Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.923
South Med J ; 113(4): 198-200, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32239233


Munchausen syndrome is a factitious disorder that is difficult to diagnose and treat. This article clarifies points for clinical recognition and management of patients with this condition. Patients with this condition often are dramatic and provide false and/or exaggerated symptoms or information. They solicit attention from physicians, going doctor-to-doctor, having repeated diagnostic tests, procedures, hospitalizations, and evidence little improvement. Adherence to treatment plans is generally suboptimal and the patients frequently leave the hospital against medical advice. A compassionate, multidisciplinary approach to treatment is advised. It often includes conjoint clinical communication between the primary care physician and a psychiatrist. Open, supportive discussion with the patient about his or her condition is important. Long-term psychotherapy and follow-up are recommended.

Síndrome de Munchausen/diagnóstico , Síndrome de Munchausen/psicologia , Gerenciamento Clínico , Humanos , Síndrome de Munchausen/epidemiologia , Processos Psicoterapêuticos
J Consult Clin Psychol ; 88(5): 455-469, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32134285


OBJECTIVE: Although most studies investigating sudden gains in treatments for posttraumatic stress disorder (PTSD) report a positive association between sudden gains and outcomes at the end of treatment, less is known about sudden gains in routine clinical care and the processes involved in their occurrence. This study investigated changes in cognitive factors (negative appraisals, trauma memory characteristics) before, during, and after sudden gains in PTSD symptom severity. METHOD: Two samples (N1 = 248, N2 = 234) of patients who received trauma-focused cognitive therapy for PTSD in routine clinical care were analyzed. Mahalanobis distance matching, including the propensity score, was used to compare patients with sudden gains and similar patients without sudden gains. Estimates from both samples were meta-analyzed to obtain pooled effects. RESULTS: Patients with sudden gains (n1 = 76, n2 = 87) reported better treatment outcomes in PTSD symptom severity, depression, and anxiety at the end of therapy and follow-up than those without sudden gains. No baseline predictors of sudden gains could be reliably identified. During sudden gains, those with sudden gains had greater changes in both cognitive factors than matched patients. Meta-analyses of the two samples showed that negative appraisals had already decreased in the session prior to sudden gains compared with matched patients. CONCLUSIONS: The pooled estimates suggest that changes in negative trauma-related appraisals precede sudden gains in PTSD symptoms. The results suggest that interventions that promote change in appraisals may also facilitate sudden gains in therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Terapia Cognitivo-Comportamental , Avaliação de Resultados em Cuidados de Saúde , Processos Psicoterapêuticos , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
Vínculo ; 16(2): 1-22, jul.-dez. 2019.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1099423


O trabalho grupal inserido em instituições e no âmbito da saúde pública tem sido ressaltado como relevante e necessário, dado o potencial que tem para promover saúde e fortalecer o vínculo entre pessoas. O estudo teve por objetivo relatar a experiência profissional acadêmica de realização de intervenções em uma Unidade Básica de Saúde (UBS) do interior mineiro. Quatro encontros com trabalhadoras de UBS, de uma hora, foram realizados, no formato de oficinas grupais. Eles foram coordenados por equipe de 4 estudantes de Psicologia, sob supervisão de professores vinculados a uma universidade pública federal, e tinham inspiração no modelo teórico-técnico dos grupos operativos de ensino e aprendizagem. As experiências geraram resultados que permitiram às funcionárias expressarem sentimentos e ideias e refletirem sobre estratégias que poderiam ser adotadas para enfrentamento de insatisfações no contexto laboral, notadamente caracterizado por precarização de relações e condições de trabalho. O processo grupal desenvolvido foi considerado ferramenta que propiciou a criação de espaços para reflexões coletivamente construídas sobre o próprio trabalho e sobre as limitações e potencialidades que lhe são inerentes, ensejando, ainda, o pensar sobre as relações entre pares.

Group work within institutions and in the field of public health has been highlighted as relevant and necessary given the potential it has to promote health and strengthen the bond between people. This study aimed to report the academic professional experience of performing interventions in a Primary Health Care Service within Minas Gerais state, Brazil. Four meetings were held with the workers in the form of group workshops (during 1-hour each). They were coordinated by a group composed of four Psychology students under the supervision of teachers that are affiliated to a public university and were inspired by the theoretical-technical model of the teaching and learning operating groups. The experiences reproduced results that allowed the participants to express feelings, thoughts and also to reflect on strategies that could be adopted to coping dissatisfaction at work environment, especially characterized by precarious relations and working conditions. The developed group process was considered a tool that allowed the creation of spaces for reflections collectively built on the work itself and on the limitations and potentialities that are inherent to it, also leading to thinking about peer relations.

