Le Trouble obsessionnel-compulsif (TOC) de l’enfant et de l’adolescent est un trouble fréquent mais encore peu reconnu. Le traitement de première intention est la thérapie cognitive et comportementale (TCC). Les objectifs de cette étude sont de démontrer la faisabilité d’un protocole de TCC en population clinique et de montrer l’évolution symptomatique pendant 18 mois. Neuf patients présentant un TOC âgés de 6 à 16 ans ont reçu 12 séances hebdomadaires de TCC. Une évaluation est réalisée avant et après le traitement puis tous les 6 mois pendant 18 mois, elle comprend la mesure des TOC (CY BOCS), également des symptômes anxieux (ECAP), de dépression (CDI), une échelle de fonctionnement global (C GAS) et d’amélioration (CGI). Trois subtests du WISC IV permettent d’analyser les capacités attentionnelles. Résultats : les patients s’améliorent de 46% à la CY BOCS après la TCC, de 69% à 18 mois. Les variations intra-individuelles montrent des profils évolutifs différents : réponse très rapide puis rémission, amélioration retardée suivie de rémission ou amélioration puis rechute. Un seul patient n’est pas répondeur. Un changement psychologique dans une optique différentielle et intra individuelle, par des techniques de ré échantillonage (Bootstrap) et de comparaison des profils (test de Kolmogorov-Smirnof) est observé pour les patients les plus sévèrement atteints initialement. Conclusions : Un protocole de TCC dans le TOC de l’enfant et de l’adolescent est réalisable en population clinique. L’efficacité est montrée et se poursuit pendant les 18 mois. La TCC permet une amélioration globale (CGI, C GAS), symptomatique (CY BOCS, ECAP, CDI) et cognitive (WISC IV). / Pediatric obsessive-compulsive disorder (OCD) is a frequent but a not usually recognized trouble. The first –line treatment is cognitive-behavioral therapy (CBT). Objective : To demonstrate the feasibility of CBT protocol delivered in an outpatient community-based clinic and to evaluate clinic symptoms at 18 months follow-up. Nine participants (age 6-16 years) received 12 CBT weekly sessions. Assessment is realized at pre and post treatment, and every 6 months during 18 months, including symptoms of TOC (CY BOC), of anxiety(ECAP), of depression ((CDI), global functioning (C GAS) and improvement (CGI). Three WISC IV subtests allow attentional capacity analysis. Results: patients improvements are : 46% at post treatment, and 69% at 18 months follow up. The intra-individual variations show differents evolutionary profiles : quick response and remission, delayed improvement followed by remission or improvement followed by relapse. Only one is non responder. A psychological change in a differential and intra-individual optical, with sample rate (Bootstrap) and profiles comparaison (test de Kolmogorov-Smirnof) is observed for the pre treatment more severe patients. Conclusions : CBT protocol of OCD in children and adolescent is feasible in community-base clinic. Efficiency is showed and continues during 18 months. CBT allows global (CGI, C GAS), symptom (CY BOCS, ECAP, CDI) and cognitive (WISC IV) improvements.

