Youth traumatized by natural disasters report high levels of posttraumatic stress as well as other types of impairing emotional distress symptoms (e.g., anxiety and depression) for many years post-trauma. Implementing school based screening and treatment programs for these youth eliminates barriers to traditional treatment settings and may provide symptom relief. The current study examines the feasibility of conducting school-based trauma-focused treatment program in the wake of disaster. Idiographic evaluation of the treatment process is incorporated into the treatment evaluation through use of multiple baseline design. Youth reporting at least severe levels of posttraumatic stress on the PTSD-RI were recruited for an expanded assessment and treatment (youth ages 8-13; N=6). Treatment (i.e., the StArT program) consisted of 10-weekly individual sessions during which different cognitive behavioral components were introduced. Youth were assessed at pre-treatment, weekly during treatment, and at post-treatment. Quantitative and qualitative findings relative to youth responses to intervention are presented and discussed in terms of the feasibility of conducting treatment in school settings and in terms of individual difference factors contributing to treatment responses. Findings from this study suggest the feasibility of school based interventions through the aid of school counselors and integration of treatment sessions into the school schedule. Youth responses to the intervention were very positive, point toward the efficacy of a disaster trauma focused cognitive behavioral therapy (the StArT program), and help to highlight particularly useful modules in youth.

No description available.

No description available.

緒論 失眠困擾對身心健康有重大的影響，除了藥物取向的治療外，失眠認知行為治療（CBT-I）有足夠的實證研究證據肯定其療效，由於在認知行為治療（CBT）的研究中有證據支持參與者在家中，對治療技術練習與執行的程度與療效有關，因此CBT-I的療效可能也與患者對治療技術的執行程度有關，過去雖然也有少數研究探討CBT-I執行程度與療效的關係，但這些研究缺乏針對CBT-I各個治療技術的執行程度評估，因此本研究欲探討CBT-I中，各項治療技術（睡眠衛生教育、放鬆訓練、刺激控制法、睡眠限制法，及認知重建）的執行程度及執行規律程度，與特定療效指標改善程度的關係。 方法 研究參與者含原發性失眠患者22位，共病其它疾患的失眠患者16位，經篩選階段確認符合收案條件後，在接受為期七週的CBT-I團體治療期間，於第二週起需每日填寫執行程度問卷，同時帶領團體的治療師也於治療第三週起，以治療師執行程度評估量表來評估參與者的執行程度。參與者在治療前後另需分別填寫一週睡眠日誌以及睡眠困擾問卷（Insomnia Severity Inventory；ISI），以睡眠日誌中的SOL、WASO、TST、SE，及ISI得分的前後測改變分數，作為代表療效指標之依變項，預測變項則為參與者自評及治療師所評估的各項治療技術之執行程度分數，治療技術包括：睡眠衛生、放鬆訓練、刺激控制法、睡眠限制法，以及認知重建；並分別以平均數代表執行程度，而以變異數代表執行期間的規律程度。 結果 資料分析以皮爾森相關分析檢驗執行程度與療效間的關聯性，在全部樣本中的結果發現，參與者自評對認知重建的平均數與WASO的改善程度有正相關，以及治療師評估CBT-I的平均數與SOL的改善程度有正相關；而參與者自評放鬆訓練的平均數越低、刺激控制法變異數越高，則ISI的改善程度越好，為不符合預期的結果。在原發性失眠組中發現治療師評估睡眠衛生的平均數與WASO的改善有正相關，治療師評估睡眠限制法的平均數與SOL、TST，以及SE的改善有正相關，而變異數與SOL的改善有負相關，以及治療師評估CBT-I的平均數與SOL的改善有正相關；而不符合預期的結果為，參與者自評執行刺激控制法的變異數與ISI的改善有正相關。最後，在共病組中並沒有發現執行程度與療效之間有顯著相關的結果，而放鬆訓練以及刺激控制法兩項治療技術，也沒有與療效指標有符合預期的顯著相關結果。 結論 對於共病失眠患者而言，治療技術的執行評估與療效間未反映出顯著相關，可能因受限於睡眠生理疾患的干擾，使得療效未如原發性失眠組明顯；而就原發性失眠組而言，睡眠限制法的執行程度是與較多療效指標達到顯著相關的治療技術，顯示睡眠限制法的執行對於改善睡眠症狀有所幫助。本研究較為重大的限制在於，治療技術執行程度評估的評分者間一致性有限，後續研究可進一步發展評估執行程度更適當的方法。 / Introduction Insomnia is a common problem that has a significant impact on patients' physical and mental health. In addition to pharmacological therapy, there are sufficient empirical data to support treatment efficacy of cognitive behavioral therapy for insomnia (CBT-I). A major part of cognitive behavioral therapy is to teach the patients to learn specific cognitive and behavioral techniques that requires to be practiced at home by the patients. Previous studies have reported an association between the degree of adherence to treatment techniques and treatment effects in cognitive behavioral therapy for disorders other than insomnia. Some studies further explored the relationship between treatment adherence and treatment outcome in CBT-I. However, none of the study looked into the adherence to different treatment components on different aspects of treatment outcome. The aim of this study therefore is to explore the relationship between the adherence to different treatment components in CBT-I and the improvement in different sleep parameters. Method Twenty-two patients with primary insomnia and sixteen patients with comorbid insomnia were recruited for this study. During the 6-week period of treatment with CBT-I, they completed a treatment adherence questionnaire daily. The therapists also evaluated the patients’ adherence weekly after treatment sessions. They were required to keep sleep diaries from one week before to one week after the end of the 6-week CBT-I program. They also completed the ISI and sleep diary for one week before and after the treatment. The treatment outcome variables included the ISI score, and sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and the sleep efficiency (SE) from sleep diaries. The treatment components evaluated included sleep hygiene, relaxation, stimulus control, sleep restriction and cognitive reconstruction. The predictive variables included the mean for the adherence degrees and the variance for the adherence regularity of the adherence score evaluated by the participants and therapists. Results Pearson correlation was used to examine the associations between the adherence to respective treatment components in CBT-I and the variables of treatment outcome. In the whole sample, the decrease of the WASO correlated significantly with adherence to cognitive reconstruction evaluated by the patients, and the decrease of the SOL correlated significantly with adherence to CBT-I evaluated by the therapists. Nonetheless, the lower adherence to relaxation and the higher variance of adherence to stimulus control, the more improvement of the ISI. In patients with primary insomnia, the decrease of WASO correlated significantly with adherence to sleep hygiene evaluated by the therapists; the decrease of SOL and the increase of TST and SE showed significant correlation with adherence to sleep restriction evaluated by the therapists; the decrease of SOL showed significant negative correlation with the variance of adherence to sleep restriction evaluated by the therapists; the decrease of SOL showed significant positive correlation with the adherence to CBT-I evaluated by the therapists. Opposite to expectation, the decrease of the ISI score correlated significantly with variability of adherence to stimulus control evaluated by the patients. Finally, in patients with comorbid insomnia, the treatment component adherence did not correlate significantly with any outcome variables. The adherence of relaxation and stimulus control did not show significant correlation with outcome variables. Conclusion In patients with comorbid insomnia, treatment effects were not associated with adherence. This may due to the multifactorial nature of comorbid insomnia. Among the treatment components, adherence to sleep restriction seems to be the most predictive factor for good treatment outcome in primary insomnia. One limitation of the present study is its low inter-rater reliability of treatment components adherence evaluation. Therefore, more appropriate methods need to be developed to evaluate the adherence of treatment techniques.

