Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed disorders of childhood. This study was designed to evaluate the effectiveness of combined parent training and structured group therapy with children diagnosed with ADHD. The study sought to evaluate the amount of parent training needed to lead to significant changes in children and parents. Families were assigned to a wait-list control condition or to one of two parent treatment conditions: a complete parent group or a handout-only group. Children participated in a seven session social skills and behavior management group. The treatments were designed to concurrently enhance skills of both parents and children. Dependent measures assessed change in the following three areas: (1) child symptomatic behaviors, (2) parental attitudes, and (3) parental behaviors. Results showed that the full parent group led to greater levels of improvement in both child behavior problems and parental feelings of stress and control. The full parent group also led to greater consistency in parenting methods. Findings in the study are discussed in the context of the parent-child coercive cycle model.

INTRODUÇÃO Segundo a 4ª edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-IV; American Psychiatric Association, 2002), o Transtorno Obsessivo- Compulsivo (TOC) caracteriza-se por obsessões e/ou compulsões recorrentes que interferem substancialmente com o funcionamento cotidiano. Ainda que a Terapia Cognitivo-Comportamental em Grupo (TCCG) tenha sido efetiva nos estudos de pacientes com TOC (Cordioli et al., 2003; Braga et al., 2005; Sousa et al., 2006), quase um terço (30%) dos pacientes não se beneficiou do tratamento em grupo nos mesmos estudos. A Entrevista Motivacional (EM) e o Mapeamento Cognitivo (MC) têm sido usados para melhorar os resultados de tratamentos. OBJETIVOS O objetivo principal do presente estudo foi avaliar os efeitos de se acrescentar duas sessões individuais de EM+MC a 12 semanas de TCCG na resposta ao tratamento dos pacientes com TOC, quando comparados apenas à TCCG. MÉTODOS Noventa e três pacientes adultos, com diagnóstico de TOC de acordo com os critérios do DSM-IV, participaram de um ensaio clínico randomizado de 14 semanas: 48 pacientes foram alocados à condição de duas sessões individuais de EM+MC seguidas de 12 semanas de TCCG e 45 receberam duas sessões individuais informativas seguidas da TCCG. Para a avaliação dos resultados foi utilizada a escala Yale-Brown de Sintomas Obsessivo-Compulsivos (Y-BOCS) como medida de desfecho primária. Como medidas de desfecho secundárias utilizou-se: a escala de Impressão Clínica Global (CGI) e o Inventário de Depressão de Beck (BDI), bem como a proporção de respondedores (definida como melhora [redução na Y-BOCS 35%] ou não-melhora [redução 35% na Y-BOCS]) e o percentual de pacientes com remissão parcial (Y-BOCS 35%, mas com escore total >8 e CGI 2) e remissão completa (Y-BOCS 8 e CGI < 2). RESULTADOS Quando os dois grupos foram comparados, ambos apresentaram redução dos sintomas do TOC. No entanto, a redução e remissão dos sintomas foram significativamente maiores no grupo da EM+MC seguido da TCCG. Além disso, os resultados positivos foram mantidos após três meses de seguimento com redução adicional de sintomas. CONCLUSÃO Este estudo é o primeiro ensaio clinico randomizado que acrescenta duas sessões individuais de EM+MC à TCCG para aumentar a resposta do tratamento em grupo para o TOC. Apesar de algumas limitações, nossos resultados sugerem que acrescentar duas sessões individuais de EM+MC à TCCG pode aumentar a efetividade da TCCG na redução dos sintomas do TOC. Estudos futuros deverão investigar isoladamente os efeitos da EM e do MC como estratégia de potencialização no tratamento do TOC. / INTRODUCTION According to the Diagnostic and Statistical Manual of Mental Disorders (DSMIV; American Psychiatric Association, 2002), Obsessive-compulsive disorder (OCD) is characterized by recurrent obsessions and/or compulsions that significantly interfere with daily functioning. Although group cognitive behavioral therapy (GCBT) has been effective for OCD patients (Cordioli et al., 2003; Braga et al., 2005; Sousa et al., 2006), almost onethird (30%) of patients did not benefit from this treatment. Motivational Interviewing (MI) and Thought Mapping (TM) have been used to enhance treatment outcome. AIMS The main goal of the present study was to examine the effects of adding individual sessions of MI and TM to 12 weeks of CBGT on the treatment outcome of OCD