Young people with Autism Spectrum Disorders (ASD) are more prone to experience anxiety disorders at a greater level compared to their neurotypical developing counterparts, causing lifelong impairments in family, social, academic and adaptive functioning. Early interventions in childhood have been designed to minimize these stressful events and to optimize children’s developmental outcomes. Cognitive behavioural therapy (CBT) is considered a first-line intervention of anxiety. The review aimed to synthesize empirical literature on modified CBT interventions from 2009 until 2019 focusing on reducing anxiety in children and adolescents with ASD. A systematic review of the literature was conducted in five databases. As a result, 10 articles were included to review. Modifications found were: a) audiovisual support and written materials, b) parental partic-ipation, c) sessions length, d) language, e) sensory and motor accommodations, f) emphasis into the behav-ioural component, g) enhancement of individual’s attention and participation, h) facilitating materials to access the content of CBT, and i) participants’ specific interests and worries. The interventions showed significant reductions in youth anxiety levels. Future research should focus on addressing which specific modifications contribute to anxiety reduction since to date, there is no evidence comparing standard CBT to modified CBT interventions. Moreover, there is a lack of anxiety-assessment instruments specially designed for individuals with ASD. In addition, considering the longstanding prevalence of male autistic rates, ASD diagnostic instru-ments should be revised to reduce bias that can mislead to an inattentive ascertainment of females with ASD.

Estudos em serviços-escola de psicologia questionam o quanto o modelo vigente atende adequadamente à clientela infantojuvenil, uma vez que é alta a evasão destes pacientes antes e durante o atendimento. Apesar de sugerirem propostas de mudanças no atendimento oferecido, pouco se comenta sobre a necessidade de treino de terapeutas e a baixa procura de crianças com problemas internalizantes, citados na literatura como os de maior incidência nesta população. Este trabalho teve como objetivo diminuir essa lacuna ao propor, elaborar e avaliar uma proposta de treinamento de estagiários no atendimento de crianças ansiosas, inscritas em serviços-escola, com o uso de um protocolo reconhecido internacionalmente para o atendimento dessas crianças (Gato Corajoso), adaptado para a realidade brasileira. Foram escolhidos dois serviços-escola vinculados ao serviço público de saúde, que atendem crianças ansiosas em duas capitais brasileiras, São Paulo e Brasília; treze terapeutas, alunos de graduação de psicologia, foram selecionados para receber o treinamento em duas etapas. Na primeira fase, foi realizado o levantamento da clientela atendida por serviços de saúde mental (n=112), na segunda, foram atendidas 20 crianças com idade entre 9 e 13 anos, enquanto outras 11 crianças com características similares constituíram o grupo controle. Os resultados sugerem que as crianças dos serviços-escola estudados apresentavam características similares às das crianças atendidas pelas clínicas-escolas de psicologia tradicionais, em relação a aspectos como idade, gênero, escolaridade, renda familiar e classe social. Apresentavam, ainda, outras características similares às verificadas nos serviços-escola de saúde, como forma de encaminhamento e queixas. Os resultados também indicam que o desempenho dos terapeutas, por meio de autoavaliação, avaliação por seus pares e por juízes, foi acima da média e a percepção do protocolo pelos próprios terapeutas foi favorável a seu uso. Além disso, os resultados apontam que as crianças ansiosas que participaram da intervenção obtiveram resultados clínicos nas escalas do CBCL indicativos de melhora, quando as crianças foram avaliadas antes e depois da intervenção e com os dados do grupo controle, após o tempo da intervenção. Com essas informações, conclui-se que o treinamento oferecido aos alunos com base em um protocolo de atendimento para ansiedade infantil mostrou-se útil para o atendimento clínico de crianças ansiosas, para ensinar aos alunos sobre terapia cognitivo-comportamental e para orientá-los sobre o que fazer ao longo das sessões de intervenção, diminuindo o impacto da falta de experiência em atendimento infantil e em atendimento grupal. Sugere-se, assim, que o uso de protocolos em treinamentos de terapeutas pode ser uma boa forma de difundir um conhecimento clínico com base em evidências / Studies on teaching clinics question how adequately the current model provides for children and teenage clients, since the evasion of these patients is high before and during treatment. Although suggestions are made for changes in the offered treatments, little is commented about the need for training therapists and the low demand of children with internalized problems, cited in literature as the problem with the highest incidence in this population. This study has the objective of decreasing this gap by proposing, elaborating and evaluating a proposal for training interns in the treatment of anxious children, enrolled in teaching clinics, with the use of an internationally recognized protocol for the treatment of these children (Coping Cat), adapted for the Brazilian reality. Two teaching clinics linked to public health services that treat anxious children in two Brazilian capitals, São Paulo and Brasilia, were chosen; thirteen therapists, which were undergraduate psychology students, were selected to receive training in two stages. During the first stage, we conducted a survey of the clients that used the mental health services (n=112); in the second stage, 20 children with ages varying between 9 and 13 were treated, while 11 other children with similar characteristics constituted the control group. The results suggest that the children from the studied teaching clinics present similar characteristics to children treated in traditional teaching psychology clinics, in aspects such as age, gender, schooling, family income and social class. They also present other similar characteristics to those verified in teaching clinics, such as the referral methods and complaints. The results also indicate that the performance of the therapists, evaluated by themselves, their colleagues and judges, was above average and that the therapists perception of the protocol was in favor of its use. Also, results show that when the children were evaluated before and after the intervention and with the data of the control group, anxious children who participated in the intervention obtained clinical results in the CBCL scales that indicated improvement. Based on this information, one may conclude that the training offered to students based on a treatment protocol for childrens anxiety was useful for the clinical treatment of anxious children, to teach the students about cognitive-behavioral therapy and to guide them on what they should do during the intervention, which decreased the impact of the lack of experience on childrens therapy and on group therapy. It is thus suggested that the use of protocols for training therapists may be a good way of spreading evidence based clinical knowledge

