Anxiety is a commonly diagnosed disorder in middle childhood that affects many aspects of the child’s life. Effective treatment is needed so that children are able to experience fewer or no symptoms of anxiety and to manage anxiety. Cognitive behavioral treatment (CBT) is widely used as a treatment for children with anxiety. CBT can either be facilitated in an individual or group format but there are inconsistencies in the literature regarding which modality is most effective. A meta-analysis was conducted to compare the effectiveness of individual CBT (ICBT) and group CBT (GCBT) in treating school-aged children with anxiety disorders. Eligible studies focused on the Coping Cat program for ICBT or GCBT programs such as FRIENDS. Participants from the selected studies were between the ages of 5-12 years and were treated by either ICBT or GCBT. Effect sizes were calculated from post-intervention measures and combined to examine group differences. It was found that ICBT was associated with a very large effect size (1.05) and GCBT (0.54) had a large effect size. This suggests that ICBT is the superior treatment modality as children who received individualized treatment reported a greater reduction or elimination of anxiety symptoms. Individual treatment allows opportunity for the therapist to work with the child and their families whereas in GCBT, there is less time to create treatment plans that are uniquely tailored. A proposed ICBT program is outlined that addresses a richer family component and social skills training.

<p>The objective of this work was to investigate reflective-functioning (RF) as a measure of process in two independent studies that included three types of brief psychotherapy. RF is defined as the ability to recognize the existence and nature of mental processes taking place in the self and in others (e.g., intentions, beliefs, desires, and wishes). Theorists have suggested the ability for RF is crucial for predicting social causality and low RF has been found related to mental disorders. It has recently been suggested in the literature that improved ability for RF might be an important component of successful psychotherapy outcome, especially with respect to achieving structuralchange. RF was in this work investigated during the process through discourse analysis of the patients’ narratives of self-other interactions in the treatment sessions. The Psychotherapy Process Q-set (PQS) was implemented in order to isolate specific components of the process (process correlates) that identified high and low RF and to investigate the links between the process correlates and outcome. The first study investigated 29 cases of cognitive-behavioral therapy(CBT) and 35 cases of interpersonal psychotherapy (IPT) with an average treatment length of 16.2 sessions in a sample from the National Institute of Mental Health (NIMH) randomized clinical trial Treatment of Depression Collaborative Research Program (TDCRP). The sample in the first study consisted of 128 sessions in total, were one session from the early part (on average the 4th session) and one session in the later part of the treatment (on average the 12th session) were rated for RF. The second study investigated a sample of 30 cases of brief psychodynamic psychotherapy (BPDT) with an average treatment length of 15.8 sessions in a naturalistic designand obtained from the Mount Zion Psychotherapy Research Group. In total, the second study included 90 sessions of BPDT, and RF was assessed during the 1st, the 5th, and the 14th session of each treatment. The results from these two studies suggested that the patients’ ability for RF, as measured through the discourse from therapy sessions, is stable (in CBT and BPDT) or decreased(IPT) during the treatments. Furthermore, the process correlates defining high RF had a relation with good outcome, and process correlates defining low RF had a relation with poor outcome.The process correlates identified during the PQS-analysis suggested that both high and low RF was linked with personality characteristics in the patients. For example, high RF was linked to patients’ ability for introspection, expression of negative emotions, and commitment to treatment.Low RF was linked to patients’ expression of passivity, defensiveness, and suspiciousness. This work supported theorists’ suggestions that brief treatments are supportive in their nature and therefore do not promote structural changes (e.g., changes in RF). It is suggested that the abilityfor RF as assessed pre-treatment might be a useful predictor for success in brief psychotherapy and could therefore be used as a patient inclusion criteria for such treatments.</p>

