Online mindfulness-based cognitive therapy for treatment-resistant depression: a parallel-arm randomized controlled feasibility trial.

Introduction: Treatment-resistant depression (TRD) presents a significant challenge, affecting approximately 30% of individuals diagnosed with major depressive disorder and leading to poor treatment responses. Innovations in digital mental health, especially online mindfulness-based cognitive therapy (eMBCT), offer promising avenues for enhancing access to effective mental health care for individuals with TRD in a clinical setting. Objective: The aim of this study was to examine the feasibility of eMBCT in an individual clinical context to decrease depressive symptoms for TRD. Methods: Conducted at the Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil, this parallel-arm, randomized controlled feasibility trial involved outpatients diagnosed with TRD, aged 18 and above. Of the 39 outpatients invited, 28 were randomized into two groups: an intervention group receiving the eMBCT program (n = 15) and a control group (n = 13). The intervention, consisting of an 8-week course, was delivered via live video sessions. Following the assessment period, participants in the control group were offered the eMBCT intervention. Assessments using standardized questionnaires were conducted at the start and end of the study. Results: Within the eMBCT group, improvements were observed in depression symptoms (Z = -3.423; p = 0.001; effect size r = 0.78), anxiety symptoms (Z = -3.361; p = 0.001; effect size r = 0.77), with no significant changes in the control group. Comparatively, the eMBCT group showed significant reductions in depression symptoms and improvements in clinical global impressions over the control group (BDI2: U = 30.5; p = 0.015; effect size r = 0.47, CGI1: U = 21.0; p = 0.004; effect size r = 0.56). Conclusion: eMBCT in an individual format combined with medication, appears to be a feasible treatment for TRD, decreasing symptoms of depression. In a future trial the control group may have a manualized intervention. Clinical trial registration: The Brazilian Clinical Trials Registry: (https://ensaiosclinicos.gov.br/rg/RBR-6zndpbv) and RBR-6zndpbv.

Terapia cognitiva para la prevención del suicidio en militares veteranos / Cognitive therapy for the prevention of suicide in military veterans

Introducción: El suicidio es la principal causa de muerte entre el personal militar veterano activo. Pese a ello, hay pocas terapias que acometan las tendencias suicidas, y el desarrollo de nuevos tratamientos es limitado. En los últimos años se ha propuesto el uso de la terapia cognitiva. Objetivo: Analizar la eficacia de la terapia cognitiva en la prevención del suicidio en militares veteranos. Desarrollo: Se realizó una revisión según la normativa PRISMA. Se consultaron las bases de datos de PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, y WOS. Se utilizó la herramienta Cochrane para valorar el riesgo de sesgo y la calidad de la evidencia se evaluó con GRADE. La terapia cognitiva es eficaz para prevenir el suicidio entre los militares veteranos. El número total de participantes en la revisión fue de 668 individuos. El número de sesiones totales osciló entre 6 y 10 y el seguimiento del programa varió entre 3 y 24 meses Conclusiones: La terapia cognitiva previene los intentos de suicidio entre los militares veteranos con ideas suicidas o un intento de suicidio reciente. También mejora la calidad de vida de los militares y sus familias, así como el patrón del sueño. Reduce la depresión, la desesperanza, el estrés postraumático, la gravedad de los síntomas, el número de suicidios y las hospitalizaciones psiquiátricas(AU)

Introduction: Suicide is the leading cause of death among active veteran military personnel. Despite this, there are few therapies that address suicidality, and the development of new treatments is limited. In recent years, the use of cognitive therapy has been proposed. Objective: Analyze the efficacy of cognitive therapy in preventing suicide in military veterans. Development: A review was carried out following the PRISMA regulations. The PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, and WOS databases were consulted. The Cochrane tool was used to assess the risk of bias and the quality of the evidence was assessed with GRADE. Cognitive therapy is effective in preventing suicide among military veterans. The total number of participants in the review was 668 individuals. The total number of sessions ranged from 6 to 10 and the follow-up of the program varied from 3 to 24 months. Conclusions: Cognitive therapy prevents suicide attempts among military veterans with suicidal ideation or a recent suicide attempt. It also improves the quality of life of service members and their families, as well as their sleep pattern. It reduces depression, hopelessness, post-traumatic stress, symptom severity, the number of suicides and psychiatric hospitalizations(AU)

Effectiveness of Cognitive Functional Therapy Versus Core Exercises and Manual Therapy in Patients With Chronic Low Back Pain After Spinal Surgery: Randomized Controlled Trial.

OBJECTIVE: Our aim was to investigate whether cognitive functional therapy (CFT) was more effective than core exercises and manual therapy (CORE-MT) in improving pain and function for patients with chronic low back pain after spinal surgery. METHODS: This study was a randomized controlled superiority trial in a university hospital and a private physical therapist clinic in Santa Catarina, Brazil. Eighty participants who were 18 to 75 years old and had chronic low back pain after spinal surgery received 4 to 12 treatment sessions of CFT or CORE-MT once per week for a maximum period of 12 weeks. Primary outcomes were pain intensity (numeric pain rating scale, scored from 0 to 10) and function (Patient-Specific Functional Scale, scored from 0 to 10) after intervention. RESULTS: We obtained primary outcome data for 75 participants (93.7%). CFT was more effective, with a large effect size, than CORE-MT in reducing pain intensity (mean difference [MD] = 2.42; 95% CI = 1.69-3.14; effect size [d] = 0.85) and improving function (MD = -2.47; 95% CI = -3.08 to -1.87; effect size = 0.95) after intervention (mean = 10.4 weeks [standard deviation = 2.17] after the beginning of treatment). The differences were maintained at 22 weeks for pain intensity (MD = 1.64; 95% CI = 0.98-2.3; effect size = 0.68) and function (MD = -2.01; 95% CI = -2.6 to -1.41; effect size = 0.81). CONCLUSION: CFT was more effective than CORE-MT, with large effect sizes, and may be an option for patients with chronic low back pain after spinal surgery. IMPACT: CFT reduces pain and improves function, with large effect sizes, compared with CORE-MT. The difference between CFT and CORE-MT was sustained at the midterm follow-up. Treatment with CFT may be an option for patients with chronic low back pain after spinal surgery.

