Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patientswith low educational attainment / Adaptação de um protocolo cognitivo comportamental para pacientes com transtorno de ansiedade generalizada com baixo nível educacional / Adaptación de un protocolo cognitivo-conductual de trastornos de ansiedad generalizada para pacientes con bajo nivel educativo

This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the difficulties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the scope of treatment in mind, the therapist must be attentive to the client's demands and particularities in order to achieve therapeutic success.

Este artigo relata a experiência de tratamento de pacientes de baixa renda com diagnóstico primário de transtorno de ansiedade generalizada (TAG) em hospital público no Rio de Janeiro, Brasil. A ideia inicial do projeto era tratamento ambulatorial, com aplicação de um modelo cognitivo para o tratamento de TAG; porém, observamos que a maioria dos pacientes apresentou baixo nível educacional, o que tornava difícil sua compreensão dos principais aspectos do tratamento cognitivo-comportamental oferecido. Assim, foram feitas adaptações no protocolo de tratamento, incluindo a forma como as técnicas foram apresentadas e aplicadas, a abordagem terapêutica utilizada e a duração das sessões. Considerando que variações de terapias cognitivas são cada vez mais aplicadas em ambulatórios hospitalares em todo o mundo, o objetivo deste artigo é apresentar as adaptações realizadas e discutir possíveis soluções para as dificuldades enfrentadas na prática clínica com pacientes com baixo nível educacional e socioeconômico. Trata-se de um estudo clínico, com apresentação de um caso ilustrativo. Os resultados obtidos foram positivos e mostraram que as adaptações no protocolo foram essenciais para o sucesso terapêutico. Conclui-se que, tendo em mente o escopo do tratamento, o terapeuta deve estar atento às demandas e particularidades do cliente a fim de obter sucesso terapêutico.

Este artículo reporta la experiencia del tratamiento de pacientes de bajos recursos con diagnóstico primario de Trastorno de Ansiedad Generalizada (TAG) en hospitales públicos de Rio de Janeiro, Brasil. La idea original era el tratamiento ambulatorio con aplicación de un modelo cognitivo para el TAG. No obstante, el bajo nivel educativo presentado por la mayoría de los pacientes hace que les resulte difícil la comprensión de los principales aspectos del tratamiento cognitivo-conductual ofrecido. Adaptaciones fueron entonces realizadas en el protocolo de tratamiento, incluyendo cómo las técnicas fueron introducidas y aplicadas, el enfoque terapéutico utilizado y la duración de las sesiones. Dado que variantes de la terapia cognitiva son cada vez más aplicadas en la atención ambulatoria hospitalaria de todo el mundo, el objetivo de este artículo es presentar las adaptaciones realizadas y analizar posibles soluciones a las dificultades encontradas en la práctica de la psicología clínica con pacientes con bajo nivel educativo y socioeconómico, a partir de un caso ilustrativo. Los resultados obtenidos, positivos, indican que las adaptaciones realizadas fueron fundamentales para el éxito de la terapia. Podemos concluir que el terapeuta debe estar atento a las demandas y particularidad del cliente a fin de que la terapia sea exitosa.

Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patientswith low educational attainment / Adaptação de um protocolo cognitivo comportamental para pacientes com transtorno de ansiedade generalizada com baixo nível educacional / Adaptación de un protocolo cognitivo-conductual de trastornos de ansiedad generalizada para pacientes con bajo nivel educativo

This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the difficulties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the scope of treatment in mind, the therapist must be attentive to the client's demands and particularities in order to achieve therapeutic success.(AU)

Este artigo relata a experiência de tratamento de pacientes de baixa renda com diagnóstico primário de transtorno de ansiedade generalizada (TAG) em hospital público no Rio de Janeiro, Brasil. A ideia inicial do projeto era tratamento ambulatorial, com aplicação de um modelo cognitivo para o tratamento de TAG; porém, observamos que a maioria dos pacientes apresentou baixo nível educacional, o que tornava difícil sua compreensão dos principais aspectos do tratamento cognitivo-comportamental oferecido. Assim, foram feitas adaptações no protocolo de tratamento, incluindo a forma como as técnicas foram apresentadas e aplicadas, a abordagem terapêutica utilizada e a duração das sessões. Considerando que variações de terapias cognitivas são cada vez mais aplicadas em ambulatórios hospitalares em todo o mundo, o objetivo deste artigo é apresentar as adaptações realizadas e discutir possíveis soluções para as dificuldades enfrentadas na prática clínica com pacientes com baixo nível educacional e socioeconômico. Trata-se de um estudo clínico, com apresentação de um caso ilustrativo. Os resultados obtidos foram positivos e mostraram que as adaptações no protocolo foram essenciais para o sucesso terapêutico. Conclui-se que, tendo em mente o escopo do tratamento, o terapeuta deve estar atento às demandas e particularidades do cliente a fim de obter sucesso terapêutico.(AU)

