Children exposed to trauma experience many negative outcomes including posttraumatic stress disorder (PTSD). Fortunately, cognitive-behavioral therapy (CBT) is an effective treatment for PTSD. Theoretically it may be that not only do children do better in treatment when their parents are involved, but that there is also a reciprocal relationship such that as children improve their parents feel better as well (and vice a versa). Using data from a randomized trial (Scheeringa & Weems, 2014), this thesis used Hierarchical Linear Modeling (HLM) to test if change in child PTSD symptoms mediates change in parent depression symptoms, and vice a versa, across treatment sessions. Results indicated that maternal depression mediates child PTSD symptoms, and that the reciprocal relationship is present. However, this was only true when child PTSD symptoms were measured by parent report. The addition of this reciprocal relationship finding to the literature and future directions are discussed.

Submitted by Fabricia Fialho Reginato (fabriciar) on 2015-07-23T00:20:08Z No. of bitstreams: 1 MarindiaBrandtner.pdf: 535266 bytes, checksum: 44b2e59858f1e72c770653a7c499c7af (MD5) / Made available in DSpace on 2015-07-23T00:20:08Z (GMT). No. of bitstreams: 1 MarindiaBrandtner.pdf: 535266 bytes, checksum: 44b2e59858f1e72c770653a7c499c7af (MD5) Previous issue date: 2012 / Nenhuma / Esta Dissertação de Mestrado aborda o processo de mudança terapêutica na Terapia Cognitivo-Comportamental (TCC), com ênfase na patologia do comprar compulsivo. A dissertação compõe-se de uma revisão sistemática sobre psicoterapia para casos de compras compulsivas e de um estudo empírico do processo de mudança em um caso de TCC. A revisão sistemática da literatura partiu do tema das compras compulsivas e suas opções psicoterapêuticas. Para tanto, foi efetuada uma busca nas bases de dados MEDLINE (NLM), Social Sciences Citation Index (Web of Sciences), Science Citation Index Expanded (Web of Science) e American Psychological Association (APA) com as palavras-chave psychotherapy (psicoterapia) and (e) compulsive buying (compras compulsivas), compreendendo o período de 2002 a 2012. Foram excluídos artigos de teóricos, de revisão e que avaliavam exclusivamente tratamento psicofarmacológico. Do total de 96 encontrados, apenas seis preencheram os critérios de inclusão. Os estudos encontrados, apesar de poucos, apontaram que existem estudos sendo desenvolvidos com propósito de testar e validar intervenções efetivas para o tratamento das compras compulsivas. Apesar dos indícios de efetividade de abordagens psicoterápicas no tratamento do comprar compulsivo, a escassez de estudos, a ausência de estudos comparativos entre diferentes psicoterapias, entre outros aspectos, indicam a necessidade de implementar pesquisas sobre a efetividade do tratamento psicológico face a face com este tipo de psicopatologia. O estudo empírico teve como objetivo avaliar resultados do tratamento psicoterápico de uma compradora compulsiva e descrever o processo terapêutico. A pesquisa foi realizada em uma clínica privada do interior do Estado do Rio Grande do Sul. As participantes foram uma terapeuta, psicóloga e especialista em Terapia Cognitivo-Comportamental, com mais de dez anos de experiência na área e uma paciente, adulta, casada, com sintomas de comprar compulsivo, aliados a depressão. Foram realizadas 12 (doze) sessões de psicoterapia, utilizando o enfoque da TCC. Todo o tratamento foi gravado em áudio e posteriormente transcrito e avaliado por uma dupla de juízes independentes, através do método Psychotherapy Process Q-Set (PQS) para a obtenção de descrições quantitativas de elementos que caracterizaram o processo terapêutico, considerando fatores da paciente, da terapeuta e da interação entre ambas. A avaliação dos resultados foi obtida através de medidas antes, durante e após o tratamento, de sintomas de comprar compulsivo (YBOCS-SV), ansiedade (BAI), depressão (BDI-II) e de ajustamento social (EAS). Este