patients when compared to the CBGT alone. METHODS Ninety-three adult outpatients, with OCD diagnosis according to the DSM-IV participated in a 14-week randomized clinical trial: 48 patients were allocated to two individual sessions of MI+TM in addition to 12-week CBGT; 45 underwent two individual information sessions followed by CBGT. For the outcomes evaluation, the Yale-Brown Obsessive Compulsive Scale (YBOCS) was used as the primary efficacy measure. As secondary efficacy measures, the Clinical Global Impressions Scale (CGI), the Beck Depression Inventory (BDI) and the proportion of responders (defined as improved [reduction 35% on the Y-BOCS] or non-improved [reduction 35% on the Y-BOCS]) and the percentage of patients in partial remission (Y-BOCS 35% but with the total score >8 and CGI 2) and full remission (Y-BOCS 8 and CGI < 2) were used. RESULTS When the two groups were compared, both presented a reduction of OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. In addition, positive outcomes were maintained at the 3-month follow-up with additional symptom reduction. CONCLUSION This study is the first randomized clinical trial which adds individual sessions of MI+TM to CBGT to improve the outcome of group treatment for OCD. Despite some limitations, our results suggest that adding MI+TM to CBGT can enhance the CBGT effectiveness in reducing OCD symptoms. Future studies should investigate the effect of the MI and the TM alone as an augmentation strategy for OCD treatment.

Dois estudos avaliaram o impacto e o processo de um modelo de grupoterapia cognitivo-comportamental para 49 meninas vítimas de abuso sexual com idade entre 9 e 16 anos. O Estudo I avaliou: o impacto do modelo na redução de sintomas de depressão, stress, ansiedade, transtorno do estresse pós-traumático (TEPT) e crenças distorcidas sobre o abuso e o efeito do tempo de espera por tratamento nestes sintomas; a manutenção do impacto da grupoterapia após 6 e 12 meses do término; e os fatores preditores para a resposta à grupoterapia. Os resultados, obtidos através do teste t para amostras pareadas apontaram que o modelo de grupoterapia apresentou impacto positivo, reduzindo significativamente os sintomas avaliados; o efeito da espera entre os grupos não revelou diferença significativa; os efeitos terapêuticos se mantiveram após um ano; e, os fatores preditores da resposta à grupoterapia foram: idade de início do abuso, presença de estupro e sintomas de revivência do TEPT antes da grupoterapia. O Estudo II avaliou o processo terapêutico a partir da análise clínica descritiva de dois casos, considerando as participantes que obtiveram escores extremos na análise da redução de sintomas. Os resultados apontaram que a idade de início do abuso, forma de abuso, experiência de abrigamento, resposta ao treino de inoculação do estresse e percepções de culpa foram aspectos que diferenciaram a resposta à grupoterapia. O modelo avaliado se mostrou efetivo para tratamento de meninas vítimas de abuso sexual. / Two studies assessed the effectiveness impact and process of a cognitive behavioral group therapy model applied to 49 female children and adolescents victims of sexual abuse (9-16 years). The Study I evaluated: the impact of the model in the reduction of symptoms of depression, anxiety, stress, post-traumatic stress disorder (PTSD) and the beliefs on the abusive experience and the effect of being in a waiting list for treatment in these symptoms; the permanence of the group therapy effects impact in a 6 and 12 months follow ups; the predictors factors for a group therapy response. The results, analyzed through the test t, revealed: the model showed positive impact, reducing the evaluated symptoms; the effect of being in the waiting list did not reveal significant difference in both groups; the therapeutic impact were maintained through the follow ups; the predictor factors for a response to group therapy were: age of the sexual abuse, rape presence and re-experiencing symptoms of the PTSD before the group therapy. The Study II assessed the therapeutic process using a two cases clinic analysis, considering the participants that obtained extremes scores in the analysis of symptoms reduction. The results pointed out to: the age of the sexual abuse, rape presence, sheltering, response the stress inoculation training and self perceptions of blame were aspects that explained the different response to the group therapy. The model was effective to the treatment of the girls victims of sexual abuse.