The objective of this work was to investigate reflective-functioning (RF) as a measure of process in two independent studies that included three types of brief psychotherapy. RF is defined as the ability to recognize the existence and nature of mental processes taking place in the self and in others (e.g., intentions, beliefs, desires, and wishes). Theorists have suggested the ability for RF is crucial for predicting social causality and low RF has been found related to mental disorders. It has recently been suggested in the literature that improved ability for RF might be an important component of successful psychotherapy outcome, especially with respect to achieving structuralchange. RF was in this work investigated during the process through discourse analysis of the patients’ narratives of self-other interactions in the treatment sessions. The Psychotherapy Process Q-set (PQS) was implemented in order to isolate specific components of the process (process correlates) that identified high and low RF and to investigate the links between the process correlates and outcome. The first study investigated 29 cases of cognitive-behavioral therapy(CBT) and 35 cases of interpersonal psychotherapy (IPT) with an average treatment length of 16.2 sessions in a sample from the National Institute of Mental Health (NIMH) randomized clinical trial Treatment of Depression Collaborative Research Program (TDCRP). The sample in the first study consisted of 128 sessions in total, were one session from the early part (on average the 4th session) and one session in the later part of the treatment (on average the 12th session) were rated for RF. The second study investigated a sample of 30 cases of brief psychodynamic psychotherapy (BPDT) with an average treatment length of 15.8 sessions in a naturalistic designand obtained from the Mount Zion Psychotherapy Research Group. In total, the second study included 90 sessions of BPDT, and RF was assessed during the 1st, the 5th, and the 14th session of each treatment. The results from these two studies suggested that the patients’ ability for RF, as measured through the discourse from therapy sessions, is stable (in CBT and BPDT) or decreased(IPT) during the treatments. Furthermore, the process correlates defining high RF had a relation with good outcome, and process correlates defining low RF had a relation with poor outcome.The process correlates identified during the PQS-analysis suggested that both high and low RF was linked with personality characteristics in the patients. For example, high RF was linked to patients’ ability for introspection, expression of negative emotions, and commitment to treatment.Low RF was linked to patients’ expression of passivity, defensiveness, and suspiciousness. This work supported theorists’ suggestions that brief treatments are supportive in their nature and therefore do not promote structural changes (e.g., changes in RF). It is suggested that the abilityfor RF as assessed pre-treatment might be a useful predictor for success in brief psychotherapy and could therefore be used as a patient inclusion criteria for such treatments.

Abstract  Individual psychological factors have been recognized to play an important role in the development of stress-related symptomatology. Despite extensive comorbidity between stress-related ill health and mood disorders, the advances in research on emotion regulation and transdiagnostics, have not been recognized in stress research to any considerable degree. In the current study, using a single subject design with multiple baselines across individuals (n=6), a transdiagnostic treatment intervention targeting maladaptive emotional regulation strategies was implemented on patients suffering from stress-related symptomatology. Results show that symptoms of exhaustion decreased in five of six participants on post-measures, with considerable convergence between measures of depression, anxiety and stress. Further investigation of treatment effects, alongside the processes linking emotion regulation and stress-related symptomatology are needed. / Sammanfattning  Individuella psykologiska faktorer spelar en viktig roll i utvecklingen av stressrelaterade symtom. Trots en omfattande samsjuklighet mellan å ena sidan stressrelaterad ohälsa, å andra sidan depression och ångest, har framsteg inom emotionsforskning och transdiagnostik inte uppmärksammats i någon stor utsträckning inom stressforskningen. I den aktuella studien användes en single subject design med multipla baslinjer mellan individer (n=6), för att implementera en emotionsinriktad transdiagnostisk behandling på patienter som lider av stressrelaterade symtom. Resultaten visar att fem av sex deltagare visade minskade tecken på utmattning efter genomgången behandling, med avsevärd konvergens mellan mått på depression, ångest och stress. För att kunna påvisa behandlingseffekter, samt förklara de processer som förbinder emotionsreglering och stressrelaterade symtom, behövs ytterligare forskning på området.

Severe motor vehicle accidents (MVAs) represent one of the most often occurring psychological traumas, and are a leading cause of Posttraumatic Stress Disorder (PTSD). However, not all persons develop PTSD after traumatic events and a great proportion of patients who show symptoms initially recover over time. This has stimulated research of psychological and biological factors that explain development and maintenance of the disorder. Fortunately, this highly distressing condition can be effectively treated, e.g. via cognitive behavioral therapy (CBT). However, brain mechanisms underlying changes due to psychological therapy in PTSD are almost unknown (Roffman, Marci, Glick, Dougherty, &amp; Rauch, 2005). On the other hand there are observations of positive changes following trauma called Posttraumatic Growth (PTG), which have stimulated research of associated psychological processes and factors. However, there is a lack of research about the relation of biological variables (e.g. measures of brain function) and PTG. Theories of brain asymmetry and emotion (Davidson, 1998b, 2004b; Heller, Koven, &amp; Miller, 2003) propose that asymmetries of brain activation are related to certain features of human emotion (e.g. valence, approach or