estudo apontou que a TCC foi efetiva no tratamento de comprar compulsivo, promovendo a redução de comportamentos disfuncionais típicos desta patologia, a reestruturação de cognições disfuncionais da paciente e a melhora dos sintomas de depressão e de ajustamento social. Os achados não permitem generalizar quais fatores foram mais importantes para estes positivos resultados, porém, a aliança terapêutica, as tarefas comportamentais, a motivação da paciente e a atitude de apoio da terapeuta, foram fatores essenciais para este processo. / This Master´s Dissertation discusses the process of therapeutic change in cognitivebehavioral therapy (CBT), with emphasis on pathology of compulsive buying. The dissertation consists of a systematic review on psychotherapy for cases of compulsive buying and an empirical study of the change process in a case of CBT. A systematic review of the literature came from the theme of her compulsive buying and psychotherapeutic options. The search found 96 articles, only six of which met the inclusion criteria. The articles found, though few, have pointed out that there are studies being developed for the purpose of testing and validating effective interventions for compulsive buying treatment. Despite the evidence of effectiveness of psychotherapeutic approaches in the treatment of compulsive buying, the scarcity of studies, the lack of comparative studies between different psychotherapies, among other things, indicate the need to implement research on the effectiveness of psychological face to face treatment with this type of psychopathology. The empirical study aimed to evaluate psychotherapy results of a compulsive buyer and to describe the therapeutic process. The research was conducted in a private clinic in the state of Rio Grande do Sul. Participants were a therapist, psychologist and expert in Cognitive Behavioral Therapy, with over ten years of experience in the field and a patient, adult, married, with symptoms of compulsive buying, coupled with depression. Twelve (12) sessions of psychotherapy were performed, using the approach of CBT. All treatment was recorded on audio, transcribed, and evaluated by a pair of independent judges with the method Psychotherapy Process Q-Set (PQS) for obtaining quantitative descriptions of elements that characterize the therapeutic process, considering patient’s, therapist’s and interaction’ factors. The evaluation of results were obtained through measurements of compulsive buying symptoms (YBOCS-SV), anxiety (BAI), depression (BDI-II) and social adjustment (EAS), performed before, during and after treatment. This study showed that CBT was effective to treat compulsive buying, promoting reductions of dysfunctional behaviors that are typical of this condition, restructuring patient´s dysfunctional cognitions and improving depressive symptoms and social adjustment. The findings do not allow generalizing what factors were most important to these positive results. However, therapeutic alliance, behavioral tasks, patient´s motivation, and therapist´s supportive attitude were essential factors to this process.

INTRODUÇÃO Segundo a 4ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV; American Psychiatric Association, 2002), o Transtorno Obsessivo- Compulsivo (TOC) caracteriza-se por obsessões e/ou compulsões recorrentes que interferem substancialmente com o funcionamento cotidiano. Ainda que a Terapia Cognitivo-Comportamental em Grupo (TCCG) tenha sido efetiva nos estudos de pacientes com TOC (Cordioli et al., 2003; Braga et al., 2005; Sousa et al., 2006), quase um terço (30%) dos pacientes não se beneficiou do tratamento em grupo nos mesmos estudos. A Entrevista Motivacional (EM) e o Mapeamento Cognitivo (MC) têm sido usados para melhorar os resultados de tratamentos. OBJETIVOS O objetivo principal do presente estudo foi avaliar os efeitos de se acrescentar duas sessões individuais de EM+MC a 12 semanas de TCCG na resposta ao tratamento dos pacientes com TOC, quando