Randomized trial of the efficacy of trial-based cognitive therapy for obsessive-compulsive disorder: preliminary findings.

INTRODUCTION: Obsessive-compulsive disorder (OCD) is the fourth most prevalent mental disorder and is a disabling condition. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitions. The treatments of choice are selective serotonin reuptake inhibitors, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP). Trial-based cognitive therapy (TBCT) is a recent and empirically validated psychotherapy with a focus on restructuring dysfunctional negative core beliefs (CBs). The objective of this study was to evaluate the efficacy of TBCT relative to ERP for treatment of OCD. METHOD: A randomized, single-blind clinical trial was conducted, randomizing 26 patients for individual treatment with TBCT (n = 12) or ERP (n = 14). The groups were evaluated at baseline, at the end of 3 months (12 sessions), and at 3, 6, and 12-month follow-ups. RESULTS: Both approaches reduced the severity of symptoms with large effect sizes. These results were maintained at the 12-month follow-up assessment. CONCLUSION: TBCT may be a valid and promising treatment for this disorder.

Randomized trial of the efficacy of trial-based cognitive therapy for obsessive-compulsive disorder: preliminary findings

Abstract Introduction Obsessive-compulsive disorder (OCD) is the fourth most prevalent mental disorder and is a disabling condition. OCD is associated with anatomical and functional changes in the brain, in addition to dysfunctional cognitions. The treatments of choice are selective serotonin reuptake inhibitors, cognitive-behavioral therapy (CBT), and exposure and response prevention (ERP). Trial-based cognitive therapy (TBCT) is a recent and empirically validated psychotherapy with a focus on restructuring dysfunctional negative core beliefs (CBs). The objective of this study was to evaluate the efficacy of TBCT relative to ERP for treatment of OCD. Methods A randomized, single-blind clinical trial was conducted, randomizing 26 patients for individual treatment with TBCT (n = 12) or ERP (n = 14). The groups were evaluated at baseline, at the end of 3 months (12 sessions), and at 3, 6, and 12-month follow-ups. Results Both approaches reduced the severity of symptoms with large effect sizes. These results were maintained at the 12-month follow-up assessment. Conclusion TBCT may be a valid and promising treatment for this disorder.

A Randomized Clinical Trial to Assess the Efficacy of Online-Treatment with Trial-Based Cognitive Therapy, Mindfulness-Based Health Promotion and Positive Psychotherapy for Post-Traumatic Stress Disorder during the COVID-19 Pandemic: A Study Protocol.

BACKGROUND: Research suggests the use of different forms of therapy as a way of decreasing dropout rates in the treatment of post-traumatic stress disorder (PTSD). The psychotherapies to be assessed in this study are trial-based cognitive therapy (TBCT), mindfulness-based health promotion (MBHP) and positive psychotherapy (PPT). OBJECTIVES: (1) to assess the online efficacy of TBCT compared to MBHP and PPT to reduce the symptoms of PTSD in the context of the Coronavirus Disease 2019 (COVID-19) pandemic; (2) to compare the efficacy of these psychotherapies in improving anxiety, depression, guilt and in promoting well-being; and (3) to describe how professionals perceive online treatment. METHODS: A randomized, multicenter, single-blind clinical trial will be conducted, with three separate arms. An estimated sample of 135 patients will receive either TBCT, MBHP or PPT and will be treated through online, individual, weekly visits, totaling 14 sessions. The primary outcome will be CAPS-5 and secondary outcomes will be HADS and WHO-5. The variables used to mediate these outcomes will be the Trauma-Related Guilt Inventory (TRGI), Negative Core Beliefs Inventory (NCBI) and the California Psychotherapy Alliance Scale (CALPAS-P). EXPECTED RESULTS: PTSD symptoms are expected to be reduced after TBCT, MBHP and PPT. No statistical difference is expected to be found among the three. DISCUSSION: The present study will evaluate and contribute towards the development of new psychotherapeutic options for patients with PTSD. The results of this study will allow the dissemination of new effective and adaptable interventions for patients with PTSD.

Behavioural activation and trial-based cognitive therapy may be beneficial to reduce suicidal ideation in major depressive disorder: A post hoc study from a clinical trial.