Student Number : 0204770E - MEd research report - School of Education - Faculty of Humanities / The present study investigates a bereavement training programme with a group of volunteer lay counsellors. In South Africa, the number of orphans resulting from an increase in parental deaths from natural causes, such as AIDS and nonnatural causes, for example violence, is increasing rapidly. The increasing number of bereaved children is creating a demand for professional support services that cannot be met by the present number of trained professionals. To address this imbalance, the training of lay counsellors is proposed. It is thus relevant to train those who are willing to help with the necessary knowledge and skills in a bereavement training programme. The present study involves ten volunteers from a Community Centre. Qualitative research methods are employed to analyse the data that is gained from the preand post-training responses to the interviews and Case Examples. Content analysis is used to elucidate the themes that emerge from the collected data. The results of the present study indicate that perceptual and developmental changes have occurred within the volunteers following the training programme, however, it is evident that further training is necessary because of the limited ability that the volunteers demonstrate in practically transferring the knowledge to new cases. In terms of this finding it is clear that factors such as language, age, educational level and personal experiences of death are important criteria to consider in the selection of volunteers for a bereavement training programme. Furthermore, traditional African perspectives of death, cultural differences and HIV/AIDS awareness need to be incorporated into future bereavement training programmes. In terms of the outcomes of the study, a positive outcome is the revision of the Bereavement Programme for children, taking cognisance of cultural sensitiveness, to make it more applicable within the local context. The results of the study also highlight the limitations and implications of the present research, which are discussed and recommendations for future research are made.

SammanfattningSömnproblem är vanligt förekommande hälsoproblem i befolkningen. Kognitiv beteendeterapi (KBT) har visats vara en effektiv behandling för personer med insomni men mindre forskning har bedrivits på effekten av KBT i grupp för personer med insomni (KBT-I) och samtidiga depressiva symtom. Studien syftade till att undersöka effekten av KBT-I i grupp med avseende på graden av insomni, depressiva symtom, och samvariationen med transdiagnostiska processer. En single-subject design användes med dagliga skattningar och för-, mellan- och eftermätningar. Resultatet visade att graden av insomni minskade för samtliga deltagare och graden av depressiva symtom minskade för majoriteten. En samvariation mellan sömnrelaterad oro, selektiv uppmärksamhet, och insomni fanns. Det återstår för framtida forskning att undersöka de transdiagnostiska processernas samband med insomni och depressiva symtom närmare. / AbstractSleep disorders are a common health problem in the population. Cognitive behavior therapy for insomnia (CBT-I) have proved to be an effective treatment for people with insomnia, but less research has been conducted on the efficacy of CBT-I in a group of people with insomnia (CBT-I) and comorbid depressive symptoms. The purpose of this study was to investigate the effect of CBT-I in group with respect to insomnia, depressive symptoms, and transdiagnostic processes. A single-subject design was used with daily estimates and pre- between-and posttest measures. The study concluded that the degree of insomnia symtoms decreased for all participants and the degree of depressive symptoms decreased for the majority. A correlation was found between sleep-related worry, selective attention, and insomnia. It remains for future research to investigate transdiagnostic processes associated with insomnia and depressive symptoms further.

