Motorised countries have more fatal road crashes in rural areas than in urban areas. In Australia, over two thirds of the population live in urban areas, yet approximately 55 percent of the road fatalities occur in rural areas (ABS, 2006; Tziotis, Mabbot, Edmonston, Sheehan & Dwyer, 2005). Road and environmental factors increase the challenges of rural driving, but do not fully account for the disparity. Rural drivers are less compliant with recommendations regarding the “fatal four” behaviours of speeding, drink driving, seatbelt non-use and fatigue, and the reasons for their lower apparent receptivity for road safety messages are not well understood. Countermeasures targeting driver behaviour that have been effective in reducing road crashes in urban areas have been less successful in rural areas (FORS, 1995). However, potential barriers to receptivity for road safety information among rural road users have not been systematically investigated. This thesis aims to develop a road safety countermeasure that addresses three areas that potentially affect receptivity to rural road safety information. The first is psychological barriers of road users’ attitudes, including risk evaluation, optimism bias, locus of control and readiness to change. A second area is the timing and method of intervention delivery, which includes the production of a brief intervention and the feasibility of delivering it at a “teachable moment”. The third area under investigation is the content of the brief intervention. This study describes the process of developing an intervention that includes content to address road safety attitudes and improve safety behaviours of rural road users regarding the “fatal four”. The research commences with a review of the literature on rural road crashes, brief interventions, intervention design and implementation, and potential psychological barriers to receptivity. This literature provides a rationale for the development of a brief intervention for rural road safety with a focus on driver attitudes and behaviour. The research is then divided into four studies. The primary aim of Study One and Study Two is to investigate the receptivity of rural drivers to road safety interventions, with a view to identifying barriers to the efficacy of these strategies.

Submitted by MARIA LUISA VICHI DE CAMPOS FARIA null (ml.vichi@gmail.com) on 2016-04-09T19:42:20Z No. of bitstreams: 1 tese-da-luisa(8).pdf: 6093134 bytes, checksum: a6a13acbe1b7e8b23ecfbb267b89b802 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-04-12T14:38:04Z (GMT) No. of bitstreams: 1 faria_mlvc_dr_bot.pdf: 6093134 bytes, checksum: a6a13acbe1b7e8b23ecfbb267b89b802 (MD5) / Made available in DSpace on 2016-04-12T14:38:04Z (GMT). No. of bitstreams: 1 faria_mlvc_dr_bot.pdf: 6093134 bytes, checksum: a6a13acbe1b7e8b23ecfbb267b89b802 (MD5) Previous issue date: 2016-03-01 / O álcool, mesmo proibido, é a substância psicoativa mais usada por adolescentes no Brasil. Em 2011 uma pesquisa nacional (PeNSE) encontrou que mais da metade dos adolescentes de 13 a 15 anos já havia experimentado álcool e que 9\% referiu problemas decorrentes do uso. Esse comportamento pode trazer consequências graves e permanentes para a vida do adolescentes e de outras pessoas. Trata-se de um problema de saúde pública sendo necessários avanços nas pesquisas sobre prevenção e sobre os cuidados específicos para essa população. O BASICS foi concebido para universitários que apresentavam padrão de uso de álcool problemático. Essa intervenção, empática e flexível, foi desenhada para ajudar esses indivíduos na tomada das melhores decisões sobre o álcool, caracterizando-se assim, como uma abordagem de redução de danos e também uma tecnologia leve. O objetivo desse estudo foi testar a efetividade do BASICS na redução do uso problemático de álcool em uma amostra de alunos do ensino médio de escolas públicas de uma cidade de 127 mil habitantes do estado de São Paulo-Brasil. Foi realizada uma análise do banco de dados de um ensaio controlado randomizado realizado ao longo do ano de 2009. De todos os alunos matriculados nas escolas públicas, 1712 eram menores de 18 anos e aceitaram fazer parte do estudo. Destes, 1149 eram abstêmios, 253 faziam uso arriscado de álcool e 310 foram considerados de baixo risco. Os indivíduos identificados com uso de risco foram sorteados para os grupos de intervenção breve (IB) ou para o grupo controle (C). O grupo C apenas preencheu os instrumentos de avaliação. Os grupos IB e C foram então avaliados após 6 e 12 meses. Não se encontrou diferença com relevância estatística entre as médias do AUDIT e AUDITC entre os grupos. Houve redução de consumo de álcool ao longo do estudo em ambos os grupos. Essa redução pode ser explicada parcialmente pelo fenômeno de regressão à media. Essa redução não se deu em função das perdas pois os alunos que abandonaram não foram aqueles com padrões mais graves de uso. Na tentativa de explicar os resultados encontrados foram levantadas as seguintes possibilidades: presença do efeito Hawthorne e a ocorrência de uma redução natural no consumo ao longo dos 12 meses em função do comportamento exploratório e não estático do uso de álcool por adolescentes. Notou-se também que uma fração considerável