WHAT IS KNOWN AND OBJECTIVE: The suicidality spectrum is a clinical challenge because of the difficulty of its management and its association with mortality. Few studies have investigated psychotherapies for reducing the components of suicidality. In this study, we compared the effect of behavioural activation (BA), trial-based cognitive therapy (TBCT) - both added to antidepressant (AD) treatment - and treatment as usual (TAU) in mitigating suicidal ideation in patients with major depressive disorder (MDD). METHODS: A post hoc study was conducted with data from a randomized clinical trial. Secondary analyses compared the treatments using scores from the items that evaluated suicidal ideation with the HAM-D (HAM-D-3) and BDI (BDI-9). A composite measurement was constructed by summing the scores from the two items (HAM-D-3 plus BDI-9). RESULTS AND DISCUSSION: Seventy-six patients were analysed (BA + AD = 24; TBCT + AD = 26 and TAU = 26). In HAM-D-3, the BA + AD group showed a statistically greater reduction than the TAU group. In BDI-9, the three groups did not show significant differences. In the HAM-D-3 plus BDI-9, TBCT + AD reduced ideations more than the TAU group. There were no differences among the psychotherapies in any of the measures. Sensitivity analyses showed improvement in suicidal ideation in both psychotherapies compared to TAU. WHAT IS NEW AND CONCLUSION: This is one of the few studies that evaluated the effect of BA and TBCT in lowering suicidal ideation. Adding these therapies to ADs seems to decrease suicidal ideation. We suggest the possible beneficial effects of BA and TBCT in the management of suicidal ideation in patients with recurrent MDD. Our findings need further studies to confirm these results.

Dropout in brief psychotherapy for major depressive disorder: Randomized clinical trial.

The aim of this paper is to analyse the factors associated with the dropout from brief psychotherapy for adults with major depressive disorder (MDD) treated at a mental health outpatient clinic. This is a randomized clinical trial with two models of psychotherapy: cognitive behavioural therapy (CBT) and supportive expressive dynamic psychotherapy (SEDP). MDD and anxiety disorders were evaluated through the Mini International Neuropsychiatric Interview-Plus. The personality disorders were evaluated by the Millon Clinical Multiaxial Inventory-III. The severity of depressive symptoms was measured using the Beck Depression Inventory-II and resilience through Resilience Scale. Of the 215 participants, 41.9% abandoned psychotherapy (n = 90), and, of these, 54.4% (n = 49) abandoned after the fourth session. The proportion of psychotherapy dropout was higher among those with nonwhite skin colour, belonging to economic classes C and D, who had children and whose depressive symptoms were moderate. Presence of obsessive-compulsive personality trait was protective against dropout. The damage caused by this abrupt interruption is evident for all those involved in the psychotherapeutic process, so the clinician should pay attention to the predictors found in this study in order to develop strategies that promote therapeutic adherence.

Inserção das estratégias cognitivo-comportamentais no CAPS álcool e drogas / Insertion of cognitive-behavioral strategies in CAPS for alcohol and drugs / inserción de estrategias cognitivo-conductuales en CAPS alcohol y drogas

Este estudo teve como objetivo conhecer a percepção de psicólogos que trabalham em Centros de Atenção Psicossocial para Álcool e Drogas sobre a inserção de estratégias das terapias cognitivo-comportamentais para o tratamento de dependência de álcool e outras drogas em sua prática. Foi realizado um estudo qualitativo de caráter exploratório, por meio de entrevistas com 16 psicólogos que atuam no Rio de Janeiro e em Minas Gerais. Os dados coletados foram analisados por meio da análise de conteúdo temática de Bardin. Os resultados apontam que, na percepção dos psicólogos, essas estratégias são passíveis de serem adotadas por esses centros e conferem bons resultados ao tratamento, embora haja limitações na formação especializada em terapia cognitivo-comportamental para lidar com a dependência de drogas entre os participantes. São discutidas a contribuição dessas terapias para a prática baseada em evidências no serviço público no que se refere ao monitoramento e avaliação de resultados, bem como sua relação compatível com a estratégia de redução de danos e com a lógica do tratamento psicossocial. Apesar das terapias cognitivo-comportamentais serem reconhecidas em outros países como intervenções bem embasadas cientificamente e apresentarem características importantes para a saúde pública, persistem obstáculos para a adoção destas ferramentas no tratamento da dependência de álcool e outras drogas nos serviços de saúde mental no Brasil.(AU)

This study aimed to understand the perception of psychologists who work in Psychosocial Care Centers for Alcohol and Drugs about the inclusion of cognitive-behavioral therapies for treating addiction to alcohol and other drugs in their practice. A qualitative exploratory study was carried out, by interviewing 16 psychologists who work in the states of Rio de Janeiro and Minas Gerais. The collected data were analyzed with Bardin's thematic content analysis. The results show that, in the psychologists' perception, these strategies are likely to be adopted in the centers and provide good results to the treatment, despite limitations in the specialized training in cognitive-behavioral therapies for dealing with drug addiction among the participants. The contribution of these therapies to evidence-based practice in the public service concerning monitoring and evaluation of results, and their compatible relationship with the harm reduction strategy and with the logic of psychosocial treatment are discussed. Although cognitive-behavioral therapies are recognized in other countries as well-founded scientific processes and provide essential characteristics for public health, challenges persist for adopting these tools in the treatment of addiction to alcohol and other drug in mental health services in Brazil.(AU)

