RESUMO
INTRODUCTION: Although recreational cannabis use and abuse are expressive worldwide, the comparison of worldwide used psychotherapies, such as cognitive behavior therapy, with contingency management in the treatment of cannabis use disorder remains inconclusive. METHODS: We screened all articles published on MEDLINE (via PubMed) published until October 2023 and conducted a systematic review with meta-analysis. RESULTS: Sixteen studies were included, and contingency management intervention likely promotes abstinence outcomes and more negative urinalyses for adults or adolescents with cannabis use disorder. DISCUSSION: This review provides moderate- to high-quality evidence that contingency management can be used to treat cannabis use disorder. However, further trials need to be developed to analyze the quantity of substance use, personal achievements, and operational improvements after treatment.
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Abuso de Maconha , Humanos , Abuso de Maconha/terapia , Terapia Comportamental/métodos , Adulto , Adolescente , Terapia Cognitivo-Comportamental/métodosRESUMO
Includes appreciations of the work: Shock treatments, psychosurgery and other somatic treatments in psychiatry, by Lothar Kalinowsky and Paul Hoch, Editorial Cientifica Médica, Barcelona, ââ1953.
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Psiquiatria , Eletrochoque , Terapia ComportamentalRESUMO
OBJECTIVE: To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN: In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors. RESULTS: Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS: Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.
Assuntos
Terapia Comportamental , Polimedicação , Psicotrópicos , Humanos , Feminino , Masculino , Criança , Psicotrópicos/uso terapêutico , Estudos Retrospectivos , Adolescente , Terapia Comportamental/métodos , Comportamento Problema , Pré-Escolar , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológicoRESUMO
BACKGROUND: The treatment for atopic dermatitis (AD) has been the focus of clinical research, and behavioral intervention is considered an indispensable treatment method. To our knowledge, no relevant meta-analysis has evaluated the effects of behavioral interventions on atopic dermatitis. OBJECTIVES: To evaluate the effects of behavioral interventions on atopic dermatitis. METHODS: The authors searched PubMed, EMBASE, and Cochrane CENTRAL to retrieve relevant RCTs (up to Feb 2022). The search strategy involved a combination of related keywords. The Cochrane Q and I2 statistics were used to assess heterogeneity. RESULTS: Six RCTs involving seven reports with 246 patients were included. The results suggested that behavioral interventions could relieve eczema severity (correlation coefficient [r = -0.39]; pâ¯<â¯0.001) and scratching severity significantly (r = -0.19; pâ¯=â¯0.017), while not affect itching intensity (r = -0.02; pâ¯=â¯0.840). A sensitivity analysis confirmed the robustness of the results. STUDY LIMITATIONS: An important limitation of this study was the insufficient number of RCTs and the limited sample size. In addition, the study lacked a control group receiving a type of intervention other than the experimental protocol. Another limitation was the short duration of follow-up. CONCLUSIONS: This study suggests that behavioral interventions could be effective in treating atopic dermatitis by reducing eczema and scratching severity. Additionally, habit-reversal behavioral therapy may be more effective for treating atopic dermatitis.
