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Prática baseada em evidências em psicologia e a eficácia da análise do comportamento clínica / Evidence-based practice in psychology and the efficacy of clinical behavior analysisJan Luiz Leonardi 07 April 2016 (has links)
Tradicionalmente, a escolha pelo tipo de intervenção psicoterápica para diferentes quadros clínicos depende fundamentalmente da experiência profissional do terapeuta e de sua predileção por determinadas estratégias clínicas. Esse cenário, entretanto, tem se modificado no contexto da prática baseada em evidências, definida pela American Psychological Association como o processo individualizado de tomada de decisão clínica que ocorre por meio da integração da melhor evidência disponível com a perícia clínica no contexto das características, cultura e preferências do cliente. O paradigma de prática baseada em evidências está em perfeita harmonia com a ideologia da análise do comportamento aplicada, que, desde a sua origem, apresenta um forte comprometimento com a sustentação empírica de seus procedimentos terapêuticos. Apesar desse comprometimento, é de fundamental importância avaliar em que medida a área está ou não produzindo evidências de eficácia. Em vista disso, o presente trabalho teve por objetivo analisar a produção de evidências empíricas da terapia analítico-comportamental (TAC) e da psicoterapia analítica-funcional (FAP), na literatura nacional e internacional, de modo a complementar as revisões sistemáticas já realizadas sobre outras modalidades de análise do comportamento clínica terapia de aceitação e compromisso (ACT), terapia comportamental dialética (DBT) e ativação comportamental (BA). Para cumprir esse objetivo, foi realizada uma revisão da literatura conduzida de forma a localizar o maior número possível de estudos empíricos sobre TAC e FAP, publicados ou não, que abarcou onze bases de dados globais e três bases de dados específicas da análise do comportamento. A seleção dos estudos obedeceu aos seguintes critérios de inclusão: ser relato de caso, experimento de caso único ou pesquisa de grupo que descreve os resultados obtidos num processo de terapia individual; ter participantes com desenvolvimento típico e idade igual ou superior a 18 anos; ter ocorrido exclusivamente no ambiente de consultório; ser fundamentado no behaviorismo radical e utilizar conceitos da análise do comportamento na descrição do processo terapêutico. No total, foram selecionados 54 trabalhos que apresentaram 72 casos. As informações de cada um dos casos foram organizadas numa planilha do Microsoft Excel e diferentes categorias de análise foram construídas de modo a possibilitar dois tipos de análise. A primeira, descritiva, abarcou a denominação dada à terapia, idade, gênero e diagnóstico dos clientes, método de pesquisa, número de sessões, avaliação da fidelidade ao procedimento, apresentação de análise de contingências, alvos da intervenção, procedimentos utilizados, eficácia, medidas de resultado e follow-up. A segunda análise consistiu em diversos cruzamentos entre esses dados. Os resultados obtidos permitem concluir que a TAC e a FAP carecem de evidências empíricas que comprovem ou rejeitem sua eficácia. À luz desses dados e das revisões sistemáticas sobre ACT, DBT e BA, argumenta-se que terapeutas e pesquisadores brasileiros têm três opções: (1) utilizar apenas os princípios comportamentais básicos, isto é, a teoria, para guiar sua prática clínica, o que é insuficiente para garantir a eficácia da intervenção; (2) adotar um dos modelos internacionais de análise do comportamento clínica; (3) sistematizar a TAC para, posteriormente, pesquisá-la experimentalmente. Espera-se que, além de oferecer o estado da arte da pesquisa clínica sobre TAC e sobre FAP, este trabalho contribua para o desenvolvimento científico das terapias comportamentais e para o fortalecimento da análise do comportamento como ciência e profissão / Traditionally, the choice of the type of psychotherapeutic intervention for various clinical conditions fundamentally depends on the professional experience of the therapist and his/her predilection for certain clinical strategies. However, this scenario has been changing in the context of evidence-based practice, defined by the American Psychological Association as the individualized process of clinical decision-making that takes place through the integration of the best available evidence with clinical expertise in the context of the characteristics, culture and preferences of the client. The paradigm of evidence-based practice is in perfect harmony with the applied behavior analysis ideology, which, since its inception, has a strong commitment to the empirical support of its therapeutic procedures. Despite this commitment, it is of fundamental importance to assess to what extent the area is or is not producing evidence of efficacy. In view of this, this thesis aimed to analyze the production of empirical evidence of behavioral-analytic therapy (TAC) and functional-analytic psychotherapy (FAP), in national and international literature, in order to complement the systematic reviews already conducted on other modalities of clinical behavior analysis acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and behavioral activation (BA). To achieve this goal, a review of the literature was conducted in order to find the largest possible number of empirical studies of TAC and FAP, published or not, which covered eleven global databases and three specific databases of behavior analysis. The selection of studies followed the following inclusion criteria: to be a case report, single-case experiment or group research that describes the results obtained in an individual therapy process; to have participants with typical development and age up to 18 years of age; to have taken place exclusively in the office environment; to be based on radical