Este artículo reporta la experiencia del tratamiento de pacientes de bajos recursos con diagnóstico primario de Trastorno de Ansiedad Generalizada (TAG) en hospitales públicos de Rio de Janeiro, Brasil. La idea original era el tratamiento ambulatorio con aplicación de un modelo cognitivo para el TAG. No obstante, el bajo nivel educativo presentado por la mayoría de los pacientes hace que les resulte difícil la comprensión de los principales aspectos del tratamiento cognitivo-conductual ofrecido. Adaptaciones fueron entonces realizadas en el protocolo de tratamiento, incluyendo cómo las técnicas fueron introducidas y aplicadas, el enfoque terapéutico utilizado y la duración de las sesiones. Dado que variantes de la terapia cognitiva son cada vez más aplicadas en la atención ambulatoria hospitalaria de todo el mundo, el objetivo de este artículo es presentar las adaptaciones realizadas y analizar posibles soluciones a las dificultades encontradas en la práctica de la psicología clínica con pacientes con bajo nivel educativo y socioeconómico, a partir de un caso ilustrativo. Los resultados obtenidos, positivos, indican que las adaptaciones realizadas fueron fundamentales para el éxito de la terapia. Podemos concluir que el terapeuta debe estar atento a las demandas y particularidad del cliente a fin de que la terapia sea exitosa.(AU)

A multidisciplinary weight-loss program: the importance of psychological group therapy

Abstract In addition to dietary factors and sedentary habits, there is a relationship between obesity and psychological variables, even without a clear distinction between cause, effect, and correlation. Despite this relationship, weight-loss programs are limited to a combination of nutrition and physical education, leaving psychological intervention out of the treatment plan. Self-esteem issues, depression, and anxiety are just some of the emotional conditions related to obesity. However, there is no information in the literature about the importance of psychological counseling in a multidisciplinary program for weight-loss in adults. In this context, the main objective of this study was to analyze the effect of cognitive-behavioral therapy in groups (CBTG) combined with nutrition and physical education within a multidisciplinary approach to treat obesity. 46 individuals (7 men and 39 women) were divided into two groups: control (GC) and psychology (GP). Baseline and intervention measures were obtained prior to intervention and before the final meeting, including physical capacity tests and the administering the International Physical Activities Questionnaire (IPAQ). Both groups attended weekly lectures given by a nutritionist and two physical education professionals for 12 weeks. In addition, the GP participated in weekly sessions of CBTG for the same period. After the program, there were significant changes in body mass index, waist circumference, body fat percentage, and strength of the lower limbs in both groups. In addition to these changes, the GP also showed improvements in diastolic blood pressure and IPAQ scores, being the only one that increased its time of weekly physical activity. Thus, it was concluded that the psychological treatment might play an important role in a multidisciplinary weight-loss program.(AU)

Frontal cortex absolute beta power measurement in Panic Disorder with Agoraphobia patients.

UNLABELLED: Panic disorder patients are hypervigilant to danger cues and highly sensitive to unpredictable aversive events, what leads to anticipatory anxiety, that is one key component of the disorder maintenance. Prefrontal cortex seems to be involved in these processes and beta band activity may be related to the involvement of top-down processing, whose function is supposed to be disrupted in pathological anxiety. The objective of this study was to measure frontal absolute beta-power (ABP) with qEEG in panic disorder and agoraphobia (PDA) patients compared to healthy controls. METHODS: qEEG data were acquired while participants (24 PDA patients and 21 controls) watched a computer simulation (CS), consisting of moments classified as "high anxiety" (HAM) and "low anxiety" (LAM). qEEG data were also acquired during two rest conditions, before and after the computer simulation display. The statistical analysis was performed by means of a repeated measure analysis of variance (two-way ANOVA) and ABP was the dependent variable of interest. The main hypothesis was that a higher ABP in PDA patients would be found related to controls. Moreover, in HAM the ABP would be different than in LAM. RESULTS: the main finding was an interaction between the moment and group for the electrodes F7, F8, Fp1 and Fp2. We observed a higher ABP in PDA patients when compared to controls while watching the CS. The higher beta-power in the frontal cortex for the PDA group may reflect a state of high excitability, together with anticipatory anxiety and maintenance of hypervigilant cognitive state. CONCLUSIONS: our results suggest a possible deficiency in top-down processing reflected by a higher ABP in the PDA group while watching the CS and they highlight the recruitment of prefrontal regions during the exposure to anxiogenic stimuli. LIMITATIONS: the small sample, the wide age range of participants and the use of psychotropic medications by most of the PDA patients.