de sujeitos evoluiu de um consumo de risco para a abstinência ao longo do estudo. Para melhor descrever esse processo foi proposto um modelo markoviano que incluiu de forma explícita o comportamento exploratório dos adolescentes e sua tendência à abstinência. Através de simulações de Monte Carlo foram estimados os parâmetros relevantes do modelo e investigada a presença do efeito Hawthorne. Por meio dessa análise constatou-se que houve uma redução do uso de álcool no grupo controle e no grupo intervenção estimulada pela participação no estudo, que os padrões de uso em ambos os grupos foram essencialmente os mesmos e que as distribuições de consumo podem ser adequadamente descritas pelo modelo proposto. Foi investigado também se parte dessa população não teria um comportamento que pudesse indicar sua predisposição para um consumo de risco em fases posteriores na vida. A partir de um modelo de clusterização de dados baseados na variável AUDIT percebeu-se que os sujeitos poderiam ser divididos em dois grupos: persistente e não persistente. Por meio de uma análise estatística usando modelos lineares generalizados conclui-se que adolescentes do sexo masculino, que iniciavam o consumo mais cedo, que possuíam amigos que se embriagavam e que eram oriundos de famílias com problemas de álcool eram mais propensos a participar do grupo persistente. Conhecer melhor o comportamento dos adolescentes quanto ao uso de álcool favorecerá o uso de desenhos experimentais mais adequados o que possibilitará uma melhor avaliação do impacto de medidas preventivas para essa população. / Alcohol, even banned is the most used psychoactive substance among adolescents in Brazil. In 2011 a national survey (PeNSE) found that more than half of adolescents aged 13 to 15 had tried alcohol and 9\% reported problems resulting from the use. This behavior can cause permanent harm for the teenagers and others. It is a public health issue that demands for specific alternatives both on treatment and prevention. The BASICS was developed for college students with problematic alcohol use. This intervention is empathetic and flexible, it was designed to help these individuals to make better decisions about alcohol consumption. BASICS is a harm reduction approach that can be classified as a soft technology. Despite its widespread use and advantages to other alternatives, the comprobation of its effectiveness remains a challenge. The aim of this study was to test the effectiveness of BASICS in reducing alcohol abuse in a sample of high school students from public schools in a city of 127,000 São Paulo State-Brazil inhabitants. In this thesis we performed a secondary database analysis of controlled ramdomized trial held throughout the year 2009. Of all students enrolled in public schools, 1712 were younger than 18 years old and agreed to be interviewed. Of these, 1149 were teetotalers, 253 were risky alcohol users and 310 were considered low risk users. Individuals with risk behavior use were drawn to the brief intervention group (IB) or the control group (C). Group C was interviewed only with the assessment tools. IB and C groups were then assessed after 6 and 12 months. There was no statistically significant difference between the means of the AUDIT and AUDITC between groups. We observed consumption reduction in both groups. This decrease can be partially explained by regression to the mean. This reduction did not occur due to attrition: students who left the study were not those with more severe usage patterns. In an attempt to explain these findings we considered the possibilities: the occurrence of Hawthorne effect and the exploratory behavior and erratic pattern of alcohol use by teenagers allows a natural reduction in consumption. It is also noted that a considerable fraction of subjects evolves from a risk consumption to abstinence throughout the study. To better describe this process a Markov model was proposed that included explicitly the exploratory behavior of adolescents and their tendency to abstinence. Through Monte Carlo simulations the model relevant parameters were estimated and we investigated the presence of the Hawthorne effect. Through this analysis we found that there was a reduction in consumption (IB and C) by participation in the research, the alcohol usage pattern was the same in both groups and that consumer distributions can be adequately described by the model. We investigated whether part of this population would have a behavior that indicated a predisposition to a risky pattern of consumption on later stages in life. Through a clustering model fot the time evolution of the AUDIT variable, we noticed that the subjects could be divided into two groups: persistent and non-persistent. Through a statistical analysis using generalized linear models we concluded that adolescent males, who started consuming alcohol earlier, who possessed binging friends and those who came from families with alcohol problems were more likely to participate in the persistent group. We also discussed experimental designs that could be used to further characterize the behavior of adolescents with respect to the alcohol use and to facilitate obtaining the impact of public preventive health policies for this population.

