A skill instruction technique based on cognitive behavioral principles was applied to thermal imagery to determine if it could enhance either subjective or physiological responsiveness. The effects of imagery instruction were compared with the effects of muscle relaxation on imagery vividness, thermal imagery involvement, and the finger temperature response. The subjects were 39 male and 29 female volunteers from a minimum security federal prison. The personality characteristic of absorption was used as a classification variable to control for individual differences. It was hypothesized that high absorption individuals would reveal higher levels of imagery vividness, involvement, and finger temperature change; that imagery skill instruction and muscle relaxation would be more effective than a control condition; and that the low absorption group would derive the greatest benefit from the imagery task instruction condition. None of the hypotheses was supported. Finger temperature increased over time during the experimental procedure but remained stable during thermal imagery. The results suggest that nonspecific relaxation effects may best account for finger temperature increases during thermal imagery. Results were discussed in relation to cognitive-behavioral theory and the characteristic of absorption.

The child-therapist alliance is believed to be a critical ingredient of successful psychotherapy for youth depression. However, only a few studies have examined the association between the alliance and clinical outcomes in the treatment of youth depression. The present thesis examined the alliance-outcome association in two treatments for youth depression: cognitive-behavioral therapy (CBT) and usual clinical care (UC). Data were from an effectiveness trial conducted in six community clinics (see Weisz et al., 2009). Forty-one youth were randomly assigned to receive CBT or UC from community clinicians. The observed early alliance, alliance shifts, and self-reported alliance did not significantly predict child- or parent-reported depression outcome. However, the direction and strength of the alliance-outcome associations differed across alliance methodology (self- and observer-report) and condition (CBT and UC). Early child alliance did significantly predict treatment satisfaction. Implications and limitations of the results are discussed.

Combat and war zone veterans are particularly vulnerable to developing Posttraumatic Stress Disorder (PTSD) due to the increased risk of experiencing trauma inherent in military service. Insomnia and nightmares are core symptoms of PTSD and can be factors in the development, maintenance, and exacerbation of PTSD. However, sleep disturbance has received relatively little attention from a treatment point of view until recently. Recent research has demonstrated that cognitive behavioral therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares are effective stand alone and combination treatments for sleep disturbance in civilian and veteran populations. Although group interventions are lower in cost and more efficient to deliver in a VA setting, studies have yet to test the feasibility and efficacy of group CBT-I/IRT combination treatment for veterans with PTSD. The current pilot study investigated the feasibility and efficacy of a combined CBT-I and IRT protocol intervention for insomnia and nightmares delivered in a group format to a sample of mixed theater veterans with PTSD. Participants (n = 34) were randomly assigned to either a treatment (n = 17) or waitlist control condition (n = 17). After baseline assessment, participants assigned to the treatment condition participated in six weekly group sessions of combined CBT-I and IRT and completed posttreatment and two month follow-up assessments. Those in the waitlist condition completed a six week waiting period. After completing post-waitlist assessment, they were given the opportunity to receive the treatment. Authors hypothesized that those in the treatment condition would experience significant improvement on self-report measures of sleep, nightmare frequency, PTSD-related sleep disturbance, beliefs about sleep, and overall PTSD and depression severity compared to the waitlist condition at posttreatment and two-month follow-up. These hypotheses were largely supported by the study results with some notable exceptions. Significant condition by time interactions were found on measures of sleep and nightmares, beliefs about sleep, and depression at posttreatment. Treatment gains were maintained at two month follow-up for sleep variables but not nightmare frequency or depression. There were no condition by time interactions for measures of PTSD or PTSD-related sleep disturbance at posttreatment. In sum, the findings of this study indicate that a combined CBT-I and IRT delivered in a group format was effective in reducing insomnia symptoms, nightmare frequency, and depression in a sample of mixed theater veterans with PTSD. The study also demonstrated the feasibility of this treatment approach with this population suggesting that a larger randomized controlled study is warranted.

The field has developed many evidence-based treatments (EBTs); the integrity of EBTs being delivered, however, has been studied less than rigorously. Because many treatment manuals are developed to be delivered session-by-session, one way to assess treatment adherence, specifically, is across the course of the case: do therapists deliver treatment components in the order prescribed? The goals of this study were to characterize how therapists deviate from prescribed order and how adherence to order relates to child characteristics. Therapy process data were collected from a subsample of children (N = 33, aged 7-15) that received cognitive behavioral therapy (CBT) to address primary symptoms of anxiety. Adherence to CBT was measured by the CBT Adherence Scale for Youth Anxiety (Southam-Gerow & McLeod, 2011). Four methods to assess order were developed. Analyses include descriptive and correlative statistics that characterize the delivery of CBT and the relation between adherence to order and pretreatment characteristics.