Magister Chirurgiae Dentium (MChD) / Periodontal disease is one of the most common diseases worldwide. Periodontal treatment aims to prevent disease progression and restore functional and aesthetic dentition. The purpose of studying periodontal treatment outcome is to assess treatment efficacy. Treatment outcome of periodontal disease is affected by multiple patient-related factors, the type of treatment provided, and the expertise of the clinician.

An experimental design, (the pretest/posttest design) was used in this study to investigate the efficacy of substance abuse treatment using two instruments, the Addiction Severity Index (ASI) and the biopsychosocial assessment. Fifty-six subjects admitted to the SYMBAS TEAM Substance Abuse Treatment Program were assessed during the initial stage of treatment using the biopsychosocial assessment and the ASI. Through the process of random selection, subjects were placed in one of two groups, an experimental group or a control group. Counselors working with the subjects in the experimental group had access to the results of the ASI and biopsychosocial assessment for treatment planning, and the counselors working with the subjects in the control group had access only to the results of the biopsychosocial assessment. At the end of treatment (gO-days), the subjects in both groups were re-assessed using the ASI to determine what differences, if any, occurred between the two sample groups. Data was analyzed using descriptive statistics along with the Student test. Results revealed that there were no statistically significant differences between the two sample groups at the .05 alpha level. However, significant reductions between the ASI pre- and posttests mean scores were noted among several of the variables in both sample groups. Also, the counselors' perceptions of the ASI suggested that the ASI was preferred over the bippsychosocial assessment for treatment planning, because of its structure and the amount of time required to administer the instrument. / Ed. D.