Excessive Reassurance Seeking (ERS) is an under-researched and poorly understood behaviour that resembles the compulsive behaviours that are typically seen in obsessional problems. ERS can be complex, persistent, extensive, debilitating and may dominate the interactions of those involved. In addition to resembling compulsive checking in Obsessive-Compulsive Disorder (OCD) it may have the effect of transferring responsibility to another person. However, it could be seen as a type of support. Both ERS and support are defined and key questions about these concepts are considered in five studies which examine ERS from the perspectives of non-clinical samples, sufferers of anxiety problems, caregivers and therapists. Study 1 qualitatively examines interpersonal components of ERS in OCD and identified the experience of frustration in caregivers as being particularly pervasive. Study 2 examines the diagnosis specific/transdiagnostic elements of ERS in OCD and health anxiety contrasted with support using mixed methods. Results revealed some limited diagnosis specificity of ERS. Strikingly, people with health anxiety did not seek support; reassurance seeking may be their default response. Study 3 uses a larger sample to quantitatively evaluate therapists’ perception of ERS and its treatment, with results suggesting that there is considerable room for improvement. Study 4 examined therapeutic intervention for ERS in treatment refractory OCD using a single case experimental design; Cognitive Behavioural Treatment (CBT) that focuses on treating ERS had beneficial effects. Study 5 tackled the diagnosis specific/transdiagnostic issues in a questionnaire by considering ERS across different anxiety problems. ERS may represent a final common pathway of multiple processes; some processes appear transdiagnostic; others may indicate disorder specificity. Overall, findings reveal the complexity of ERS and its likely nature as a safety-seeking behaviour which requires attention in treatment. Engendering support as an alternative to reassurance in CBT may be particularly promising.

No description available.