A Atenção Primária à Saúde (APS) pode ser uma possibilidade de acesso a usuários de álcool em uso de risco ou dependência, sendo a Intervenção Breve (IB) uma possiblidade de intervenção. Este estudo clínico randomizado por cluster objetiva verificar a efetividade da IB quando comparado ao grupo controle. Os participantes do estudo (Grupo Intervenção - GI - e Grupo Controle - GC) foram contatados por visita domiciliar após indicação dos serviços de Estratégia de Saúde da Família (ESF) da região Oeste de Saúde de Ribeirão Preto - SP. Os usuários inclusos foram usuários maiores de 18 anos e com escore de consumo >= 7, segundo AUDIT. Os instrumentos utilizados foram AUDIT (Alcohol Use Disorders Identification Test), ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), perfil sociodemográfico e Diário de consumo de álcool. Após as intervenções foram realizados follow-up de um mês e seis meses após término da última intervenção. As medidas quantitativas de desfecho foram a pontuação no instrumento AUDIT, na qual se utilizou as alterações na pontuação do instrumento como balizador para verificar a efetividade das intervenções. No grupo intervenção realizou-se ainda uma entrevista semiestruturada. A análise estatística foi feita com uso Regressão Linear Multinível para a amostra do estudo (23 participantes) e o mesmo com a amostra simulada de 30, 50 e 100 participantes hipotéticos. Os 23 participantes (12 do GI e 11 do GC) tinham média de idade em 48.2 anos, sendo 16 participantes homens (nove no GI e sete no GC). Sobre os anos de estudo, a média foi de 7.8 anos (GI a média foi de 9.5 e no GC 6.3 anos). No total, foram realizadas 323 visitas domiciliares. Referente consumo, a bebida mais escolhida foi cerveja e 15 dos 23 participantes não sabiam expressar como se sentiam antes da ingestão de bebida alcoólica. No que diz respeito ao uso de outras drogas na vida, dez participantes da amostra usavam apenas álcool (quatro do GI e seis do GC). Sete participantes usavam álcool e tabaco (quatro GI e três GC). Cinco participantes eram usuários de múltiplas drogas (3 GI e 2 GC). Entre as múltiplas drogas, as mais comuns foram a maconha e a cocaína. Sobre o comportamento de consumo abusivo de álcool episódico o consumo mais abusivo variou de 2,85 a 16, 2 doses. A média dos AUDIT durante o follow up não diferiu muito. A média de AUDIT do GI foi de 15.5 (T0), 16.25 (T1) e 11.6 (T2). Para o GC a média foi de 15.36 (T0), 8.1 (T1), 16.36 (T2). Sobre os resultados da efeito multinivel misto, na amostra real deste estudo não houve diferença significativa (p= 0.80) entre os grupo intervenção e controle, embora tenha sido observado efeito da intervenção. Sobre os dados prevenientes da simulação com tamanho amostral de 30, 50 e 100 participantes hipotéticos, não teve significância estatística, embora o efeito seja mantido. No que se refere aos resultados qualitativos, processados em três classes pelo software Alceste, foram analisados 74% do conteúdo textual, com riqueza de palavras de 94.05%, cujo conteúdo resultou em três classes: classe 1, com 33% da análise e correspondeu ao contexto geral do beber: pessoas e ocasiões que promovem ou desestimulam o beber, e os estímulos foram encontros com os amigos, os sentimentos negativos e às relações sociais; classe 2, 28% da análise e fez alusão ao indivíduo estar dependente de drogas em geral, situou o consumo de todas as substâncias (incluído o álcool) num contexto prejudicial; classe 3, que predominou com 39%, referiu-se ao indivíduo nos aspectos frequência, quantidade e abandono do consumo. Dados referentes ao perfil da amostra, bebida de escolha e influência cultural foram corroborados em outros estudos. Apareceu ainda que, o consumo de álcool não está vinculado apenas às preferências pessoais. O estudo revelou ser possível realizar a IB, todavia, há necessidade de encontrar as estratégias mais efetivas para contactar os usuários e envolver suas famílias e a equipe local dos serviços de saúde. O conhecimento de aspectos qualitativos mostrou que o consumo ligado ao hábito cotidiano pareceu se relacionar a padrão de consumo mensal alto, por isso, mais danoso. Inferiu-se ainda que nesta amostra esse padrão de consumo pode ser devido à carência de orientações e aconselhamento dos profissionais de saúde sobre o hábito de beber. As vivências sociais foram relacionadas ao consumo, prover espaços e momentos de lazer na comunidade sem o incentivo ao uso de álcool e/ou substâncias psicoativas, poderia auxiliar na diminuição do consumo ou abstinência das mesmas / Primary Health Care (PHC) may be a possibility for access to alcohol users who use risk or dependence and Brief Intervention (IB) is a possible intervention. Thus, this clinical trial randomized by cluster aimed to verify the effectiveness of IB when