Callous and unemotional (CU) traits in children with conduct problems have been indicated as precursors to adult psychopathy. The analysis of the sensitivity to rewards and punishment in this population may be useful in the identification of effective behavior modification programs and particularly the delineation of ineffective punishment procedures. Scores on the Child Psychopathy Scale, Inventory of Callous and Unemotional Traits, Contingency Response Rating Scale and the Sensitivity to Reward Sensitivity to Punishment – Children Revised scale were used to evaluate 20 children, aged 7-13, recruited from FIU’s Center for Children and Families. The sample comprised 14 males and 6 females displaying a range of psychopathic traits measured by the CPS, with scores from 9 to 46 (M = 28.45, SD = 10.73). Sensitivity to punishment was examined using a behavioral task in which children endured various amounts of either white noise (type I punishment) or time-out from positive reinforcement (type II punishment) in order to gain access to a demonstrated reinforcer. The sample was stratified on the basis of the magnitude of psychopathy scores, and sensitivity to rewards and punishment were evaluated using a Behavioral Activation / Behavioral Inhibition framework by examining task performance: the frequency and duration of punishment conditions selected, electrodermal activity (skin conductance response), and parent-reported measures of child sensitivity to reward and punishment. Results indicated that the magnitude of CU traits was directly proportional to hyposensitivity to punishment and hypersensitivity to reward. Children with elevated levels of CU traits elected to endure a greater frequency and duration type I punishment in order to maintain continued access to the reinforcer. Significant differences were not found between high- and low-psychopathy children in the selection of type II punishment. The findings indicate that although there may be a hyporeactivity to type I punishment in children with CU traits, the use of a type II punishment by the removal of a positive stimulus has demonstrated treatment efficacy. The difference in sensitivity to rewards and the types of effective punishment in children with CU traits may affect reinforcement based learning, leading to the ineffectiveness of traditional methods informing the development of social responses.

Esse estudo propõe um modelo psicoterápico em grupo para crianças e adolescentes com diagnóstico de Transtornos disruptivos, do controle de impulsos e da conduta (APA, 2014), a partir do modelo apresentado por Lopes (2015), e integrado aos métodos e técnicas propostos pelo grupo alemão dirigido por Christof Loose (Loose, Graaf e Zarbock, 2015). Loose et al. (2015) acrescentam à Terapia Cognitiva Focada no Esquema para crianças e adolescentes diversos materiais para tratamento de transtornos específicos. Esse grupo tem se despontado na apresentação de estudos para esse público, pois a partir da teoria proposta por Jeffrey Young (Young, 2003), têm se dedicado a pesquisas e publicações de materiais inovadores. No decorrer do trabalho o leitor poderá apreciar os fundamentos da Terapia do Esquema para crianças e adolescentes, alguns estudos sobre Transtornos Disruptivos, do controle de impulsos e da conduta, programas de tratamento em grupo para esse público – e que já otém resultados positivos nas intervenções, a tradução literal do protocolo proposto por Loose et al. (2015), e a proposta do protocolo em grupo, com base nos métodos e técnicas da Terapia Cognitiva Focada no Esquema (TCFE). Nos anexos deste trabalho são apresentados os materiais traduzidos de Loose et al. (2015), tais como os formulários indicados para utilização na aplicação das técnica e roteiros de entrevistas; e outros instrumentos propostos para as etapas de avaliação, intervenção e psicoeducação com as crianças e adolescentes, e com seus familiares. Esse trabalho visa acrescentar às práticas dos psicólogos brasileiros, alternativas eficazes de tratamento, apresentando a metodologia de avaliação inicial, as etapas da psicoterapia para as crianças e suas famílias. / This study proposes a group psychotherapeutic model for children and adolescents with a diagnosis of Disruptive Disorders, of impulse control and behavior (APA, 2014), based on the model presented by Lopes (2015), and integrated with the methods and techniques proposed by German group directed by Christof Loose (Loose, Graaf and Zarbock, 2015). Loose et al. (2015) add to Scheme Therapy for children and adolescents various materials for treatment of specific disorders. This group has emerged in the presentation of studies for this audience, because from the theory proposed by Jeffrey Young (Young, 2003), have been dedicated to research and publications of innovative materials. In the course of the work the reader will be able to appreciate the fundamentals of Scheme Therapy for children and adolescents, some studies on Disruptive Disorders, impulse control and behavior, group treatment programs for this audience - and that already have positive results in the interventions, the literal translation of the protocol proposed by Loose et al. (2015), and the proposal of the protocol in a group, based on the methods and techniques of Cognitive Therapy Focused on the Scheme (TCFE). In the annexes of this work are presented the materials translated from Loose et al. (2015), such as the forms indicated for use in the application of interviews techniques and scripts; and other instruments proposed for the stages of evaluation, intervention and psychoeducation with children and adolescents, and with their families. This work aims to add to the practices of Brazilian psychologists effective treatment alternatives, presenting the methodology of initial evaluation, the stages of psychotherapy for children and their families. / Dissertação (Mestrado)