Assuntos
Dermatite Atópica , Ensaios Clínicos Controlados Aleatórios como Assunto , Dermatite Atópica/terapia , Dermatite Atópica/psicologia , Humanos , Resultado do Tratamento , Índice de Gravidade de Doença , Terapia Comportamental/métodos , Prurido/terapia , Prurido/psicologia , FemininoRESUMO
AIMS: Evaluate the impact of an intervention program in non-adherent patients with ulcerative colitis. METHODS: Parallel controlled randomized clinical trial (1:1), approved by the ethics committee (No. 3.068.511/2018) and registered at The Brazilian Clinical Trials Registry (No. RBR-79dn4k). Non-adherent ulcerative colitis patients according to the Morisky-Green-Levine-test were included. Recruitment began in August 2019 until August 2020, with 6-month follow-up. All participants received standard usual care, and additionally the intervention group received educational (video, educational leaflet, verbal guidance) and behavioral interventions (therapeutic scheme, motivational and reminder type short message services). Researchers were blinded for allocation prior to data collection at Visits 1 and 2 (0 and 6 months). Primary outcome: 180-day adherence rate, with relative risk 95%CI. Secondary outcome: 180-day quality of life according to SF-36 domains, using Student's t test. Variables with p<0.20 were selected for regression. Analysis included data from August/2019 to May/2021. RESULTS: Forty-six and 49 participants were allocated in control and intervention groups, respectively. Two were excluded due to intervention refusal, and 4 and 6 were lost to follow-up in control and intervention groups. There was no post-intervention adherence rate difference, even after adjustment for type of non-adherence (unintentional/both/intentional) as confounder, or if considered as adherent the intervention group participants lost in follow-up. Interventions promoted better quality of life scores even after multivariate analysis for "Pain", when adjusted for ulcerative colitis severity, sex, and marital status (ß = 18.352, p = 0.004), "Vitality", when adjusted for ulcerative colitis severity (ß = 10.568, p = 0.015) and "Emotional Aspects", when adjusted for disease severity, income, and education (ß = 24.907, p = 0.041). CONCLUSIONS: The intervention program was not able to produce a significant medication adherence rate difference between comparative groups, however, there was a significant improvement in quality of life. Study limitations may include: sample size calculated to identify differences of 30%, leading to a possible insufficient power; non blinded participants, exposing the results to the risk of performance bias; outcomes based on self-reported data.
Assuntos
Colite Ulcerativa , Envio de Mensagens de Texto , Humanos , Colite Ulcerativa/tratamento farmacológico , Qualidade de Vida , Adesão à Medicação , Terapia ComportamentalRESUMO
The second external cause of death from unintentional injuries is falls in people over 60 and is a worldwide Public Health problem. Associated factors are identified early in Primary Health Care. Thus, we analyze professional narratives about older adults/old age and the organization of services in the presence of fall-inducing frailty. A structured narrative was applied under the following stages: understanding the context, setting/plot/character analysis, and interpretive synthesis. Data were collected from August to November 2022, distributing 21 health professionals in three Narrative Focus Groups. In the analyses, the collective conceptions dialogued with Bourdieu's Epistemology of field, habitus, and capital. Technical and common sense representations of older adults were simultaneously observed among the results, along with the belief of old age as a problematic life stage. Care is centered on the installed disease/ailment. Encouraging autonomy and self-care emerges in integrative health practices, which older adults underestimate. Professionals access the lives of older adults according to their habitus, which, in turn, is structured (structuring) in the disputes for installed capital. Thus, the care provided disregards subjectivities and symbolic systems associated with falls.
Assuntos
Lesões Acidentais , Fragilidade , Humanos , Idoso , Serviços de Saúde , Terapia Comportamental , Dissidências e DisputasRESUMO
BACKGROUND: Functional constipation and enuresis frequently coexist. Constipation treatment often results in resolution or improvement of the enuresis. However, besides the classical presentation, patients can present with occult constipation (OC) diagnosed in complementary evaluation; in addition, semi-occult constipation (SOC) can be detected by means of a detailed questionnaire. OBJECTIVE: To quantify OC and SOC frequency in children with monosymptomatic or non monosymptomatic enuresis (MNE or NMNE). METHODS: Otherwise healthy children/adolescents, with enuresis refractory to behavioral therapy and denying constipation after simple questions, answered a structured bowel habit questionnaire and were submitted to a plain abdominal radiological exam. Constipation was classified considering the Boston diagnostic criteria (to allow diagnosis at initial stages), and fecal loading in the X-ray quantified ≥10 by the Barr score. Children with constipation received a standardized treatment (except 26 "pilot" children). RESULTS: Out of 81 children, 80 aged 9.34±2.07 years, 52.5% male, were diagnosed with constipation: 30 OC, 50 SOC; 63.75% had MNE, 36.25% NMNE (six NMNE without behavioral therapy). Demographic data and the Barr score were similar for OC and SOC, but SOC children experienced significantly more constipation complications (retentive fecal incontinence and/or recurrent abdominal pain). Not showing the Bristol Stool Scale (BSS) to 24 "pilot" children, or absence of constipation symptoms accompanying BSS predominantly type 3, in 13 children, did not significantly impact the detection of constipation by the Barr score. Children identifying BSS 3 or ≤2 had similar results. Twenty-eight children, with adequate follow-up after treatment, improved or recovered from constipation at 44 of their 52 follow-up visits. CONCLUSION: In patients with MNE or NMNE refractory to behavioral therapy, and who initially denied constipation after simple questions, a detailed questionnaire based on the Boston diagnostic criteria detected SOC in 61.7%, and the radiological Barr score revealed fecal loading (OC) in 37.0% of them.