Reducing the symptomatology of panic disorder: the effects of a yoga program alone and in combination with cognitive-behavioral therapy.

INTRODUCTION: Yoga is a holistic system of different mind-body practices that can be used to improve mental and physical health. It has been shown to reduce perceived stress and anxiety as well as improve mood and quality of life. Research documenting the therapeutic benefits of yoga has grown progressively for the past decades and now includes controlled trials on a variety of mental health conditions such as depression, anxiety, and panic disorder. OBJECTIVES: The primary goal of this study was to investigate the effects of yoga in patients suffering from panic disorder. We aimed at observing the efficacy of yoga techniques on reducing the symptomatology of panic disorder (anxiety and agoraphobia), compared to a combined intervention of yoga and psychotherapy. METHOD: Twenty subjects previously diagnosed with panic disorder were selected. Subjects were randomly assigned to both experimental groups: Group 1 (G1-Yoga: 10 subjects) attended yoga classes and Group 2 (G2-CBT + Yoga: 10 subjects) participated in a combined intervention of yoga practice followed by a cognitive-behavioral therapy (CBT) session. Both interventions occurred weekly for 100 min and lasted 2 months. Subjects were evaluated two times during the study: pre-test and post-test. Psychometric tools included the Beck Anxiety Inventory (BAI), Hamilton Anxiety Rating Scale (HAM-A), The Panic Beliefs Inventory (PBI), and Body Sensations Questionnaire (BSQ). RESULTS: Statistical analysis showed significant reductions in anxiety levels associated with panic disorder (G1: BAI - p = 0.035, HAM-A - p = 0.000; G2: BAI - p = 0.002, HAM-A - p = 0.000), panic-related beliefs (G1: PBI - p = 0.000; G2: PBI - p = 0.000) and panic-related body sensations (G1: BSQ - p = 0.000; G2: BSQ - p = 0.000) both in G1 and G2. However, the combination of yoga and CBT (G2) showed even further reductions in all observed parameters (mean values). CONCLUSION: This study observed significant improvement in panic symptomatology following both the practice of yoga and the combination of yoga and psychotherapy. While contemplative techniques such as yoga promote a general change in dealing with private events, CBT teaches how to modify irrational beliefs and specific cognitive distortions. The results observed in G2 might indicate that the techniques complemented each other, increasing the intervention efficacy. These findings are in agreement with many investigations found in the literature which observed improvements in different mental health parameters after the practice of contemplative techniques alone or combined to psychotherapy. Future research joining psychological and physiological variables could help better elucidate the mechanisms through which mind-body practices work to improve mental health.

O uso do teatro do oprimido no tratamento em grupo para transtorno de ansiedade social / Using theater of the oppressed in group treatment for social anxiety disorder

O Teatro do Oprimido (TO), criado por Augusto Boal na década de 1960, é um conjunto de técnicas, exercícios e jogos teatrais que tem como objetivo principal colocar o teatro a serviço da transformação social. O transtorno de ansiedade social (TAS) é considerado um transtorno grave, de curso crônico, que pode chegar a ser incapacitante, e, atualmente, o tratamento considerado mais efetivo para esses casos é a terapia cognitivo-comportamental (TCC). Objetivou-se desenvolver um programa de tratamento psicológico estruturado para TAS, aliando a TCC em grupo às técnicas do TO, e avaliar sua eficácia em comparação a um grupo-controle em lista de espera. Foram avaliados 35 sujeitos que participaram do tratamento, e 21 em lista de espera. As avaliações ocorreram antes do início, ao final e um mês após a terapia. Foram realizadas 18 sessões, duas vezes por semana, com duração de duas horas cada. Os instrumentos utilizados foram os Inventários Beck de Depressão e Ansiedade, o Inventário de Ansiedade e Fobia Social (SPAI), a Escala de Medo da Avaliação Negativa (FNE) e a Escala de Autoestima. O grupo experimental apresentou resultados significativos em comparação ao grupo-controle em todos os instrumentos aplicados. O grupo experimental melhorou, mas o grupo-controle, não. Os resultados encontrados indicam que o modelo proposto foi uma intervenção com resultado superior à passagem do tempo(AU)