El trabajo grupal insertado en instituciones y en el ámbito de la salud pública ha sido resaltado como relevante y necesario, dado el potencial que tiene para promover salud y fortalecer el vínculo entre personas. El estudio tuvo por objetivo relatar la experiencia profesional académica de la realización intervenciones en una Unidad Básica de Salude (USB) del interior minero. Cuatro encuentros con trabajadoras de la UBS, de 1h, fueron realizados, en el formato de oficinas grupales. Ellos fueron coordinados por un equipo de 4 estudiantes de Psicología, bajo supervisión de profesores vinculados a una universidad pública federal, y tenían inspiración en el modelo teórico-técnico de los grupos operativos de enseñanza y aprendizaje. Las experiencias generaron resultados que permitieron a los funcionarios expresar sentimientos e ideas y reflexionar sobre las estrategias que pudieran ser adoptadas para el enfrentamiento de la insatisfacción en el contexto laboral, caracterizado por la precarización de las relaciones y las condiciones de trabajo. El proceso grupal desarrollado fue considerado una herramienta que propició la creación de espacios para reflexiones colectivas construidas sobre el propio trabajo y sobre las limitaciones y potencialidades que son inherentes y que el pensamiento sobre las relaciones entre pares.

Humanos , Masculino , Feminino , Atenção Primária à Saúde , Psicologia , Encenação , Saúde do Trabalhador , Processos Psicoterapêuticos , Capacitação de Recursos Humanos em Saúde , Estresse Ocupacional , Questionário de Saúde do Paciente
Am J Psychoanal ; 79(4): 484-493, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31636400


Psychoanalysis is a narrative activity of a very special kind. One could even say that the method of free association is a subversive activity since its purpose is to cut through layers of previous conditioning in the effort to open new spaces in the psyche. The hypercathexis of neurotic functioning can only be transformed if new, unknown dynamics are able to emerge, and can then be invested by the subject. This process necessitates economic change-investing novel psychic functioning. Aided by personal analytic experience, the psychoanalyst's role is to help initiate and support this subversive activity in the patient by initiating him/her into the method of free association. Difficulties arise when neither the patient, nor the analyst are comfortable with the symbolic and metaphorical dynamics of free association. Reacting to Freud's lack of interest in an emotional analytic process with the patient, Ferenczi considered the analytical space as a mutual frame, to be transformed in and by the intimate psychoanalytical process. The author explores Ferenczi's Clinical Diary as the construction of an intimate space through narration, attempting to discover Ferenczi's techniques in this subversive activity.

Psicanálise/história , Terapia Psicanalítica/métodos , Processos Psicoterapêuticos , Aliança Terapêutica , História do Século XX , Humanos , Narração , Transferência Psicológica
J Consult Clin Psychol ; 87(10): 927-940, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556669


OBJECTIVE: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. METHOD: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. RESULTS: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02). CONCLUSIONS: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Dor Crônica/terapia , Atenção Plena , Grupos de Autoajuda , Adulto , Afeto , Idoso , Analgesia/psicologia , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/psicologia , Transtornos Relacionados ao Uso de Opioides/terapia , Processos Psicoterapêuticos , Resultado do Tratamento
Estud. psicol. (Natal) ; 24(3): 237-246, Jul.-Sept. 2019. graf, tab
Artigo em Inglês | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1098236


The psychophysiological substrate of Post-traumatic stress disorder (PTSD) is associated with deregulation of neural networks involving mind-body interaction and is the subject of considerable research. It has been managed using pharmacological treatment associated or not with complementary treatments. The aim of this study was to systematize the knowledge about the types and effectiveness of complementary treatments using somatic interventions in the PTSD setting. According to the revised literature, the complementary approaches are based on Somatic Experiencing®, meditation and brainspotting techniques, and are anchored in the search for regulating the underlying neural mechanisms. However, there is little scientific production on these treatments, despite the positive clinical impact of their results, particularly for Somatic Experiencing®, which has presented good results. For the authors, further controlled trials involving improvement of symptoms and their association with possible biological markers are necessary to corroborate the efficacy of this therapy.