Este estudio tiene como objetivo comprender la percepción de los psicólogos que trabajan en Centros de Atención Psicosocial de Alcohol y Drogas sobre la inserción de estrategias de terapia cognitivo-conductual para el tratamiento de la adicción al alcohol y otras drogas en su práctica. Se realizó un estudio exploratorio cualitativo, a través de entrevistas con dieciséis psicólogos que trabajan en los estados de Rio de Janeiro y Minas Gerais. Los datos recopilados se analizaron mediante el análisis de contenido temático de Bardin. Los resultados muestran que, en la percepción de los psicólogos, es probable que estas estrategias se adopten en el estos centros y proporcionen buenos resultados en el tratamiento, aunque existen limitaciones en la formación especializada en terapia cognitivo-conductual para la adicción a las drogas entre los participantes. Se discute la contribución de esas terapias a la práctica basada en la evidencia en el servicio público con respecto al seguimiento y evaluación de resultados, así como su relación compatible con la estrategia de Reducción de Daños y con la lógica del tratamiento psicosocial. Aunque las terapias cognitivo-conductuales sean reconocidas en otros países como intervenciones científicamente bien fundamentadas y brinden características importantes para la salud pública, persisten obstáculos para la adopción de estas herramientas en el tratamiento de la adicción al alcohol y otras drogas en los servicios de salud mental en Brasil.(AU)

Caso clínico de un adulto con trastorno de personalidad obsesivo-compulsiva según clasificación del DSM-V / Clinical Case of an Adult with Obsessive-Compulsive Personality Disorder According to the DSM-V Classification

Resumen Esta investigación presenta el caso clínico de un adulto que padece un trastorno de la personalidad obsesivo-compulsiva. El objetivo es presentar en detalle el procedimiento seguido en los consultorios de psicología de la Universidad de Ibagué mediante la integración de técnicas cognitivas y humanistas mostrando la eficacia y viabilidad de este tratamiento y su aplicación. Los resultados obtenidos, muestran mejorías relevantes como: mayor flexibilidad cognitiva, disminución de la activación fisiológica producto de la alteración emocional y ansiedad ante la falta de control, adquisición de habilidades para la solución de problemas, autocontrol emocional y de los pensamientos acerca de la percepción de sí mismo y de los demás. Se concluye que la formulación clínica cognitivo-humanista y el tratamiento ofrecido resultó pertinente y efectivo respecto a los objetivos terapéuticos perseguidos.

Abstract This research presents the clinical case of an adult with obsessive-compulsive personality disorder. The objective is to present in detail the procedure followed in the psychology offices of the University of Ibague by integrating cognitive and humanistic techniques to demonstrate the effectiveness and feasibility of this treatment and its application. The results obtained show relevant improvements, such as greater cognitive flexibility, a decrease of physiological activation as a result of emotional alteration and anxiety in the face of lack of control, acquisition of problem-solving skills, emotional self-control, and control of thoughts about the perception of oneself and others. It is concluded that the cognitive-humanistic intervention and the treatment given were pertinent and effective for the therapeutic objectives pursued.

Brief online behavioral cognitive intervention for anxiety symptoms: what was learned during and for after the pandemic period?

Cognitive therapies comprise a widely recognized group of psychological interventions with considerable empirical support for different mental health conditions. These interventions can be used both in a traditional clinical setting and in crisis situations, especially those involving self-perception of overestimated risk, high vulnerability, and low coping capacity. The world is currently under a crisis, specifically, the COVID-19 pandemic, which can bring substantial impact on people's routine and cause significant psychological distress. In this context, telehealth interventions are becoming a standard practice and, thus, cognitive therapists could also support patients and people in the general population using this tool for the emerging issues. This text provides a brief overview of the main issues that may arise in the current pandemic situation as possible targets for the practice of cognitive therapists and the main evidence-based strategies that could be used in this context.(AU)

As terapias cognitivas compreendem um grupo amplamente reconhecido de intervenções psicológicas, com considerável suporte empírico para diferentes condições de saúde mental. Essas intervenções podem ser utilizadas tanto em ambiente clínico tradicional quanto em situações de crise, principalmente aquelas envolvendo autopercepção de risco superestimado, alta vulnerabilidade e baixa capacidade de enfrentamento. O mundo vive atualmente uma situação de crise, especificamente, a pandemia de COVID-19, que pode trazer um impacto substancial na rotina das pessoas e causar sofrimento psicológico significativo. Nesse contexto, as intervenções de cuidado online estão se tornando uma prática padrão e, assim, os terapeutas cognitivos também poderiam apoiar seus pacientes e pessoas da população em geral usando esta ferramenta para as questões emergentes. Este texto fornece uma breve visão geral das principais questões que podem surgir na atual situação de pandemia como possíveis alvos para a prática de terapeutas cognitivos e as principais estratégias baseadas em evidências que podem ser utilizadas por eles neste contexto.(AU)

Las terapias cognitivas comprenden un grupo ampliamente reconocido de intervenciones psicológicas, con considerable apoyo empírico para diferentes condiciones de salud mental. Estas intervenciones pueden utilizarse tanto en un entorno clínico tradicional como en situaciones de crisis, especialmente aquellas que implican un riesgo auto percibido sobrestimado, alta vulnerabilidad y baja capacidad de afrontamiento. El mundo atraviesa actualmente una situación de crisis, específicamente la pandemia de COVID-19, que puede tener un impacto sustancial en la rutina de las personas y causar una angustia psicológica significativa. En este contexto, las intervenciones de atención en línea se están convirtiendo en una práctica estándar y, por lo tanto, los terapeutas cognitivos también podrían ayudar a sus pacientes y personas en la población general utilizando esta herramienta para problemas emergentes. Este texto ofrece una breve descripción de los principales problemas que pueden surgir en la situación pandémica actual como posibles objetivos para la práctica de los terapeutas cognitivos y las principales estrategias basadas en la evidencia que pueden ser utilizadas por ellos en este contexto.(AU)