The Theatre of the Oppressed (TO) was created by Augusto Boal in the 1960's. It is a set of techniques, theater games, and exercises, that aims to put theater at the service of social transformation. Social Anxiety Disorder (SAD) is considered to be a serious disorder, of chronic course, that can lead to incapacity. Cognitive-Behavioral Therapy (CBT) is considered to be the most effective treatment for SAD. The objective of this research was to develop a structured psychological treatment for SAD, combining group CBT with techniques of TO and having those results compared with a stand-by list control group. Thirty-five patients that participated in the treatment, and twenty-one individuals from the stand-by list, were evaluated. The evaluations occurred one month prior to the beginning of the therapy, at the end of the therapy, one month after the therapy. The protocol had eighteen sessions of two hours each. The sessions happened twice a week and the instruments used in the research were the Beck Depression Inventory, the Beck Anxiety Inventory, the Social Phobia Anxiety Inventory (SPAI), the Fear of Negative Evaluation (FNE), and Self-Esteem Scale. The results found showed a significant statistical difference between the control group and the experimental group, all instruments considered. The experimental group improved in a significant way while the control group did not. The results indicate that the proposed protocol was more effective than the passage of time(AU)

Alpha absolute power measurement in panic disorder with agoraphobia patients.

BACKGROUND: Panic attacks are thought to be a result from a dysfunctional coordination of cortical and brainstem sensory information leading to heightened amygdala activity with subsequent neuroendocrine, autonomic and behavioral activation. Prefrontal areas may be responsible for inhibitory top-down control processes and alpha synchronization seems to reflect this modulation. The objective of this study was to measure frontal absolute alpha-power with qEEG in 24 subjects with panic disorder and agoraphobia (PDA) compared to 21 healthy controls. METHODS: qEEG data were acquired while participants watched a computer simulation, consisting of moments classified as "high anxiety"(HAM) and "low anxiety" (LAM). qEEG data were also acquired during two rest conditions, before and after the computer simulation display. RESULTS: We observed a higher absolute alpha-power in controls when compared to the PDA patients while watching the computer simulation. The main finding was an interaction between the moment and group factors on frontal cortex. Our findings suggest that the decreased alpha-power in the frontal cortex for the PDA group may reflect a state of high excitability. CONCLUSIONS: Our results suggest a possible deficiency in top-down control processes of anxiety reflected by a low absolute alpha-power in the PDA group while watching the computer simulation and they highlight that prefrontal regions and frontal region nearby the temporal area are recruited during the exposure to anxiogenic stimuli.

Cross-cultural adaptation, validation and reliability of the brazilian version of the Richmond Compulsive Buying Scale.

OBJECTIVE: To present the process of transcultural adaptation of the Richmond Compulsive Buying Scale to Brazilian Portuguese. METHODS: For the semantic adaptation step, the scale was translated to Portuguese and then back-translated to English by two professional translators and one psychologist, without any communication between them. The scale was then applied to 20 participants from the general population for language adjustments. For the construct validation step, an exploratory factor analysis was performed, using the scree plot test, principal component analysis for factor extraction, and Varimax rotation. For convergent validity, the correlation matrix was analyzed through Pearson's coefficient. RESULTS: The scale showed easy applicability, satisfactory internal consistency (Cronbach's alpha=.87), and a high correlation with other rating scales for compulsive buying disorder, indicating that it is suitable to be used in the assessment and diagnosis of compulsive buying disorder, as it presents psychometric validity. CONCLUSION: The Brazilian Portuguese version of the Richmond Compulsive Buying Scale has good validity and reliability.

Cross-cultural adaptation, validation and reliability of the brazilian version of the Richmond Compulsive Buying Scale

OBJECTIVE: To present the process of transcultural adaptation of the Richmond Compulsive Buying Scale to Brazilian Portuguese. METHODS: For the semantic adaptation step, the scale was translated to Portuguese and then back-translated to English by two professional translators and one psychologist, without any communication between them. The scale was then applied to 20 participants from the general population for language adjustments. For the construct validation step, an exploratory factor analysis was performed, using the scree plot test, principal component analysis for factor extraction, and Varimax rotation. For convergent validity, the correlation matrix was analyzed through Pearson's coefficient. RESULTS: The scale showed easy applicability, satisfactory internal consistency (Cronbach's alpha=.87), and a high correlation with other rating scales for compulsive buying disorder, indicating that it is suitable to be used in the assessment and diagnosis of compulsive buying disorder, as it presents psychometric validity. CONCLUSION: The Brazilian Portuguese version of the Richmond Compulsive Buying Scale has good validity and reliability.