Assuntos
Enurese Noturna , Adolescente , Humanos , Criança , Masculino , Feminino , Enurese Noturna/diagnóstico , Enurese Noturna/terapia , Constipação Intestinal/complicações , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Defecação , Terapia ComportamentalRESUMO
AIM: To evaluate the acceptance of behaviour management techniques by Spanish and Colombian parents used in paediatric dentistry and the influence of factors that determine their consent during regular treatment and in emergency situations. MATERIALS: An anonymous questionnaire was carried out in which 9 behaviour management techniques (BMTs) used in paediatric dentistry by Spanish and Colombian parents were evaluated in cases of regular dental treatment and in emergency situations (pain and/or dental trauma). The techniques evaluated were: tell-show-do (TSD), voice control, positive reinforcement, distraction, parental presence-absence, nitrous oxide, passive and active restraint, and general anaesthesia. The questionnaire also included information on the sociodemographic information about parents and their children, previous dental experience, and dental anxiety of the parents. The data were analysed using SPSSTM software, r. 26 of IBMTM. A value of p≤ 0.05 was considered as statically significant. RESULTS: A total sample of 124 questionnaire (62 from each country) was obtained. The basic BMT were the most accepted in both countries, especially by Spanish parents. In emergency situations, statistically significant differences were obtained in the acceptance of nitrous oxide and general anesthesia compared to their use in routine treatments (p<0.001). There were no significant differences in the preference of the techniques in relation to the age of the children or parental dental anxiety (p>0.05). An association was found between the socioeconomic status and the acceptance of nitrous oxide (p=0.005) and general anesthesia (p=0.004). CONCLUSION: The basic techniques were the most accepted by Spanish and Colombian parents. However, the Spanish parents had a better perception of both types of techniques compared to the Colombians. Their preference was influenced by factors such as annual income and need for urgent treatment of their children.
Assuntos
Comportamento Infantil , Óxido Nitroso , Criança , Humanos , Óxido Nitroso/uso terapêutico , Colômbia , Terapia Comportamental , PaisRESUMO
BACKGROUND: Social occupational therapy developed in Brazil in the late 1970s and early 1980s as a practice approach to the social issues experienced by vulnerable populations. AIM: The aim of this study was to analyse the theoretical-methodological framework which has supported social occupational therapy practices and interventions in Brazil. METHOD: In a scoping review following PRISMA- ScR, the following databases were searched for publications reporting the practices and interventions of social occupational therapy: Scopus, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS) and The Cochrane Library. RESULTS: Twenty-six publications met the inclusion criteria. The interventions were aimed at socially vulnerable children and young people at risk of violations of their rights. The studies employed active/participatory pedagogical methodologies which make the participant groups' protagonism central to their learning and intervention process. These approaches are supported by social and human science epistemologies. CONCLUSIONS: Social occupational therapy has inaugurated a paradigm shift by prioritising working with populations in situations of vulnerability arising from socioeconomic, cultural, political and identity issues. This perspective is anchored in theoretical approaches which are strongly linked to collective social actions which arose from the conditions of Brazil's period of military dictatorship. SIGNIFICANCE: At a time when there has been increasing emphasis on addressing marginal groups and widening health inequalities social occupational therapy practice in community development contexts around a focus on vulnerability has been of increasing interest in the wider knowledge sphere of the profession. This article presents a scoping review for anglophone readers.