compared to the control group. The participants of the study (Intervention Group - IG - and Control Group - CG) were contacted by a home visit after indicating the Family Health Strategy (ESF) services of the West Region of Health of Ribeirão Preto/São Paulo state. The included users were users older than 18 years and with consumption score >= 7, according to AUDIT score. The instruments used were AUDIT (Alcohol Use Disorders Identification Test), ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), sociodemographic profile and Alcohol consumption diary. After the interventions, follow-up was performed one month and six months after the last intervention. The quantitative measures of outcome were the score in the AUDIT instrument, in which the changes in the instrument score were used as a benchmark to verify the effectiveness of the interventions. In the IG, a semi-structured interview was also carried out. The statistical analysis was done using Multi Level Linear Regression for the study sample (23 participants) and the same with the simulated sample of 30, 50 and 100 hypothetical participants. The 23 participants (12 from IG and 11 from CG) had a mean age of 48.2 years, of which 16 were men (nine in IG and seven in CG). Over the years of study, the mean was 7.8 years (mean IG was 9.5 and in CG 6.3 years). In total, 323 home visits were carried out. Regarding consumption, the most chosen beverage was beer and 15 of the 23 participants could not express how felt before drinking alcohol. Concerning the use of other drugs in life, ten participants in the sample used only alcohol (four from IG and six from CG). Seven participants used alcohol and tobacco (four IG and three CG). Five participants were users of multiple drugs (3 IG and 2 CG). Among the multiple drugs, the most common were marijuana and cocaine. On the behavior of abusive consumption episodic, the most abusive consumption ranged from 2.85 to 16.2 doses. The average AUDIT during the follow up did not differ much. The mean AUDI of the IG was 15.5 (T0), 16.25 (T1) and 11.6 (T2). For CG, the mean was 15.36 (T0), 8.1 (T1), 16.36 (T2). Concerning the results of the mixed multilevel effect, in the actual sample of this study there was no significant difference (p = 0.80) between the intervention and control groups, although the intervention effect was observed. Regarding the data of the simulation with sample size of 30, 50 and 100 hypothetical participants, it was not statistically significant also, although the effect was maintained. Regarding the qualitative results, processed in three classes by the software Alceste, 74% of the textual content was analyzed, with a wealth of words of 94.05%. Regarding Class 1, 33% of the analysis corresponds to the general context of drinking, people and occasions that promote or discourage drinking, where the incentive can be encounters with friends, negative feelings and social relations. Class 2 accounted for 28% of the analysis and refers to the individual being dependent of drugs in general, not just alcohol, placing the consumption of all substances in the same context. As for Class 3, higher class with 39%, refers to the individual regarding the frequency, quantity and abandonment of consumption. The knowledge of qualitative aspects showed us that the consumption linked to the daily habits seems to be related to patterns of high consumption monthly doses and, therefore, more harmful, even if in this sample it was observed that the consumption is high also possibly due to lack of guidance and conversations with professional about the habit of drinking. As the social experiences were related to the consumption high doses of alcohol, perhaps provide spaces and moments of leisure free alcohol could help in the diminution or abstinence to the alcohol

Orientador: Florence Kerr-Corrêa / Resumo: O álcool, mesmo proibido, é a substância psicoativa mais usada por adolescentes no Brasil. Em 2011 uma pesquisa nacional (PeNSE) encontrou que mais da metade dos adolescentes de 13 a 15 anos já havia experimentado álcool e que 9\% referiu problemas decorrentes do uso. Esse comportamento pode trazer consequências graves e permanentes para a vida do adolescentes e de outras pessoas. Trata-se de um problema de saúde pública sendo necessários avanços nas pesquisas sobre prevenção e sobre os cuidados específicos para essa população. O BASICS foi concebido para universitários que apresentavam padrão de uso de álcool problemático. Essa intervenção, empática e flexível, foi desenhada para ajudar esses indivíduos na tomada das melhores decisões sobre o álcool, caracterizando-se assim, como uma abordagem de redução de danos e também uma tecnologia leve. O objetivo desse estudo foi testar a efetividade do BASICS na redução do uso problemático de álcool em uma amostra de alunos do ensino médio de escolas públicas de uma cidade de 127 mil habitantes do estado de São Paulo-Brasil. Foi realizada uma análise do banco de dados de um ensaio controlado randomizado realizado ao longo do ano de 2009. De todos os alunos matriculados nas escolas públicas, 1712 eram menores de 18 anos e aceitaram fazer parte do estudo. Destes, 1149 eram abstêmios, 253 faziam uso arriscado de álcool e 310 foram considerados de baixo risco. Os indivíduos identificados com uso de risco foram sorteados para os grupos d... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Alcohol, even banned is the most used psychoactive substance among adolescents in Brazil. In 2011 a national survey (PeNSE) found that more than half of adolescents aged 13 to 15 had tried alcohol and 9\% reported problems resulting from the use. This behavior can cause permanent harm for the teenagers and others. It is a public health issue that demands for specific alternatives both on treatment and prevention. The BASICS was developed for college students with problematic alcohol use. This intervention is empathetic and flexible, it was designed to help these individuals to make better decisions about alcohol consumption. BASICS is a harm reduction approach that can be classified as a soft technology. Despite its widespread use and advantages to other alternatives, the comprobation of its effectiveness remains a challenge. The aim of this study was to test the effectiveness of BASICS in reducing alcohol abuse in a sample of high school students from public schools in a city of 127,000 São Paulo State-Brazil inhabitants. In this thesis we performed a secondary database analysis of controlled ramdomized trial held throughout the year 2009. Of all students enrolled in public schools, 1712 were younger than 18 years old and agreed to be interviewed. Of these, 1149 were teetotalers, 253 were risky alcohol users and 310 were considered low risk users. Individuals with risk behavior use were drawn to the brief intervention group (IB) or the control group (C). Group C ... (Complete abstract click electronic access below) / Doutor

No description available.

Socialstyrelsen menar att primärvården står inför en utmaning att tillgodose tillgänglig psykologisk behandling till ett växande behov. Ett möjligt tillvägagångssätt skulle kunna vara Integrerad beteendehälsa som eftersträvar att kunna erbjuda korta psykologiska interventioner med hög tillgänglighet. Syftet med föreliggande studie var att jämföra två varianter av Integrerad beteendehälsa; ett sedvanligt upplägg med Brief Interventions och ett upplägg med utökad bedömning och möjligheten till vägledd självhjälp för ett specifikt problem. Det här med avseende på generella symtom och symtom specifika för just det problem som patienter erhållit självhjälp för, alternativt bedömts skulle ha passat för självhjälp avseende ett specifikt problem. Resultaten visade att den generella symtomnivån förbättrades för gruppen som helhet, samt inom respektive grupp. Den problemspecifika symtomnivån sjönk för både patienter som erhållit vägledd självhjälp och för patienter som erhållit Brief Interventions men vars problemprofil visat att de hade passat för en specifik självhjälpsmanual. Någon signifikant skillnad i symtomförändring, oavsett generell eller problemspecifik, kunde inte hittas. I diskussionen problematiseras bland annat den interna validiteten och den naturalistiska miljön lyfts som en styrka. / The national board of health and wellfare are stating that primary care faces a major challenge in providing available psychological treatment to an increasing need. One possible approach is Integrated Behavioral Health, which strives towards offering brief psychological interventions with great access. The purpose of the following study was to compare two different methods of Integrated Behavioral Health; an ordinary set up with Brief Interventions and one set up with extended assesment and the possibility of guided self-help treatment for a particular problem. This regarding general as well as specific symptoms for the particular problem the patient has received guided self-help for, or considered to have been suited for. The results showed that the general level of symptoms improved for all patients, merged into one group, and within the respective group. The level of the problem-specific symptom decreased for patients who received guided self-help and for patients who received Brief Interventions, but whose problem profile showed that they had fit for a specific self-help manual. No significant difference in symptom change, regardless of general or problem- specific, could be found. In the discussion, the internal validity is discussed, and the naturalistic environment is described as a strength.