Validação e aferição de fidedignidade da versão brasileira da Compulsive Buying Scale / Validation and reliability of the Brazilian version of Compulsive Buying Scale

INTRODUÇÃO: A Escala de Compras Compulsivas (CBS) é um instrumento breve e de fácil aplicação, que visa avaliar as principais dimensões do transtorno das compras compulsivas, centrando-se no controle dos impulsos. OBJETIVO: O presente estudo tem como objetivo validar e aferir a fidedignidade da versão brasileira da Escala de Compras Compulsivas (CBS). MÉTODOS: Para validade de construto, foi realizada análise fatorial com extração dos componentes principais e rotação Varimax. A correlação entre a escala CBS e as medidas de depressão e ansiedade, assim como do transtorno obsessivo-compulsivo, foi avaliada por meio do coeficiente de Pearson, para estudo da validade convergente e divergente. A consistência interna foi aferida por meio do coeficiente alfa de Cronbach. RESULTADO: A CBS apresentou bons parâmetros psicométricos, sendo considerada válida e fidedigna em sua versão brasileira. No que concerne às correlações, a CBS apresenta uma correlação inversamente proporcional com outras escalas diagnósticas para o transtorno das compras compulsivas, indicando, portanto, ser um excelente instrumento de aferição dessa desordem. A CBS apresentou alto coeficiente alfa de Cronbach (0,86), demonstrando boa confiabilidade. CONCLUSÃO: Embora seja uma escala curta, com poucos itens, a versão brasileira da escala de compras compulsivas apresenta boas propriedades psicométricas, apresentando-se como um importante instrumento para avaliação desse construto.

BACKGROUND: The Compulsive Buying Scale is a short and easy-to-apply instrument, which comprises the main dimensions of the compulsive buying disorder, focusing on impulse control. OBJECTIVE: This study aims to validate and assess the reliability of the Brazilian version of the Compulsive Buying Scale. METHODS: To assess construct validity, a factor analysis with principal components extraction and Varimax rotation was conducted. The correlations between the CBS and measures for depression, anxiety, and obsessive-compulsive disorder were assessed with the Pearson coefficient, evaluating convergent and divergent validity. The internal consistency was measured using Cronbach's alpha coefficient. RESULT: The psychometric parameters of the Brazilian version of the CBS were satisfactory and the instrument was considered valid and reliable. The CBS showed an inversely correlation with other diagnostic scales for the compulsive buying disorder. Cronbach's alpha coefficient (0.86) was high, demonstrating a satisfactory reliability of the Portuguese CBS. DISCUSSION: Although the Brazilian version of the Compulsive Buying Scale is a short version with just a few items, the scale has excellent psychometric properties, presenting itself as an important tool to detect and evaluate compulsive buying disorder.

The effectiveness of cognitive behavioral group therapy in treating bipolar disorder: a randomized controlled study.

OBJECTIVE: Recent studies suggest that, when combined with pharmacotherapy, structured psychotherapy may modify the course of bipolar disorder. However, there are few studies that have examined the effects of cognitive behavioral group therapy on the course of this disorder. The aim of the present study was to evaluate the effectiveness of 14 sessions of cognitive behavioral group therapy, combined with pharmacotherapy, on the treatment of patients with bipolar disorder, and to compare our results against those from the use of pharmacotherapy alone. METHOD: Forty-one patients with bipolar I and II disorder participated in the study and were randomly allocated to one of two treatment groups; thirty-seven patients remained in the study until its completion. Mood and anxiety symptoms were measured in all subjects. Statistical analysis was used to investigate if the groups differed with respect to demographic characteristics and the scores recorded in the pre- and post-treatment stages, as well as during treatment (intra/inter groups). RESULTS: Patients showed statistically similar population characteristics. The association of cognitive behavioral group therapy and pharmacological treatment proved to be effective. Patients who had undergone cognitive behavioral group therapy presented fewer symptoms of mania, depression and anxiety, as well as fewer and shorter mood change episodes. CONCLUSION: Cognitive behavioral group therapy sessions substantially contributed to the improvement of depression symptoms.

The effectiveness of cognitive behavioral group therapy in treating bipolar disorder: a randomized controlled study / A eficácia da terapia cognitivo-comportamental para o tratamento do transtorno bipolar: um estudo controlado e randomizado

