, in patients with COPD. 22 patients randomly divided into three groups participated in the research. The patients of the first group (n=7) received the hospital’s medical standard of care. The second group (n=8) received the medical standard of care and cognitive-behavioral therapy sections (CBT) and the third group (n=7) received the procedures mentioned before with one psychoeducation section added. The participants were evaluated before and after the treatment, with the Beck Anxiety and Depression Inventory and the Saint George’s Respiratory Questionnaire (SGRQ), to quality of life. The data were analyzed with techniques from non-parametric statistics to repeated measur