A Terapia Cognitivo-Comportamental Aplicada ao CAPS ad: Uma Revisão de Escopo / The Cognitive-Behavioral Therapy Applied to CAPS ad: A Scope Review / La Terapia Cognitivo-Conductual Aplicada al CAPS ad: Una Revisión del Alcance

Este estudo tem como objetivo realizar uma revisão de escopo sobre estratégias cognitivas e/ou comportamentais empregadas no tratamento de dependência de álcool e outras drogas no mundo, assim como levantar estudos sobre o uso destas abordagens em CAPS ad no Brasil. Foram levantados artigos de revisão sobre "estratégias cognitivas ou comportamentais para tratamento de dependência de álcool e outras drogas" e publicações com o tema "uso de terapias cognitivas e/ou comportamentais em CAPS ad". Foram encontradas apenas cinco publicações relatando emprego de terapias cognitivas e comportamentais em CAPS ad. Estes estudos descreveram intervenções em grupos coordenados por psicólogos, enfermeiros ou outros profissionais de nível superior. Foram incluídos ainda 23 artigos de revisão sobre resultados de tratamentos de base cognitivo-comportamental para tratamento de dependência de álcool e outras drogas. Conclui-se que as estratégias cognitivo-comportamentais apresentam várias características vantajosas à saúde pública, como a possibilidade de sistematização em protocolos, o que facilita sua aplicação e avaliação de resultados terapêuticos. No entanto, persistem obstáculos para adoção desta abordagem nos serviços de saúde mental no Brasil, sendo então necessário avançar no desenvolvimento de instrumentos de políticas públicas que permitam a difusão de boas práticas de intervenções comprovadamente custo-efetivas e acessíveis à população. (AU)

This study aims to conduct an escope review on the use of cognitive-behavioral approaches to treatment of alcohol and other drug addiction in CAPS ad, as well as find studies on the use of this approach in CAPS ad in Brazil. We conducted searches with the theme "use of cognitive and / or behavioral therapies in CAPS ad" and review articles on "cognitive or behavioral strategies for treatment of alcohol and other drug dependence". Only five publications were found reporting the use of cognitive and behavioral therapies in CAPS ad. These studies described interventions in groups coordinated by psychologists, nurses or other graduated professionals. Twenty-three review articles on outcomes of cognitive-behavioral treatments for addiction treatment of alcohol and other drugs were also included. We concluded that cognitive-behavioral strategies showcase several advantageous characteristics to public health, such as the possibility of systematization in protocols, which facilitates their application and evaluation of therapeutic results. However, obstacles to the adoption of this approach in mental health services in Brazil persist, so it is necessary to advance in developing public policy instruments that allow the dissemination of good practices in interventions that are proven to be cost-effective and accessible to the population. (AU)

Este estudio tiene como objetivo realizar una revisión del alcance sobre el empleo de abordajes cognitivo-conductuales para tratamiento de dependencia de alcohol y otras drogas en los CAPS ad en Brasil. Se levantaron publicaciones con el tema "uso de terapias cognitivas y/o conductuales en CAPS ad" y artículos de revisión sobre "estrategias cognitivas o conductuales para el tratamiento de la dependencia del alcohol y otras drogas". Se encontraron sólo cinco publicaciones que relatan empleo de terapias cognitivas y conductuales en CAPS ad. Estos estudios describieron intervenciones en grupos coordinados por psicólogos, enfermeros u otros profesionales de nivel superior. Se incluyeron 23 artículos de revisión sobre resultados de tratamientos de base cognitivo-conductual para tratamiento de dependencia de alcohol y otras drogas. Se concluye que las estrategias cognitivo-conductuales presentan varias características ventajosas para la salud pública, como la posibilidad de sistematización en protocolos, lo que facilita su aplicación y evaluación de resultados terapéuticos. Sin embargo, persisten obstáculos para la adopción de este enfoque en los servicios de salud mental en Brasil, por lo que es necesario avanzar en el desarrollo de instrumentos de política pública que permitan la difusión de buenas prácticas de intervenciones que demuestren ser costo-efectivas y accesibles a la población. (AU)

Abordagem cognitivo-comportamental na escola: possibilidades de intervenção / Cognitive behavioral approach at school: possibilities for intervention

RESUMO O objetivo deste artigo é descrever técnicas grupais desenvolvidas nas turmas do 3º e 6º ano do ensino fundamental de uma escola municipal situada em uma cidade do interior do estado do Rio Grande do Sul. As técnicas tiveram o intuito de intervir em demandas escolares associadas a relações interpessoais e comportamentos desafiadores e opositores tendo como base os pressupostos teóricos e práticos da abordagem cognitivo-comportamental. Os grupos foram homogêneos, com média de 10 estudantes, com objetivo de psicoeducação e de orientação/ treinamento, visando a promoção de saúde na escola. A experiência relatada colabora com a práxis metodológica da área a qual pertence, oferecendo relatos de práticas singulares que podem ser adaptadas a outros contextos e demandas escolares similares.

ABSTRACT The objective of this article is to describe group techniques that have developed in the 3rd and 6th grade classes of a municipal school located in a city in the state of Rio Grande do Sul. These techniques, based on the theoretical and practical assumptions of cognitive behavioral theory, have intended to intervene in school demands related to interpersonal relationships and challenging behavior and opposing behaviors. The groups have been homogeneous, with an average of 10 students, aiming at psychoeducation and orientation / training, with the objective at to promote health at school. The reported experience collaborates with the methodological praxis of the area to which it belongs, offering reports of singular practices that can be adapted to other similar contexts and school demands.