Insomnia is defined as difficulty initiating or maintaining sleep, or nonrestorative sleep that lasts for at least one month and is accompanied by significant impairment in daytime functioning including fatigue, irritability, and/or difficulty concentrating. It is one of the most common complaints reported by individuals with cancer, especially around the time of cancer diagnosis and treatment. Yet it is often unrecognized and untreated, leading to adverse health consequences and increased healthcare costs. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recommended as the gold standard for treating insomnia among individuals with cancer. Multiple studies have tested and proven the efficacy and effectiveness of CBT-I among individuals with cancer. However, only one study has investigated the efficacy of CBT-I in individuals newly diagnosed with cancer who are undergoing cancer treatment. Moreover, previous studies have been limited by their focus on largely homogenous samples of White, well-educated women with breast cancer. The dissemination of CBT-I among individuals with cancer is greatly limited by the lack of available providers and resources needed to implement the standard face-to-face treatment. One strategy to address this shortage has been to abbreviate standard CBT-I into low-intensity modalities that require fewer resources and can be self-administered on the Internet. The current study sought to examine the feasibility and acceptability, as well as the efficacy of one such program, an online low-intensity CBT-I intervention, Sleeping Healthy Using the Internet (SHUTi), supplemented with clinician support, in a sample of individuals newly diagnosed with heterogeneous malignancies who were undergoing chemotherapy and/or radiation. Results yielded support for the feasibility and acceptability of addressing individuals’ insomnia with a low-intensity CBT-I intervention while they are undergoing cancer treatment. With regard to sleep, there were significant treatment effects observed on a global measure of insomnia severity and on subjective sleep consolidation. There were also significant treatment effects for depressive symptoms. Findings are discussed in the context of study limitations and for the purpose of expanding the literature on disseminating CBT-I early in the cancer care trajectory.

Brief, easy to use, psychometrically strong (i.e., pragmatic) instruments are needed to support implementation research; the current study assessed whether it was possible to develop a pragmatic observational treatment integrity instrument and reduce the amount of time coders spend making treatment integrity ratings (while maintaining score validity) of therapists delivering two protocols of individual cognitive-behavioral treatment (ICBT) for youth anxiety in research and practice settings. The 12-item instrument was derived from four observational treatment integrity instruments with promising score reliability and validity that assess adherence, competence, differentiation, and alliance. A sample of 106 youths (M age = 10.12, SD = 1.81, ages 7-14; 42.50% Female; 69.80% Caucasian) received one of three treatments to address anxiety: standard ICBT in a research setting (n = 51) or standard ICBT (n = 22), modular ICBT (n = 16), or usual care (UC; n = 17) in practice settings. Four coders independently coded five- and 15- minute segments sampled from four sessions from each client (N = 756 sessions). Ten percent of sessions were double-coded for reliability purposes. Reliability, sensitivity to change, construct validity, and predictive validity from the two segments were compared to full session treatment integrity scores independently archived in a study assessing the same clients. Across five- and 15-minute segments, the instrument produced promising score reliability and convergent validity evidence for adherence, competence, and alliance items (items intended for inclusion in ICBT for youth anxiety; M ICCs = .62, SD = .17; M rs = .58, SD = .12) and poor score reliability and validity evidence for differentiation items (items intended for inclusion in other treatment domains; M ICCs = .21, SD = .28; M rs = .27, SD = .25). This study met its primary aim, to develop an instrument that can be coded in less than 20 minutes while maintaining evidence of score validity. Researchers interested in developing such instruments can use this study design as a roadmap. Future research should investigate whether psychometric findings replicate across samples, why certain items (e.g., client-centered interventions) did not evidence score validity, and how this type of instrument can inform EBT training.