comparados apenas à TCCG. MÉTODOS Noventa e três pacientes adultos, com diagnóstico de TOC de acordo com os critérios do DSM-IV, participaram de um ensaio clínico randomizado de 14 semanas: 48 pacientes foram alocados à condição de duas sessões individuais de EM+MC seguidas de 12 semanas de TCCG e 45 receberam duas sessões individuais informativas seguidas da TCCG. Para a avaliação dos resultados foi utilizada a escala Yale-Brown de Sintomas Obsessivo-Compulsivos (Y-BOCS) como medida de desfecho primária. Como medidas de desfecho secundárias utilizou-se: a escala de Impressão Clínica Global (CGI) e o Inventário de Depressão de Beck (BDI), bem como a proporção de respondedores (definida como melhora [redução na Y-BOCS 35%] ou não-melhora [redução 35% na Y-BOCS]) e o percentual de pacientes com remissão parcial (Y-BOCS 35%, mas com escore total >8 e CGI 2) e remissão completa (Y-BOCS 8 e CGI < 2). RESULTADOS Quando os dois grupos foram comparados, ambos apresentaram redução dos sintomas do TOC. No entanto, a redução e remissão dos sintomas foram significativamente maiores no grupo da EM+MC seguido da TCCG. Além disso, os resultados positivos foram mantidos após três meses de seguimento com redução adicional de sintomas. CONCLUSÃO Este estudo é o primeiro ensaio clinico randomizado que acrescenta duas sessões individuais de EM+MC à TCCG para aumentar a resposta do tratamento em grupo para o TOC. Apesar de algumas limitações, nossos resultados sugerem que acrescentar duas sessões individuais de EM+MC à TCCG pode aumentar a efetividade da TCCG na redução dos sintomas do TOC. Estudos futuros deverão investigar isoladamente os efeitos da EM e do MC como estratégia de potencialização no tratamento do TOC. / INTRODUCTION According to the Diagnostic and Statistical Manual of Mental Disorders (DSMIV; American Psychiatric Association, 2002), Obsessive-compulsive disorder (OCD) is characterized by recurrent obsessions and/or compulsions that significantly interfere with daily functioning. Although group cognitive behavioral therapy (GCBT) has been effective for OCD patients (Cordioli et al., 2003; Braga et al., 2005; Sousa et al., 2006), almost onethird (30%) of patients did not benefit from this treatment. Motivational Interviewing (MI) and Thought Mapping (TM) have been used to enhance treatment outcome. AIMS The main goal of the present study was to examine the effects of adding individual sessions of MI and TM to 12 weeks of CBGT on the treatment outcome of OCD patients when compared to the CBGT alone. METHODS Ninety-three adult outpatients, with OCD diagnosis according to the DSM-IV participated in a 14-week randomized clinical trial: 48 patients were allocated to two individual sessions of MI+TM in addition to 12-week CBGT; 45 underwent two individual information sessions followed by CBGT. For the outcomes evaluation, the Yale-Brown Obsessive Compulsive Scale (YBOCS) was used as the primary efficacy measure. As secondary efficacy measures, the Clinical Global Impressions Scale (CGI), the Beck Depression Inventory (BDI) and the proportion of responders (defined as improved [reduction 35% on the Y-BOCS] or non-improved [reduction 35% on the Y-BOCS]) and the percentage of patients in partial remission (Y-BOCS 35% but with the total score >8 and CGI 2) and full remission (Y-BOCS 8 and CGI < 2) were used. RESULTS When the two groups were compared, both presented a reduction of OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. In addition, positive outcomes were maintained at the 3-month follow-up with additional symptom reduction. CONCLUSION This study is the first randomized clinical trial which adds individual sessions of MI+TM to CBGT to improve the outcome of group treatment for OCD. Despite some limitations, our results suggest that adding MI+TM to CBGT can enhance the CBGT effectiveness in reducing OCD symptoms. Future studies should investigate the effect of the MI and the TM alone as an augmentation strategy for OCD treatment.