Cognitive functional therapy (CFT) compared with core training exercise (CTE) in patients with failed back surgery syndrome (FBSS): A study protocol for a randomized controlled trial.

OBJECTIVE: This study aims to investigate the efficacy of cognitive functional therapy (CFT) compared to core training exercise (CTE) on pain and specific disability of patients with failed back surgery syndrome (FBSS). DESIGN: This will be a randomized controlled clinical trial of two groups with blinded evaluators. SETTING: The study will be conducted at the Federal University of Santa Catarina (UFSC) and a private clinic in Florianópolis, SC, Brazil. PARTICIPANTS: A total of 80 participants, of both sexes, with FBSS. INTERVENTION: Subjects will be randomized into two groups: one group receiving CFT or CTE. Individuals will be assisted once a week, for a maximum period of 12 weeks, with four being the minimum number of visits and 12 being the maximum number of visits. MEASUREMENTS: The primary outcomes will be pain and specific disability. CONCLUSIONS: This is the first study investigating whether CFT is efficacious for patients with FBSS and chronic low back pain. The study's sample size was calculated to detect the effect of clinically relevant treatment with a low risk of bias. This clinical trial was designed to be able to reproduce an approach as a physiotherapist trained in CFT would do. That is, in a pragmatic way, increasing the significance of this study. CTE comprises a strategy widely used by physiotherapists to treat low back pain. Given that the scientific evidence of its efficacy for pain management is limited, the findings of this study will assist physiotherapists in their clinical decision-making.

Relações familiares e cognições disfuncionais de adolescentes: uma revisão sistemática / Family relations and adolescents dysfunctional cognitions: a systematic review / Relaciones familiares y cogniciones disfuncionales de los adolescentes: una revisión sistemática

O bom funcionamento familiar é fundamental para o desenvolvimento saudável e cognitivo de crianças e adolescentes. Neste sentido, o objetivo do presente estudo foi reunir, sistematizar e analisar pesquisas que tratassem da associação entre relações familiares e cognições disfuncionais dos filhos entre 2008 e 2019. A partir da busca em cinco bases de dados, utilizando como referência o PRISMA, foram selecionados 13 artigos. A análise dos artigos indicou uma grande variedade de termos utilizados para descrever tanto as relações familiares (por exemplo, parentalidade, conflitos) quanto as cognições (cognições mal adaptativas, distorções cognitivas, crenças metacognitivas). Em termos das associações, foi encontrado um padrão entre relações familiares disfuncionais e cognições relacionadas à ansiedade. Diante dos achados, sugere-se que terapias infantojuvenis visem também o aprimoramento da capacidade parental de resolver problemas, com o objetivo de reduzir conflitos intrafamiliares.

A functional family environment is vital to the healthy and cognitive development of children and adolescents. In this sense, the aim of this study was to gather, systematize and analyze researches that addressed the connections between family relations and children's dysfunctional cognitions between 2008 and 2019. From the search in five databases, using PRISMA as a reference, 13 articles were selected. The analysis of the articles indicated a wide variety of terms used to describe both family relations (for example, parenting, conflicts) and cognitions (maladaptive cognitions, cognitive distortions, metacognitive beliefs). In terms of associations, a pattern was found between dysfunctional family relations and anxiety-related cognitions. Given the findings, it is suggested that children and adolescent therapies also aim at improving parental capacity to solve problems, with the objective of reducing intra-family conflicts.

El buen funcionamiento familiar es fundamental para el desarrollo saludable y cognitivo de niños y adolescentes. En este sentido, el objetivo de este estudio fue reunir, sistematizar y analizar investigaciones que abordaron las asociaciones entre las relaciones familiares y las cogniciones disfuncionales de los niños entre 2008 y 2019. De la búsqueda en cinco bases de datos, utilizando PRISMA como referencia, se seleccionaron 13 artículos. El análisis de los artículos indicó una amplia variedad de términos utilizados para describir tanto las relaciones familiares (por ejemplo, la paternidad, los conflictos) como las cogniciones (cogniciones desadaptativas, distorsiones cognitivas, creencias metacognitivas). En términos de asociaciones, se encontró un patrón entre las relaciones familiares disfuncionales y las cogniciones relacionadas con la ansiedad. Dados los hallazgos, se sugiere que las terapias infanto-juveniles tengan como objetivo mejorar la capacidad de los padres para resolver problemas, con el objetivo de reducir los conflictos intrafamiliares.

A randomized clinical trial to assess the efficacy of trial-based cognitive therapy compared to prolonged exposure for post-traumatic stress disorder: preliminary findings.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a prevalent mental health condition that is often associated with psychiatric comorbidities and changes in quality of life. Prolonged exposure therapy (PE) is considered the gold standard psychological treatment for PTSD, but treatment resistance and relapse rates are high. Trial-based cognitive therapy (TBCT) is an effective treatment for depression and social anxiety disorder, and its structure seems particularly promising for PTSD. Therefore, we evaluated the efficacy of TBCT compared to PE in patients with PTSD. METHODS: Ninety-five patients (77.6% females) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for PTSD were randomly assigned to receive either TBCT (n = 44) or PE (n = 51). Patients were evaluated before and after treatment, and at follow-up 3 months after treatment. The primary outcome was improvement in PTSD symptoms as assessed by the Davidson Trauma Scale (DTS). Secondary outcomes were depression, anxiety, and dysfunctional attitudes assessed by the Beck Depression/Anxiety Inventories and Dysfunctional Attitudes Scale, as well as the dropout rate. RESULTS: A significant reduction in DTS scores was observed in both arms, but no significant difference between treatments. Regarding the secondary outcomes, we found significant differences in depressive symptoms in favor of TBCT, and the dropout rate was lower in the TBCT group than the PE group. CONCLUSION: Our preliminary results suggest that TBCT may be an effective alternative for treating PTSD. Further research is needed to better understand its role and the mechanisms of change in the treatment of this disorder.