O futebol é um esporte coletivo, em que desempenhos individuais podem definir o resultado de um jogo ou de um campeonato. Especialmente em cobranças de pênalti, o destino da partida encontra-se nos pés do cobrador. A ansiedade no momento das cobranças de pênalti em jogos de futebol de campo é um dos motivos que podem fazer com que um jogador de futebol não converta a cobrança em gol. Neste estudo experimental controlado foi testado um protocolo de biofeedback e psicologia cognitivo-comportamental com o objetivo de reduzir o estado de ansiedade em atletas de futebol amadores de futebol de campo de 15 e 16 anos de idade. Os participantes do grupo experimental foram avaliados antes de duas competições de pênaltis, que aconteceram antes e depois de quatro encontros de intervenção com o protocolo de biofeedback e psicologia cognitivo-comportamental para a redução de ansiedade dos jogadores de futebol que participaram do grupo ativo, em relação ao grupo controle / Soccer is a collective sport in which individual performances can define the outcome of a game or a championship. Especially at penalties shootouts, the destination of the match is at the feet of the penalty taker. Anxiety at the time of penalty kicks at soccer matches is one of the reasons why a soccer player may not score the goal. In this controlled experimental study, a protocol of biofeedback and cognitive-behavioral psychology was tested with the objective of reducing the state anxiety in 15 and 16 year old amateur soccer athletes. Participants in the experimental group were assessed before two penalty shoot-outs, which took place before and after four intervention sessions with a biofeedback and cognitive-behavioral psychology protocol. The results showed that the protocol was efficient as a method and effective in reducing the anxiety state of soccer players who participated in the experimental group, in comparison to the control group

A família é um componente fundamental para o desenvolvimento e socialização infantil. Práticas educativas parentais adequadas e consistentes influenciam positivamente o repertório comportamental e emocional da criança, além do relacionamento intrafamiliar. No entanto, apesar da necessidade de orientar pais ser amplamente mencionada na literatura, há poucas intervenções estruturadas descritas que visem esse objetivo, sobretudo anteriores ao surgimento de queixas clínicas infantis. Mais escassas ainda são as modalidades de orientação de pais que incorporam aspectos cognitivos e emocionais. Este estudo visa contribuir com a aquisição e aprimoramento de práticas educativas parentais adequadas e investir em uma melhor interação familiar, ao propor e investigar o PROPAIS II, um programa de orientação de pais Cognitivo-Comportamental de duração breve. Este se volta para pais de crianças em idade escolar e finalização da educação infantil e enquadra-se no contexto de promoção de saúde, sendo realizada em instituições não governamentais de educação e fortalecimento de vínculos. Participaram do estudo 25 pais ou cuidadores de crianças, de duas instituições não governamentais de grande porte do Interior de São Paulo. Os instrumentos utilizados foram: Child Behavior Checklist (CBCL 6/18 anos), Escalas de Qualidade na Interação Familiar (EQIF-versão pais) e Critério de Classificação Econômica Brasil (CCEB). Os participantes foram submetidos às seis sessões do Programa e duas sessões de testagem, uma anterior e uma posterior ao grupo interventivo. O Programa foi aplicado em grupos, com média de cinco participantes cada, sendo oferecido em seis grupos independentes. Para verificar a efetividade do Programa para os participantes foram realizadas análises quantitativa dos dados comparando os escores pré e pós-intervenção e análise qualitativas dos relatos dos pais nas sessões e na avaliação final, coletadas por registro das falas durante as sessões. O intervalo de confiança adotado para o estudo foi de 95%. Os resultados indicam que os participantes obtiveram melhoras significativas na Interação Familiar, adotando práticas educativas mais positivas e adequadas, ganhando também maior consciência acerca de seus sentimentos, comportamentos e emoções. Sugerem também ampliação da compreensão do comportamento de seus filhos e dos próprios, relacionados ao educar, sinalizando a importância da inserção do Modelo Cognitivo na orientação de pais. As queixas comportamentais infantis, na percepção dos pais, mostraram modificações quanto a problemas externalizantes, sobretudo agressividade. Os resultados obtidos após as seis sessões apontam para a importância de se investir no treinamento para aquisição de melhores práticas educativas parentais e interação familiar mais saudável. O estudo sinalizou também dificuldades na adesão dos pais para formação dos grupos, justificando novos investimentos para compreensão de fatores relacionados à baixa adesão e para que abarque mais participantes. / Family is a key to child\'s development and socialization. Appropriate and consistent parenting practices positively influence the behavioral and emotional repertoire of the child and the intrafamily relationship. However, despite the need to counsel parents be widely reported in the literature, structured interventions aimed at this goal are scarcely represented in the literature, especially prior to the emergence of children\'s clinical complaints. Rarer still are the modalities of parents\' guiding incorporating cognitive and emotional aspects. This study aims to contribute to the acquisition and improvement of appropriate parenting practices and invest in a better family interaction, while proposing to investigate the PROPAIS II, a brief Cognitive-Behavioral program of parents\' guiding. This program aims to parents of school- age children and completion of early childhood education and fits in the context of health promotion, being performed in non-governmental educational institutions and strengthening of bonds. Study participants were 25 parents or caregivers of children, two non-governmental institutions of Ribeirão Preto - SP. The instruments employed were the Child Behavior Checklist (CBCL 6/18 years), Scales of Quality Family Interaction (EQIF-parent version) and Brazil Economic Classification Criterion (CCEB). Participants underwent six sessions of the program and two testing sessions, one before and one after the interventive group. The program was applied in groups, averaging five participants each, being offered in six independent groups. To assess the effectiveness of the program for participants, quantitative data analysis were employed, comparing pre and post intervention, and qualitative analysis using parental reports at sessions and final assessment scores collected by recording the speeches during the sessions were made. The confidence interval for the study was 95%. The results indicate that participants experienced significant improvements in Family Interaction, adopting more positive and appropriate educational practices, also gaining greater awareness of feelings, behaviors and emotions. Results also suggest expanding the understanding of the behavior of their children and themselves, related to education, signaling the importance of inserting the Cognitive Model in parental guiding. Child behavioral complaints and parents\' perception showed changes as externalizing problems, particularly aggression. Results after six sessions point out to the importance of investing in training to acquire better parenting practices and healthy family interaction. The study also signaled difficulties in adhering to parent guiding groups, justifying new investments for understanding factors related to poor adherence and encompassing more participants.

