Background: Generalized anxiety disorder (GAD) shows the weakest treatment response among anxiety disorders. This study aimed at examining whether an acceptance-based group behavioral therapy (ABBT) for patients in a Brazilian anxiety disorders program, combining mindfulness and exposure strategies, can improve clinical outcome when compared with a standard nondirective supportive group therapy (NDST). Methods: Ninety-two individuals diagnosed with GAD were randomized to receive 10 sessions of either ABBT or NDST. Assessments at pretreatment, midtreatment, posttreatment, and 3-month follow-up comprised the following outcome measures: Hamilton Anxiety Rating Scale (HAM-A), Penn State Worry Questionnaire (PSWQ), Depression Anxiety and Stress Scale (DASS), and the Clinical Global Impressions (CGI). The World Health Organization Quality of Life (WHOQOL) was administered at pretreatment and posttreatment. Results: The mixed-effects regression models for DASS-stress, Hamilton Anxiety Interview, and CGI showed a significant effect for Time and the Time × Treatment effect, but not for the Treatment main effect. Similarly, there was a significant Time × Treatment effect for the PSWQ, but not main effects of Time or Treatment. Altogether, these data indicate that symptoms decreased in both conditions across treatment and follow-up, and that the rate of change was more rapid for those participants in the ABBT condition. We found no differences between groups from pretreatment to posttreatment in DASS-anxiety or any secondary outcome measure, but for the physical health domain of WHOQOL, which was faster in ABBT. Conclusions: Both groups showed good clinical outcomes, but in general, participants of the ABBT group improved faster than those in the NDST group.
As terapias cognitivo-comportamentais no tratamento da bulimia nervosa: uma revisãoThe cognitive-behavior therapies in the treatment of bulimia nervosa: a review ABSTRACTObjective: To review the literature about the use of cognitive-behavior therapy in bulimia nervosa treatment, between 2009 and 2013. Methods: Three electronic databases were researched, and articles in English, Portuguese and Spanish were selected. Results: After the analysis and exclusion of the articles, followed the PRISMA methods, were chosen 20 articles. Selected articles were produced in Europe or in United States of America, in English. The diagnosis of the sample ranged from only bulimia nervosa (60%) that included the people with binge eating disorders (35%), and mixed eating disorders diagnoses (5%). The researches were conducted mostly with women. The cognitive-behavior therapy in your classic form in
Objective: Exposure and response prevention (ERP) is effective to treat obsessive-compulsive disorder (OCD), but the lack of tolerance to the aversion nature of exposure techniques results in a high drop-out rate. There have been reports of a generic stress endurance effect of serotonin (5-HT) in the central nervous system (CNS) which might be explained by suppression of defensive fixed action patterns. Previous studies have proposed that higher baseline 5-HT concentration and slow decrease in concentration during drug treatment of OCD were predictors of good clinical response to 5-HT reuptake inhibitors. The objective of this study was to investigate whether pre-treatment platelet rich plasma (PRP) 5-HT concentration is associated with latency of treatment response and final response to an ERP protocol for obsessive-compulsive disorder (OCD). Methods: Thirty adult and treatment-free OCD patients were included in an 8-week, 16-session ERP protocol. 5-HT concentration was determined at baseline and after treatment. Patients with a reduction X30% on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at the end of ERP were defined as responders. Results: A positive correlation between baseline 5-HT concentration and reduction of symptoms on the Y-BOCS was observed after 4 weeks. Baseline 5-HT concentration was not correlated with clinical response after 8 weeks of ERP, possibly due to the similar though delayed clinical response of patients with lower (compared to those with higher) baseline 5-HT concentration. Patients with higher 5-HT baseline concentration also showed more improvement in depressive symptoms with treatment. Conclusion:The present results partially support the hypothesis of a stress endurance effect of 5-HT in OCD patients. According to the literature, fast onset responders possibly have more or larger 5-HT containing neurons, higher endogenous 5-HT synthesis or lower monoamine oxidase activity; all these hypotheses remain to be investigated.
Resumo O Ensaio Clínico Aleatorizado (ECA) é considerado o tipo de desenho metodológico com maior poder de verificação da eficácia das psicoterapias. Entretanto, especialmente a partir da segunda metade do século XX, muitas críticas direcionadas às concepções epistemológicas subjacentes às ditas “ciências duras” atingiram também, no âmbito das ciências da saúde, os estudos que adotavam esse desenho. Este artigo é uma reflexão crítica sobre algumas das objeções feitas aos ECAs, avaliando de que maneira e até que ponto estes poderiam se configurar como estratégia válida de investigação científica no contexto crítico apontado. Conclui-se que o ECA pode e deve ser utilizado - desde que em contexto crítico - por seu valor pragmático, enquanto produtor de predições e intervenções capazes de solucionar problemas clínicos, inevitavelmente definidos e estabelecidos a partir do ponto de vista particular de uma comunidade.