Cette étude porte sur une intervention de groupe basée sur la thérapie cognitivo-comportementale pour l’hyperphagie boulimique (HB), dont les effets potentiels sur la qualité de vie reliée au poids, la fréquence et la sévérité des crises de boulimie, les symptômes dépressifs, l’image corporelle et le poids corporel ont été mesurés, et le degré d’acceptation par les participantes a été documenté. Ainsi, 11 femmes avec un surplus de poids et répondant aux critères diagnostiques de l’HB ont été recrutées du printemps 2012 à l’hiver 2013, dans la région de Montréal. Le programme comportant huit séances hebdomadaires était dispensé par une nutritionniste et une psychothérapeute. La qualité de vie reliée au poids (Impact of Weight on Quality of Life), la fréquence des crises de boulimie (rappel des sept derniers jours), la sévérité des crises de boulimie (Binge Eating Scale), les symptômes dépressifs (Inventaire de Beck pour la dépression), l’insatisfaction corporelle (Body Shape Questionnaire) et le poids corporel ont été mesurés avant et à la fin de l’intervention. Puis, un questionnaire pour mesurer l’acceptation par les participantes était soumis au terme du programme. Le taux de participation aux séances était aussi colligé. Les résultats montrent que notre programme a permis une amélioration significative du score global de la qualité de vie reliée au poids de 8,4 ± 13,3, ainsi qu’en termes d’estime de soi et de travail. Aussi, une diminution significative de la fréquence des crises de boulimie de 2,1 ± 2,1 jours, de la sévérité des crises de boulimie dont le score a diminué de 10,9 ± 7,7, des symptômes dépressifs dont le score a diminué de 8,3 ± 5,7 et de l’insatisfaction corporelle dont le score a diminué de 32,8 ± 17,1, ont été observées. Toutefois, il n’y a pas eu de perte de poids au terme de l’intervention. Puis, le programme a été bien accepté par les participantes tel que démontré par le taux de participation aux séances de 93,8 % et la satisfaction mesurée par l’appréciation des divers éléments du programme de 4,6 sur 5 et la pertinence de ceux-ci de 4,8 sur 5. Ces données suggèrent que l’intervention de groupe semble être prometteuse pour améliorer les symptômes et conséquences de l’HB, à l’exception du poids. / This study focuses on a group intervention for binge eating disorder (BED), by measuring its potential effects on the quality of life related to weight, frequency and severity of binge episodes, depressive symptoms, body dissatisfaction and body weight, and documenting the degree of acceptance of the intervention by the participants. Thus, 11 overweight women that met the BED diagnostic criteria were recruited from spring 2012 to winter 2013, in Montreal. The program includes eight weekly sessions based on Cognitive Behavioral Therapy provided by a nutritionist and a psychotherapist. Quality of life related to weight (Impact of Weight on Quality of Life), binge eating frequency (recall of the last seven days), binge eating severity (Binge Eating Scale), depression (Beck Inventory for depression), body dissatisfaction (Body Shape Questionnaire) and body weight were measured before and after the intervention. Then, a questionnaire to assess the acceptance by the participants was submitted at the end of the program. The rate of participation was also collected. The results showed that our program has resulted in significant improvements in the overall quality of life score related to weight of 8.4 ± 13.3, and in terms of self-esteem and work. We also observed a decrease in binge eating frequency by 2.1 ± 2.1 days as well as in binge eating severity, depressive symptoms and body dissatisfaction whose scores decreased by 10.9 ± 7.7, 8.3 ± 5.7 and 32.8 ± 17.1 respectively. However, there was no significant difference in weight at the end of the intervention. Also, the program was well accepted by the participants with a participation rate of 93.8%. Satisfaction and relevance of the program scored respectively 4,6 and 4,8 out of 5. These data suggest that the group intervention seems to be a promising method to improve the symptoms and consequences of HB, except for weight.

Made available in DSpace on 2016-03-22T17:27:18Z (GMT). No. of bitstreams: 1 taiane.pdf: 500923 bytes, checksum: bb4a10bbb2a2448b84aceb8f2e29daa6 (MD5) Previous issue date: 2013-01-17 / Introduction: The literature indicates high occurrence of anxiety symptoms in people who have depression, this index simultaneously suggests the importance of studying the impact of anxiety symptoms in treatment for depression. Objective: To evaluate the impact of anxiety symptoms in remission of depressive symptoms in brief psychotherapies for depression at follow-up six months. Methods: Randomized clinical trial with youth of 18 to 29 years old who met diagnostic criteria for depression assessed by the Structured Clinical Interview for DSM (SCID). Depressive