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Terapia Ocupacional , Criança , Humanos , Adolescente , Brasil , Terapia Comportamental , AprendizagemRESUMO
De acordo com a visão vigente, aprende-se a ser psicoterapeuta comportamental em cursos, onde se ensinam teoria, intervenções e técnicas; e na supervisão, onde a atuação do terapeuta é aprimorada. O objetivo deste estudo foi examinar uma terceira via de aprendizagem. O que os terapeutas aprendem na relação com seus clientes? Foram entrevistados 14 terapeutas analítico-comportamentais, cognitivo comportamentais ou comportamentais contextuais, a respeito do que aprenderam com seus clientes para sua prática clínica. A análise das transcrições foi pautada nos preceitos da grounded theory analysis. Os resultados sugerem que os terapeutas aprendem sobre algumas coordenadas importantes do processo terapêutico: a singularidade de cada cliente, a responsabilidade do cliente e do terapeuta para o processo e sobre as suas limitações como terapeuta. Expandem suas competências clínicas: como enxergar além de rótulos e julgamentos, assumir uma postura terapêutica, flexibilidade e autenticidade. Adquirem estratégias clínicas, aprendem a ceder espaço para o cliente, a respeitar o tempo do cliente e responder às suas necessidades. Finalmente, aprendem a manejar riscos e contrariedades, a lidar com a proximidade no relacionamento, como usar dos seus equívocos a favor da terapia e conduzir aspectos burocráticos da sua profissão.
According to the current view, the role of a behavioral therapist is trained in courses which theory, interventions and techniques are taught and in clinical supervision supervision where the beginner's performance is shaped. The aim of this study was to explore a third learning pathway. What do therapists learn in their relationship with their clients? Fourteen behavioral and cognitive-behavioral therapists were interviewed about what they learned from their clients. The transcripts were examined according to the precepts of grounded theory analysis. The results suggest that therapists learn about important coordinates of the therapeutic process: the uniqueness of each client, the client's and therapist's responsibility in the process, and also about therapists limitations. They expand their clinical competencies: how to see beyond labels and evaluations, to assume a therapeutic stance, be flexible and authentic. They acquire clinical strategies, learning to allow due space to the client, to respect the client's time and to respond to their needs. Finally, they learn how to manage risks and setbacks, to deal with closeness in the relationship, take advantage of their errors in favor of therapy and how to manage bureaucratic aspects of their profession.
Según la visión actual, la profesión de psicoterapeuta se aprende de los profesores que imparten teoría, intervenciones y técnicas y de los supervisores que acompañan la actuación. El objetivo de este estudio fue identificar una tercera vía de aprendizaje: ¿qué aprenden los terapeutas con sus clientes? Se entrevistó a catorce terapeutas conductuales y cognitivo-conductuales sobre lo que aprendieron con sus clientes. El análisis de datos se basó en los preceptos del análisis de teoría fundamentada. Los resultados sugieren que los terapeutas aprenden sobre las coordenadas importantes del proceso terapéutico: la singularidad de cada cliente, la responsabilidad del cliente y del terapeuta por el proceso y sus limitaciones como terapeuta. Los terapeutas amplían sus competencias clínicas: cómo ver más allá de las etiquetas y los juicios, adoptar una postura terapéutica, desarrollar flexibilidad y autenticidad. Adquirir estrategias clínicas, aprender a darle espacio al cliente, respetar el tiempo del cliente y responder a sus necesidades. Finalmente, aprenden a gestionar los riesgos y contratiempos, a lidiar con la proximidad al cliente, a aprovechar los conceptos erróneos a favor de la terapia y a gestionar los aspectos burocráticos de su profesión.
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Humanos , Masculino , Feminino , Pacientes , Terapia Comportamental , Processos Psicoterapêuticos , Psicoterapeutas/educação , Relações InterpessoaisRESUMO
Antecedentes: La violencia contra la mujer (VCM) y la pandemia por COVID-19 son problemáticas que han afectado la salud mental de las mujeres, con secuelas como la depresión. Objetivo: Comparar la eficacia del tratamiento breve de activación conductual (BATD) y la terapia cognitiva conductual (TCC) con adaptaciones culturales administradas online (telesalud) para la depresión en víctimas de VCM durante la COVID-19 en México. Método: Se realizó un ensayo clínico aleatorizado con 20 mujeres mexicanas de 18-60 años con depresión que experimentaron VCM en los últimos seis meses durante la COVID-19. Las participantes fueron asignadas de manera aleatorizada 1:1 a los grupos BATD y TCC. Para el análisis de datos se aplicaron las pruebas Friedman y U de Mann-Whitney, y se estimó el Índice de Cambio Confiable. Resultados: Se encontró una disminución en síntomas depresivos (p < .001) e incremento en los niveles de activación (p < .001) a favor del grupo BATD, al término de la intervención y en el seguimiento en contraste con la TCC. Conclusiones: La BATD mostró ser eficaz en crisis de emergencia sanitaria en contextos de VCM. Aunar evidencia de intervenciones eficientes para esta población contribuye a mitigar las afecciones de salud mental.
Background: Violence against women (VAW) and the COVID-19 pandemic are issues that have affected women's mental health, with sequela such as depression. Objective: To compare the efficacy of brief behavioral activation therapy (BATD) and cognitive behavioral therapy (CBT) with cultural adaptations administered online by telehealth for depression in victims of VAW during COVID-19 in Mexico. Method: A randomized clinical trial was conducted with 20 Mexican women aged 18-60 years with depression who experienced VAW in the last six months during COVID-19. Participants were randomized 1:1 to the BATD and CBT groups. For data analysis, Friedman and Mann-Whitney U tests were applied, and the Reliable Change Index was estimated. Results: A decrease in depressive symptoms (p < .001) and an increase in activation levels (p < .001) were found in favor of the BATD group at the end of the intervention and at follow-up, in contrast to CBT. Conclusions: BATD was shown to be effective in health emergency crises in VAW contexts. Gathering evidence of efficient interventions for this population contributes to mitigating mental health conditions.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Psicoterapia/métodos , Depressão/terapia , Violência contra a Mulher , Terapia Comportamental , Terapia Cognitivo-Comportamental , Seguimentos , Resultado do Tratamento , Depressão/diagnóstico , Pandemias , MéxicoRESUMO
BACKGROUND: Dialectical behaviour therapy (DBT) skills groups have shown promise as an effective treatment for clients with emotional dysregulation, especially when combined with individual DBT. However, their efficacy is not well established as an online therapy, or in the Latinx population. AIMS: This study aimed to explore satisfaction, retention and effects of an internet-based DBT group added to individual online sessions. METHOD: An ABAB withdrawal experimental single-case design was conducted to evaluate the effect of a brief online DBT skills group on emotional dysregulation, anxiety and depression for five Latinx participants. DBT skills group (phase B) were compared with placebo group sessions (phase A) and fortnightly individual DBT sessions were offered throughout to manage risk. RESULTS: Visual inspection showed a decrease in level of emotional dysregulation and a large effect size according to the Nonoverlap of All Pairs when comparing group DBT and placebo phases. Although depression symptoms decreased after introducing group DBT, anxiety indicators decreased most during the second round of group placebo sessions. DISCUSSION: Whilst only a pilot, this study suggests that online group DBT in Latinx populations is feasible and effective for changing emotional regulation processes but may not effectively target anxiety. Future research might increase the number of DBT sessions in order to enhance learning opportunities and generalization. Replication with larger sample sizes and diverse modalities is needed.