This study explores the subjective experiences of CBT therapists who have undergone personal therapy and seeks to gain insight into the significance of personal therapy in CBT clinical practice. Seven CBT therapists who have undergone personal therapy were interviewed. Interpretative Phenomenological Analysis (IPA) was chosen to generate rich interview data. Participants were asked about their experience of personal therapy in clinical practice. Participants' narratives were analysed using IPA to identify common themes. The analysis resulted in twelve interrelated themes from which three master themes emerged. The first theme, 'Personal therapy creates conflict', explores a paradox that arises between personal therapy and CBT clinical practice; participants suggest that personal therapy equips them with therapeutic tools that paradoxically hinder their capacity to practice a standardised protocol-led CBT. The second master theme, 'Personal therapy ties me to humanity', suggests that the gap between personal therapy and CBT practice narrows by participants' 'use of self': calling upon their own vulnerabilities to forge fundamental connections with their clients based on the shared experience of being human. This study finds that all participants value 'being human' with their clients, however, struggle to find the space 'to just be' within an action-focused, goal-orientated CBT model. This is further explored in the final theme, 'Personal therapy: Being and doing'. Potential implications of the themes that emerged were considered. This study contributes to the literature on CBT and counselling psychology, and to the understanding of a divide in the psychotherapy profession between evidence-based priorities and expectations of reflective practice.

Estudos em serviços-escola de psicologia questionam o quanto o modelo vigente atende adequadamente à clientela infantojuvenil, uma vez que é alta a evasão destes pacientes antes e durante o atendimento. Apesar de sugerirem propostas de mudanças no atendimento oferecido, pouco se comenta sobre a necessidade de treino de terapeutas e a baixa procura de crianças com problemas internalizantes, citados na literatura como os de maior incidência nesta população. Este trabalho teve como objetivo diminuir essa lacuna ao propor, elaborar e avaliar uma proposta de treinamento de estagiários no atendimento de crianças ansiosas, inscritas em serviços-escola, com o uso de um protocolo reconhecido internacionalmente para o atendimento dessas crianças (Gato Corajoso), adaptado para a realidade brasileira. Foram escolhidos dois serviços-escola vinculados ao serviço público de saúde, que atendem crianças ansiosas em duas capitais brasileiras, São Paulo e Brasília; treze terapeutas, alunos de graduação de psicologia, foram selecionados para receber o treinamento em duas etapas. Na primeira fase, foi realizado o levantamento da clientela atendida por serviços de saúde mental (n=112), na segunda, foram atendidas 20 crianças com idade entre 9 e 13 anos, enquanto outras 11 crianças com características similares constituíram o grupo controle. Os resultados sugerem que as crianças dos serviços-escola estudados apresentavam características similares às das crianças atendidas pelas clínicas-escolas de psicologia tradicionais, em relação a aspectos como idade, gênero, escolaridade, renda familiar e classe social. Apresentavam, ainda, outras características similares às verificadas nos serviços-escola de saúde, como forma de encaminhamento e queixas. Os resultados também indicam que o desempenho dos terapeutas, por meio de autoavaliação, avaliação por seus pares e por juízes, foi acima da média e a percepção do protocolo pelos próprios terapeutas foi favorável a seu uso. Além disso, os resultados apontam que as crianças ansiosas que participaram da intervenção obtiveram resultados clínicos nas escalas do CBCL indicativos de melhora, quando as crianças foram avaliadas antes e depois da intervenção e com os dados do grupo controle, após o tempo da intervenção. Com essas informações, conclui-se que o treinamento oferecido aos alunos com base em um protocolo de atendimento para ansiedade infantil mostrou-se útil para o atendimento clínico de crianças ansiosas, para ensinar aos alunos sobre terapia cognitivo-comportamental e para orientá-los sobre o que fazer ao longo das sessões de intervenção, diminuindo o impacto da falta de experiência em atendimento infantil e em atendimento grupal. Sugere-se, assim, que o uso de protocolos em treinamentos de terapeutas pode ser uma boa forma de difundir um conhecimento clínico com base em evidências / Studies on teaching clinics question how adequately the current model provides for children and teenage clients, since the evasion of these patients is high before and during treatment. Although suggestions are made for changes in the offered treatments, little is commented about the need for training therapists and the low demand of children with internalized problems, cited in literature as the problem with the highest incidence in this population. This study has the objective of decreasing this gap by proposing, elaborating and evaluating a proposal for training interns in the treatment of anxious children, enrolled in teaching clinics, with the use of an internationally recognized protocol for the treatment of these children (Coping Cat), adapted for the Brazilian reality. Two teaching clinics linked to public health services that treat anxious children in two Brazilian capitals, São Paulo and Brasilia, were chosen; thirteen therapists, which were undergraduate psychology students, were selected to receive training in two stages. During the first stage, we conducted a survey of the clients that used the mental health services (n=112); in the second stage, 20 children with ages varying between 9 and 13 were treated, while 11 other children with similar characteristics constituted the control group. The results suggest that the children from the studied teaching clinics present similar characteristics to children treated in traditional teaching psychology clinics, in aspects such as age, gender, schooling, family income and social class. They also present other similar characteristics to those verified in teaching clinics, such as the referral methods and complaints. The results also indicate that the performance of the therapists, evaluated by themselves, their colleagues and judges, was above average and that the therapists perception of the protocol was in favor of its use. Also, results show that when the children were evaluated before and after the intervention and with the data of the control group, anxious children who participated in the intervention obtained clinical results in the CBCL scales that indicated improvement. Based on this information, one may conclude that the training offered to students based on a treatment protocol for childrens anxiety was useful for the clinical treatment of anxious children, to teach the students about cognitive-behavioral therapy and to guide them on what they should do during the intervention, which decreased the impact of the lack of experience on childrens therapy and on group therapy. It is thus suggested that the use of protocols for training therapists may be a good way of spreading evidence based clinical knowledge