An alarming portion of youth experience traumatic events during childhood, and there is a robust body of literature documenting the adverse consequences of trauma exposure on the developing child. Fortunately, numerous empirically-supported phase-based interventions have been developed for youth that target the deleterious effects of trauma. While several of these interventions have demonstrated symptom reduction from the baseline to completion of treatment, much less is known regarding the trajectory of posttraumatic stress symptoms (PTSS) during the course of treatment. Information in this regard may have important implications for service delivery and help to illuminate the mechanisms of change responsible for treatment outcomes. Furthermore, gender-related differences in the prevalence and expression of PTSS following trauma exposure have been observed, but the reasons for these differences is unclear and there is a paucity of research concerning whether boys and girls may progress differently through trauma-focused treatment. As a result, the aims of this study were to (1) examine the progression of PTSS during the various components of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); (2) assess whether symptoms progress differently for males and females; (3) examine whether (a) sexual abuse history or (b) age moderates any gender-related symptom differences identified; and (4) explore the trauma narratives of boys and girls. This study utilized an embedded sequential mixed methods design. For the quantitative strand, aggregate scores on the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) were mapped for the entire sample and then according to gender at baseline, during various components of TF-CBT, and at termination among a sample (N = 138) of polyvictimized youth ages 7-18 who completed TF-CBT at a university-based child trauma treatment clinic. Mixed Analysis of Variance (ANOVA) analyses were conducted for each of the outcome measures (UCLA-PTSD RI overall, arousal, avoidance, and intrusion scores) to examine whether there were symptom differences between males and females from baseline to completion of TF-CBT, and 2 X 2 full factorial ANOVAs were conducted to determine whether sexual violence history or age moderated the relationship between gender and symptom severity during any phase of TF-CBT. For the qualitative strand, trauma narratives (N = 16) completed during TF-CBT were analyzed through the use of thematic analysis. Findings revealed that males and females reported differences in PTSS symptoms from baseline to termination of treatment, and during various phases of treatment. Additionally, thematic analysis of the trauma narratives augmented findings from the quantitative strand and revealed variations in the narratives of males and females. Although further investigation is warranted, study findings help to further understand the complex interplay between gender and the progression of PTSS during treatment. Implications for practice, policy and social work education are discussed.

The studies presented in this thesis sought to investigate a number of developmental factors that influence the efficacy of preventive intervention for child anxiety disorders. Preventive intervention has emerged as a vital step forward in clinical research following data indicating anxiety disorders are among the most common forms of psychopathology in youngsters (Kashani & Orvaschel, 1990; Mattison, 1992). Several risk and protective factors associated with childhood anxiety disorders have been identified, along with effective treatment protocols (Kendall, 1994; Howard & Kendall, 1996; Barrett, 1998, 1999; Silverman et al., 1999a, 1999b), as prerequisites to the development of preventive programs for child anxiety problems (Spence, 2001). The first objective of this research was to add to the literature on risk and protective factors by investigating the role of peer interaction in the development of child anxiety problems. Study one examined developmental differences in the influence of peer interaction on children's anxiety-related cognition and behaviour. One hundred and sixty two children enrolled in grade 6 (n = 96) aged between 9 and 10 years, and grade 9 (n = 66) aged between 14 and 16 years participated in the study. Participants were stratified into either an at risk group or to a healthy group, based on their anxiety scores on the Spence Child Anxiety Scale (SCAS; Spence, 1997), and further allocated to a peer group comprising of 3 'healthy' (non-anxious) and 3 'at risk' (high anxious) children. Prior to and following a peer discussion, participants completed a standardised self-report measure of threat interpretation and response plans to two ambiguous vignettes (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996). Results showed all participants evidenced changes in threat interpretation and response plans following the discussion with peers (p < .001). Overall, findings highlight the potential importance of peer interaction in the development of anxiety-related cognition and behaviour. The findings of study one have important implications for the future development of school-based intervention programs; specifically those conducted in the classroom. Study two sought to advance the current research on preventive intervention for child anxiety by establishing the age at which youngsters benefit the most from the FRIENDS program as a classroom-based universal intervention. Study two presents the results of a longitudinal study evaluating the effects of a universal school-based intervention for child anxiety at two developmental stages. The study involved a cohort of 733 children enrolled in grade 6 (n = 336, 45.6%) aged between 9 and 10 years, and grade 9 (n = 401, 54.4%) aged between 14 and 16 years, Participants were allocated to either a school-based cognitive behavioural intervention or to a monitoring group. Participants completed standardised measures of anxiety, depression and coping style. Participants identified as 'at risk' of an anxiety disorder were assessed for a clinical diagnosis with a structured diagnostic interview. Results indicated the universal intervention effective in significantly reducing anxiety (p < .001), depression (p < .001) and behaviour avoidance in children at post- intervention and 12-month follow-up intervals. Grade 6 children reported significantly higher anxiety at pre-intervention and greater reductions in anxiety at post intervention compared with the grade 9 (p < .001), although both primary and secondary school participants showed equal reductions in anxiety at 12-month follow up. Overall, findings suggest universal intervention potentially successful in reducing symptoms of anxiety and increasing coping skills in children. Primary school children reported the greatest changes in anxiety symptoms, suggesting earlier preventive intervention potentially more advantageous than later intervention. Developmental differences in anxiety, depression and coping strategies are discussed in addition to the implications and limitations of this study and directions for future research.

<p>Priestley's One-to-One CBT programme is intended to reduce criminal recidivism. Data were collected from 1484 programme rounds in Sweden. 776 of these cases contained the data necessary for this study and were used in the analyses. The data included pre- and postprogramme test scores on areas addressed in the programme. The purpose of this study was to examine whether the tests or background data of participants have predictive properties for dropout and recidivism and whether test scores differ between sub-groups. To do this, t-tests and logistic regression analyses were performed. There were significant improvements on all scores post-programme. Only age predicted completion, with older participants being more likely to complete the program. Several variables were found to have predictive properties for recidivism. The most potent predictor for nonrecidivism was programme completion. The study finds a relation between some of the tests measuring psychological change, and recidivism. This partly supports the theory behind the programme.</p><p> </p>

<p>The purpose of this essay is to perform a comparative study of first a pedagogical/rhetorical and then a therapeutic method, to help students overcome their speech anxiety. My choice stayed at focusing on the academic world and the benefits offered to mainly students. I have chosen two institutions with long experience of work with speech anxiety: Instutionen of Swedish, rhetoric and journalism at Södertörns Högskola and Student Health at Uppsala University. I want to find the advantages and disadvantages of the two universities and in no way define what is more favorable.</p>

The present dissertation consists of three empirical studies on children and adolescents presenting with various specific phobias in Stockholm, Sweden and in Virginia, USA. The overall aim was to contribute to our understanding of childhood fears, anxiety and phobias and to evaluate the efficacy and portability of a one-session treatment of specific phobias in youth. Study I tested the dimensionality of the Parental Bonding Instrument, across three generations and for two countries, and examined if parenting behaviors of indifference and overprotection were associated with more anxiety problems in children. The results showed that the four-factor representation of parental behavior provided an adequate fit for the instrument across informants. Perceived overprotection was associated with significantly more anxiety symptoms and comorbid diagnosis in children. Study II explored parent-child agreement on a diagnostic screening instrument for youths. The results indicated that children scoring high on motivation at treatment entry had generally stronger parent-child agreement on co-occurring diagnoses and severity ratings. Parents reported overall more diagnoses for their children, and parents who themselves qualified for a diagnosis seemed more tuned in to their children’s problematic behavior. Study III compared a one-session treatment with an education-supportive treatment condition, and a wait-list control condition for children presenting with various types of specific phobias. The results showed that both treatment conditions were superior to the wait-list control condition and that one-session exposure treatment was superior to education-supportive treatment on several measures. Treatment effects were maintained at a 6-month follow-up. Overall, the above findings suggest that the one-session treatment is portable and effective in treating a variety of specific phobias in children and adolescents.

Four interrelated studies on drug users in prison are presented within the framework of a proposed model for approaching the enhancement of health for persons that builds on an existential view of prisoners’ needs, as well as the risk management and “good lives” perspectives. Risk management is the major focus in current offender rehabilitation based on research on “what works,” which has shown that focusing treatment on risk factors termed “criminogenic needs,” such as impulsivity, poor family relations and drug abuse, reduces recidivism by 10-15 percentage points. The “good lives” perspective proposes that offender rehabilitation should go beyond risk management and also address non-criminogenic needs such as autonomy, relatedness and competence as foundations for building personally meaningful lives. Study I explores the assessment of drug use problems, and describes the psychometric evaluation of the Drug Use Disorders Identification Test (DUDIT), a newly developed 11-item test for quick screening of drug-related problems. Studies II-IV explore treatment for offenders in prison identified as drug users. Study II is a randomized controlled trial of two auricular acupuncture treatments for men and women in prison, inconclusive with regard to point specificity but showing that participants in both groups reported reduced symptoms of discomfort and improved night-time sleep. Study III evaluates the Reasoning &amp; Rehabilitation program, an internationally widespread cognitive-behavioral program for groups of offenders. Results showed significant pro-social short-term changes in sense of coherence, impulsivity and attitudes towards the criminal justice system, as well as a 25% lower risk of reconviction among program completers compared to matched controls. However, the quasi-experimental nature of the study precludes any certainty regarding program effects; a selection bias whereby more motivated program participants are recruited could explain the findings. Study IV is a pilot project exploring the special needs of a subgroup of drug-using inmates with psychiatric and/or violent co-morbidity. Inmates housed in psychiatric prison units were offered long-term auricular acupuncture treatment. Half of the 22 inmates in the study received treatment twice a week for over eight weeks, and those treated over 25 times had lower psychopharmacological medication levels than untreated controls. Studies I-IV address individual facets of a proposed model for enhancing health among drug users in prison. The health enhancement model approaches offender rehabilitation from perspectives of existential psychology, good lives and risk management. Specific definitions of physical, social, psychological/personal and spiritual needs indicate a framework according to which prison treatment can help drug-using offenders find ways to secure healthy need satisfaction.