This research was designed to examine the relationship between the willingness to forgive in specific situations and intensity of Early Maladaptive Schemas in a nonclinical sample of adults. Forty-one people participated in the survey, with an average age of 27.8 years. Were used three instruments: the Enright Forgiveness Inventory (EFI), the Crowne-Marlowe Social Desirability Scale and the Young Schema Questionnaire (short version). After application of the measures, statistical procedures were applied. In terms of results related to EFI, the same way in other studies that used this scale, were found positive correlations of the subscales of behavior, cognition and affection among themselves and with the total score of EFI, as well as with the 1-Item Forgiveness Scale an independent measure to evaluate how much the individual has forgiven the offender, in a complete mode. The results also showed that the EFI total score and the 1-Item Forgiveness Scale correlated positively, while the social desirability scale didn t show significant correlations with any of the two measures. Concerning the intensity of the offense, there was a negative correlation of this variable with measures of forgiveness, indicating that the degree of forgiveness was less the greater the perceived intensity of injury. With respect to the intensity of forgiveness, the average degree of forgiveness of the participants was 266 points a score that ranges from 60 (low degree of forgiveness) to 360 (high degree of forgiveness) and over half of the sample (61%, n = 25) reported levels of forgiveness higher than average. In terms of degrees of forgiveness measured by subscales of the EFI, the results showed that sample expressed more intensely the cognitive forgiveness (M = 96.8). The degree of affective forgiveness (M = 81.3) remained significantly lower than the degree of behavioral forgiveness (M = 88.2) and cognitive forgiveness, indicating that it was harder to participants offer the emotional forgiveness. Finally, considering the main objective of this research, the results showed negative correlations between the measure of forgiveness used as a criterion variable (1-Item Forgiveness Scale) and four of the five domains of schemes proposed by Young, to wit: disconnection and rejection (&#961; = -0.534, p <0.05), impaired autonomy and performance (&#961; = -0.440, p < 0.05), other-directedness (&#961; = -0.371, p < 0.05) and finally, the impaired limits domain (&#961; = -0.472, p < 0.01). Thus, the probability of the participants forgive their offenders has decreased as a function of the magnitude of the participant's domains and their schemes. The results observed in this study expands the current knowledge about the process of forgiveness, as well as about its interface with the cognitive structures called schemas, which have an important role in the organization of the personality, from the therapeutic point of view in cognitive approaches. / Esta pesquisa teve como objetivo principal analisar a relação entre a disposição para perdoar em situações específicas e a intensidade dos Esquemas Iniciais Desadaptativos (EIDs) em uma amostra não clínica de indivíduos adultos. Participaram da pesquisa 41 pessoas, com idade média de 27,8 anos. Foram utilizados três instrumentos de avaliação: a Escala de Atitudes para o Perdão (EFI), a Escala de Desejabilidade Social de Crowne-Marlowe e o Questionário de Esquemas Young (versão breve). Após a coleta, os dados foram submetidos a procedimentos estatísticos descritivos e correlacionais. Em se tratando dos resultados referentes à EFI, assim como em outros estudos que utilizaram a mesma escala, foram verificadas correlações positivas das subescalas de comportamento, julgamento e afeto, entre si, e com o escore total da EFI, assim como com a escala independente Item do Perdão uma escala independente que mede o quanto o indivíduo perdoou o ofensor de forma completa. Os resultados mostraram também que o escore total da EFI e do Item do Perdão correlacionaram-se positivamente, enquanto que a escala de desejabilidade social não apresentou correlações significantes com nenhuma das duas medidas. Com relação à medida de intensidade da ofensa, observou-se uma correlação negativa desta variável com as medidas de perdão, indicando que o grau de perdão foi tanto menor quanto maior a intensidade percebida da mágoa. Com respeito à intensidade do perdão, o grau médio do perdão dos participantes foi de 266 pontos num escore que varia de 60 (baixo grau de perdão) a 360 (alto grau de perdão) sendo que mais da metade da amostra (61%, n = 25) reportou graus de perdão superiores à média. Em se tratando dos graus de perdão medidos pelas subescalas da EFI, os resultados mostraram que a amostra expressou o perdão mais intensamente pela via cognitiva. O grau de perdão afetivo (M = 81,3) permaneceu significativamente menor que o grau de perdão comportamental (M = 88,2) e cognitivo (M = 96,8), indicando que foi mais difícil para os participantes perdoar afetivamente. Finalmente, considerando o objetivo principal desta pesquisa, os resultados mostraram correlações negativas entre a medida de perdão utilizada como variável critério (Item do Perdão) e quatro dos cinco domínios de esquemas propostos por Young, a saber: desconexão e rejeição (&#961; = -0,534; p < 0,05), autonomia e desempenho prejudicados (&#961; = -0,440; p < 0,05), orientação para o outro (&#961; = -0,371; p < 0,05) e por fim, o domínio de limites prejudicados (&#961; = -0,472; p < 0,01). Assim, a probabilidade de que os participantes perdoassem de forma completa seus ofensores foi menor à medida que apresentassem maior intensidade nestes domínios e seus esquemas. Os resultados verificados nesta pesquisa ampliam o conhecimento atual que se tem em relação ao processo de perdão em si, bem como a respeito de sua interface com as estruturas cognitivas denominadas esquemas, que têm um importante papel na organização da personalidade, do ponto de vista terapêutico nas abordagens cognitivas. / Mestre em Psicologia Aplicada