OBJECTIVE: Recent studies suggest that, when combined with pharmacotherapy, structured psychotherapy may modify the course of bipolar disorder. However, there are few studies that have examined the effects of cognitive behavioral group therapy on the course of this disorder. The aim of the present study was to evaluate the effectiveness of 14 sessions of cognitive behavioral group therapy, combined with pharmacotherapy, on the treatment of patients with bipolar disorder, and to compare our results against those from the use of pharmacotherapy alone. METHOD: Forty-one patients with bipolar I and II disorder participated in the study and were randomly allocated to one of two treatment groups; thirty-seven patients remained in the study until its completion. Mood and anxiety symptoms were measured in all subjects. Statistical analysis was used to investigate if the groups differed with respect to demographic characteristics and the scores recorded in the pre- and post-treatment stages, as well as during treatment (intra/inter groups). RESULTS: Patients showed statistically similar population characteristics. The association of cognitive behavioral group therapy and pharmacological treatment proved to be effective. Patients who had undergone cognitive behavioral group therapy presented fewer symptoms of mania, depression and anxiety, as well as fewer and shorter mood change episodes. CONCLUSION: Cognitive behavioral group therapy sessions substantially contributed to the improvement of depression symptoms.

OBJETIVO: Estudos recentes sugerem que uma psicoterapia estruturada aplicada junto com a farmacoterapia pode alterar o curso do transtorno afetivo bipolar. Entretanto, poucos estudos investigam os resultados da terapia cognitivo-comportamental em grupo sobre este transtorno psiquiátrico. O objetivo desta pesquisa foi avaliar a eficácia de 14 sessões de terapia cognitivo-comportamental em grupo concomitante à farmacoterapia para bipolares e comparar com a farmacoterapia sozinha. MÉTODO: Quarenta e um pacientes com transtorno bipolar I e II participaram do estudo e foram alocados aleatoriamente para um dos dois grupos; trinta e sete preencheram todas as escalas. Os sintomas de humor e ansiedade de todos os participantes foram avaliados. A análise estatística foi utilizada para investigar se os grupos diferiam com relação aos dados demográficos e entre os escores pré-, durante e pós-tratamento (intra/intergrupos). RESULTADOS: Os participantes dos dois grupos mostraram-se similares nas características demográficas. A adição da terapia cognitivo-comportamental em grupo ao tratamento farmacológico foi efetiva. O grupo da terapia cognitivo-comportamental em grupo apresentou menos sintomas de mania, depressão e ansiedade, bem como uma redução na frequência e duração dos episódios de humor. CONCLUSÃO: As sessões de terapia cognitivo-comportamental em grupo foram especialmente importantes na melhora dos sintomas depressivos.

Os benefícios do yoga nos transtornos de ansiedade / Benefits of yoga practices for anxiety disorders

Nos últimos anos, estudos têm mostrado que um grande número de pessoas experimentará algum tipo de transtorno de ansiedade de maneira contínua ou recorrente. Terapias complementares como o yoga vêm provando sua eficácia significativa na redução dos sintomas de ansiedade. Portanto, o objetivo deste estudo é discutir o uso de yoga como intervenção para o tratamento de transtornos de ansiedade com base nos resultados de grandes estudos controlados. Esta análise concluiu que o yoga parece ser uma intervenção consistente, bem-sucedida e com boa relação custo-benefício no tratamento dos transtornos de ansiedade. No entanto, este é um novo campo de pesquisa e novas investigações combinando variáveis psicológicas e fisiológicas são necessárias para estabelecer um protocolo de yoga como intervenção principal ou complementar no tratamento da ansiedade

Over the last years, studies have shown that a great number of individuals will experience some kind of anxiety disorder on a continuing or recurring basis. Complementary therapies such as yoga have been proved to significantly reduce anxiety symptoms. Therefore, the goal of this study was to discuss the use of yoga as an intervention for treating anxiety disorders based on findings from major controlled studies. This analysis has concluded that yoga seems to be a consistent, cost-effective and successful health care intervention in the treatment of anxiety disorders. However, this is a new field of research and further investigations combining psychological and physiological variables are necessary to establish yoga as a main or complementary protocol in the treatment of anxiety

Tradução e adaptação semântica da Compulsive Buying Scale para o português brasileiro / Translation and semantic adaptation of the Compulsive Buying Scale for Brazilian Portuguese

OBJETIVO: A Compulsive Buying Scale (Escala de Compras Compulsivas), instrumento breve e de fácil aplicação, apresenta como vantagem abarcar as principais dimensões do transtorno, sendo elas a compulsão pelas compras e o comportamento impulsivo. O presente estudo tem como objetivo a adaptação transcultural para o português do Brasil da Escala de Compras Compulsivas. MÉTODOS: Para a etapa de adaptação semântica, dois psicólogos bilíngues e um tradutor fluente em português e inglês traduziram a escala de seu idioma de origem, o inglês, para o português. Em um segundo momento, foi realizada a retrotradução da escala por dois tradutores e um psicólogo. Finalmente, a escala foi aplicada em 20 participantes, de modo que pudessem ser feitos ajustes semânticos no instrumento em questão. RESULTADOS: A colaboração entre profissionais especialistas em tradução bilíngue fluentes nos idiomas inglês e português brasileiro, e psicólogos clínicos capacitados à avaliação sobre o constructo a ser mensurado, possibilitou o ajuste dos termos utilizados na versão final da escala para o idioma português, assegurando adequação semântica do instrumento. Assim, todos os itens obtiveram aprovação superior a 90 por cento em sua aplicação experimental. CONCLUSÃO: A versão da escala de compras compulsivas adaptada para o idioma português foi elaborada com êxito.