O transtorno de estresse pós-traumático (TEPT),cujo substrato psicofisiológico é associado à desregulação de redes neurais que envolvem a interação mente-corpo, é objeto de muitas pesquisas e vem sendo manejado usando tratamento farmacológico associado ou não a tratamentos complementares.O objetivo desse estudo foi sistematizar o conhecimento sobre os tipos e eficácia de tratamentos complementares que utilizam intervenções somáticas no quadro do TEPT. Segundo a literatura revisada, as intervenções somáticas são baseadas em técnicas de experiência somática, meditação, brainspotting e estão ancoradas na busca da regulação dos mecanismos neurais subjacentes. Todavia, constatou-se baixa produção científica destes tratamentos, apesar do impacto clínico positivo de seus resultados, particularmente para experiência somática® que apresentou bons resultados. Para os autores, mais estudos controlados envolvendo melhora dos sintomas e sua associação a possíveis marcadores biológicos são necessários para corroborar a eficácia desta terapia.

El trastorno de estrés postraumático (TEPT), cuyo sustrato psicofisiológico está asociado a la desregulación de redes neuronal que involucran la interacción mente-cuerpo, es objeto de muchas investigaciones y viene siendo manejado usando tratamiento farmacológico asociado o no a tratamientos complementarios. El objetivo de este estudio fue sistematizar el conocimiento sobre los tipos y la eficacia de los tratamientos complementarios que utilizan intervenciones somáticas en el trastorno de estrés postraumático. De acuerdo con la literatura revisada, las intervenciones somáticas se basan en técnicas de experiencia somática, meditación, braquines y están ancladas en la búsqueda de la regulación de los mecanismos neurales subyacentes. Sin embargo, se constató baja producción científica de estos tratamientos, a pesar del impacto clínico positivo de sus resultados, particularmente para la experiencia somática®, que presentó buenos resultados. Para los autores, más ensayos controlados involucran la mejora de los síntomas y su asociación a posibles marcadores biológicos son necesarios para corroborar la eficacia de esta terapia.

Sinais e Sintomas , Transtornos Somatoformes , Transtornos de Estresse Pós-Traumáticos , Processos Psicoterapêuticos , Brasil , Literatura de Revisão como Assunto , Saúde Mental
Pap. psicol ; 40(2): 89-100, mayo-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183639


La Práctica (Clínica) Basada en la Evidencia se define como la integración de la mejor investigación disponible con la pericia clínica y las características, preferencias y cultura del paciente. Del mismo modo, la variable terapeuta empieza a mostrar su influencia decisi-va en el resultado de los tratamientos psicológicos. En este trabajo se pone el énfasis en la figura del terapeuta en el contexto del pro-grama de formación PIR de especialistas en Psicología Clínica de nuestro Sistema Nacional de Salud. Se revisan los constructos pericia, efectos del terapeuta y se presenta la Práctica Deliberada como un sistema de entrenamiento que puede ayudar a mejorar los resultados de los clínicos y sus tratamientos. Se realizan recomendaciones concretas para mejorar el modelo de supervisión durante la residencia PIR y se discuten algunas de las implicaciones y limitaciones del estado actual de la cuestión

Evidence-based (clinical) practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences. Similarly, the therapist factor is beginning to show its decisive influence on the outcome of psychological treatments. This paper emphasizes the therapist factor in the context of the PIR training program of Clinical Psychology specialists within our National Health System. Expertise and therapist effects are reviewed and deliberate practice is presented as a training system that can help clinical psychologists to improve their outcomes and treatments. Specific recommendations are made to improve the supervision model during PIR training and the implications and limitations of the topic are discussed

Humanos , Psicologia Clínica/métodos , Psicoterapia/métodos , Aptidão/fisiologia , Competência Clínica , Processos Psicoterapêuticos , Psicologia Clínica/instrumentação , Prática Clínica Baseada em Evidências , Sistemas Nacionais de Saúde
Gerais (Univ. Fed. Juiz Fora) ; 12(2): 371-388, jul.2019.
Artigo em Português | LILACS | ID: biblio-1006232


O artigo toma como objeto de estudo as modalidades disponibilizadas de atendimento à população por serviços-escola de Psicologia. Parte do pressuposto de que a formação e a atuação em Psicologia têm sido perpassadas por significativas mudanças no contexto sócio-histórico-político do Brasil. Das clássicas áreas educação, saúde e trabalho, a Psicologia passa a responder demandas de distintos campos da vida da população. Trata-se de estudo descritivo, quantitativoqualitativo, constituído de levantamento bibliográfico da produção científica (2011 a 2015) sobre o tema. Vinte e quatro artigos foram identificados na pesquisa e sistematizados em três blocos de conteúdo: atividades educacionais, de autoavaliação e clínicas. As publicações versam prioritariamente sobre atividades educacionais e clínicas, sendo estas as que reúnem maior quantidade de artigos. Devido à tarefa dirigida à Psicologia de responder a demandas com as quais historicamente não se envolveu, pelo menos de forma hegemônica, é indispensável problematizar o Serviço-escola em sua função pedagógica, ético-política e social.