Assuntos
Ansiedade , Depressão , Terapia do Comportamento Dialético , Regulação Emocional , Humanos , Ansiedade/terapia , Terapia Comportamental , Hispânico ou Latino , Resultado do Tratamento , Depressão/terapiaRESUMO
Purpose: To measure the effects of an exercise program on the physical capacities of older adults such as strength, flexibility, balance, and aerobic capacity. Patients and Methods: This was a quasi-experimental study on a population of 5550 older adults and a sample of 4830 participants in an active aging program designed by the Municipal Health Secretary. The exercise program lasted 12 months, and pre-and post-program intervention measures were recorded using the senior fitness test. Results: Most participants were women (92.4%) and their mean age was 70.7 years (standard deviation, 7.3 years; range, 60-97 years). All areas showed significant differences before and after the program in terms of the participants' physical capabilities (p < 0.05), muscular strength and flexibility had a more significant mean difference and a large effect (>0.80), except for aerobic capacity, which had a small effect. Conclusion: The present study revealed that a supervised physical exercise program at the community level has positive effects on the physical capacities of coordination, balance, flexibility, strength, and aerobic capacity, which are essential components for a better functional capacity at this stage of life, with improvements that encompassed the improved self-perception of their health status, a reduction of overweight and obesity. The reinforcement of these programs is recommended, consequently, promoting pre-sport games and sports championships among the elderly population, as a public health strategy.
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Exercício Físico , Força Muscular , Humanos , Idoso , Feminino , Masculino , Envelhecimento , Terapia Comportamental , Terapia por ExercícioRESUMO
OBJECTIVES: To compare the real-world frequency, timing, duration, difficulty, and helpfulness of 3 infant Behavioral Sleep Intervention (BSI) approaches: Unmodified Extinction, Modified Extinction, and Parental Presence and to examine the effectiveness and safety of these approaches by comparing infant sleep, parent sleep, daytime sleepiness, depression, and parent-infant bonding between parents who had and had not implemented these interventions. STUDY DESIGN: Participants were 2090 parents (75% mothers, 79% White/Caucasian) of US infants (49% girls) aged 3-18 months (M = 9.1, SD = 4.1). Parents completed online questionnaires regarding their infant's sleep, their own sleep, daytime sleepiness, depression levels, and parent-infant bonding. Infant sleep was assessed via objective-albeit exploratory-autovideosomnography data obtained from the 14 days prior to survey completion. RESULTS: Sixty-four percent of parents reported implementing BSIs. The average age at intervention was 5.3 months (SD = 2.6). Unmodified and Modified Extinction were rated as significantly more difficult to implement compared with Parental Presence but also as more helpful, shorter, and quicker to show improvements. Infant nighttime sleep was longer and more consolidated in the Unmodified and Modified Extinction groups compared with the Parental Presence and non-BSI groups. No differences were found between BSI groups in parent sleep, sleepiness, depression, or parent-infant bonding. CONCLUSIONS: Implementation of BSIs outside clinical settings is pervasive and occurs earlier than generally recommended. Unmodified and Modified Extinction were associated with longer and more consolidated infant sleep. Despite concerns regarding the potential harm of BSIs, implementation of these approaches was not linked with negative outcomes, providing additional evidence for their safety and effectiveness.
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Distúrbios do Sono por Sonolência Excessiva , Mães , Feminino , Lactente , Humanos , Masculino , Pais , Sono , Terapia ComportamentalRESUMO
Objective Chronic pain is an important health problem and affects both quality of life and mental health. This study assessed psychological inflexibility, pain intensity, quality of life, anxiety and depression symptoms, self-efficacy, and social support among patients with chronic pain. Method A quasiexperimental design was used to assess six adult participants pre- and post-group intervention (eight sessions) based on acceptance and commitment therapy. Results After the intervention, the patients experienced a reduction in psychological inflexibility, pain, and depression and anxiety symptoms and improvements in quality of life and self-efficacy. The quality of life and depression symptoms and the domains of quality of life and psychological inflexibility were negatively correlated. Conclusion Acceptance and commitment therapy is a promising treatment for the interdisciplinary treatment of the Pain Clinic.
Objetivo Dor crônica é um problema de saúde prevalente que acarreta prejuízos para qualidade de vida e saúde mental. Este estudo avaliou inflexibilidade psicológica, intensidade da dor, qualidade de vida, sintomas de ansiedade e de depressão, autoeficácia e suporte social em pacientes com dor crônica. Método Utilizou delineamento quase-experimental e os seis participantes adultos foram avaliados por meio de instrumentos no pré e pós-intervenção em grupo (oito sessões) com Terapia de Aceitação e Compromisso. Resultados Após a intervenção houve redução da inflexibilidade psicológica e da dor, melhora da qualidade de vida, redução dos sintomas de ansiedade e de depressão e aumento da autoeficácia. Houve correlação inversa entre qualidade de vida e sintomas de depressão e entre domínios da qualidade de vida e inflexibilidade psicológica. Conclusão Conclui-se que a Terapia de Aceitação e Compromisso é um tratamento promissor a ser integrado no atendimento interdisciplinar da Clínica de dor.