Acceptance and Commitment Therapy and Drug Use: A Systematic Review / Terapia de Aceitação e Compromisso e Uso de Drogas: Uma Revisão Sistemática / Terapia de Aceptación y Compromiso y Uso de Drogas: Una Revisión Sistemática

Abstract The harmful use of psychoactive substances has been considered one of the biggest public health issues. Several approaches are used for the treatment of disorders related to substance use in the face of the challenges imposed. This study aimed to identify the empirical works that used ACT for the treatment of substance use and their respective results regarding acceptance, feasibility, and reduction in the severity of dependence, as well as the results related to comorbidities and other aspects associated with drugs use by a systematic review of the literature on the subject, using the recommendations of the Preferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA) guide and searches in PubMed, APA PsycNET, SciELO, ScienceDirect, Web of Science, VHL, and LILACS. In total, 17 studies were analyzed, allowing the observation of an increase in psychological flexibility, attenuation of treatment dropout rates, and a reduction in substance use in the analyzed interventions.

Resumo O uso prejudicial de substâncias psicoativas tem sido considerado um dos maiores problemas de saúde pública. Diversas abordagens são utilizadas para o tratamento dos transtornos relacionados ao uso de substâncias diante dos desafios impostos. O presente estudo teve por objetivo identificar os trabalhos empíricos que utilizaram a ACT para o tratamento do uso de substâncias e seus respectivos resultados no que diz respeito à aceitação, viabilidade e redução da gravidade da dependência, bem como nos resultados relacionados às comorbidades e demais aspectos associados ao uso através de uma revisão sistemática da literatura acerca do tema, utilizando-se das recomendações do guia Preferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA) e buscas nas bases Pubmed, APA PsycNET, SciELO, ScienceDirect, Web of Science, BVS e LILACS. Foram analisados 17 estudos, permitindo observar aumento da flexibilidade psicológica, atenuação das taxas de abandono do tratamento e redução do consumo de substâncias nas intervenções analisadas.

Resumen El uso nocivo de sustancias psicoactivas se ha considerado como uno de los mayores problemas de salud pública. Se utilizan varios enfoques para el tratamiento de los trastornos relacionados con el consumo de sustancias frente a los desafíos impuestos. Este estudio tuvo como objetivo identificar los trabajos empíricos que utilizaron ACT para el tratamiento del consumo de sustancias y sus respectivos resultados en cuanto a la aceptación, viabilidad y reducción de la gravedad de la dependencia, así como los resultados relacionados con las comorbilidades y otros aspectos asociados al uso, desde una revisión sistemática de la literatura sobre el tema y utilizando las recomendaciones de la guía Preferred Report Items for Systematic Reviews and Meta-Analyzes (PRISMA) y búsquedas en PubMed, APA PsycNET, SciELO, ScienceDirect, Web of Science, VHL y LILACS. Se analizaron 17 estudios, lo que permitió observar un aumento de la flexibilidad psicológica, una atenuación de las tasas de abandono del tratamiento y una reducción del consumo de sustancias en las intervenciones analizadas.

Fadiga mental ocasionada por tarefa cognitiva de imagética motora: análise sistemática / Mental failure occurred by the cognitive task of motor imagine: systematic analysis

O objetivo geral deste estudo é analisar, por meio da revisão sistemática da literatura, os efeitos da fadiga mental provocada por uma tarefa cognitiva de imagética motora. Para a análise literária, foram utilizados os bancos de dados eletrônicos: Public Medline (PubMed), Scientific Electronic Library Online (Scielo) e Scopus. Foram analisados estudos experimentais, realizados em humanos, nos idiomas português e inglês, publicados de 2004 a 2019. As palavras chaves utilizadas foram: motor imagery/ imagética motora, sustained attention/ atenção sustentada e mental fadigue/ fadiga mental. A tarefa de Imagética Motora (IM) é definida como uma execução mental do movimento do corpo, entretanto, sem nenhuma saída motora. Alguns autores sugerem que o indivíduo começaria a desenvolver fadiga acima de 60 trilhas de imagética motora. Dessa forma, pode comprometer os resultados de protocolos terapêuticos e/ou desportivos, além de desempenhar um risco eminente de problemas de saúde, como é o caso das doenças cardiovasculares, epiléticas e Karoshi (morte por excesso de trabalho). Sendo assim, em tarefas mais prolongadas, a fadiga mental diminui o desempenho na tarefa e aumenta o tempo para a sua execução. Portanto, conclui-se que o tempo da tarefa cognitiva interfere no tempo de reação devido a fadiga mental provocado pela tarefa cognitiva de atenção sustentada.