symptoms were assessed using the Hamilton Depression Scale (HAM-D), while the anxiety symptoms were assessed using the Hamilton Anxiety Scale (HAM-A). The protocols of psychotherapy used were: Cognitive Narrative Psychotherapy (CNP) and Cognitive Behavioral Psychotherapy (CBP), both with seven sessions. At the end of treatment and at follow-up six months an evaluation was made with the HAM-D and HAM-A. Results: The sample included 97 patients divided evenly between the protocols of psychotherapy. There was a significant positive moderate correlation between the severity of anxiety symptoms at baseline and remission of depressive symptoms at post-intervention (r = 0.444 p <0.001), while at follow-up six months not there was a significant correlation (r = 0.181 p = 0.164). There was remission of anxiety symptoms (8.69 ± 7.93) and depressive symptoms (6.38 ± 5.4o) after the brief psychotherapies. The remission of anxiety symptoms remained at follow-up of six months (7.59 ± 8.31, p = 0,228) and the same was true for the remission if depressive symptoms (6.48 ± 5.04, p = 0,879). Conclusion: The severity of anxiety symptoms contributed to greater remission of depressive symptoms after brief psychotherapies in the short term. However, in long term, the severity of the anxiety symptoms has no impact on the remission of the depressive symptoms. The brief psychotherapies for depression demonstrate efficacy in the remission of depressive and anxious symptoms / Introdução: A literatura aponta alta ocorrência de sintomas ansiosos em indivíduos que apresentam depressão, este índice simultâneo sugere a importância de se estudar o impacto dos sintomas ansiosos no tratamento para depressão. Objetivo: Avaliar o impacto dos sintomas ansiosos na remissão de sintomas depressivos em psicoterapias breves para depressão no follow-up de seis meses. Método: Ensaio clínico randomizado com jovens de 18 à 29 anos que preencheram critério diagnóstico de depressão avaliado através da Structured Clinical Interview for DSM (SCID). Os sintomas depressivos foram avaliados através da Hamilton Depression Scale (HAM-D), enquanto os sintomas ansiosos foram avaliados através da Hamilton Anxiety Scale (HAM-A). Os protocolos de psicoterapia utilizados foram: Psicoterapia Cognitiva Narrativa (PCN) e Psicoterapia Cognitivo Comportamental (PCC), ambos com sete sessões. Ao fim do tratamento, bem como, no follow-up de seis meses foi realizada uma avaliação com as escalas HAM-D e HAM-A. Resultados: A amostra total contou com 97 pacientes distribuídos homogeneamente entre os protocolos de psicoterapia. Houve uma correlação moderada positiva significativa entre a severidade dos sintomas ansiosos no baseline e a remissão de sintomas depressivos no pós-intervenção (r=0,444 p<0,001), no entanto, no follow-up de seis meses a correlação não foi estatisticamente significativa (r=0,181 p=0,164). Houve remissão de sintomas ansiosos (8,69±7,93) e de sintomas depressivos (6,38±5,40) após as psicoterapias breves. A remissão dos sintomas ansiosos manteve-se no follow-up de seis meses (7,59±8,31; p=0,228) e o mesmo ocorreu para a remissão se sintomas depressivos (6,48±5,04; p=0,879). 47 Conclusão: A severidade dos sintomas ansiosos contribuiu para maior remissão de sintomas depressivos após psicoterapias breves em curto prazo. Contudo, a longo prazo, a severidade dos sintomas ansiosos não apresenta impacto sobre a remissão dos sintomas depressivos. As psicoterapias breves para depressão demonstram eficácia na remissão de sintomas ansiosos e depressivos

Insomni och depression är psykiatriska åkommor som idag drabbar många människor. Forskning har visat att det råder en stor samsjuklighet mellan diagnoserna där många drabbade lider av samtidig insomni och depression vilket utgör en stor belastning för den enskilde individen. Patienter rapporterar ofta en negativ påverkan på kognitiva funktioner, bland annat minnessvårigheter och problem med koncentration och uppmärksamhet. Inom forskningen råder det i dagsläget en osäkerhet kring vilka kognitiva nedsättningar som karakteriserar personer med dessa diagnoser och på vilka sätt de skiljer sig åt. Det finns också ett behov av att undersöka vilken roll kognitiv förmåga spelar för människors möjlighet att tillgodogöra sig psykologisk behandling. I föreliggande studie var syftet att undersöka dessa båda områden. Resultaten visade inte på några signifikanta skillnader mellan personer med insomni, personer med depression och personer med det komorbida tillståndet avseende kognitiva funktioner, när det mättes genom test av uppmärksamhet, arbetsminne och exekutiva funktioner. Däremot framkom vissa samband mellan arbetsminne och förbättring av upplevda sömnbesvär, liksom mellan förmåga till bibehållen uppmärksamhet och förbättring av depressionssymtom. Vidare forskning med större och jämnare urvalsgrupper behövs för att undersöka stabiliteten i dessa fynd.

Background: Controversy surrounds the questions whether co-occurring depression has negative effects on cognitivebehavioral therapy (CBT) outcomes in patients with panic disorder (PD) and agoraphobia (AG) and whether treatment for PD and AG (PD/AG) also reduces depressive symptomatology. Methods: Post-hoc analyses of randomized clinical trial data of 369 outpatients with primary PD/AG (DSM-IV-TR criteria) treated with a 12-session manualized CBT (n = 301) and a waitlist control group (n = 68). Patients with comorbid depression (DSM-IV-TR major depression, dysthymia, or both: 43.2% CBT, 42.7% controls) were compared to patients without depression regarding anxiety and depression outcomes (Clinical Global Impression Scale [CGI], Hamilton Anxiety Rating Scale [HAM-A], number of panic attacks, Mobility Inventory [MI], Panic and Agoraphobia Scale, Beck Depression Inventory) at post-treatment and follow-up (categorical). Further, the role of severity of depressive symptoms on anxiety/depression outcome measures was examined (dimensional). Results: Comorbid depression did not have a significant overall effect on anxiety outcomes at post-treatment and follow-up, except for slightly diminished post-treatment effect sizes for clinician-rated CGI (p = 0.03) and HAM-A (p = 0.008) when adjusting for baseline anxiety severity. In the dimensional model, higher baseline depression scores were associated with lower effect sizes at post-treatment (except for MI), but not at follow-up (except for HAM-A). Depressive symptoms improved irrespective of the presence of depression. Conclusions: Exposure-based CBT for primary PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbid depression or depressive symptomatology. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

This paper presents the Social Phobia Psychotherapy Research Network. The research program encompasses a coordinated group of studies adopting a standard protocol and an agreed-on set of standardized measures for the assessment and treatment of social phobia (SP). In the central project (study A), a multicenter randomized controlled trial, refined models of manualized cognitive-behavioral therapy and manualized short-term psychodynamic psychotherapy are compared in the treatment of SP. A sample of 512 outpatients will be randomized to either cognitive-behavioral therapy, short-term psychodynamic psychotherapy or waiting list. Assessments will be made at baseline, at the end of treatment and 6 and 12 months after the end of treatment. For quality assurance and treatment integrity, a specific project using highly elaborated measures has been established (project Q). Study A is complemented by 4 interrelated add-on projects focusing on attachment style (study B1), on cost-effectiveness (study B2), on variation in the serotonin transporter gene in SP (study C1) and on structural and functional deviations of the hippocampus and amygdala (study C2). Thus, the Social Phobia Psychotherapy Research Network program enables a highly interdisciplinary research into SP. The unique sample size achieved by the multicenter approach allows for studies of subgroups (e.g. comorbid disorders, isolated vs. generalized SP), of responders and nonresponders of each treatment approach, for generalization of results and for a sufficient power to detect differences between treatments. Psychological and biological parameters will be related to treatment outcome, and variables for differential treatment indication will be gained. Thus, the results provided by the network may have an important impact on the treatment of SP and on the development of treatment guidelines for SP. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Sömnsvårigheter inklusive insomni är ett utbrett problem för stora delar av befolkningen. Personer med insomni tenderar att oroa sig över sin sömn och har dysfunktionella antaganden kring sömnbristens konsekvenser. Studiens huvudsakliga syfte var att undersöka om skillnader i utfall mellan två behandlingsmetoder för insomni kunde tillräknas en exponeringseffekt. Studiens hypoteser var: 1a) Patienter som deltar i sömnrestriktion kommer få en större reducering av oro över sin sömn. 1b) Det finns ett samband mellan hög följsamhet till behandlingsmetoden och minskad oro över sömnen. 2) En kraftigare exponering medför lägre följsamhet till behandlingsmetoden. 