Assuntos
Psicoterapia de Grupo , Terapia Comportamental , Medicina do Comportamento , Dor Crônica , Terapia de Aceitação e CompromissoRESUMO
O distanciamento social ocasionado pela pandemia de Covid-19 levou a profundas mudanças na rotina das famílias com crianças pequenas, aumentando o estresse no ambiente doméstico. Este estudo analisou a experiência de planejamento e implementação de um projeto de extensão universitária que ofereceu orientação a pais com filhos de 0 a 11 anos por meio de chamadas de áudio durante a pandemia. O protocolo de atendimento foi desenvolvido para atender às necessidades de famílias de baixa renda e listava problemas específicos relacionados ao confinamento em casa e ao fechamento das escolas seguidos por uma variedade de estratégias de enfrentamento. A análise de 223 queixas relatadas pelos usuários em 130 ligações revelou que 94% dos problemas referidos pelos pais foram contemplados pelo protocolo de atendimento e estavam relacionados aos problemas externalizantes (39%) ou internalizantes (26%) das crianças ou ao declínio do bem-estar subjetivo dos pais (29%). Serviços de apoio devem orientar os pais quanto ao uso de práticas responsivas e assertivas que promovam o bem-estar emocional da criança e estabeleçam expectativas comportamentais em contextos estressantes. A diminuição dos conflitos entre pais e filhos resultante do uso dessas estratégias tende a reduzir o sofrimento dos pais, aumentando sua sensação de bem-estar subjetivo. Recomenda-se ampla divulgação dessas iniciativas e seguimento dos casos.(AU)
The social distancing the COVID-19 pandemic entailed has led to profound changes in the routine of families with young children, increasing stress in the home environment. This study analyzed the experience of planning and implementing a university extension program that offered support to parents with children from 0 to 11 years old via audio calls during the COVID-19 pandemic. The service protocol was developed to meet the needs of low-income families and listed specific problems related to home confinement and school closure followed by a variety of coping strategies. The analysis of 223 complaints reported by users in 130 calls revealed that 94% of the problems reported by parents were addressed by the protocol and were related to children's externalizing (39%) or internalizing (26%) problems or to the decline in parents' subjective well-being (29%). Support services should guide parents on the use of responsive and assertive practices that promote the child's emotional well-being and set behavioral expectations in stressful contexts. The reduction in conflicts between parents and children resulting from the use of these strategies tends to reduce parents' suffering, increasing their sense of subjective well-being. Wide dissemination of these initiatives and case follow-up are recommended.(AU)
La distancia social causada por la pandemia de COVID-19 condujo a cambios profundos en la rutina de las familias con niños pequeños, aumentando el estrés en el entorno del hogar. Este estudio analizó la experiencia de planificar e implementar un proyecto de extensión universitaria que ofreció orientación a los padres con niños de cero a 11 años a través de llamadas de audio durante la pandemia COVID-19. El protocolo de atención se desarrolló para satisfacer las necesidades de las familias de bajos ingresos y enumeró problemas específicos relacionados con el confinamiento en el hogar y el cierre de la escuela, seguido de una variedad de estrategias de afrontamiento. El análisis de 223 quejas informadas por los usuarios en 130 llamadas reveló que el 94% de los problemas informados por los padres fueron abordados por el protocolo de atención y estaban relacionados con los problemas de externalización (39%) o internalización (26%) de los niños o la disminución del bienestar subjetivo de los padres (29%). Los servicios de apoyo deberían aconsejar a los padres sobre el uso de prácticas receptivas y asertivas que promuevan el bienestar emocional del niño y establezcan expectativas de comportamiento en contextos estresantes. La reducción de los conflictos entre padres e hijos como resultado del uso de estas estrategias tiende a reducir el sufrimiento de los padres, aumentando su sensación de bienestar subjetivo. Se recomienda una amplia difusión de estas iniciativas y seguimiento de casos.(AU)