Objective: Generalized anxiety disorder (GAD) is a chronic and disabling disorder associated with various impairments and shows a significant prevalence in the worldwide and Brazilian populations. This study aimed to investigate the longitudinal relationship of two symptoms relevant to the disorder (worry and depressive symptoms) in the context of a randomized clinical trial (RCT) by using a cross-lagged panel model (CLPM) analysis. Methods: A total of 92 adult patients with GAD were randomized to receive ten sessions of either acceptance‐based group behavioral therapy (ABBT) or nondirective supportive group therapy (NDST). Treatment had four time-point measures. Worries were measured using the Penn State Worry Questionnaire (PSWQ), and depression was measured using the Depression Anxiety Stress Scales (DASS-D). Results: The NDST model revealed significant paths from worry to depression (first wave) and from depression to worry (second wave). There was no other significant cross-lagged effect. These data show that there was an influence between symptoms only during one of the treatment groups, and without a homogeneous and constant pattern in any of the cross-lagged routes. Conclusion: A supportive group psychotherapy potentially interferes with the pattern of the direct relationship between worries and depressive symptoms in adults with GAD.
Agradeço à Marília, Gael e Clarissa pela alegria, os sorrisos, os abraços, as brincadeiras, a confiança, as palavras, a presença, o respeito, a compreensão e por me apoiarem incondicionalmente na realização de meus projetos. Não houve um só dia de trabalho em que a dor por não poder estar com vocês não me tenha visitado, e o amor de vocês me confortado. Agradeço ao Rodrigo, muito mais que um irmão, que me apresentou a Psicologia, e a quem nunca serei capaz de retribuir tudo o que fez para que eu me tornasse quem sou. E à Tati, por ser parte essencial da minha história. Aos meus pais, pela liberdade, autonomia, senso de responsabilidade e respeito. À Ciça, Totônio, meus tios e primos, pelo carinho e disponibilidade. Aos avós e tios dos meus filhos, Hélio, Márcia, Júlia, Reco e Laís, pelo amor genuíno a eles e por me ensinarem um jeito novo de se relacionar com as pessoas e com a vida. Às mestras Angela Piza e Chris Cupertino, pela amizade! Ao meu orientador, Francisco Lotufo, pelo exemplo. À Celia Ignácio e Mariangela Savoia, por terem apostado em mim desde o início. E ao Márcio Bernik, pela confiança em meu trabalho. À Sílvia Sztamfater e Fernanda Tamburú pela participação na fase preliminar deste projeto. Ao Felipe Corchs e à Daisy Hernandes, pelas sempre boas conversas. Agradeço, também, a todos os colegas do AMBAN pelos anos de parceria, e a todos os profissionais que colaboraram com a pesquisa. Sou grato à Liz Roemer pelo incentivo e suporte, e à Sarah Hayes-Skelton, pela assistência nas análises estatísticas. Agradeço, ainda, às professoras Sônia Meyer e Cláudia Oshiro, bem como aos colegas de disciplina pelas proveitosas discussões. Ao grande Thiago Lelis, com quem pretendo continuar aprendendo sempre, pela generosidade e inabalável paciência; e à Ana Cristina Pletsch, pela fiel parceria por tantos anos. Ao Nico e à Greice, pelos momentos compartilhados em família, e ao Mig e à Thaís, pelas pizzas e risadas de sábado à noite. À Andrea, Assaz, Camps, Capim, Lucas, Nana e Renê, acima de tudo, pela amizade que transcende qualquer papel social ou relação de trabalho. Finalmente, este trabalho é resultado do esforço conjunto de um grupo grande de pessoas. Sem o compromisso de cada um desses profissionais, este projeto nunca teria saído do papel. Idealizado e escrito no início de 2015, e carinhosamente apelidado de "projeto Flexpsi", a ideia audaciosa de realizar um ensaio clínico com quase 100 participantes alçou voo. E quando dei por mim, o projeto não era mais apenas meu. Deparavame todo o trabalho funcionando, com tantas pessoas mobilizadas e comprometidas com a qualidade da pesquisa, se apropriando espontaneamente de tudo aquilo; via o empenho de cada uma para garantir que não houvesse nenhum erro de processo, nenhum furo técnico, nenhum escorregão ético, nenhum desentendimento pessoal. E tudo isso me enchia de entusiasmo e confiança. Essa equipe foi tão especial que, mesmo com tantos detalhes para pensar, materiais para elaborar, tarefas para realizar, processos para gerenciar, prazos para cumprir e burocra...
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