3) Det finns ett samband mellan minskad oro över sömnen och minskade insomnisymptom. Data användes där 185 deltagare randomiserats till någon av KBT-behandlingarna för insomni sömnkomprimering (n=93) och sömnrestriktion (n=92). Oron hade minskat för studiedeltagarna fem veckor efter behandlingsstart men inga signifikanta skillnader påträffades mellan grupperna. Ett signifikant samband observerades mellan minskning av insomnisymptom och oro över sömnbrist. Slutsatser från uppsatsen är det redan etablerade sambandet mellan oro och insomni bekräftas. Studien kunde inte bekräfta hypotesen att exponering leder till minskad oro. Vidare forskning rekommenderas för att avgöra hur exponering kan användas för patienter med insomni för att möjliggöra effektivare behandlingsmetoder. / Sleep impairments including insomnia is a widespread problem affecting a large quantity of the population. Insomnia patients tend to worry about their sleep and having dysfunctional beliefs about sleep deficit consequences. The main purpose of this study was to examine if differences in results between two treatment methods could be attributed to effects of exposure. The hypotheses in the study were: 1a) Patients who participate in sleep restriction will have a greater reduction of sleep-related worry. 1b) There is a correlation between high compliance to the treatment methods and reduced sleep-related worry. 2) A greater exposure induces lower compliance to the treatment methods. 3a) There is a correlation between reduction of sleep-related worry and reduction of insomnia symptoms. Data consisted of 185 participants who was randomised into the CBT-treatments for insomnia sleep compression (n=93) or sleep restriction (n=92). A hypothesis was that sleep restriction implicate more exposure than sleep compression. Worry had decreased among participants after five weeks of treatment but no significant differences occurred between the groups. A significant correlation occurred between reduction of insomnia symptoms and reduction of worries regarding sleep deficit. Conclusions is that the already established correlation between worry and insomnia is confirmed. This study failed to confirm that exposure leads to reduced worry. Further research is advised to determine how exposure can be used for insomnia patients to enable more efficient treatment methods. / ClinicalTrials.gov Identifier: NCT02743338, CompRest - a Comparison Between Sleep Compression and Sleep Restriction for Treating Insomnia

Made available in DSpace on 2016-08-03T16:34:40Z (GMT). No. of bitstreams: 1 ELAINE F FERNANDES.pdf: 724683 bytes, checksum: e96a0d1306ccd662e5059be967ebf83d (MD5) Previous issue date: 2005-03-08 / Research of bibliographical and monographical nature, this paper investigates the psychophysics relaxation in the health area, of children in a period of eight years, between January 1997 and November 2004. Initially, based in neuropsychological literature, it describes the relaxation role in homeostasis and the conscious body health, emphasizing the pleasure and painful behavior. Next, it describes and analyses several relaxation techniques, Jacobson Progressive Relaxation, Schulz Autogenos and Michaux Relaxation. To develop this research it was used 27 databases, due to the lack of production of this theme, per base. As result, it shows the total of 500 articles about relaxation, 200 of them related to children. They are national and international articles, most of them in English. Following this, it classifies these group in production by year, showing a significant increasing, although it is not systematic in number, from 14 articles in 1997 to 39 in 2004. As for the thematic, the data reveals first, the interest in pain, second in breathing problems and third in anxiety. The articles about pain, as they are in more quantity, have more detailed analysis, with discrimination by year, situation type, relaxation usage and pathology characterized by painful behavior. Finally, it is made a classification of the articles due to the usage of relaxation in clinical problems mainly the physical ones, those of affectionate-emotional psychic background, those with no usage of drugs and those with psychic background with the aid of drugs and psychiatric treatment. To discuss the results, several articles researched are also mentioned. Due to the richness of data, showing up the increasing of professionals in this health area, it is suggested further reading. / Trabalho de natureza monográfica bibliográfica investiga o relaxamento psicofísico na área da saúde, em crianças, por um intervalo de oito anos, entre janeiro de 1997 e novembro de 2004. Inicialmente, com base em literatura neuropsicológica, descreve o papel do relaxamento na busca da homeostase e da consciência corporal saudável, enfocando comportamentos de prazer e dor. A seguir, descreve e analisa diversas técnicas de relaxamento, Relaxamento Progressivo de Jacobson, Autógeno de Schultz e Relaxamento de Michaux. A fim de desenvolver sua pesquisa utiliza-se de 27 bases de dados, devido a pouca produção encontrada sobre o tema, por base. Como