Tinnitus is common, and some individuals with tinnitus display high levels of distress. Cognitive behavioural therapy (CBT) is effective in reducing tinnitus distress, but is rarely available. CBT-based self-help, with or without guidance, has yielded positive results in other problem areas, and one initial randomized controlled trial (RCT) has shown promising results for tinnitus. This thesis is based on four studies; Study I showed that Internet-based self-help treatment with e-mail guidance alleviated tinnitus distress among consecutive patients and was rated as credible as traditional treatments. Active participation in treatment predicted outcome. Study II, an RCT, showed that an extended and more interactive version of the Internet-based self-help treatment with e-mail therapist support appeared to be equally effective as a group treatment. In study III, another RCT, a self-help book with weekly telephone support was superior to a wait-list control group. No strong evidence for the importance of telephone contact on outcome was found. In both study II and III, the positive outcome remained after one year and self-help approaches appeared more therapist time-effective compared to group treatment. Also, the received treatment-dose for patients in guided self-help was not lower than in the group treatment. Study IV found that the ‘Stages of Change’, from the transtheoretical model, are probably not the right theoretical framework to use with tinnitus patients. Predictors of outcome were found, but they were not in line with the theory behind the Stages of Change. The predictors were better understood when conceptualized as coping, showing that helplessness and less coping before treatment correlated with better outcome. In sum, guided cognitive behavioural self-help can decrease tinnitus distress. It appears to be therapist time-effective and shows effects comparable to or slightly below traditional CBT for tinnitus. Effects remain one year after treatment and generalize to a routine clinical setting.

No description available.