This article investigates the types of service available to the population by Psychology Training Clinics. It is based on the assumption that training and practice in Psychology have been permeated by significant changes in the sociohistorical-political context of Brazil. From the classic fields of school, health and work, Psychology starts to respond to demands from different areas of population life. This is a descriptive, quantitative-qualitative study, consisting of a literature review on the subject (2011 to 2015). 24 articles were identified in the search of the literature and analysed in three content blocks: school, self-assessment and clinical activities. The publications are primarily about educational and clinical activities, and they bring together a greater number of articles. Due to the task directed to Psychology to respond to the demands with which it has historically not been involved, at least in a hegemonic way, it is indispensable to problematize the Psychology Training Clinic in its pedagogical, ethical-political and social function.

Psicologia Aplicada , Processos Psicoterapêuticos , Prática Psicológica
Clin Psychol Psychother ; 26(5): 586-602, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31153157


Many outcome measures and session-related questionnaires in psychotherapy are designed for weekly or biweekly administration. Yet, today, technical developments allow for higher frequency assessments to monitor human change dynamics more closely by daily assessments. For this purpose, the Therapy Process Questionnaire (TPQ) was developed, with a specific focus on inpatient psychotherapy. In this article, we present an explorative and confirmative factor analysis of the TPQ on the basis of the time series data of 150 patients collected during their hospital stay (mean time series length: 69.1 measurement points). A seven-factor solution was identified, which explains 68.7% of variance and associates 43 items onto the factors, which are "well-being and positive emotions," "relationship with fellow patients," "therapeutic relationship and clinical setting," "emotional and problem intensity," "insight/confidence/therapeutic progress," "motivation for change," and "mindfulness/self-care." The internal consistency (Cronbach's α), the inter-item correlations of the subscales, and the discriminative power of the items are excellent. The TPQ can be applied in practice and research for creating time series with equidistant measurement points and time series lengths, which are appropriate for the application of nonlinear analysis methods. Especially in clinical practice, it is important to identify precursors of phase transitions, changing synchronization patterns, and critical or instable periods of a process, which now is possible by internet- or app-based applications of this multidimensional questionnaire.

Transtornos Mentais/terapia , Processos Psicoterapêuticos , Autorrelato , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes
Artigo em Inglês | IBECS | ID: ibc-183854


Members of the Sikh Khalsa who make their residence in the United States represent a psychologically underserved and understudied population. A lack of awareness of psychological services contributes to this status; however, the challenges inherent in reconciling cultural norms within the United States with the native cultures of immigrant populations should not be neglected. As a consequence of the paucity of ethnically Sikh psychotherapists, the number of therapists with a competent cultural understanding of this population is limited. By sharing the insights and observations culled from dialogue with members of a Sikh community recovering in the wake of a national tragedy, we present our insights and an approach to therapeutic intervention developed to facilitate future psychotherapeutic endeavors both in Sikh communities and other ethnic minorities at large. The model developed in this study identifies demographic issues, therapeutic approach, gender bias, language, confidentiality, peer support, and immigrant status as the most important factors when treating this population. Ultimately, it is our intention to elevate awareness of some of the idiosyncratic complexities involved in treatment and research of this underserved minority group, particularly as our population continues to diversify

No disponible

Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Transtornos Mentais/terapia , Psicoterapia/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/terapia , Saúde das Minorias Étnicas , Processos Psicoterapêuticos , Índia/etnologia , Religião e Psicologia , Competência Cultural , Emigrantes e Imigrantes/psicologia , Estados Unidos/epidemiologia , Terrorismo/psicologia , Sobreviventes/psicologia
Neural Plast ; 2019: 7067592, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31065259


Aging is a physiological process accompanied by cognitive decline, principally in memory and executive functions. Alterations in the connectivity of the default mode network (DMN) have been found to participate in cognitive decline, as well as in several neurocognitive disorders. The DMN has antisynchronic activity with attentional networks (task-positive networks (TPN)), which are critical to executive function and memory. Findings pointing to the regulation of the DMN via activation of TPN suggest that it can be used as a strategy for neuroprotection. Meditation is a noninvasive and nonpharmacological technique proven to increase meta-awareness, a cognitive ability which involves the control of both networks. In this review, we discuss the possibility of facilitating healthy aging through the regulation of networks through meditation. We propose that by practicing specific types of meditation, cognitive decline could be slowed, promoting a healthy lifestyle, which may enhance the quality of life for the elderly.