The general objective of this study is to analyze the effects of mental fatigue caused by cognitive task of motor imagery through the systematic analysis of the literature. For the literary analysis we used the electronic databases: Public Medline (PubMed), Scientific Electronic Library Online (Scielo) and Scopus. The experimental studieswere performed in humans, both Portuguese and English, published from 2004 to 2019. The keywords used were motor imagery, sustained attention and mental fatigue. The task of Motor Imagery (IM) it is as a mental execution of body movement, however, with not motor output response. Some authors suggest people begin to develop fatigue that over 60 tracks of motor imagery. In this way, it can compromise the results of therapeutic and/or sports protocols, as well as pose an imminent risk of health problems, such as cardiovascular diseases, epilepsy and Karoshi (death from overwork). Thus, in longer tasks, mental fatigue decreases performance on the task and increases the time for its execution. Therefore, it is conclusion that time of the cognitive task interferes in the reaction time due to the mental fatigue caused by the cognitive task of sustained attention.

Evaluation of FunFRIENDS program in prevention of anxiety in Brazilian children: a randomized controlled pilot trial / Avaliação do programa FunFRIENDS na prevenção da ansiedade em crianças brasileiras: um estudo piloto randomizado controlado

Abstract This study aimed to evaluate the effects of the FunFRIENDS protocol on anxiety symptoms, internalizing problems and prosocial behavior in 4- to 5-year old children. Participated of this study 43 children with an allocation ratio of 1:1 between groups (Intervention Group [IG], N = 21; Control Group [CG], N = 22) from a public school in the city of Sao Paulo participated in the study. Behaviors were evaluated by using standardized questionnaires (PAS, CBCL, SDQ, SCBE) assessing the behavioral profile of the children at three different periods; baseline (T0), one month (T1) and three months (T2) after the intervention. It was observed a reduction in the intensity of anxiety symptoms in the IG after the intervention but with no significant effect. Overall, there were no significant differences between the IG and the CG in most behaviors on all periods evaluated. On both Intention-to-Treat analyses also it was not detected significant effects of the intervention. This is the first Brazilian study evaluating the effects of FunFRIENDS program and the implications of these findings are discussed and its significance for future research.

Resumo Este estudo teve como objetivo avaliar os efeitos do protocolo FunFRIENDS sobre sintomas de ansiedade, problemas de internalização e comportamento pró-social em crianças de 4 a 5 anos de idade. Participaram 43 crianças que foram alocadas na proporção de 1:1 entre os grupos: (Grupo Intervenção [GI], N = 21; Grupo Controle [GC], N = 22) de uma escola pública da cidade de São Paulo. Os comportamentos foram avaliados por meio de questionários padronizados (PAS, CBCL, SDQ, SCBE), que avaliaram o perfil comportamental das crianças em três momentos distintos; linha de base (T0), um mês (T1) e três meses (T2) após a intervenção. Observou-se uma redução na intensidade dos sintomas de ansiedade no GI após a intervenção, mas sem efeito significativo. De forma geral, não houve diferenças significativas entre o GI e o GC na maioria dos comportamentos em todos os períodos avaliados. Nas duas análises de Intenção-de-Tratar, também não foram detectados efeitos significantes da intervenção. Este é o primeiro estudo no Brasil avaliando os efeitos do programa FunFRIENDS e as implicações destes achados são discutidas para futuras pesquisas.

Translation, adaptation, and evidence of content validity of the Schema Mode Inventory / Tradução, adaptação e evidências de validade de conteúdo do schema mode inventory / Traducción, adaptación y evidencia de validez de contenido del inventario de modo de esquema

Content validity indicates the extent to which each item of an instrument measures the phenomenon of interest and its dimension within what it proposes to investigate. This research aimed to perform the translation and to raise the validity evidence of the Schema Mode Inventory instrument, thus initiating its cultural adaptation. Eight specialists from the Schema Therapy area participated as evaluators, who answered two instruments: one investigating the Content Validity Coefficient (CVC) and another one the Kappa Concordance Analysis. From the semantic bias, results show that a large part of the instrument measures what it proposes to measure, demonstrating content validity evidence for the Brazilian context (CVC: 0.56 to 0.99; Mean Kappa overall: 0.74).

A validade de conteúdo representa a extensão com que cada item de um instrumento comprova o fenômeno de interesse e sua dimensão dentro daquilo que se propõe a investigar. Os objetivos desta pesquisa foram realizar a tradução e apresentar as evidências de validade de conteúdo do instrumento Schema Mode Inventory - versão reduzida, iniciando assim sua adaptação cultural. Para isso, participaram oito especialistas da área da Terapia do Esquema, que responderam a dois instrumentos: um que investiga o Coeficiente de Validade de Conteúdo (CVC) e outro que realiza a Análise de Concordância Kappa. Os resultados indicaram que, considerando o viés semântico, grande parte do instrumento mede o que sugere medir, possuindo então evidências de validade de conteúdo para o contexto brasileiro (CVC: de 0,56 a 0,99; Kappa médio geral: 0,74).

La validez de contenido representa la extensión con que cada elemento de un instrumento comprueba el fenómeno de interés y su dimensión dentro de lo que se propone investigar. El objetivo de esta investigación fue realizar la traducción y levantar las evidencias de validez de contenido del instrumento Schema Mode Inventory - versión reducida, iniciando así su adaptación cultural. Ocho especialistas del área de Terapia de esquema participaron como evaluadores, quienes respondieron dos instrumentos: uno investigando el Coeficiente de Validez del Contenido (CVC) y otro el Análisis de Concordancia Kappa. Los resultados indicaron que, por el sesgo semántico, gran parte del instrumento mide lo que sugiere medir, poseyendo entonces evidencias de validez de contenido para el contexto brasileño (CVC: 0,56 a 0,99; Kappa promedio general: 0,74).