This thesis addresses the hypothesis “ Intragroup cultural differences between client and therapist will adversely affect client – therapist consonance in their perception of arts therapies group treatment” The literature review of intercultural psychotherapy, arts therapies and congruence research is contextualised in a discussion of the arts therapies in the UK, in particular group therapy in psychiatry. The discussion of the evolution of a multi modal research design incorporates an ethnographic perspective. The researcher shows how the setting and two pilot studies as well as the Evidence Based Practice initiative influenced the design. The main concepts in the research question are defined and the sample analysed within its local context. Helping and hindering factors in arts therapies group sessions are identified through cluster analysis of questionnaires and focus groups. The next stage of the analysis examines which client, therapist and treatment variables are shown to affect dissonance. Five case studies show the interaction of these variables for individual clients. The concluding chapter discusses the findings and critiques the methodology, as well as providing recommendations for further research. The hypothesis of the research is found invalid; cultural background variables alone do not create client-therapist dissonance. The findings show that client, therapist and treatment variables interact to create dissonance. Client diagnosis, stage of treatment and cultural background interact with their experience of the arts therapies medium. In an arts therapy group context the structuring of the group and the interpretation of the arts expression as symbol or index, will interact with client and therapist cultural background variables. The intragroup variations are migration history, nationality, religious orientation and first language spoken. Cultural difference with the therapist affecting dissonance was evident for those clients who were third generation English / British and who had grown up and were still resident in an non-urban area (small town or village in a predominantly agricultural region) with little cultural diversity. Intergroup difference affected attrition for one client, influenced more by peer than therapist dissonance. Treatment interruptions, the theoretical orientation of the therapists and peer dissonance interact with the client-therapist dissonance. Recommendations for practice are formulated from these findings. These concern adjusting practice to allow for a greater emphasis on expression and play, differing client perceptions about symbolism and the establishing of an early therapeutic alliance.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Em todo o mundo é alta a prevalência dos transtornos depressivos e ansiosos, em especial no nível primário. Uma das estratégias terapêuticas é o atendimento em grupo que propicia bons resultados e cuidado adequado, incluindo melhor aproveitamento do tempo e maior abrangência no atendimento segundo experiências relatadas em diversos países.O objeto deste estudo é o discurso de mulheres com transtornos depressivos e ansiosos atendidas em grupo na atenção primária. O objetivo é conhecer representações e questões sobre o processo de adoecimento de mulheres atendidas na Estratégia de Saúde da Família (ESF) diagnosticadas com transtornos depressivos e ansiosos. Os grupos terapêuticos ocorreram em Postos de Saúde da Família, no município de Petrópolis, Rio de Janeiro, realizados pelos profissionais da ESF (médicos e enfermeiros) e supervisionados por especialistas em saúde mental. A pesquisa se deu com base análise de material de observação de dois grupo em comunidades distintas. Foi utilizado o método qualitativo, com analise das falas que foram organizadas em categorias segundo o método análise de conteúdo. Resultados: Transtornos depressivos e ansiosos são retratados no discurso das mulheres nos grupos como um processo solitário, sem apoio, compreensão e ajuda de terceiros. São agravantes: dificuldades financeiras, falta de lazer, sobrecarga de obrigações e cobranças.O álcool é retratado como apaziguador do sofrimento e da solidão. Relatam relacionamentos insatisfatórios e ocupam posições de submissão, sentindo-se desempoderadas, sem ver saída para sua situação, perpetuando pensamentos e ações, retroalimentando o sofrimento emocional. Valorizam o grupo enquanto espaço terapeutico. A possibilidade de verem retratado nas colegas situações similares encoraja a ajuda mútua. Estes são aspectos que auxiliam na autopercepção e no empoderamento. A intervenção se mostrou aplicável na atenção primária, sendo factível a não especialistas de saúde mental. / All over the world, there is a high prevalence of depressive and anxiety disorders, especially in primary care. One of the therapeutically strategies is group support which allows good results and proper care, including better time management and wider range in support according to reported previous experiences in many different countries. The aim in this study is grounded on womens speech with depressive and anxiety disorders supported in primary care group. The goal is to understand their representations and issues about these women sickening process who are under supervision in Family Health Strategy (FHS) diagnosed with depressive and anxiety disorders. The therapeutic groups happened in the Family Health Unit placed in the city of Petropolis, Rio de Janeiro, carried out by FHP professionals, both doctors and nurses, and supervised by mental health specialists. The research is based on the observation material analysis provided by two groups from different communities. The qualitative method was used, analysing their speech which were organized in categories according to methodology for qualitative data analysis, usually called content analysis. Results: depressive and anxiety disorders are portrayed in these wome1s speech as a lonely process, with support, understanding and help from others. Financial difficulties, lack of leisure, overload in responsibilities are aggravating, Alcohol usage is felt as an instrument to ease their pain and loneliness. They say they are in unsatisfactory relationships and are in submissive positions as well, which make them feel powerless, perpetuating actions and thoughts, providing emotional pain feedback. They value the group as a therapeutical space. The chances of being portrayed in other subjects in similar positions provide mutual support. These are aspects which bear their self perception and in their empowerment. The method has proved to applicable in primary care, possible to non specialists in mental health.