Encéfalo/fisiologia , Envelhecimento Saudável/fisiologia , Envelhecimento Saudável/psicologia , Meditação , Processos Psicoterapêuticos , Atenção/fisiologia , Disfunção Cognitiva/prevenção & controle , Humanos , Metacognição , Atenção Plena , Vias Neurais/fisiologia
Schmerz ; 33(4): 329-332, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31037342


A patient with long-term fibromyalgia syndrome and concomitant post-traumatic stress disorder is reported. The relocation to a so-called external safe site resulted within a very short time in a sustained remission of the fibromyalgia syndrome, due to psychotherapeutic interventions. This shows that-according to the clinical guidelines-a psychiatric examination and, if necessary, targeted therapy of the psychiatric comorbidity is indispensable in patients with fibromyalgia syndrome.

Fibromialgia , Dor , Transtornos de Estresse Pós-Traumáticos , Comorbidade , Fibromialgia/complicações , Humanos , Dor/diagnóstico , Manejo da Dor/psicologia , Processos Psicoterapêuticos , Transtornos de Estresse Pós-Traumáticos/complicações
Psychotherapy (Chic) ; 56(2): 285-296, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31144852


Different forms of psychotherapy are effective for cluster C personality disorders, but we know less about what in-session processes promote change. Contrasting successful and unsuccessful cases may elucidate processes that facilitate or impede outcome and offer suggestions for clinical practice and future research. In this exploratory outcome-process study, 10 successful and 10 unsuccessful cases were selected from a randomized trial comparing cognitive therapy and short-term psychodynamic psychotherapy for cluster C personality disorders. Videotaped sessions were rated with the Psychotherapy Process Q-Set (PQS). The treatments were compared in terms of which PQS items differentiated successful and unsuccessful cases, as well as their resemblance with PQS prototypes of "ideal treatments." Therapists' behavior in early sessions was also explored. Results indicate that successful cases in our sample were characterized by a more active and engaged patient. In contrast, unsuccessful cases were characterized by a more directive or "controlling" therapist stance. Correlations with PQS prototypes were moderate to strong in both successful and unsuccessful cases, suggesting that optimal and suboptimal interpersonal processes may be independent of adherence to particular treatments. Exploration of therapist behaviors in early sessions indicated that therapists were more likely to adjust their way of working in the successful cases. Our result suggests that patient engagement and therapists' early efforts to improve the therapy relationship may be pivotal for successful outcome, whereas therapist controlling behavior may obstruct the treatment process, regardless of therapy model used. The impact of these in-session processes should be examined more closely in larger samples in future studies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Terapia Cognitivo-Comportamental/métodos , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Processos Psicoterapêuticos , Psicoterapia Breve/métodos , Psicoterapia Psicodinâmica/métodos , Adulto , Feminino , Humanos , Masculino , Psicoterapia/métodos , Resultado do Tratamento
Res Aging ; 41(8): 772-793, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31043126


We experimentally investigated gratitude's impact on loneliness and health in older adults. Participants were assigned to a daily gratitude writing exercise (treatment group) or a control group. Self-reported loneliness and health (i.e., subjective well-being, subjective health, health symptoms) were measured daily over a 3-week period. In support of our hypotheses, within-person variability in gratitude predicted differences in loneliness and health. Furthermore, those in the treatment group showed stronger cumulative effects of gratitude on loneliness and health symptoms when aggregated across the 20-day study. Additionally, a series of conditional, multilevel indirect effect models found that loneliness acted as a mechanism for gratitude's differential impact on subjective well-being and health symptoms across conditions. Taken together, this study provides initial evidence that a simple gratitude exercise can strengthen associations among daily gratitude and loneliness and, consequently, improve health, for older adults.