Made available in DSpace on 2015-03-05T19:35:31Z (GMT). No. of bitstreams: 0 Previous issue date: 22 / Nenhuma / A Doença Pulmonar Obstrutiva Crônica (DPOC) é uma patologia frequentemente acompanhada de um aumento dos sintomas de ansiedade e depressão. O objetivo desta dissertação foi investigar o efeito de uma intervenção psicológica cognitivo-comportamental associada à Psicoeducação nos sintomas de ansiedade, depressão e qualidade de vida em pacientes com DPOC. Participaram da pesquisa 22 pacientes divididos aleatoriamente em três grupos. Os pacientes do primeiro grupo (n=7) receberam o atendimento padrão do hospital. O segundo (n=8), o atendimento padrão e sessões de Terapia Cognitivo-Comportamental (TCC) e, para o terceiro (n=7), todo o procedimento anterior acrescido de uma sessão de Psicoeducação. Os participantes foram avaliados antes e após o atendimento com o Inventário Beck de Ansiedade e Depressão e o Saint George’s Respiratory Questionnaire (SGRQ), para a Qualidade de vida. Os dados foram analisados com técnicas estatísticas não-paramétricas para medidas repetidas. Os resultados indicaram que os participante / The Chronic Obstructive Pulmonary Disease (COPD) is a pathology often accompanied by an increase of anxiety and depression symptoms. The goal of this dissertation was the inquiry on the effects of a cognitive-behavioral psychological intervention associated to a psychoeducation of anxiety and depression symptoms, as well as quality of life, in patients with COPD. 22 patients randomly divided into three groups participated in the research. The patients of the first group (n=7) received the hospital’s medical standard of care. The second group (n=8) received the medical standard of care and cognitive-behavioral therapy sections (CBT) and the third group (n=7) received the procedures mentioned before with one psychoeducation section added. The participants were evaluated before and after the treatment, with the Beck Anxiety and Depression Inventory and the Saint George’s Respiratory Questionnaire (SGRQ), to quality of life. The data were analyzed with techniques from non-parametric statistics to repeated measur