The aim of the present study was to examine the prevalence of eating disorder symptoms in patients with obsessive-compulsive disorder (OCD). Additional aims were to assess whether having comorbid eating disorders could influence the treatment outcome for OCD, and if symptoms of eating disorders were reduced after treatment for OCD. The sample consisted of 93 patients with a primary diagnosis of OCD. The patients underwent assessment with the Yale-Brown Obsessive-Compulsive Scale, Beck Depression Inventory, and Eating Disorder Inventory both prior to and after treatment. First, the analysis showed that the sample of OCD patients had higher prevalence of eating disorders than a population of physically active students. Moreover, the women in the sample had significantly more symptoms of eating disorders than the men. Correlational analysis showed that eating disorders did not affect the treatment outcome for OCD; the patients generally had a significant improvement of OCD symptoms. On the other hand, symptoms of eating disorders were not significantly reduced after treatment. Summarized, this study concludes that there is a high prevalence of eating disorder symptoms among patients with OCD. It further shows that comorbid eating disorders does not hinder the effect of treatment for OCD. However, as the symptoms of eating disorders persist after such treatment, an implication of the present study is that these symptoms may need closer attention.

Two decades of research on obsessive-compulsive disorder (OCD) has helped us develop a strong understanding of why obsessions are often followed by the performance of a compulsive act. What we have understood less well is why that act is repeated, even though it often results in an increase, rather than decrease, in discomfort. Emergent research on compulsive checking implicates a number of beliefs—including perceived responsibility, perceived harm, need for certainty, and beliefs about one’s memory— that may influence behavioural parameters (e.g., check duration) of checking episodes. Furthermore, it has also been suggested that the act of compulsive checking may recur in part because of a self-perpetuating mechanism in which checking has paradoxical effects on these beliefs. Finally, some researchers have proposed that attentional focus (e.g., focus on threat) during checking may be related these paradoxical outcomes. At present, these ideas are mostly speculative, in part because there have been so few detailed studies of the actual phenomenology of compulsive rituals. The purpose of the present research was to gather phenomenological data on compulsions as performed by a clinical sample under ecologically valid conditions. Study 1 extended emergent research suggesting that compulsions may persist because the act of checking has a number of ironic effects on beliefs. Individuals with a diagnosis of obsessive-compulsive disorder (OCD) and anxious controls (AC) completed a naturalistic stove task in our laboratory kitchen. Participants were fitted with portable eyetracking equipment and left on their own to boil a kettle, turn the stove off, and check to ensure that the stove is safe before leaving the kitchen. Surrounding the stove were household items that are “threatening” (e.g., matches) or “non-threatening” (e.g., mugs). Ratings of mood, responsibility, harm (severity, probability) and memory confidence were taken pre- and post-task and a portable eyetracker was used to monitor attention throughout the stove task. We examined the relations between behavioural indices (check duration, attentional focus) and pre- and post-task ratings of responsibility, perceived harm, mood, and memory confidence. Although we found that OCD (as compared to AC) participants took significantly longer to leave the kitchen after using the stove, we found no evidence that stronger pre-task ratings of responsibility, perceived harm, or memory confidence were associated with longer check duration. However, we found some evidence of an ironic effect whereby greater check duration was associated with greater perceived harm and decreased certainty about having properly ensured the stove was off. Of note, these ironic effects were not unique to participants with OCD, but were also observed in the AC group. With respect to the eyetracking data, we found minimal evidence linking threat fixations and beliefs in participants with OCD. In contrast, a number of interesting relations emerged in the eyetracking data of our anxious control participants. For AC participants, a greater proportion of time spent looking at the stove was associated with greater post-task sense of responsibility for preventing harm, greater post-task harm estimates, decreased certainty (about having ensured the stove was off), and decreased confidence in memory for the task. In Study 2, individuals with a diagnosis of OCD completed a structured diary of their compulsions as they occurred naturally over a three˗day period. Participants recorded the circumstances leading to each compulsion and reported on the acts involved in the compulsive ritual, the duration and repetitiveness of the ritual, and the criteria used to determine completeness of the ritual. The findings of this study suggest that unsuccessful compulsions (i.e., compulsions in which certainty was not achieved) were associated with a longer duration (trend), more repetitions, a higher standard of evidence, and offered little in the way of distress reduction. These findings are discussed within the theoretical context of cognitive˗behavioural model of obsessive˗compulsive disorder and clinical implications are offered.