Made available in DSpace on 2016-04-28T20:38:07Z (GMT). No. of bitstreams: 1 Perisson Dantas do Nascimento.pdf: 1613318 bytes, checksum: dc98bc4ee2d10b844964f573706401e4 (MD5) Previous issue date: 2012-05-11 / This work aims to verify that the contributions of verbal and bodily therapeutic interventions of Bioenergetic Analysis in the treatment of patients with primary and secondary complaints of organic pain. This intention is consistent with international efforts in researching the therapeutic efficacy of body psychotherapy. We start from the hypothesis that the diagnosis and intervention in the body with neo-Reichian techniques can serve as catalysts in the process of patient care traditionally regarded as psychosomatic. We focused on a qualitative method to clinical research, in which eight patients with various somatic complaints were submitted to twelve sessions of psychotherapy in bioenergetics and evaluated by instruments measuring psychological stress and general health conditions before and after intervention therapy. Data are presented through a characterization of the social profile of the patients, as well as through case studies, linking with the results obtained in the tests. Some issues raised by patients confirm the working hypotheses discussed in the literature, such as development history of trauma and family violence, abandonment experiences, coldness and detachment from the mother figure and a bond ambivalent love / heartbreak with the father figure; difficulties to experience pleasure in life and sexuality; emerging symptom associated with a particular crisis of life, due to a chronic disease process. Tests have shown mixed results, which are discussed in accordance with the circumstances in each case as indicative apparent adverse findings show that obtained in the process of intervention can increase the psychic stress, resulting in a crisis condition required for significant changes. Despite this, patients report improvements in relation to the disease and how to regulate their emotions, emphasizing the importance of bioenergetic exercises in the care and procedures. We conclude with the belief that a specific listening to body in the therapeutic process serves as a communication channel that facilitates empathy in the integrated health and the need to broaden the scope of this research, with additional experimental procedures / Esse trabalho busca verificar quais as contribuições terapêuticas das intervenções verbais e corporais da Análise Bioenergética no tratamento de pacientes com queixas primárias e secundárias de sofrimento orgânico, coadunando com os esforços internacionais em pesquisar a eficácia da psicoterapia corporal. Partimos da hipótese que o diagnóstico e intervenção corporais na vertente neorreichiana podem servir como catalisadores no processo de cuidado de pacientes tradicionalmente considerados como psicossomáticos. Privilegiou-se um método qualitativo clínico de pesquisa, no qual oito pacientes, com queixas somáticas variadas, foram submetidas a doze sessões de psicoterapia bioenergética, sendo avaliadas por instrumentos psicológicos de medição do estresse e de condições de saúde geral, antes e depois da intervenção. Os dados são apresentados através de uma caracterização do perfil social das pacientes, bem como através de estudos de caso, articulando com os resultados obtidos nos testes. Alguns temas levantados pelas pacientes confirmam hipóteses de trabalho discutidas na literatura, tais como: histórico de traumas de desenvolvimento e violência intrafamiliar; experiências de abandono, frieza e distanciamento da figura materna e um vínculo ambivalente de amor/mágoa com a figura paterna; dificuldades de experimentar prazer na vida e na sexualidade; o sintoma surgindo associado a uma crise específica de vida, decorrente de um processo de adoecimento crônico. Os testes demonstraram resultados variados, que são discutidos de acordo com o contexto de cada caso, pois aparentes indicativos desfavoráveis revelam que as descobertas obtidas no processo de intervenção podem aumentar a tensão psíquica, resultando num estado de crise necessária para mudanças importantes. Apesar disso, as pacientes relatam melhoras na relação com a doença e na forma de regular suas emoções, enfatizando a importância dos exercícios e procedimentos nos atendimentos. Concluímos o trabalho com a convicção de que a escuta diferenciada do corpo no processo terapêutico serve como canal de comunicação que facilita a empatia no cuidado integrado em saúde, bem como a necessidade de ampliar o escopo dessa pesquisa, com procedimentos experimentais complementares

No description available.

No description available.

I chose the theme of obsessive-compulsive disorder as a topic of my thesis. The main reason was that it is a disorder I have worked as a therapist in individual or group therapy frequently. Also I have participated in several studies as evaluator in Psychiatric Centre, and I collected data from dozens of patients. In the first part the thesis deals with the symptoms, clinical picture, prevalence, aetiology and treatment of OCD. Thesis is focuses on behavioural and cognitive models of the disorder in detail, because the treatment used in the present group of patients was CBT. Various models of cognitive behavioural therapy I discuss in more detail, because they allow different views of what happens to the patient and how to change it. The practical part has two parts. The first deals with the effectiveness of group cognitive behavioral approach for OCD patients, who use antidepressants but were resistant to previous treatment and were attended a daycare center at the Prague Psychiatric Center. The second part of the thesis deals with finding a predictor of successful cognitive behavioral therapy in these patients. The aim was to determine whether certain demographic or clinical factors that we evaluated before treatment may predict success outcome. The result is the finding that severity of the...