No description available.

O presente estudo avaliou a efetividade de uma tecnologia social de capacitação profissional em um modelo de grupoterapia cognitivo-comportamental voltado a psicólogos que trabalham com o atendimento clínico de crianças e adolescentes vítimas de abuso sexual. O Estudo I avaliou o impacto da capacitação profissional nos índices de esgotamento emocional (burnout) e de tensão ocupacional (job strain) dos participantes, bem como o impacto no trabalho. Participaram 30 psicólogos que trabalham em instituições públicas do Estado do Rio Grande do Sul. Do total da amostra, 19 compuseram o grupo experimental (G1, formado por participantes da capacitação profissional) e 11 compuseram o grupo de comparação (G2, formado por não-participantes da capacitação profissional). Os instrumentos utilizados foram o Job Content Questionnaire; o Maslach Burnout Inventory, a Escala de Impacto do Treinamento no Trabalho e uma ficha de dados biosociodemográficos. Para G1, foi observado um elevado índice de impacto no trabalho. Referente aos índices de burnout, a exaustão emocional e a baixa-realização no trabalho mantiveram-se estáveis entre T1 e T2, enquanto a despersonalização diminuiu. Para G2, todos os indicadores de burnout aumentaram significativamente. Em relação aos níveis de tensão ocupacional, a demanda de trabalho aumentou para G1, enquanto que se manteve estável para G2. Já os níveis de ‘controle no trabalho’ mantiveram-se estáveis para G1, enquanto houve diminuição significativa para G2, sobretudo devido à diminuição dos índices da variável ‘uso de habilidades’. O Estudo II objetivou avaliar o processo da capacitação profissional, visando a observar as potencialidades e limitações do programa oferecido. A amostra foi composta por 28 psicólogos participantes da tecnologia social de capacitação profissional. Os participantes responderam a um questionário de dados biossociodemográficos e a fichas de avaliação da capacitação, ao final de cada encontro. Os resultados obtidos mediante a ficha de avaliação apresentaram um nível elevado de satisfação com o programa de capacitação profissional oferecido. Sugestões e comentários adicionais, bem como opiniões sobre os aspectos mais positivos e mais negativos do curso forneceram subsídios para melhoramentos em edições futuras. Os resultados dos dois estudos sugerem que a Tecnologia Social de Capacitação Profissional é um recurso importante para a formação teorico-prática, bem como para o bem-estar no trabalho dos profissionais que lidam com a demanda do abuso sexual infanto-juvenil no Estado do Rio Grande do Sul. / This study evaluated the effectiveness of a social technology of professional training in a cognitive-behavioral group-therapy model, addressed to clinical psychologists who treat children victims of sexual abuse. Study I evaluated the effects of the professional training in the indexes of burnout and job strain of the participants, as well the impact of the training at work. The sample was composed by 30 psychologists who work in public institutions at the state of Rio Grande do Sul (Brazil). From the total sample, 19 were part of the experimental group (G1, composed by participants of the training program) and 11 were a comparison group (G2, formed by non-participants of the training program). The instruments were the Job Content Questionnaire, the Maslach Burnout Inventory, the Job Training Evaluation Scale and a bio-sociodemographic protocol. The results showed that the training program presented a high impact on the job performance. Regarding to the burnout indexes in G1, the results showed that exhaustion and reduced personal accomplishment remained stable, while depersonalization presented a significant reduction, through T1 to T2. To G2, the three burnout domains increased significantly. Regarding to the job strain levels, the workload increased to G1 and remained stable for G2. The levels of control remained stable for G1, while