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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.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-11T13:14:58Z No. of bitstreams: 1 claudiaaparecidadecarvalho.pdf: 3575170 bytes, checksum: 19ed07de4125cf818caada8c5ba2e810 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T17:08:30Z (GMT) No. of bitstreams: 1 claudiaaparecidadecarvalho.pdf: 3575170 bytes, checksum: 19ed07de4125cf818caada8c5ba2e810 (MD5) / Made available in DSpace on 2016-01-25T17:08:30Z (GMT). No. of bitstreams: 1 claudiaaparecidadecarvalho.pdf: 3575170 bytes, checksum: 19ed07de4125cf818caada8c5ba2e810 (MD5) Previous issue date: 2015-02-02 / O tabagismo é resultante da dependência de nicotina e o uso do tabaco está associado a várias doenças e mortes. O Objetivo do estudo foi avaliar a eficácia de uma sessão de Intervenção Breve para dependentes de tabaco que procuram tratamento em Unidades de Atenção Primária à Saúde (UAPS) em Juiz de Fora. Método: Comparou-se a abordagem intensiva do fumante que segue o protocolo do Ministério da Saúde (MS) e se utiliza da visão Cognitivo-Comportamental com oito sessões semanais utilizando o modelo de intervenção breve, que consiste em uma forma de aconselhamento na tentativa de modificar o comportamento através de técnicas motivacionais com uma única sessão. Os participantes foram alocados em cada grupo de tratamento através de randomização. Os desfechos avaliados: cessação, motivação, redução do número de cigarros, grau de intensidade da dependência da nicotina, sintomas de depressão e ansiedade, fissura, adesão ao tratamento, tentativas de cessação para fumar. Participaram do estudo cinquenta e duas (52) pessoas. As avaliações de seguimento foram realizadas por telefone, em três e seis meses, após as intervenções. O estudo foi um piloto de um ensaio clínico randomizado com análises descritivas. Resultados: A maior parte das pessoas que compuseram o presente estudo era do sexo feminino (82,7%), com idade média de 49 anos (DP 9,6). Na avaliação de dependência de nicotina predominou o grau elevado, na linha de base, nos grupos. Nos seguimentos o grupo IB apresentou diminuição e a manteve. A motivação era alta na linha de base, nos grupos. Nos seguimentos manteve-se alta e ausente no grupo IB e alta no ACC. Os grupos apresentaram sintomas de ansiedade na linha de base. Nos seguimentos houve aumento no grupo IB e diminuição, no controle. Os grupos também apresentaram sintomas de depressão. Nos seguimentos, no grupo IB, a depressão elevou-se e no controle, diminuiu. Na linha de base as pessoas apresentaram fissura moderada nos dois grupos. Nos seguimentos, a fissura manteve-se moderada no grupo IB. O grupo IB não relatou abstinência. O número de tentativas de parar de fumar aumentou. Houve redução no número de cigarros fumados e influência no comportamento de saúde. Discussão: O estudo piloto demonstrou que é possível reduzir o consumo de tabaco, mudar o comportamento de saúde, aumentar o número de tentativas de parar de fumar e manter os níveis de fissura e dependência de nicotina por meio de uma intervenção breve de sessão única. Conclusão: Uma intervenção (IB) individual, com uma sessão e menor tempo de treinamento para sua realização, menor custo para aplicação, mostrou-se promissora quando comparada ao grupo ACC. Sugere-se novos estudos para avaliar a IB em tabagismo. / Smoking is the result of nicotine addiction, and tobacco use is associated with various diseases and causes of death. The Objective of the study was to evaluate the effectiveness of a Brief Intervention (BI) session for tobacco addicts seeking treatment in Primary Health Care Units (PHCUs) in Juiz de Fora. Method: We compared the intensive treatment of the smoker, which follows the Ministry of Health (MH) protocol and uses the Cognitive-Behavioral Approach (CBA), in eight weekly sessions, with the Brief Intervention model, which consists of a form of counseling in an attempt to modify behavior through motivational techniques, in a single session. Participants were assigned to each treatment group in random order. The outcomes measured were: cessation, motivation, reduced number of cigarettes, intensity level of nicotine dependence, symptoms of depression and anxiety, craving, adherence to treatment, smoking cessation attempts. Fifty-Two (52) persons participated in the study. Follow-up evaluations were conducted by phone, at three and six months after the interventions. The study was a pilot for a randomized clinical trial with descriptive analyses. Results: Most of the people in this study were female (82.7%), with a mean age of 49 years (SD 9.6). In the baseline assessment, a high level of nicotine dependence predominated in the groups. In the follow-ups, the BI group showed and maintained a decrease. Motivation was high at the baseline, in the groups. In the follow-ups it remained high and absent in the BI group and high in the CBA group. The groups showed symptoms of anxiety in the baseline. In the follow-ups there was an increase, in the BI group, and a reduction, in the control group. The groups also showed symptoms of depression. In the follow-ups, depression increased in the BI group and decreased in the control group. In the baseline, people had moderate craving in both groups. In the follow-ups, craving remained moderate in the BI group. The BI group did not report abstinence. The number of attempts to quit smoking increased. There was a reduction in the number of cigarettes smoked and an influence on health behavior. Discussion: The pilot study showed that it is possible to reduce tobacco use, change health behavior, increase the number of attempts to quit smoking, and control the levels of nicotine craving and dependence through a brief intervention in a single session. Conclusion: An individual intervention (BI), in one session, with less training time for its administration and a lower cost to implement, showed promising results when compared to the CBA group. Further studies are suggested to evaluate the BI for smoking treatment.

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.

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.

Clinicians frequently treat patients suffering from more than one mental disorder. As they have to choose which disorder to treat first, knowledge on generalization effects or even comorbidity-associated obstacles should guide the clinician’s decision. Patients with panic disorder (PD) and agoraphobia (AG) often suffer from other mental disorders, e.g. social anxiety disorder (SAD) [1]. Nevertheless, evidence is missing whether cognitive-behavioral therapy (CBT) for PD/AG generalizes to SAD or whether comorbid SAD impedes the treatment of primary PD/AG.