withdrawal tendencies, arousal). Whereas an enormous increase in the understanding of structural and functional abnormalities in PTSD could be achieved in the last decades due to neuroimaging research, there are still numerous unanswered questions. Especially, there is only little research explicitly examining activation asymmetries in PTSD. Furthermore, as mentioned, research is sparse investigating alterations of brain function that are associated with successful psychological treatment of PTSD. Finally, there is no published study examining how measures of brain function are related to PTG. This thesis presents 3 studies investigating electroencephalographic (EEG) asymmetries in survivors of severe motor vehicle accidents. The first part of the thesis (chapter 2) is devoted to a literature review about description (chapter 2.1), epidemiology (chapter 2.2 and 2.3), risk factors (chapter 2.4), psychological theories (chapter 2.5), biological mechanisms particularly neuroimaging findings (chapter 2.6), and treatment of PTSD (chapter 2.7.). Chapter 2.8 gives a short review on definition and research of Posttraumatic Growth. Chapter 2.9 provides an overview of models and research regarding brain asymmetry and emotion. In chapter 3.1, a study is presented that investigated hemispheric asymmetries (EEG alpha) among MVA survivors with PTSD, with subsyndromal PTSD, and without PTSD as well as non-exposed healthy controls during a baseline condition and in response to neutral, positive, negative, and trauma-related pictures (study I). Next, the findings of study II are presented (chapter 3.2). This study examined the effect of cognitive behavioral therapy on measures of EEG activity. Therefore, EEG activity before and after CBT in comparison to an assessment only Wait-list condition was measured. In chapter 3.3 a correlational study (study III) is presented that examined the relationship between frontal brain asymmetry and selfreported posttraumatic growth after severe MVAs. Finally, in chapter 4 the findings are summarized and discussed with respect to (1) the state/trait debate in frontal asymmetry research and (2) current psychological theories of PTSD and PTG. In addition, the use of neuroscientific research for psychotherapy is discussed. Suggestions are presented for future goals for “brain” research of PTSD and treatment of PTSD. / Schwere Verkehrsunfälle stellen eines der am häufigsten vorkommenden psychologischen Traumata dar, und sind eine Hauptursache der Posttraumatischen Belastungsstörung (PTBS). Jedoch entwickeln nicht alle Personen nach traumatischen Ereignissen eine PTBS und bei einem Großteil remittieren anfängliche PTBS-Symptome. Dies stimulierte die Erforschung von psychologischen und biologischen Faktoren, die die Entstehung und Aufrechterhaltung der PTBS erklären. Glücklicherweise kann die PTBS effektiv, z.B über die kognitive Verhaltenstherapie (KVT), behandelt werden. Jedoch sind Gehirnmechanismen, die mit klinischen Änderungen aufgrund der psychologischen Therapie in PTSD einhergehen, nahezu unbekannt (Roffman, Marci, Glick, Dougherty, Rauch, 2005). Auf der anderen Seite gibt es Berichte von positiven Änderungen nach traumatischen Ereignissen, die als Posttraumatische Reifung (PTR) bezeichent werden. Dies hat in kürzerer Vergangenheit die Forschung von verbundenen psychologischen Prozessen und Faktoren stimuliert. Jedoch gibt es kaum Untersuchungen über die Beziehung von biologischen Variablen (z.B Messungen der Gehirnfunktion) und PTR. Diese Arbeit präsentiert 3 Studien, die electroenzephalographische (EEG) Asymmetrien bei Opfern schwerer Verkehrsunfälle untersuchten. Der erste Teil der Arbeit (Kapitel 2) widmet sich einer Literaturrezension über: die Beschreibung (Kapitel 2.1), Epidemiologie (Kapitel 2.2 und 2.3), Risikofaktoren (Kapitel 2.4), psychologische Theorien (Kapitel 2.5), biologische Mechanismen besonders Neuroimaging Ergebnisse (Kapitel 2.6), und Behandlung der PTBS (Kapitel 2.7.). Kapitel 2.8 gibt einen kurzen Überblick über die Definition und Forschung zur Posttraumatischen Reifung. Kapitel 2.9 gibt eine Übersicht zu aktuellen Modellen und empirischen Befunden bezüglich Gehirnasymmetrien und Emotionen. Kapitel 3.1 präsentiert eine Studie, in der hemisphärische Asymmetrien (im EEG-Alpha Band) bei Unfallopfern mit PTBS, subsyndromaler PTBS, und ohne PTBS sowie gesunden Kontrollpersonen ohne Unfall untersucht wurden: während einer Ruhemessung und einer Emotionsinduktions-bedingung (neutrale, positive, negative und trauma-spezifische Bilder) (Studie I). Danach werden die Ergebnisse der Studie II (Kapitel 3.2) präsentiert. Hier wurde die Wirkung der kognitiven Verhaltenstherapie auf Messungen der EEG-Aktivität untersucht. Deshalb wurde EEG-Aktivität vor und nach einer KVT im Vergleich mit einer Warten-Gruppe gemessen. Kapitel 3.3 präsentiert eine Korellationsanalyse (Studie III), bei der die Beziehung zwischen der frontalen Gehirnasymmetrie und posttraumatischer Reifung untersucht wurde. Am Ende der Arbeit (Kapitel 4) werden die Ergebnisse zusammengefasst und in Bezug auf (1) die state/trait-Debatte im Rahmen der Asymmetrie-Forschung diskutiert sowie (2) ein Bezug zu aktuellen psychologische Theorien von PTSD und PTG hergestellt. Außerdem wird der Nutzen von neurobiologischer Forschung für die Psychotherapie besprochen. Dabei werden Vorschläge für zukünftige Projekte für die &quot;Gehirn&quot;-Forschung im Zusammenhang mit der PTBS, deren Behandlung und PTG gemacht.