Apesar de constituírem parte fundamental da prática clínica em psiquiatria e saúde mental, as psicoterapias ainda são pouco investigadas do ponto de vista científico. Este estudo tem o objetivo de examinar as preferências de profissionais da saúde mental em relação às escolas de psicoterapia ao longo da história e investigar a aplicação clínica corrente de uma das abordagens psicoterápicas mais praticadas na atualidade. Tanto quanto sabemos, este é o primeiro estudo a conduzir uma revisão sistemática e metaregressão que examina as prevalências globais de orientações teóricas entre psicoterapeutas ao longo dos últimos 50 anos, e especialmente na ultima década, conforme apresentado no primeiro artigo. A utilização no momento atual de intervenções cognitivo-comportamentais para um amplo espectro de transtornos psiquiátricos e outras condições médicas foi o objeto de estudo do segundo artigo. Por meio de busca computadorizada de artigos da literatura em bancos de dados eletrônicos, conduzimos uma revisão sistemática de pesquisas realizadas com profissionais de saúde que investigaram sobre suas afiliações a escolas psicoterápicas publicadas no período entre 1960 e 2012. Sessenta artigos que apresentavam dados originais com porcentagens específicas de preferências dos terapeutas por uma das 5 escolas de psicoterapia de maior preferência foram incluídos na análise. Posteriormente foi realizada uma segunda revisão sistemática de todos ensaios clínicos randomizados (ECRs) publicados no ano de 2014 que descreviam a comparação de uma intervenção cognitivo-comportamental com outra forma de intervenção psicossocial ou tratamento médico. Trezentos e noventa e quatro ECRs foram identificados e incluídos na análise final. Os dados analisados no primeiro estudo demostram que na ultima década a terapia cognitivo-comportamental (TCC) é o modelo teórico praticado por cerca de 28% dos psicoterapeutas pesquisados, seguido pela abordagem eclética/integrativa praticada por cerca de 23% dos profissionais. A orientação teórica psicanalítica e psicodinâmica foi endossada por 15% dos profissionais de saúde pesquisados. No segundo estudo, dados extraídos de artigos publicados no ano de 2014 revelaram que cerca de 58.000 indivíduos foram submetidos a intervenções cognitivas e comportamentais para tratamento de 22 diferentes diagnósticos médicos e psiquiátricos. Conforme esperado, 20% dos ensaios abordaram tratamentos para transtornos depressivos. Outras condições médicas, como tratamentos para dores e fadiga crônicas, e sintomas colaterais de tratamentos para o câncer, foram tratadas com intervenções cognitivas e comportamentais em 75 estudos, 19% do total. Um em cada 4 estudos foi feito em grupo; 65/394 estudos realizaram intervenções via computador; e quase todos (95% do total) foram realizados em países de alta renda econômica. Há um interesse crescente na utilização do modelo cognitivo-comportamental de psicoterapia por parte dos profissionais de saúde mental. Desde que iniciou sua trajetória, esta abordagem foi a única dentre as 5 estudadas que apresentou aumentos sistemáticos na porcentagem de terapeutas que professavam sua utilização na prática clinica. Um grande número de resultados de ECRs realizados em um único ano, com amostras de estudos conduzidos em todos quadrantes do planeta, relatando sua utilização cada vez mais abrangente para diferentes condições clínicas, demonstra a tendência de consolidação definitiva das terapias cognitivas comportamentais em nosso arsenal terapêutico. / Despite being an essential part of clinical practice in psychiatry and mental health, psychotherapies are still poorly investigated from a scientific point of view. This study aims to examine the endorsements of mental health professionals to psychotherapeutic orientations throughout history and to investigate the current clinical applications of one of the most practiced psychotherapeutic approaches. To our knowledge, this study is the first one to conduct a systematic review and meta-regression examining the prevalence of theoretical orientations amongst psychotherapists worldwide in the last 50 years, particularly in the last decade, as presented in the first article. The current uses of cognitive-behavioral interventions in a wide scope of psychiatric and other medical disorders was the second article focus. From a computerized literature search, we conducted a systematic review of the literature identifying any research conducted with health professional published in the period between January 1960 and December 2012. Sixty papers containing original data about the single preferred orientation of psychotherapists for one of the five most endorsed schools of psychotherapy were included in the final analysis. Then a second systematic review of the literature of all published papers in the year of 2014 describing randomized controlled trials that compared cognitive behavioral therapies with another form of psychosocial intervention or medical treatment was conducted. Three hundred ninety four studies were identified and included in the final analysis. The analysis of the data from the first study shows that in the last decade cognitive-behavioral therapy is the theoretical model practiced by around 28% of the researched psychotherapists, followed by the eclectic/integrative approach preferred by around 23% individuals. The psychoanalytic and psychodynamic theoretical orientation was endorsed by 15% of health professionals. In the second study, extracted data from papers published in the year of 2014 revealed that around 58,000 individuals underwent cognitive and behavioral interventions for the treatment of 22 different medical and psychiatric diagnoses. As expected, treatments for depressive disorders were the focus in 20% of trials. Other medical conditions, as chronic pain and fatigue, and collateral symptoms of cancer treatments, and insomnia, were treated with cognitive behavioral interventions in 75 studies, 19% of total. One in every 4 studies conducted group treatments; 65/394 studies performed computer-assisted psychosocial interventions; and almost all (95% of total) were conducted in high-income economy countries. There is a growing interest by mental health professionals in the cognitivebehavioral model. Since its appearance, this approach was the only one amongst the 5 studied that showed systematic increases in the percentages of therapists’ endorsements. The high number of randomized clinical trials conducted in a single year, with study samples from all planet quadrants, reporting an increasingly widespread use for different clinical conditions, demonstrates a definite consolidation of cognitive behavioral therapies in our therapeutic arsenal.