Introdução: Eventos traumáticos em nossa sociedade, a gravidade dos quadros psicopatológicos que podem advir desses eventos e a dificuldade terapêutica que podem significar levam à necessidade de embasar solidamente as medidas terapêuticas e de prevenção nas características individuais das vítimas de trauma, sendo o Transtorno de Estresse Pós- Traumático (TEPT) o principal transtorno psiquiátrico associado aos acidentes e a violência. Objetivo: Avaliar os efeitos da psicoterapia ultra-breve psicodinamicamente orientada no TEPT e TEA. Método: A amostra foi composta por 27 mulheres que foram atendidas no período de maio de 2008 e novembro de 2009 que completaram pelo menos quatro semanas de tratamento no Núcleo de Estudos e Tratamento do Trauma Psíquico (NET-TRAUMA) do Hospital de Clínicas de Porto Alegre (HCPA), Brasil. 85,2%(23) das pacientes preencheram os critérios para TEPT e 14,8%(4) tinham TEA . As pacientes foram avaliadas antes e após intervenção psicoterápica através das escalas: Davidson Trauma Scale (DTS), Inventário Beck de Depressão (BECK), Defense Style Questionaire (DSQ-40), Childhood Trauma Questionnaire (CTQ) Impressão Clínica Global (CGI) e Avaliação Global do Funcionamento (GAF). Resultados: Após tratamento houve melhora na sintomatologia das escalas DTS, BECK, CGI E GAF, mesmo controlando para uso de psicofármacos. Com tamanho de efeito elevado na comparação entre as escala no pré e pós-tratamento: CGI d=1,18, GAF d= 1,03, DTS d=0,95 e BDI d=0,9. Houve uma redução da defesa de projeção (p=0,036) e um aumento na defesa humor (p=0,024). Encontramos uma associação positiva entre a diminuição de sintomas de TEPT e a diminuição no escore do fator imaturo (p=0,032 r=0,43). Conclusões: A psicoterapia ultra-breve psicodinamicamente orientada mostrou-se eficaz para o tratamento do TEPT e TEA. Houve melhora na sintomatologia das escalas DTS, BECK, CGI E GAF, mesmo controlando para uso de psicofármacos. / Introduction: Traumatic events in our society, the severity of psychopathology that may result from such events and therapeutic difficulty may mean that lead to the necessity of basing solidly therapeutic measures of prevention and individual characteristics of victims of trauma, the Posttraumatic Stress Disorder (PTSD), the main psychiatric disorders associated with accidents and violence. Objective: To evaluate the effects of psychotherapy ultra-brief psychodynamically oriented PTSD and ASD. Method: The sample consisted of 27 women who were treated between May 2008 and November 2009 who completed at least four weeks of treatment in the Center for Research and Treatment of Psychic Trauma (NET-TRAUMA), Hospital de Clinicas de Porto Alegre ( HCPA), Brazil. 85.2% (23) of patients met criteria for PTSD and 14.8% (4) had ASD. Scales used were: Davidson Trauma Scale (DTS), Beck Depression Inventory (BECK), Defense Style Questionaire (DSQ-40), Childhood Trauma Questionnaire (CTQ), Clinical Global Impression (CGI), and the Global Assessment of Functioning (GAF). Results: After treatment there was improvement in symptoms scales DTS, BECK, CGI and GAF, even controlling for use of psychoactive drugs. With such a large effect on the comparison between the scale before and after treatment: d = 1.18 CGI, GAF d = 1.03, d = 0.95 DTS and BDI d = 0.9. There was a reduction in the defense of projection (p = 0.036) and an increase in defense humor (p = 0.024). We found a positive association between the reduction of PTSD symptoms and reduction in score of the immature factor (p = 0.032 r = 0.43). Conclusions: The ultra-brief psychotherapy psychodynamically oriented proved effective for the treatment of PTSD and ASD. There was improvement in symptoms scales DTS, BECK, CGI and GAF, even controlling for use of pharmacological drugs.