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O transtorno obsessivo-compulsivo (TOC) possui freqüentemente curso crônico, incapacitando cerca de 10% dos seus portadores. Os sintomas interferem de forma acentuada na vida do paciente, alterando suas rotinas e causando incompreensão dos familiares e daqueles que convivem com ele. A terapia cognitivo-comportamental em grupo (TCCG) é um tratamento eficaz, reduzindo os sintomas do TOC em mais de 70% dos portadores, sendo que ao redor de 27% obtêm remissão completa dos sintomas. Entretanto, cerca de 30% não obtêm nenhuma melhora. Conhecer as razões pelas quais esses pacientes não melhoram e identificar os fatores preditores associados ao aproveitamento ou não da terapia poderia auxiliar em uma melhor compreensão do TOC, numa melhor indicação do tratamento e no desenvolvimento de estratégias que incrementem sua eficácia. O presente estudo foi realizado com 181 pacientes com TOC, que cumpriram um programa de TCCG de 12 sessões semanais de 2 horas, entre outubro de 1999 e dezembro de 2006, no Programa de Transtornos de Ansiedade (PROTAN) do Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS) e tinha como objetivo verificar, em pacientes portadores de TOC, a existência de fatores preditores da resposta à TCCG.Os pacientes foram avaliados antes, durante e ao final do tratamento com os seguintes instrumentos: Y-BOCS, Y-BOCS chek-list, CGI, WHOQOL-BREF. Foi utilizada uma entrevista clínica estruturada com a finalidade de colher dados sobre os sintomas do paciente, histórico da doença, tratamentos anteriores e estabelecimento do diagnóstico do TOC de acordo com o DSM-IV-TR. Também foram coletados dados demográficos, socioeconômicos, status ocupacional, uso de medicação e critérios deinclusão na pesquisa. A entrevista foi complementada pelo MINI (International Neuropsychiatric Interview) para verificar a presença de comorbidades. Considerou-se como “resposta” a redução no mínimo de 35% nos escores da Y-BOCS e uma pontuação na CGI “normal” ou “limítrofe para doença” do pós para o pré-tratamento. O estudo pretende verificar se as seguintes variáveis: sexo, idade do paciente no início do tratamento, tempo de duração da doença, idade de início da doença, situação conjugal, nível de instrução, situação ocupacional, tipo de início da doença, curso, intensidade dos sintomas do TOC no início do tratamento, juízo crítico, história familiar, tipos de sintomas, uso de medicação específica para o TOC concomitante à TCCG estão associadas ou não com a resposta ao tratamento. Para avaliar a associação entre as variáveis categóricas à resposta ao tratamento, foi utilizado o teste qui-quadrado de Pearson. Nas variáveis dicotômicas foi aplicada a correção de Yates. Para avaliar as variáveis quantitativas em relação às categorias de resposta ao tratamento, foi utilizado o teste t de Student para amostras independentes. As variáveis que obtiveram um nível descritivo amostral (valor p) menor do que 0,25 foram inseridas no modelo de regressão logística múltipla.Fatores associados com uma melhor resposta à TCCG: sexo feminino (p=0,074); melhor juízo crítico acerca dos sintomas da doença (p=0,017); melhor qualidade de vida antes do início do tratamento: domínio físico (p=0,039), domínio psicológico (p<0,001), domínio ambiental (p=0,038), domínio social (p=0,053). Fatores associados com piores resultados: maior gravidade global da doença no início do tratamento, avaliada pela CGI (p=0,007); maior número de comorbidades associadas ao TOC (p=0,063); presença de fobia social (p=0,044) e distimia (p=0,072); presença de compulsão de repetição (p=0,104).Numa segunda etapa da análise estatística, incluiu-se no modelo todas as variáveis que na primeira fase haviam apresentado associação com os resultados. As variáveis que na análise de regressão logística múltipla permaneceram associadas significativamente foram: sexo feminino (ORAjustado=2,58; p=0,021); domínio psicológico da WHOQOLBREF (ORAjustado=1,05; p=0,011); juízo crítico (ORAjustado=2,67; p=0,042) e CGI-gravidade antes do inicio da terapia (ORAjustado=0,62; p=0,045). Embora alguns fatores relacionados com a resposta ao tratamento tenham sido identificados, poder prever quais os pacientes irão aproveitar a terapia e quais não irão se beneficiar é uma questão em aberto e está longe de ser esclarecida. As razões para essas dificuldades podem estar relacionadas à heterogeneidade do TOC e das amostras utilizadas nos diferentes estudos, além da falta de padronização das técnicas psicoterápicas utilizadas. Por fim, é possível que fatores não-específicos relacionados com a pessoa do terapeuta, com a qualidade da relação terapêutica, além da motivação