Essai doctoral présenté à la Faculté des arts et des sciences en vue de l’obtention du grade de Docteur en psychologie, option psychologie clinique (D.Psy.)

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A review of the research related to Medical Family Therapy demonstrates that the inclusion of marriage and family therapists as part of the healthcare team offers benefits such as decreased utilization of healthcare, decreased costs, increased positive outcomes for patients and healthcare systems. However, studies demonstrate the difficulty with communication between providers limiting access to marriage and family therapists. Results of this study identified benefits to working with medical family therapists including broadening the understanding and using a collaborative effort to help the patient improve and get better. Participants also identified barriers to collaboration such as the lack of knowledge of and access to MedFTs, their inclusion in the system, MDs finding value in the MedFT profession, and that the communication process is lacking. Further need for improved communication at the referral and follow-up stages in collaborative practices is shown. In order to move more toward collaborative practices, PCPs and MedFTs need to develop and disseminate training on treatment notes, communication, team meetings, and continuance of collaborative work with one another.

PDT, psykodynamisk psykoterapi, och KBT, kognitiv beteendeterapi, är idag de dominerande psykoterapiinriktningarna i Sverige. Metoderna har i olika skeden rekommenderats av myndigheter och meningsmotsättningar om vilken metod som är mest lämplig har förekommit. Följande studie avsåg att utforska hur sex intervjuade KBT-psykoterapeuter samarbetar med sina PDT-kollegor och utifrån patienters behov eventuellt överväger PDT. En induktiv tematisk analys tillämpades där psykoterapeuterna beskrev upplevelsen av samarbete med PDT-terapeuter i termer av ett positivt dynamiskt utbyte samtsom en negativ upplevelse av fördomsfullt bemötande från PDT-terapeuter och mindre metodologiskt utbyte. Bilden av PDT som komplementär metod hos de intervjuade KBT-psykoterapeuterna speglade ambivalens kring PDT:s effektivitet och användbarhet. Alliansens kvalitet beskrevs som avgörande för om byte sker till PDT-kollega under pågående KBT-behandling. Studiens resultat jämfördes med en tidigare enkätstudie i vilken gruppsykologiska mekanismer antagits påverka samarbetet mellan terapeuter av olika metodinriktning.En tentativ beskrivning ges av processen bakom dessa gruppmekanismer.