behaviorism and to use behavior analysis concepts in the description of the therapeutic process. In total, 54 works that presented 72 cases were selected. The information regarding each one of the cases has been organized in a Microsoft Excel worksheet and different analysis categories have been designed so as to enable two kinds of analysis. The first kind was a descriptive one, and embraced the name given to the therapy, age, gender and diagnosis of clients, research method, number of sessions, evaluation of procedure fidelity, description of analysis of contingencies, targets of intervention, procedures used, efficacy, outcome measures and follow-up. The second kind consisted of the analysis of different combinations of these data. The results lead to the conclusion that TAC and FAP lack empirical evidence to support or reject their efficacy. In light of these data and the systematic reviews on ACT, DBT and BA, it is argued that Brazilian therapists and researchers have three options: (1) use only the basic behavioral principles, i.e. the theory, to guide their clinical practice, which is insufficient to ensure the efficacy of the intervention; (2) adopt one of the international models of clinical behavior analysis; (3) systematize TAC so that it can be researched experimentally afterwards. It is expected that, in addition to offering the state of the art of clinical research on TAC and on FAP, this work will contribute to the scientific development of behavioral therapies and to the strengthening of behavior analysis as a science and profession
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Bedeutung, Erfassung und Veränderung interpersonaler Problemmuster in der Psychotherapieforschung : Eine Untersuchung mit dem Inventar zur Erfassung interpersonaler Probleme / Impact, evaluation and modification of interpersonal problem patterns in psychotherapy research : a study with the Inventory of Interpersonal ProblemsSalzer, Simone 28 June 2010 (has links)
No description available.
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Caractériser et comprendre le processus de changement des psychothérapies complexes : modélisation des processus, mécanismes et conditions des changements associés à la psychothérapie de 66 enfants et adolescents présentant des troubles du spectre autistique / Characterizing and understanding the process of change in complex psychotherapies : modeling the processes, mechanisms and conditions of changes associated with the psychotherapy of 66 children and adolescents with autism spectrum disordersThurin, Jean-Michel 31 May 2017 (has links)
La méthodologie de l’évaluation en psychothérapie s’est longtemps limitée aux résultats issus d’essais cliniques comparatifs de groupes. L’objectif, engagé dans les années 2000, de comprendre ce qui cause son efficacité a engagé un renouvellement méthodologique. Son application concrète est peu documentée. La première partie présente, à partir d’une revue de la littérature centrée sur l’introduction de la recherche sur le processus associée aux résultats, comment le paradigme interactionnel multifactoriel de la psychothérapie a stimulé le développement de méthodes adaptées à la complexité et à l’observation en conditions naturelles. La seconde partie introduit autour de cinq axes principaux les questions méthodologiques générales et spécifiques de cette nouvelle orientation : 1. une épistémologie interactionnelle et transactionnelle ; 2. Un recentrage sur les études mixtes intensives de cas ; 3. Une investigation clinique et théorique multifocale des processus et mécanismes de changement ; 4. une forte relation clinicien-chercheur ; 5. une approche statistique innovante. La troisième partie expose l’expérience et les questions soulevées par la mise en œuvre de ce programme dans le cadre d’un réseau de recherche clinique centré sur les pratiques, du recueil des données jusqu’à l’analyse des processus et mécanismes de changement, et les résultats qui en sont issus. La quatrième partie présente une revue détaillée de la littérature. Ce travail devrait favoriser les collaborations avec les disciplines connexes et l’efficience des traitements par une meilleure connaissance des conditions et des mécanismes de changement associée au développement d’une base de données issue d’études de cas. / The methodology of assessment in psychotherapy has long been limited to results from comparative group clinical trials. The objective, expressed in the 2000s, to understand what is causing its effectiveness has involved a methodological renewal. Its concrete application is poorly documented. The first part presents, from a review of the literature focusing on the introduction of research on the process associated with outcomes, how the multifactorial interactional paradigm of psychotherapy has stimulated the development of methods adapted to the complexity and observation in natural conditions. The second part introduces the general and specific methodological questions of this new orientation around five main axes: 1. an interactional and transactional epistemology; 2. A refocusing on intensive mixed case studies; 3. A multifocal clinical and theoretical investigation of the processes and mechanisms of change; 4. a strong clinical-researcher relationship; 5. an innovative statistical approach. The third part presents the experience and issues raised by the implementation of this program as part of a practice-oriented clinical research network, from data collection to analysis of processes and mechanisms of change, and results. The fourth part presents a detailed review of the literature. This work should foster collaborations with related disciplines and treatment efficiency through a better understanding of the conditions and mechanisms of change associated with the development of a case study database.
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