e capacidade de tolerar frustração por parte do paciente possam exercer um papel importante que não tem sido avaliado pelas pesquisas. / Obsessive-compulsive disorder (OCD) frequently is a chronic disorder that incapacitates about 10% of patients. Symptoms severety affect the life of patients, change their routines and cause misunderstandings with family and all those that have contact with the patient. Group cognitive-behavioral therapy (GCBT) in 12 two-hour weekly sessions is an efficient treatment that reduces OCD symptoms in over 70% of the patients and results in complete remission of symptoms in 27%. However, about 30% of the patients do not show any improvement. The knowledge of reasons why these patients do not improve and the identification of factors associated with these different therapy outcomes may help to understand OCD better, and may inform treatment indications and the development of strategies to increase its efficacy. This study included 181 patients with OCD treated with 12 session of GCBT from October 1991 to December 2006 at the Anxiety Disorders Program (Programa dos Transtornos de Ansiedade – PROTAN) of Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. The purpose of this study was to investigate predictors of response to GCBT.The following instruments were used to evaluate patients before and at the end of the treatment: Y-BOCS, Y-BOCS checklist, CGI, WHOQOL-BREF. Evaluation was conducted by means of a structured clinical interview to collect data about the patient’s symptoms, disease history, previous treatments, and OCD diagnosis according to DSM-IVTR (APA, 2002). Demographic and socioeconomic data, occupational status, use of medication and criteria for inclusion in the study were also recorded. The interview wascomplemented with the MINI (International Neuropsychiatric Interview) to investigate comorbidities. Response criteria were: >35% reduction in Y-BOCS scores and normal or borderline CGI scores at post-treatment evaluation. The study investigated the possible association of the following variables with response to treatment: sex, age at beginning of treatment, disease duration, age at onset, marital status, education, occupation, type of disease onset, disease course, intensity of OCD symptoms at beginning of treatment, insight, family history, types of symptoms, and use of antiobsessional medications during GCBT. The Pearson chi-square test was used to evaluate the association between categorical variables and response to treatment. Yates correction was performed for dichotomous variables. The Student t test for independent samples was used to evaluate quantitative variables in relation to categories of response to treatment. Variables that achieved a p value lower than 0.25 were included in the initial logistic regression model, which evaluated the predictors of response to treatment and also controlled for possible confounding variables. The following factors showed associations with response to GCBT: women had greater odds of responding to treatment (p=0.074); better insight into disease symptoms was associated with better results (p=0.017); better quality of life before the beginning of treatment was also associated with better results (physical domain: p=0.039; psychological domain: p<0.001; environmental domain: p=0.038; social domain: p=0.053); patients with greater global severity of disease according to CGI had worse results (p=0.007); a greater number of associated comorbidities (p=0.063), social phobia (p=0.044) and dysthymia (p=0.072) were associated with poorer results; repeating compulsion was also associated with lower odds of responding to treatment (p=0.104).In the second stage of statistical analysis, all variables associated with results in the first analysis were included in the multivariate model, and the variables that retained significance were: female sex (ORAdjusted=2.58; p=0.021); WHOQOL-BREF psychological domain (ORAdjusted=1.05; p=0.011); insight (ORAdjusted=2.67; p=0.042) and CGI-severity before GCBT (ORAdjusted=0.62; p=0.045). Although we identified some factors associated with response to treatment, predicting which patients will benefit from therapy and which will not is still an open question. The reasons for such different outcomes may be associated with the heterogeneity of OCD and of the samples used in different studies, as well as with the lack of standardization of the psychotherapeutic techniques used. Finally, unspecific factors not associated with the person of the therapist, the quality of the therapeutic relationship, and the patient’s motivation and tolerance to frustration may play an important role that remains to be evaluated.