Syftet med uppföljningsstudien var att undersöka deltagares upplevelser av verksamma/hindrande komponenter i behandlingen Hästunderstödd Kognitiv Beteendeterapi (HU-KBT) 12-18 månader efter avslutad behandling. Syftet var också att undersöka vad deltagarna upplever att de uppnått genom att delta i behandlingen HU-KBT. Semistrukturerade intervjuer genomfördes med fem deltagare. Intervjumaterialet analyserades med hjälp av kvalitativ tematisk analys. Ett flertal komponenter i behandlingen beskrevs som hjälpsamma; gruppen, terapeuten, hästen, miljön och olika specifika psykoterapeutiska komponenter. Hindrande behandlingskomponenter som framkom var negativa aspekter av att behandlas i grupp samt för lite tid. Effekter av behandlingen som beskrevs av deltagarna var förbättrad ångesthanteringsförmåga, förhöjd energinivå, förbättrad gränssättningsförmåga, minskat behov av att ha kontroll och ta ansvar för andra, ökad självinsikt, en ökad medvetenhet om och förståelse för känslor och hur dessa kan hanteras samt en förbättrad arbetsförmåga. Övrigt som framkom i intervjuerna var att förväntningarna var blandade, att det kunde finnas övriga livsomständigheter som kan ha påverkat utfallet av behandlingen, att effekten av behandlingen ofta var fördröjd, att behandlingen upplevdes som effektiv, att det förekom olika sätt som användes för att förhindra återfall samt att det fanns önskemål om att få ta del av ytterligare behandling och att behandlingen ska rikta sig till fler grupper av människor och även kunna erbjudas i förebyggande syfte. Resultaten ser lovande ut men det behövs ytterligare forskning för att vidare undersöka behandlingens effektivitet och verksamma komponenter. / The purpose of the follow-up study was to examine the participants' experiences of active/inhibitory components in the treatment Equine Assisted Cognitive Behavioral Therapy (HU-KBT) 12-18 months after treatment completion. The purpose was also to investigate the participant´s self-perceptions of achievement by participating in the HU-KBT treatment. Semi-structured interviews were conducted with five participants. The interview material was analyzed using qualitative thematic analysis. Several components of the treatment were described as helpful; the group, the therapist, the horse, the environment and several specific psychotherapeutic components. Obstructive treatment components that emerged were negative aspects of being treated in group and shortage of time. Effects of the treatment described by the participants were improved anxiety management, increased energy levels, improved ability to set boundaries, reductions in need to control others or to take responsibility for them, increased self-awareness, increased awareness and understanding of emotions and how they can be managed and an improved ability to work. Other things that emerged in the interviews were expectations were mixed; other life circumstances may have affected the outcome of the treatment; the effect of the treatment was often delayed; the treatment was perceived as effective; various ways were used to prevent relapse; there was a desire to gain access to further treatment and that the treatment should be aimed at more groups of people and also be offered for preventive purposes. The results look promising, but further research is needed to further investigate the efficacy and the operating components of the treatment.

Background: Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PD/AG). It is unknown, how variants of CBT differentially modulate brain networks involved in PD/AG. This study was aimed to evaluate the effects of therapist-guided (T+) versus selfguided (T–) exposure on the neural correlates of fear conditioning in PD/AG. Method: In a randomized, controlled multicenter clinical trial in medication-free patients with PD/AG who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before (t1) and after CBT (t2). Quality-controlled fMRI data from 42 patients and 42 healthy subjects (HS) were obtained. Patients were randomized to two variants of CBT (T+, n = 22, and T–, n = 20). Results: The interaction of diagnosis (PD/AG, HS), treatment group (T+, T–), time point (t1, t2) and stimulus type (conditioned stimulus: yes, no) revealed activation in the left hippocampus and the occipitotemporal cortex. The T+ group demonstrated increased activation of the hippocampus at t2 (t2 > t1), which was positively correlated with treatment outcome, and a decreased connectivity between the left inferior frontal gyrus and the left hippocampus across time (t1 > t2). Conclusion: After T+ exposure, contingency-encoding processes related to the posterior hippocampus are augmented and more decoupled from processes of the left inferior frontal gyrus, previously shown to be dysfunctionally activated in PD/AG. Linking single procedural variants to neural substrates offers the potential to inform about the optimization of targeted psychotherapeutic interventions.

While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.