Children who express externalizing behaviors in school are at greater risk of school failure and peer rejection. They are also at greater risk of developing antisocial behaviors, addiction to drugs, mental health problems and delinquency. Many teachers experience difficulties in working with pupils expressing externalizing behaviors. The aim of this thesis is to evaluate a classroom behavior management program called Comet. The main principle of Comet is to get the teacher to use effective strategies when the pupil who is targeted for intervention, and the rest of class, are behaving appropriately and inappropriately. Two versions of the program are evaluated in the thesis: Comet for teachers (Comet-T) and Comet for parents (Comet-P). Three studies are committed to evaluate Comet-T. In the first study Comet-T was compared to an active control group. 100 children (aged 8) were randomized into Comet-T or the control group. At post test and follow-up Comet-T received a better results in reducing externalizing problems, peer problems and teacher behavior management. An analysis of mediators showed that changes in teacher behaviors mediated externalizing behavior. In the second study, children (aged 6 -13) were randomized into two groups. 44 pupils received Comet-T and 42 pupils received a combined intervention consisting of Comet-T at school and Comet-P at home. At post test and follow-up the results show that the combination of Comet-T and Comet-P reduced the externalizing behaviors at home more than Comet-T (only). However, there were no significant differences between the two conditions regarding decrease in externalizing behaviors at school. In the third study Comet-T was compared to a brief version called Comet-TB. At post test Comet-TB had a greater reduction of externalizing behaviors compared to Comet-T. The studies conclude that teachers can use behavior management techniques to decrease externalizing behaviors in the classroom. Furthermore, teachers cannot rely on parent management programs in order to decrease externalizing problems in school. Instead, behavior problems in school need to be solved within school settings. Finally, even a brief program can be effective in order to decrease externalizing behaviors.

Introdução: Eventos traumáticos em nossa sociedade, a gravidade dos quadros psicopatológicos que podem advir desses eventos e a dificuldade terapêutica que podem significar levam à necessidade de embasar solidamente as medidas terapêuticas e de prevenção nas características individuais das vítimas de trauma, sendo o Transtorno de Estresse Pós- Traumático (TEPT) o principal transtorno psiquiátrico associado aos acidentes e a violência. Objetivo: Avaliar os efeitos da psicoterapia ultra-breve psicodinamicamente orientada no TEPT e TEA. Método: A amostra foi composta por 27 mulheres que foram atendidas no período de maio de 2008 e novembro de 2009 que completaram pelo menos quatro semanas de tratamento no Núcleo de Estudos e Tratamento do Trauma Psíquico (NET-TRAUMA) do Hospital de Clínicas de Porto Alegre (HCPA), Brasil. 85,2%(23) das pacientes preencheram os critérios para TEPT e 14,8%(4) tinham TEA . As pacientes foram avaliadas antes e após intervenção psicoterápica através das escalas: Davidson Trauma Scale (DTS), Inventário Beck de Depressão (BECK), Defense Style Questionaire (DSQ-40), Childhood Trauma Questionnaire (CTQ) Impressão Clínica Global (CGI) e Avaliação Global do Funcionamento (GAF). Resultados: Após tratamento houve melhora na sintomatologia das escalas DTS, BECK, CGI E GAF, mesmo controlando para uso de psicofármacos. Com tamanho de efeito elevado na comparação entre as escala no pré e pós-tratamento: CGI d=1,18, GAF d= 1,03, DTS d=0,95 e BDI d=0,9. Houve uma redução da defesa de projeção (p=0,036) e um aumento na defesa humor (p=0,024). Encontramos uma associação positiva entre a diminuição de sintomas de TEPT e a diminuição no escore do fator imaturo (p=0,032 r=0,43). Conclusões: A psicoterapia ultra-breve psicodinamicamente orientada mostrou-se eficaz para o tratamento do TEPT e TEA. Houve melhora na sintomatologia das escalas DTS, BECK, CGI E GAF, mesmo controlando para uso de psicofármacos. / Introduction: Traumatic events in our society, the severity of psychopathology that may result from such events and therapeutic difficulty may mean that lead to the necessity of basing solidly therapeutic measures of prevention and individual characteristics of victims of trauma, the Posttraumatic Stress Disorder (PTSD), the main psychiatric disorders associated with accidents and violence. Objective: To evaluate the effects of psychotherapy ultra-brief psychodynamically oriented PTSD and ASD. Method: The sample consisted of 27 women who were treated between May 2008 and November 2009 who completed at least four weeks of treatment in the Center for Research and Treatment of Psychic Trauma (NET-TRAUMA), Hospital de Clinicas de Porto Alegre ( HCPA), Brazil. 85.2% (23) of patients met criteria for PTSD and 14.8% (4) had ASD. Scales used were: Davidson Trauma Scale (DTS), Beck Depression Inventory (BECK), Defense Style Questionaire (DSQ-40), Childhood Trauma Questionnaire (CTQ), Clinical Global Impression (CGI), and the Global Assessment of Functioning (GAF). Results: After treatment there was improvement in symptoms scales DTS, BECK, CGI and GAF, even controlling for use of psychoactive drugs. With such a large effect on the comparison between the scale before and after treatment: d = 1.18 CGI, GAF d = 1.03, d = 0.95 DTS and BDI d = 0.9. There was a reduction in the defense of projection (p = 0.036) and an increase in defense humor (p = 0.024). We found a positive association between the reduction of PTSD symptoms and reduction in score of the immature factor (p = 0.032 r = 0.43). Conclusions: The ultra-brief psychotherapy psychodynamically oriented proved effective for the treatment of PTSD and ASD. There was improvement in symptoms scales DTS, BECK, CGI and GAF, even controlling for use of pharmacological drugs.