Made available in DSpace on 2016-08-03T16:34:28Z (GMT). No. of bitstreams: 1 ELAINE F FERNANDES.pdf: 724683 bytes, checksum: e96a0d1306ccd662e5059be967ebf83d (MD5) Previous issue date: 2005-03-08 / Research of bibliographical and monographical nature, this paper investigates the psychophysics relaxation in the health area, of children in a period of eight years, between January 1997 and November 2004. Initially, based in neuropsychological literature, it describes the relaxation role in homeostasis and the conscious body health, emphasizing the pleasure and painful behavior. Next, it describes and analyses several relaxation techniques, Jacobson Progressive Relaxation, Schulz Autogenos and Michaux Relaxation. To develop this research it was used 27 databases, due to the lack of production of this theme, per base. As result, it shows the total of 500 articles about relaxation, 200 of them related to children. They are national and international articles, most of them in English. Following this, it classifies these group in production by year, showing a significant increasing, although it is not systematic in number, from 14 articles in 1997 to 39 in 2004. As for the thematic, the data reveals first, the interest in pain, second in breathing problems and third in anxiety. The articles about pain, as they are in more quantity, have more detailed analysis, with discrimination by year, situation type, relaxation usage and pathology characterized by painful behavior. Finally, it is made a classification of the articles due to the usage of relaxation in clinical problems mainly the physical ones, those of affectionate-emotional psychic background, those with no usage of drugs and those with psychic background with the aid of drugs and psychiatric treatment. To discuss the results, several articles researched are also mentioned. Due to the richness of data, showing up the increasing of professionals in this health area, it is suggested further reading / Trabalho de natureza monográfica bibliográfica investiga o relaxamento psicofísico na área da saúde, em crianças, por um intervalo de oito anos, entre janeiro de 1997 e novembro de 2004. Inicialmente, com base em literatura neuropsicológica, descreve o papel do relaxamento na busca da homeostase e da consciência corporal saudável, enfocando comportamentos de prazer e dor. A seguir, descreve e analisa diversas técnicas de relaxamento, Relaxamento Progressivo de Jacobson, Autógeno de Schultz e Relaxamento de Michaux. A fim de desenvolver sua pesquisa utiliza-se de 27 bases de dados, devido a pouca produção encontrada sobre o tema, por base. Como resultados, levanta ao todo 500 artigos sobre relaxamento, sendo 200 em crianças. São artigos nacionais e internacionais, com predomínio do idioma inglês. A seguir, classifica esses artigos por ano de produção, constatando um crescimento significativo, porém não sistemático em seu número, de 14 artigos em 1997, para 39, em 2004. Quanto à temática, os dados revelam em primeiro lugar, um interesse em dor, em segundo em problemas respiratórios, e, em terceiro lugar, em ansiedade. Os artigos sobre dor, por serem os mais numerosos levantados, sofrem análise mais detalhada, com discriminação da quantidade de artigos por ano e dos tipos de situação e de patologia caracterizados por quadro álgico. Finalmente é feita uma classificação dos artigos segundo a utilização do relaxamento junto à problemática clínica predominantemente física, a de fundo psíquico afetivo-emocional, sem utilização de fármacos e, a de fundo psíquico, com intervenção psiquiátrica farmacológica. Na discussão dos resultados, vários artigos pesquisados são também comentados. Dada a riqueza dos dados, evidenciando interesse crescente de profissionais da área da Saúde na literatura levantada, sugere-se pesquisa complementar

Este trabalho apresenta o processo iterativo de criação, desenvolvimento e avaliação de um programa de computador para psicoeducação sobre Transtorno Obsessivo-Compulsivo (TOC). Na primeira fase foi criado um protótipo interativo e autoadministrado. A segunda fase consistiu em avaliações com experts, que levaram a importantes alterações no protótipo. O resultado dessas etapas gerou um programa com 3 módulos de psicoeducação. A terceira fase foi um ensaio com usuários, do qual participaram 21 sujeitos entre 19 e 55 anos. Os instrumentos utilizados foram o Y-BOCS, escalas subjetivas para avaliação da intensidade dos sintomas de TOC, humor e ansiedade, questões de usabilidade e log do programa. Os participantes levaram em média 8 dias para completar o programa, e o tempo médio de uso totalizou 2 horas e 14 minutos. Apenas uma questão dos quizzes teve frequência de acertos abaixo de 70%. O nível médio de satisfação foi de 8,33 no primeiro módulo, 8,71 no segundo e 9,00 no terceiro. Foi encontrada diferença nos escores obsessivos do Y-BOCS entre os dois momentos de avaliação e diferença estatisticamente significativa na escala subjetiva de sintomas do TOC entre os módulos 1 e 2, e 1 e 3. O programa obteve um bom nível de satisfação dos usuários e apresenta potencial efeito de redução de sintomas percebidos. O modelo de desenvolvimento do programa é aplicável a outros contextos em Psicologia e o protótipo desenvolvido pode ser utilizado como matriz para intervenções semelhantes. / This study presents the iterative process of creating, developing and evaluating a psychoeducational software addressed at Obsessive-Compulsive Disorder (OCD). In stage 1, an interative and self-administered prototype was created. Second stage consisted of evaluations with experts, which led to important changes in the prototype. The results of these steps generated a three-module psychoeducational software. Third stage was a usability trial with users, 21 participants, ranging from 19 to 55 years old. Measures used were Y-BOCS, subjective scales to assess OCD symptoms intensity, humor and anxiety, usability questions, and the system log. Participants took an average of 8 days to complete the intervention, and the average time of software usage was 2 hours and 14 minutes. Only one quiz question showed less than 70% correct answers. Mean level of satisfaction was 8,33 for the first module, 8,71 for the second and 9,00 for the third. A difference was found on obsessive scores of Y-BOCS at the two evaluation times, and a statistically significant difference was found on the scale of OCD symptoms intensity, between modules 1 e 2, and 1 and 3. The software reached a good level of satisfaction among users and shows a potential effect in reduction of perceived symptoms. The model of development may be used with other psychological applications, and the prototype may be used as a strucutral matrix for similar interventions.