Atividades Cotidianas , Solidão/psicologia , Redação , Idoso , Feminino , Promoção da Saúde , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Processos Psicoterapêuticos , Distribuição Aleatória , Comportamento Social
Nervenarzt ; 90(7): 690-694, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31073672


BACKGROUND: Mental health professionals use various strategies to prevent involuntarily committed persons from absconding under an open door policy. OBJECTIVE: To provide an ethical framework for the evaluation of the replacement of locked ward doors by formal coercion or treatment pressures. METHODS: Empirically informed conceptual and ethical analysis. RESULTS: The replacement of locked ward doors by formal coercive measures applied to individual persons, such as mechanical restraint or seclusion, is ethically problematic. The use of treatment pressures, for example in the context of intensified observational measures, requires a differentiated ethical evaluation and does not necessarily constitute the milder means in comparison to locked ward doors. CONCLUSION: Unexplored conceptual, empirical and ethical issues surrounding open door policies and treatment pressures should be clarified by means of psychiatric and ethical research. In clinical practice, the choice of the least burdensome and least restrictive measures for involuntarily committed persons should be facilitated by appropriate ethical support services.

Coerção , Transtornos Mentais/terapia , Processos Psicoterapêuticos , Isolamento de Pacientes/ética , Isolamento de Pacientes/legislação & jurisprudência , Psiquiatria/ética , Psiquiatria/normas
Nervenarzt ; 90(7): 724-732, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31073674


BACKGROUND: Implementation of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). The idea of human rights developed during the era of the Enlightenment. This idea has been publicly discussed since the French Revolution of 1789 and its specification has been demanded politically. Important steps in this process were the General Declaration of Human Rights adopted by the UN in 1948 and the CRPD from 2006, which was especially relevant for psychiatric actions. Meanwhile, the idea of human rights has influenced the legislation in many countries and has thus become normatively binding, e. g. in the Basic Law of Germany, in the regulations for patient care and in the professional rules for physicians. AIM AND QUESTIONS: To sensitize for reflection on one's own actions and to gain a critical distance from the general overall opinion. Then not only the global validity of the CRPD is frequently violated, as in crisis regions but also in the everyday routine when, for example, the workload prevents psychiatric personnel from taking time for essential conversations with psychiatric patients in order to support their self-determination. MATERIAL AND METHODS: These aspects are illustrated and explained with the aid of multifarious examples from the relevant literature and from own experience. RESULTS AND DISCUSSION: Human rights are a regulative idea that provide a framework and direction for psychiatric actions; however, as an idea they compete with other ideas that try to control the trends of the day (the Zeitgeist) that determine daily practice. Not only the suppression of human rights from public consciousness, e. g. with the eugenics in the first third of the previous century but also their absolutization and poor implementation, as in the Italian psychiatry reform of 1978, damage psychiatric patients. Therefore, it appears necessary to sensitize psychiatrists to reflect on the Zeitgeist and its influence on their own actions and to recognize that their own opinions and actions can also influence the Zeitgeist.

Direitos Humanos , Processos Psicoterapêuticos , Pessoas com Deficiência/legislação & jurisprudência , Pessoas com Deficiência/psicologia , Alemanha , Direitos Humanos/tendências , Humanos , Itália , Nações Unidas
J Consult Clin Psychol ; 87(5): 446-456, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30998047


OBJECTIVE: Although cognitive change has long been posited to drive symptom improvements in cognitive therapy (CT) of depression, whether it does so remains controversial. Methodological challenges have contributed heavily to the lack of resolution on this issue. Using a patient-reported measure of cognitive change, we tested the role of cognitive change in contributing to symptom change in CT. In addition, we tested whether therapists' use of cognitive methods intended to promote cognitive changes predicted these changes. We also tested the specificity of the relation of cognitive methods and cognitive change by examining other psychotherapy process variables. METHOD: In a sample of 126 patients who participated in CT of depression, patients rated immediate cognitive change (CC-Immediate) at the end of each session and sustained cognitive change (CC-Sustained) at the start of each subsequent session. Observers rated therapist adherence and alliance for the first five sessions. Depressive symptoms were assessed at each session. For all predictors, we disaggregated within- and between-patient effects. RESULTS: Focusing on within-patient predictors, CC-Sustained mediated the relation of CC-Immediate and subsequent symptom change. In addition, both CC-Immediate and CC-Sustained predicted symptom change. Therapist adherence to cognitive methods was the only within-patient variable to predict CC-Immediate. CONCLUSIONS: These findings are consistent with the view that cognitive change contributes to symptom reductions in CT, and that therapists' use of cognitive methods contributes to cognitive changes during sessions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Processos Psicoterapêuticos , Adolescente , Adulto , Idoso , Terapia Cognitivo-Comportamental/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem