No description available.

Veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn are presenting for treatment with high rates of combat-related posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), spurring a need for clinical research on optimal treatment strategies. While exposure therapy has long been supported as an efficacious treatment for combat-related PTSD, some clinicians are hesitant to utilize this treatment for veterans with TBI history due to presumed cognitive deficits that may preclude successful engagement. The purpose of this study was to compare exposure therapy process variables in veterans with PTSD only and veterans with PTSD+TBI. Results suggest that individuals with PTSD+TBI engage successfully in exposure therapy, and do so no differently than individuals with PTSD only. Additional analyses indicated that regardless of TBI status, more severe PTSD was related to longer sessions, more sessions, and slower extinction rate during imaginal exposure. Finally, in a subset of participants, self-report of executive dysfunction did not impact exposure therapy process variables. Overall, findings indicate that exposure therapy should be the first-line treatment for combat-related PTSD regardless of presence of TBI history.

No description available.

The current study takes an initial step toward deriving a method for empirically based, theory-driven treatment matching in a military population suffering from PTSD. Along with the more overt symptoms of PTSD (e.g., persistent hyperarousal), secondary cognitive symptoms have also been shown to be significantly associated with avoidance and intrusive symptoms, as well as contribute to functional impairment. Based on the factor analytic and treatment literature for PTSD, it appears that there are two central mechanisms associated with beneficial therapeutic change that underlies both CPT and PE treatments (i.e., habituation, changes in cognitions). Additionally, different traumatic events and peritraumatic responses may be associated with unique symptom profiles and may necessitate targeted treatment. The present study proposes a novel approach to treatment matching based on the factor structure of PTSD and underlying mechanisms of treatment response. More broadly, this paper provides evidence for a broader understanding of peritraumatic responses and the potential implications of these responses for symptom profiles and illness trajectories.

Research psychologists often complain that practitioners disregard research evidence whilst practitioners sometimes accuse researchers of failing to produce evidence with sufficient ecological validity. The tension that thus arises is highlighted, using the specific illustrative examples of two treatment methods for post-traumatic disorder (PTSD): Eye-Movement Desensitisation and Reprocessing (EMDR) and exposure based interventions. Contextual reasons for the success or failure of particular treatment models that are often only tangentially related to the theoretical underpinnings of the models are discussed. Suggestions regarding what might be learnt from these debates are put forward and implications for future research are discussed.

A Paralisia Cerebral (PC) é definida como um grupo de desordens permanentes do desenvolvimento da postura e movimento, causando limitação em atividades. Assim, com o intuito de promover melhora de desempenho motor, os programas de reabilitação utilizam cada vez mais ambientes de realidade virtual, entretanto com poucas evidências de sua eficácia na transferência de desempenho para ambientes reais. Portanto, o objetivo deste trabalho é verificar se o treino de tarefa em ambiente virtual (sem toque) auxilia na melhora de desempenho em tarefas em ambiente com característica mais real (com toque) nas pessoas com PC. Para a realização deste trabalho foram avaliadas 80 pessoas, divididas em dois grupos: 40 no grupo PC e 40 no grupo controle composto por indivíduos com desenvolvimento típico (DT) com idade entre 8 e 21 anos (13,7 ± 3,6 anos), 24 do sexo masculino e 16 do sexo feminino, sendo o grupo DT pareado por idade e sexo ao grupo PC. Os resultados apontam que o ambiente mais virtual (kinect for windows) apresentou pior desempenho em todas as fases do estudo. Para o grupo PC a prática constante apontou pior desempenho apenas no ambiente mais virtual, enquanto no grupo DT, o pior desempenho foi encontrado para o ambiente mais real. Além disto, a prática prévia em ambiente virtual promoveu melhor desempenho na tarefa com características mais reais. Os participantes de ambos os grupos retiveram o desempenho adquirido, exceto pelos que realizaram a prática da primeira sequência no ambiente mais virtual. Todos também transferiram o desempenho para tarefa em maior velocidade e com interação pelo toque no botão do teclado. O grupo com PC apresentou pior desempenho que o grupo DT apenas nas fases de retenção e transferências. Concluímos então, que todos os indivíduos, tanto do grupo controle como experimental, conseguiram melhorar o desempenho durante a prática em ambos ambientes (real e virtual) e transferir o desempenho para a tarefa com maior velocidade e com características mais reais, independentemente se iniciaram pela prática aleatória ou constante. Além disto, a prática prévia em ambiente virtual promoveu melhor desempenho quando a mesma tarefa foi realizada em ambiente com características mais reais / Cerebral Palsy (CP) is defined as a group of permanent disorders of the development of posture and movement, causing limitation in activities. Thus, with the aim of promoting motor performance improvement, rehabilitation programs increasingly use virtual reality environments, but with little evidence of their effectiveness in transferring performance to real environments. Therefore, the goal of this work is to verify if the task training in virtual environment (without touch) helps the improvement of performance in tasks in environment with more real characteristic (with touch) in people with CP. Eighty people were evaluated, divided into two groups: 40 in the CP group and 40 in the control group composed of individuals with typical development (TD) aged between 8 and 21 (13.7 ± 3.6 years) , 24 males and 16 females. The TD group matches the CP group on both age and gender distribution. The results show that the most virtual environment (kinect for windows) presented worse performance in all phases of the study. For the CP group, the constant practice showed worse performance only in the most virtual environment, whereas in the TD group, the worst performance was found at the most real environment. In addition, the previous practice in virtual environment resulted in better performance in the task with more real characteristics. Participants in both groups retained their performance, except for those who performed the first sequence in the most virtual environment. Everyone also transferred the performance to task at a higher speed and with interaction by touching the keyboard button. The CP group presented worse performance than the TD group only in the retention and transfer phases. We conclude that all individuals, both control and experimental, were able to improve performance during practice in both real and virtual environments and transfer performance to the task with higher speed and with more real characteristics, regardless of whether they started with practice. In addition, previous practice in virtual environment promoted better performance when the same task was performed in an environment with more real characteristics

Interest in Virtual Reality (VR) is growing fast. Tech companies are now starting to identify its most relevant application that will make it desireable. The use of VR in healthcare and mental health, has been proven through clinical research. Moreover, patient support programs extend treatment to people’s homes. An underlying opportunity was to envision a service for remote treatment of phobias with exposure therapy through VR. During the process, I conducted desk research, interviews, a workshop, prototyping and user testing. I collected evidence to lay out the service experience and communicate the key role of the therapist in the overall journey. My goal was to maximize the leaning outcome of exposure therapy and avoid the return of fear. Focusing on VR for the mobile phone, as the most accessible hardware for the broad audience, I created examples of exposure experience, that demonstrate the therapist’s presence and the user’s interactions with the environment.

Nous avons réalisé deux expériences afin d'évaluer l'efficacité de la désensibilisation systématique combinée à la musique et déterminer la contribution exacte de la musique. Dans la première expérience, nous avons comparé l'effet de la désensibilisation systématique combinée à la musique méditative in vivo et l’effet de la désensibilisation systématique combinée à une musique relaxante enregistrée. La comparaison porte sur les niveaux d’envie pendant l'exposition à des stimuli associées à la substance, sur la réactivité à l’envie dans la vie quotidienne, sur les pensées permissives et les croyances liées à l’envie ainsi que sur la dépression et l'anxiété. La deuxième expérience a consisté à identifier la contribution exacte de la musique au contre-conditionnement de stimuli associés à la substance ainsi qu’à l'amélioration des autres variables. Les résultats de la première expérience ont révélé que les deux formes de traitement provoquent une diminution de la réactivité aux stimuli associées à la substance et ont des influences positives importantes sur les autres variables. La deuxième expérience a démontré que l'écoute de la musique relaxante induit des réductions significatives de l’envie pendant l'exposition à des stimuli associées à la substance et qu’elle améliore les croyances liées au comportement compulsif. En conclusion, ces études ont démontré la contribution significative de la musique à la désensibilisation systématique pour le traitement de la dépendance aux substances. Elle ouvre ainsi de nouvelles voies pour l'utilisation de la musique comme un outil thérapeutique complémentaire pour la réhabilitation des personnes dépendantes aux substances. / Two experiments were conducted in order to examine the effectiveness of music-assisted systematic desensitization and determine the exact contribution of listening to music in the therapeutic process. The first experiment examined the effect of live-played meditation music and recorded relaxing music combined with systematic desensitization, on craving responses during exposure to substance-conditioned cues, craving reactivity in everyday life, permissive thoughts on substance use, craving beliefs, depression and anxiety. The second experiment investigated the exact therapeutic contribution of listening to recorded relaxing music in the counterconditioning of cues related to substance use and the extinction of the implicated craving responses, as well as in the amelioration of everyday life craving reactivity, craving beliefs, depression and anxiety. The results of the first trial revealed an emphatic amelioration of craving intensity in response to cues conditioned with substance use and significant or close to statistical significance positive influences on the other variables by both forms of treatment. The findings of the second experiment suggested that listening to recorded relaxing music accounts for significant reductions in craving intensity during exposure to substance-conditioned cues and in craving beliefs associated with compulsive behaviour. In conclusion, this study showed the significant therapeutic contribution of music to in vitro cue-exposure therapy for substance addiction treatment and opens new avenues for future exploration and use of music as a complementary therapeutic tool in the rehabilitation of substance addicted individuals.

Orientadores: Simone Botelho Pereira, Cássio Luís Zanettinni Riccett / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T01:20:14Z (GMT). No. of bitstreams: 1 Silva_ValeriaRegina_M.pdf: 1669073 bytes, checksum: 323991e89ad6dee82fb3e930b3074e31 (MD5) Previous issue date: 2015 / Resumo: Introdução: A literatura recente tem investigado o efeito do treinamento abdominopélvico (TAP) como meio de prevenção e tratamento das disfunções do assoalho pélvico. Neste contexto, exercícios que promovam o treinamento muscular de forma global estão sendo explorados na pesquisa clinica. No presente estudo foram utilizados dois protocolos de TAP: um por meio de cinesioterapia e outro por meio de realidade virtual, a fim de investigar a interação dos músculos do compartimento abdominopélvico e, consequentemente, o comportamento dos músculos do assoalho pélvico (MAP) e Transverso do Abdômen (Tra) associado ao Obliquo Interno (OI), nas situações de contração voluntaria máxima (CVM), e de coativação. Objetivos: Investigar a atividade elétrica dos músculos do assoalho pélvico (MAP) e dos músculos abdominais (Tra/OI) frente a dois protocolos de treinamento: TAP Cinesioterapia (TAP CAP) e TAP Realidade Virtual (TAP RV); bem como identificar a presença de coativação entre os músculos. Pacientes e Métodos: Participaram desta pesquisa 47 mulheres jovens, nulíparas, continentes com idade média de 25,79 (±3,85) anos, divididas de forma randomizada em dois grupos: (G1) TAP_CAP (n=22) e (G2) TAP_RV (n=25). Os protocolos foram supervisionados por fisioterapeuta treinado, com duração de 30 minutos por sessão, três vezes por semana, totalizando 10 sessões. As mulheres foram avaliadas antes e após a realização dos protocolos, por meio de palpação digital (PD) dos MAP e eletromiografia (EMG) simultânea dos MAP e Tra/OI. Resultados: Os grupos apresentaram-se homogêneos quanto às condições sociodemográficas. Na avaliação por Palpação Digital observou-se aumento significativo na contratilidade dos MAP tanto no TAP_CAP (p=0,001) como no TAP_RV (p=0,0001), sem diferença entre os grupos (p=0,1). Em contrapartida, quando avaliado por EMG, não foi verificado diferença significativa na análise pré e pós- treinamento (p=0,05) em nenhum dos grupos. Ao solicitar a contração voluntária máxima do músculo Transverso do abdômen/ obliquo interno, para observação da coativação, observou-se resultado significativo (p=0,001) no grupo TAP RV após o treinamento. Entretanto, não foram encontrados resultados significativos no grupo TAP_CAP. Conclusão: O treinamento abdominopélvico por meio de realidade virtual proporcionou melhora da coativação dos músculos do assoalho pélvico em resposta à contração do Tra / Abstract: Introduction: Recent literature has investigated the abdominopelvic training effect (APT) effect as means of to prevent and treat pelvic floor dysfunction. In this context, globally muscle training exercises are being explored in clinical research. In the present study, two abdominopelvic protocols were used: by kinesiotherapy and by virtual reality, aiming to investigate the interaction of abdominopelvic enclosure muscles, and consequently, the behavior of the pelvic floor muscles (PFM) and transversus abdominis/internal obliquos (Tra/IO) muscle, in some peculiarly situations like maximum voluntary contraction (MVC) and coactivation. Aims: To investigate the pelvic floor and abdominal muscle¿s electrical activity using two training protocols: APT by kinesiotherapy (APT K) and APT by virtual reality (APT VR); as well as to indentify the presence of coactivation between these muscles. Patients and Methods: 47 young, nulliparous and continent women (mean age 25.79±3.85 years) participated in this study. They were randomly divided into two groups: (G1) APT_K (n=22) and (G2) APT_VR (n=25). The protocols were supervised by a physiotherapist, lasting 30 minutes per session, three times per week, during 10 sessions. The women were assessed before and after the completion of the protocols by digital palpation (DP) and electromyography (EMG) of simultaneous MAP and Tra/IO. Results: The groups were homogeneous in demographic conditions. There was a significant increase in PFM contractility in both APT_K (p = 0.001) and APT_VR (p=0.0001) groups when assessed by digital palpation, with no difference in the comparison between groups (p=0.1). In contrast, when measured by EMG, PFM electromyography activity did not showed a significant difference in pre and post training analysis (p=0.05). When requesting the Transverse / internal oblique maximum voluntary contraction, for observation of coactivation, a significant result (p=0.001) was observed in APT_VR group after training. However, no significant results were found in APT_K group. Conclusion: The abdominopelvic training by virtual reality showed an improvement in the coactivation of pelvic floor muscle contraction in response to Tra / Mestrado / Fisiopatologia Cirúrgica / Mestra em Ciências

A Paralisia Cerebral (PC) é definida como um grupo de desordens permanentes do desenvolvimento da postura e movimento, causando limitação em atividades. Assim, com o intuito de promover melhora de desempenho motor, os programas de reabilitação utilizam cada vez mais ambientes de realidade virtual, entretanto com poucas evidências de sua eficácia na transferência de desempenho para ambientes reais. Portanto, o objetivo deste trabalho é verificar se o treino de tarefa em ambiente virtual (sem toque) auxilia na melhora de desempenho em tarefas em ambiente com característica mais real (com toque) nas pessoas com PC. Para a realização deste trabalho foram avaliadas 80 pessoas, divididas em dois grupos: 40 no grupo PC e 40 no grupo controle composto por indivíduos com desenvolvimento típico (DT) com idade entre 8 e 21 anos (13,7 ± 3,6 anos), 24 do sexo masculino e 16 do sexo feminino, sendo o grupo DT pareado por idade e sexo ao grupo PC. Os resultados apontam que o ambiente mais virtual (kinect for windows) apresentou pior desempenho em todas as fases do estudo. Para o grupo PC a prática constante apontou pior desempenho apenas no ambiente mais virtual, enquanto no grupo DT, o pior desempenho foi encontrado para o ambiente mais real. Além disto, a prática prévia em ambiente virtual promoveu melhor desempenho na tarefa com características mais reais. Os participantes de ambos os grupos retiveram o desempenho adquirido, exceto pelos que realizaram a prática da primeira sequência no ambiente mais virtual. Todos também transferiram o desempenho para tarefa em maior velocidade e com interação pelo toque no botão do teclado. O grupo com PC apresentou pior desempenho que o grupo DT apenas nas fases de retenção e transferências. Concluímos então, que todos os indivíduos, tanto do grupo controle como experimental, conseguiram melhorar o desempenho durante a prática em ambos ambientes (real e virtual) e transferir o desempenho para a tarefa com maior velocidade e com características mais reais, independentemente se iniciaram pela prática aleatória ou constante. Além disto, a prática prévia em ambiente virtual promoveu melhor desempenho quando a mesma tarefa foi realizada em ambiente com características mais reais / Cerebral Palsy (CP) is defined as a group of permanent disorders of the development of posture and movement, causing limitation in activities. Thus, with the aim of promoting motor performance improvement, rehabilitation programs increasingly use virtual reality environments, but with little evidence of their effectiveness in transferring performance to real environments. Therefore, the goal of this work is to verify if the task training in virtual environment (without touch) helps the improvement of performance in tasks in environment with more real characteristic (with touch) in people with CP. Eighty people were evaluated, divided into two groups: 40 in the CP group and 40 in the control group composed of individuals with typical development (TD) aged between 8 and 21 (13.7 ± 3.6 years) , 24 males and 16 females. The TD group matches the CP group on both age and gender distribution. The results show that the most virtual environment (kinect for windows) presented worse performance in all phases of the study. For the CP group, the constant practice showed worse performance only in the most virtual environment, whereas in the TD group, the worst performance was found at the most real environment. In addition, the previous practice in virtual environment resulted in better performance in the task with more real characteristics. Participants in both groups retained their performance, except for those who performed the first sequence in the most virtual environment. Everyone also transferred the performance to task at a higher speed and with interaction by touching the keyboard button. The CP group presented worse performance than the TD group only in the retention and transfer phases. We conclude that all individuals, both control and experimental, were able to improve performance during practice in both real and virtual environments and transfer performance to the task with higher speed and with more real characteristics, regardless of whether they started with practice. In addition, previous practice in virtual environment promoted better performance when the same task was performed in an environment with more real characteristics