O transtorno obsessivo-compulsivo (TOC) possui freqüentemente curso crônico, incapacitando cerca de 10% dos seus portadores. Os sintomas interferem de forma acentuada na vida do paciente, alterando suas rotinas e causando incompreensão dos familiares e daqueles que convivem com ele. A terapia cognitivo-comportamental em grupo (TCCG) é um tratamento eficaz, reduzindo os sintomas do TOC em mais de 70% dos portadores, sendo que ao redor de 27% obtêm remissão completa dos sintomas. Entretanto, cerca de 30% não obtêm nenhuma melhora. Conhecer as razões pelas quais esses pacientes não melhoram e identificar os fatores preditores associados ao aproveitamento ou não da terapia poderia auxiliar em uma melhor compreensão do TOC, numa melhor indicação do tratamento e no desenvolvimento de estratégias que incrementem sua eficácia. O presente estudo foi realizado com 181 pacientes com TOC, que cumpriram um programa de TCCG de 12 sessões semanais de 2 horas, entre outubro de 1999 e dezembro de 2006, no Programa de Transtornos de Ansiedade (PROTAN) do Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS) e tinha como objetivo verificar, em pacientes portadores de TOC, a existência de fatores preditores da resposta à TCCG.Os pacientes foram avaliados antes, durante e ao final do tratamento com os seguintes instrumentos: Y-BOCS, Y-BOCS chek-list, CGI, WHOQOL-BREF. Foi utilizada uma entrevista clínica estruturada com a finalidade de colher dados sobre os sintomas do paciente, histórico da doença, tratamentos anteriores e estabelecimento do diagnóstico do TOC de acordo com o DSM-IV-TR. Também foram coletados dados demográficos, socioeconômicos, status ocupacional, uso de medicação e critérios deinclusão na pesquisa. A entrevista foi complementada pelo MINI (International Neuropsychiatric Interview) para verificar a presença de comorbidades. Considerou-se como “resposta” a redução no mínimo de 35% nos escores da Y-BOCS e uma pontuação na CGI “normal” ou “limítrofe para doença” do pós para o pré-tratamento. O estudo pretende verificar se as seguintes variáveis: sexo, idade do paciente no início do tratamento, tempo de duração da doença, idade de início da doença, situação conjugal, nível de instrução, situação ocupacional, tipo de início da doença, curso, intensidade dos sintomas do TOC no início do tratamento, juízo crítico, história familiar, tipos de sintomas, uso de medicação específica para o TOC concomitante à TCCG estão associadas ou não com a resposta ao tratamento. Para avaliar a associação entre as variáveis categóricas à resposta ao tratamento, foi utilizado o teste qui-quadrado de Pearson. Nas variáveis dicotômicas foi aplicada a correção de Yates. Para avaliar as variáveis quantitativas em relação às categorias de resposta ao tratamento, foi utilizado o teste t de Student para amostras independentes. As variáveis que obtiveram um nível descritivo amostral (valor p) menor do que 0,25 foram inseridas no modelo de regressão logística múltipla.Fatores associados com uma melhor resposta à TCCG: sexo feminino (p=0,074); melhor juízo crítico acerca dos sintomas da doença (p=0,017); melhor qualidade de vida antes do início do tratamento: domínio físico (p=0,039), domínio psicológico (p<0,001), domínio ambiental (p=0,038), domínio social (p=0,053). Fatores associados com piores resultados: maior gravidade global da doença no início do tratamento, avaliada pela CGI (p=0,007); maior número de comorbidades associadas ao TOC (p=0,063); presença de fobia social (p=0,044) e distimia (p=0,072); presença de compulsão de repetição (p=0,104).Numa segunda etapa da análise estatística, incluiu-se no modelo todas as variáveis que na primeira fase haviam apresentado associação com os resultados. As variáveis que na análise de regressão logística múltipla permaneceram associadas significativamente foram: sexo feminino (ORAjustado=2,58; p=0,021); domínio psicológico da WHOQOLBREF (ORAjustado=1,05; p=0,011); juízo crítico (ORAjustado=2,67; p=0,042) e CGI-gravidade antes do inicio da terapia (ORAjustado=0,62; p=0,045). Embora alguns fatores relacionados com a resposta ao tratamento tenham sido identificados, poder prever quais os pacientes irão aproveitar a terapia e quais não irão se beneficiar é uma questão em aberto e está longe de ser esclarecida. As razões para essas dificuldades podem estar relacionadas à heterogeneidade do TOC e das amostras utilizadas nos diferentes estudos, além da falta de padronização das técnicas psicoterápicas utilizadas. Por fim, é possível que fatores não-específicos relacionados com a pessoa do terapeuta, com a qualidade da relação terapêutica, além da motivação e capacidade de tolerar frustração por parte do paciente possam exercer um papel importante que não tem sido avaliado pelas pesquisas. / Obsessive-compulsive disorder (OCD) frequently is a chronic disorder that incapacitates about 10% of patients. Symptoms severety affect the life of patients, change their routines and cause misunderstandings with family and all those that have contact with the patient. Group cognitive-behavioral therapy (GCBT) in 12 two-hour weekly sessions is an efficient treatment that reduces OCD symptoms in over 70% of the patients and results in complete remission of symptoms in 27%. However, about 30% of the patients do not show any improvement. The knowledge of reasons why these patients do not improve and the identification of factors associated with these different therapy outcomes may help to understand OCD better, and may inform treatment indications and the development of strategies to increase its efficacy. This study included 181 patients with OCD treated with 12 session of GCBT from October 1991 to December 2006 at the Anxiety Disorders Program (Programa dos Transtornos de Ansiedade – PROTAN) of Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. The purpose of this study was to investigate predictors of response to GCBT.The following instruments were used to evaluate patients before and at the end of the treatment: Y-BOCS, Y-BOCS checklist, CGI, WHOQOL-BREF. Evaluation was conducted by means of a structured clinical interview to collect data about the patient’s symptoms, disease history, previous treatments, and OCD diagnosis according to DSM-IVTR (APA, 2002). Demographic and socioeconomic data, occupational status, use of medication and criteria for inclusion in the study were also recorded. The interview wascomplemented with the MINI (International Neuropsychiatric Interview) to investigate comorbidities. Response criteria were: >35% reduction in Y-BOCS scores and normal or borderline CGI scores at post-treatment evaluation. The study investigated the possible association of the following variables with response to treatment: sex, age at beginning of treatment, disease duration, age at onset, marital status, education, occupation, type of disease onset, disease course, intensity of OCD symptoms at beginning of treatment, insight, family history, types of symptoms, and use of antiobsessional medications during GCBT. The Pearson chi-square test was used to evaluate the association between categorical variables and response to treatment. Yates correction was performed for dichotomous variables. The Student t test for independent samples was used to evaluate quantitative variables in relation to categories of response to treatment. Variables that achieved a p value lower than 0.25 were included in the initial logistic regression model, which evaluated the predictors of response to treatment and also controlled for possible confounding variables. The following factors showed associations with response to GCBT: women had greater odds of responding to treatment (p=0.074); better insight into disease symptoms was associated with better results (p=0.017); better quality of life before the beginning of treatment was also associated with better results (physical domain: p=0.039; psychological domain: p<0.001; environmental domain: p=0.038; social domain: p=0.053); patients with greater global severity of disease according to CGI had worse results (p=0.007); a greater number of associated comorbidities (p=0.063), social phobia (p=0.044) and dysthymia (p=0.072) were associated with poorer results; repeating compulsion was also associated with lower odds of responding to treatment (p=0.104).In the second stage of statistical analysis, all variables associated with results in the first analysis were included in the multivariate model, and the variables that retained significance were: female sex (ORAdjusted=2.58; p=0.021); WHOQOL-BREF psychological domain (ORAdjusted=1.05; p=0.011); insight (ORAdjusted=2.67; p=0.042) and CGI-severity before GCBT (ORAdjusted=0.62; p=0.045). Although we identified some factors associated with response to treatment, predicting which patients will benefit from therapy and which will not is still an open question. The reasons for such different outcomes may be associated with the heterogeneity of OCD and of the samples used in different studies, as well as with the lack of standardization of the psychotherapeutic techniques used. Finally, unspecific factors not associated with the person of the therapist, the quality of the therapeutic relationship, and the patient’s motivation and tolerance to frustration may play an important role that remains to be evaluated.