resultados, levanta ao todo 500 artigos sobre relaxamento, sendo 200 em crianças. São artigos nacionais e internacionais, com predomínio do idioma inglês. A seguir, classifica esses artigos por ano de produção, constatando um crescimento significativo, porém não sistemático em seu número, de 14 artigos em 1997, para 39, em 2004. Quanto à temática, os dados revelam em primeiro lugar, um interesse em dor, em segundo em problemas respiratórios, e, em terceiro lugar, em ansiedade. Os artigos sobre dor, por serem os mais numerosos levantados, sofrem análise mais detalhada, com discriminação da quantidade de artigos por ano e dos tipos de situação e de patologia caracterizados por quadro álgico. Finalmente é feita uma classificação dos artigos segundo a utilização do relaxamento junto à problemática clínica predominantemente física, a de fundo psíquico afetivo-emocional, sem utilização de fármacos e, a de fundo psíquico, com intervenção psiquiátrica farmacológica. Na discussão dos resultados, vários artigos pesquisados são também comentados. Dada a riqueza dos dados, evidenciando interesse crescente de profissionais da área da Saúde na literatura levantada, sugere-se pesquisa complementar.

xiv, 105 p. ill. (some col.) / Depression during adolescence is highly prevalent with as many as 20% experiencing a major depressive episode by the age of 18. Adolescent depression causes significant impairment across life areas including school functioning, such as poor academic performance and decreased academic achievement. Despite the existence of many evidence-based treatment options, merely 25% of depressed adolescents receive treatment. For this reason, it is essential that easily accessible preventive interventions for adolescent depression be developed and made available. Computerized interventions could broaden the reach of prevention efforts and preliminary results indicate that they have the potential to successfully prevent adolescent depression. The Coping with Depression course is an empirically validated cognitive-behavioral depression treatment and prevention program that is well-suited for computerized delivery. This dissertation reports on the development and evaluation of a web-based interactive multimedia version of the adolescent Coping with Depression course with students experiencing subclinical levels of depression. The Blues Blaster program includes the following six modules, with five mini-sessions in each: (a) defining depression, (b) mood monitoring, (c) increasing fun activities, (d) increasing positive thinking, (e) recognizing negative thinking, and (f) decreasing negative thinking. Key concepts are presented and reinforced in a variety of engaging ways within each session, including video, animation, comic strips, graphics, interactive exercises, and games. The Blues Blaster program was evaluated in a randomized controlled trial with 161 adolescents who were randomly assigned to either the Blues Blaster or informationonly control conditions. Participants were assessed at baseline, post-treatment (six weeks after baseline), and six-month follow-up. Results demonstrated greater improvement for the Blues Blaster condition in depression levels, negative thoughts, behavioral activation, knowledge, self-efficacy, and school functioning compared to the information-only control condition. These findings suggest that this targeted prevention program is appropriate for use with middle school students to decrease depression levels and therefore the risk that they will develop major depression in the future. / Committee in charge: Christopher Murray， Chairperson； Deanne Unruh， Member； Jeffrey Sprague， Member； John R. Seeley， Member； Sara Hodges， Outside Member

The thesis contains two parts, to bind: The first part describes the phenomenon of homelessness and homeless people in the Czech Republic, with main reference to their ambiguous definition. Characterizes the dedicated assistance to the homeless and from social work to therapeutic help. Describes the basic form of therapeutic exposure and focus, emphasizes psychotherapeutic orientations, which are suitable for a group of homeless people, with an emphasis on cognitive-behavioral therapy (CBT). The first part of the research continues, describing the organization of the St. Paul's House (DsP), which took place in the first orientation research whose aim was to determine whether CBT is the most appropriate psychotherapeutic direction in psychotherapeutic work with the homeless in the DsP, and how psychotherapy is implemented in the DsP. After the landmark research was carried out research whose aim was to find feedback, experience and opinion shelter users in the implementation of the DsP and the course of psychotherapy.