OBJECTIVE: The Compulsive Buying Scale, a short and easy-to-apply instrument, has the advantage of comprising the main dimensions of the disorder, which are the compulsion for buying and the impulsive behavior. The present work aimed to adapt the scale transculturally to Brazilian Portuguese. METHODS: To the step of semantic adaptation, a Portuguese-English Translator and two bilingual Psychologists translated the scale from English to Portuguese. Secondly, it was translated back to English for validation by two translators and a Psychologist. Finally, the scale was applied to 20 participants in order to perform semantic adjustments to the instrument. RESULTS: The collaboration of professional translators and clinical psychologists, able to evaluate the quality of the material, made possible the adjustment of the text used in the final version of the scale in Portuguese, thus assuring semantic adequation. All items had approval of over 90 percent in the experimental application. CONCLUSION: The Brazilian Portuguese version of the Compulsive Buying Scale was successfully created.

Current concept of anxiety: implications from Darwin to the DSM-V for the diagnosis of generalized anxiety disorder.

This article proposes a revision of the historical evolution of the concepts of generalized anxiety disorder (GAD). Currently, Darwin's evolutionary theory is the hegemonic paradigm for modern science and influences research on mental disorders. Throughout the 20th Century, the editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association) have changed the diagnostic criteria for GAD, reflecting the prevailing psychiatric understanding of this disorder. The prevalence and symptoms of major depression and GAD show the fragility of the categorical conception of these conditions. Differences in cultural views towards anxiety disorders also suggest that anxiety cannot have a uniform definition. This article provides contributions for reflecting future guidelines concerning the diagnostic criteria for GAD in DSM-V.

Cognitive-behavioral therapy for bipolar disorder.

Bipolar disorder is one of the most serious and prevalent psychiatric disorders. The aim of the present article is to review the efficiency of cognitive-behavioral therapy (CBT) for bipolar patients. Some studies show consistent evidence that cognitive therapy, concomitant to psycho-education and pharmacological treatment, offers efficacy in different phases of the disease. In most of the studies, patients undergoing CBT showed improvements in quality of life, with a reduction in both frequency and duration of mood episodes, as well as higher degrees of compliance and fewer hospitalizations. More studies are required to prove the effectiveness of CBT for bipolar disorder in the context of standardizing diagnostic criteria and measuring instruments to evaluate the disorder's different phases and severity.

Quality of life and symptom dimensions of patients with obsessive-compulsive disorder.

The aim of this study was to evaluate the impact of different dimensions of obsessive-compulsive symptoms, of co-morbid anxious depressive symptoms, and of sociodemographic characteristics on the quality of life of patients with obsessive-compulsive disorder (OCD). We evaluated 53 patients with OCD and 53 age- and gender-matched individuals from the community with a sociodemographic questionnaire, the Structured Clinical Interview for the Diagnosis of Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, (DSM-IV), the Short-Form Health Survey-36 (SF-36), the Saving Inventory-Revised, the Obsessive-Compulsive Inventory-Revised, the Beck Depression Inventory and the Beck Anxiety Inventory. A series of stepwise linear regression analyses were performed, having the SF-36 dimensions as the dependent variables and the sociodemographic and clinical features as the independent ones. Patients with OCD displayed significantly lower levels of quality of life in all dimensions measured by the SF-36, except bodily pain. A model that included depressive symptoms, hoarding and employment status predicted 62% of the variance of the social functioning dimension of the quality of life of patients with OCD. Washing symptoms explained 31% of the variance of limitation due to physical health problems. Further, a series of models that included depressive, but not obsessive-compulsive symptoms, explained the remaining SF-36 dimensions. The severity of depressive and anxiety symptoms seems, therefore, to be powerful determinants of the level of quality of life in patients with OCD.

The Brazilian Portuguese version of the Saving Inventory-Revised: internal consistency, test-retest reliability, and validity of a questionnaire to assess hoarding.