for G2 they decreased, mainly due to lower rates of the skill discretion indexes. Study II aimed to evaluate the process of the professional training program. The sample was composed by 28 psychologists whom participated of the training program. Participants responded a bio-sociodemographic protocol and the session evaluation form. The indicators of the evaluation forms presented a high level of satisfaction with the professional training program. Suggestions and additional commentaries, as well opinions about the most positive and negative aspects of the program provided subsidies to improve future editions of the training program. The results of both studies suggest that the Social Technology of Training Program is an important resource to the theoretical and practical qualification as well as for the well-being of the professionals who work with child victims of sexual abuse at the Rio Grande do Sul state, in Brazil.

Dois estudos avaliaram o impacto e o processo de um modelo de grupoterapia cognitivo-comportamental para 49 meninas vítimas de abuso sexual com idade entre 9 e 16 anos. O Estudo I avaliou: o impacto do modelo na redução de sintomas de depressão, stress, ansiedade, transtorno do estresse pós-traumático (TEPT) e crenças distorcidas sobre o abuso e o efeito do tempo de espera por tratamento nestes sintomas; a manutenção do impacto da grupoterapia após 6 e 12 meses do término; e os fatores preditores para a resposta à grupoterapia. Os resultados, obtidos através do teste t para amostras pareadas apontaram que o modelo de grupoterapia apresentou impacto positivo, reduzindo significativamente os sintomas avaliados; o efeito da espera entre os grupos não revelou diferença significativa; os efeitos terapêuticos se mantiveram após um ano; e, os fatores preditores da resposta à grupoterapia foram: idade de início do abuso, presença de estupro e sintomas de revivência do TEPT antes da grupoterapia. O Estudo II avaliou o processo terapêutico a partir da análise clínica descritiva de dois casos, considerando as participantes que obtiveram escores extremos na análise da redução de sintomas. Os resultados apontaram que a idade de início do abuso, forma de abuso, experiência de abrigamento, resposta ao treino de inoculação do estresse e percepções de culpa foram aspectos que diferenciaram a resposta à grupoterapia. O modelo avaliado se mostrou efetivo para tratamento de meninas vítimas de abuso sexual. / Two studies assessed the effectiveness impact and process of a cognitive behavioral group therapy model applied to 49 female children and adolescents victims of sexual abuse (9-16 years). The Study I evaluated: the impact of the model in the reduction of symptoms of depression, anxiety, stress, post-traumatic stress disorder (PTSD) and the beliefs on the abusive experience and the effect of being in a waiting list for treatment in these symptoms; the permanence of the group therapy effects impact in a 6 and 12 months follow ups; the predictors factors for a group therapy response. The results, analyzed through the test t, revealed: the model showed positive impact, reducing the evaluated symptoms; the effect of being in the waiting list did not reveal significant difference in both groups; the therapeutic impact were maintained through the follow ups; the predictor factors for a response to group therapy were: age of the sexual abuse, rape presence and re-experiencing symptoms of the PTSD before the group therapy. The Study II assessed the therapeutic process using a two cases clinic analysis, considering the participants that obtained extremes scores in the analysis of symptoms reduction. The results pointed out to: the age of the sexual abuse, rape presence, sheltering, response the stress inoculation training and self perceptions of blame were aspects that explained the different response to the group therapy. The model was effective to the treatment of the girls victims of sexual abuse.