Stress and monotonous work contribute substantially to the development of chronic musculoskeletal disorders. Yet, the pathophysiological mechanisms underlying the process, particularly the involvement of autonomic regulation, remain unclear. It has been suggested that altered motor control resulting from distorted sensory information from fatigued muscles may be an important component in the development of musculoskeletal disorders. Animal studies have shown that sympathetic nervous system activation exerts actions in skeletal muscles, such as vasoconstriction and modulation of afferent information from muscle spindles. However, few attempts have been made to address this issue in humans. Therefore, the first aim of the thesis was to investigate the impact of repetitive computer work with and without additional stressors on muscle oxygenation and position sense in the upper extremity. Assuming an important role of stress in the development of chronic musculoskeletal symptoms, one may expect open or latent manifestations of such symptoms in patients with non-specific stress-related illnesses. It is possible that sympathetic activation may influence pain perception, and that treatments aimed at reducing stress may also affect the pain experience. Thus, the second aim of the thesis was to evaluate the effects of a cognitive-behavioral training program and a physical activity program for patients with stress-related illnesses on autonomic reactivity, pain, and perceived health. First, a laboratory model of computer mouse use was characterized in terms of biomechanical exposure of the wrist, and wrist position sense was determined before and after 45 minutes of continuous mouse use. Then, the effects of performing the computer mouse work under time pressure and precision demands were determined. Autonomic activity and muscle oxygenation in the upper extremity were measured during the work, and wrist position sense was assessed before and after the work. When patients with stress-related illnesses were compared to healthy individuals in autonomic reactivity to functional tests, pressure-pain thresholds, and ratings of health, indications of a relation between autonomic reactivity and symptoms of pain was found. Hence, in a subsequent evaluation of a cognitive-behavioral training program and a physical activity program for patients with stress-related illnesses, post intervention effects on autonomic reactivity to functional tests, pressure-pain thresholds, ratings of health and return-to-work were studied during a period of 12 months after the intervention. The main findings were the following. 1) Wrist kinetics data obtained during the computer mouse work showed similarities to previously presented data for mouse-operated design tasks. 2) When time pressure and precision demands were added to the computer work, increased autonomic activity paralleled with decreased muscle oxygenation in the upper extremity was found. Wrist position sense accuracy, however, did not decrease after the work as it did when the work was performed without the additional demands. The result is intriguing, as it does not appear to be in concordance with previous animal studies. 3) Patients with stress-related illnesses showed higher autonomic reactivity to cognitive and physical laboratory tests than healthy control subjects. They also had substantially lower pressure-pain thresholds in the back, and rated poorer health and health-related behavior than the control subjects. 4) We found little difference in effect of cognitive-behavioral training and physical activity, compared to usual care, for patients with stress-related illnesses. Patients in the control group showed an improvement of about the same magnitude as in the treatment groups over the 12-month follow-up period. The present findings indicate a non-additive relation between autonomic activity during repetitive work and position sense inaccuracy. Furthermore, patients with stress-related illnesses often reported pain in the neck, shoulders, and lower back. This was associated with lower pressure-pain thresholds in the back and a modest increase in sympathetic reactivity to physical and mental tests, which might suggest a potential use of these methods in the clinical examination and rehabilitation of patients with stress-related illnesses.