Introdução: Eventos traumáticos em nossa sociedade, a gravidade dos quadros psicopatológicos que podem advir desses eventos e a dificuldade terapêutica que podem significar levam à necessidade de embasar solidamente as medidas terapêuticas e de prevenção nas características individuais das vítimas de trauma, sendo o Transtorno de Estresse Pós- Traumático (TEPT) o principal transtorno psiquiátrico associado aos acidentes e a violência. Objetivo: Avaliar os efeitos da psicoterapia ultra-breve psicodinamicamente orientada no TEPT e TEA. Método: A amostra foi composta por 27 mulheres que foram atendidas no período de maio de 2008 e novembro de 2009 que completaram pelo menos quatro semanas de tratamento no Núcleo de Estudos e Tratamento do Trauma Psíquico (NET-TRAUMA) do Hospital de Clínicas de Porto Alegre (HCPA), Brasil. 85,2%(23) das pacientes preencheram os critérios para TEPT e 14,8%(4) tinham TEA . As pacientes foram avaliadas antes e após intervenção psicoterápica através das escalas: Davidson Trauma Scale (DTS), Inventário Beck de Depressão (BECK), Defense Style Questionaire (DSQ-40), Childhood Trauma Questionnaire (CTQ) Impressão Clínica Global (CGI) e Avaliação Global do Funcionamento (GAF). Resultados: Após tratamento houve melhora na sintomatologia das escalas DTS, BECK, CGI E GAF, mesmo controlando para uso de psicofármacos. Com tamanho de efeito elevado na comparação entre as escala no pré e pós-tratamento: CGI d=1,18, GAF d= 1,03, DTS d=0,95 e BDI d=0,9. Houve uma redução da defesa de projeção (p=0,036) e um aumento na defesa humor (p=0,024). Encontramos uma associação positiva entre a diminuição de sintomas de TEPT e a diminuição no escore do fator imaturo (p=0,032 r=0,43). Conclusões: A psicoterapia ultra-breve psicodinamicamente orientada mostrou-se eficaz para o tratamento do TEPT e TEA. Houve melhora na sintomatologia das escalas DTS, BECK, CGI E GAF, mesmo controlando para uso de psicofármacos. / Introduction: Traumatic events in our society, the severity of psychopathology that may result from such events and therapeutic difficulty may mean that lead to the necessity of basing solidly therapeutic measures of prevention and individual characteristics of victims of trauma, the Posttraumatic Stress Disorder (PTSD), the main psychiatric disorders associated with accidents and violence. Objective: To evaluate the effects of psychotherapy ultra-brief psychodynamically oriented PTSD and ASD. Method: The sample consisted of 27 women who were treated between May 2008 and November 2009 who completed at least four weeks of treatment in the Center for Research and Treatment of Psychic Trauma (NET-TRAUMA), Hospital de Clinicas de Porto Alegre ( HCPA), Brazil. 85.2% (23) of patients met criteria for PTSD and 14.8% (4) had ASD. Scales used were: Davidson Trauma Scale (DTS), Beck Depression Inventory (BECK), Defense Style Questionaire (DSQ-40), Childhood Trauma Questionnaire (CTQ), Clinical Global Impression (CGI), and the Global Assessment of Functioning (GAF). Results: After treatment there was improvement in symptoms scales DTS, BECK, CGI and GAF, even controlling for use of psychoactive drugs. With such a large effect on the comparison between the scale before and after treatment: d = 1.18 CGI, GAF d = 1.03, d = 0.95 DTS and BDI d = 0.9. There was a reduction in the defense of projection (p = 0.036) and an increase in defense humor (p = 0.024). We found a positive association between the reduction of PTSD symptoms and reduction in score of the immature factor (p = 0.032 r = 0.43). Conclusions: The ultra-brief psychotherapy psychodynamically oriented proved effective for the treatment of PTSD and ASD. There was improvement in symptoms scales DTS, BECK, CGI and GAF, even controlling for use of pharmacological drugs.