Pathological hoarding results in clutter that precludes normal activities and creates distress or dysfunction. It may lead to an inability to complete household functions, health problems, social withdrawal, and even death. The aim of this study was to describe the validation of the Brazilian version of the hoarding assessment instrument, the Saving Inventory-Revised. Sixty-five patients with obsessive-compulsive disorder (OCD) and 70 individuals from the community were assessed using the Structured Clinical Interview for the Diagnosis of DSM-IV (clinical sample), the Saving Inventory-Revised, the Obsessive-Compulsive Inventory-Revised, the Beck Depression Inventory, and the Beck Anxiety Inventory. The Brazilian version of the Saving Inventory-Revised exhibited high internal consistency (Cronbach's alpha = .94 for OCD and .84 for controls), high to moderate test-retest reliability and, using the hoarding dimension of the Obsessive-Compulsive Inventory-Revised as a reference point, high to moderate convergent validity. The Saving Inventory-Revised total scores also correlated significantly with comorbid anxiety and depressive symptoms.

Terapia cognitivo-comportamental e o TDAH subtipo desatento: uma área inexplorada

O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) é definido a partir de um curso crônico o qual conduz a diversos comprometimentos. Em adultos, as maiores dificuldades são de organização, sustentação da atenção e memória. O transtorno apresenta como características nucleares a desatenção, a hiperatividade e a impulsividade, e seu diagnóstico é fundamentalmente clínico. Nosso objetivo é relatar o caso de uma cliente adulta diagnosticada com TDAH subtipo desatento e Depressão Maior, tratada apenas com Terapia Cognitivo-Comportamental (TCC) em 20 sessões. Inicialmente serão apresentadas as características clínicas do TDAH e breve revisão do tratamento com TCC. As medidas pré e pós-tratamento envolveram o Inventário de Depressão de Beck e Adult Self-Report Scale. Entre as intervenções utilizadas estavam a psicoeducação, o questionamento socrático e as estratégias de organização. Após a TCC a cliente não mais preenche critérios para depressão maior, além de apresentar redução dos sintomas de TDAH.

Attention Deficit Hyperactivity Disorder (ADHD) is defined from a chronic course which leads to several impairments. In adults, the greatest difficulties are in organization, sustained attention and memory. The disorder presents as core characteristics: inattention, hyperactivity and impulsivity and its diagnosis is mainly clinical. Our aim is to report the case of an adult client diagnosed with ADHD inattentive subtype and Major Depression, treated only with Cognitive-Behavioral Therapy (CBT) in 20 sessions. Initially we will present the clinical characteristics of ADHD and a brief review of the treatment of ADHD with CBT. We will then describe the search in the literature about the efficacy of CBT without medication in adults with ADHD inattentive subtype. The measures pre and post-treatment were: Beck Depression Inventory and Adult Self-Report Scale. Some interventions were psychoeducation, Socratic questioning and strategies to improve organization. After CBT, the client no longer meets criteria for major depression and there was a decrease in symptoms of ADHD.

Empathy and symptoms dimensions of patients with obsessive-compulsive disorder.

Patients with obsessive-compulsive disorder (OCD) often display cognitions and/or behaviors that may well reflect the existence of "hyper-attachment" to different environmental elements, including their offspring, family members, divine entities, or even inanimate objects. Based on the fact that both OCD symptoms and physiologic interpersonal attachment mechanisms involve overlapping ventral fronto-limbic circuits, we hypothesized that there is a relationship between empathy, evaluated with the Interpersonal Reactivity Index (IRI), and OCD symptom dimensions. We evaluated 53 patients with OCD and 53 age- and sex-matched individuals from the community with the Structured Clinical Interview for the Diagnosis of DSM-IV axis I disorders, the Saving Inventory-Revised, the IRI (composed of four sub-scales), the Obsessive-Compulsive Inventory - Revised, the Beck Depression Inventory, and the Beck Anxiety Inventory. Patients with OCD displayed greater levels of affective empathy (i.e., empathic concern (p=0.006) and personal discomfort (p<0.001)) than community controls. In bivariate analyses, the severity of hoarding symptoms of patients with OCD correlated with empathic concern (r=0.39; p<0.001), fantasy (r=0.36; p<0.01), and personal discomfort (r=0.39; p<0.001). In partial correlation analyses adjusting for comorbid depression and anxiety, only the association between hoarding and fantasy remained robust (r=0.41; p<0.001). A model that included severity of hoarding, depression, and anxiety symptoms predicted 33% of the variance on the fantasy scale. Our findings suggest that hoarding is linked to specific aspects of interpersonal reactivity. Comorbid depression and anxiety, however, explain a large proportion of the empathic profile exhibited by patients with OCD.