Assuntos
Humanos , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Orientação , Pais , Satisfação Pessoal , Criança , Comportamento Problema , COVID-19 , Ansiedade , Relações Pais-Filho , Apetite , Jogos e Brinquedos , Resolução de Problemas , Psicologia , Agitação Psicomotora , Qualidade de Vida , Leitura , Recreação , Ensino de Recuperação , Infecções Respiratórias , Segurança , Salários e Benefícios , Serviços de Saúde Escolar , Autoimagem , Transtorno Autístico , Sono , Ajustamento Social , Condições Sociais , Conformidade Social , Meio Social , Isolamento Social , Problemas Sociais , Socialização , Fatores Socioeconômicos , Análise e Desempenho de Tarefas , Telefone , Temperamento , Terapêutica , Tempo , Desemprego , Violência , Terapia Comportamental , Jornada de Trabalho , Políticas, Planejamento e Administração em Saúde , Abuso Sexual na Infância , Tédio , Neurociências , Viroses , Atividades Cotidianas , Luto , Exercício Físico , Divórcio , Maus-Tratos Infantis , Desenvolvimento Infantil , Saúde Mental , Vacinação em Massa , Terapia de Relaxamento , Imunização , Comportamento Autodestrutivo , Direitos Civis , Poder Familiar , Transtorno de Pânico , Entrevista , Cognição , Violência Doméstica , Transmissão de Doença Infecciosa , Aula , Crianças com Deficiência , Senso de Humor e Humor , Internet , Criatividade , Intervenção em Crise , Choro , Vulnerabilidade a Desastres , Impacto Psicossocial , Autonomia Pessoal , Morte , Amigos , Agressão , Depressão , Impulso (Psicologia) , Economia , Educação Inclusiva , Escolaridade , Emoções , Empatia , Docentes , Conflito Familiar , Relações Familiares , Medo , Consumo Excessivo de Bebidas Alcoólicas , Refeições , Retorno ao Trabalho , Esperança , Otimismo , Pessimismo , Autocontrole , Fobia Social , Sistemas de Apoio Psicossocial , Equilíbrio Trabalho-Vida , Experiências Adversas da Infância , Tempo de Tela , Asco , Tristeza , Solidariedade , Angústia Psicológica , Intervenção Psicossocial , Teletrabalho , Estresse Financeiro , Insegurança Alimentar , Análise de Sentimentos , Fatores Sociodemográficos , Vulnerabilidade Social , Apoio Familiar , Governo , Culpa , Saúde Holística , Homeostase , Hospitalização , Zeladoria , Distúrbios do Início e da Manutenção do Sono , Ira , Aprendizagem , Deficiências da Aprendizagem , Atividades de Lazer , Solidão , Transtornos MentaisRESUMO
The Component Model of Parenting (CMP), from an evolutionary perspective, proposes a phylogenetically evolved repertoire of six systems (body contact, body stimulation, face-to-face exchange, object stimulation, and primary care) and two parenting styles (distal and proximal) by combining some of these systems. We developed the Inventory of Parenting Systems and Styles (ISEP) and applied it to hospitals and schools to analyze its psychometric properties. The parenting measure analysis we propose evolved 70 primary caregivers of young children with a mean age of 22.44 months. ISEP consists of 26 daily situations and assesses the most common parenting practices caregivers adopted in each one of them. Besides, we created a Coding Guide to Parenting Practice. It enabled us to classify each response according to the CMP systems. We found a variance of 84.67% and 95.55% in codification agreement between expert judges and a significant intraclass correlation coefficient for all parenting systems, which discloses validity evidence on the response process of the inventory. Our analyses indicated the occurrence of all parental systems, with a prevalence of narrative envelope and body stimulation. Cluster analysis revealed two clusters, one formed by proximal style and another by distal style, in accordance with the interactions of the system, representing a validity of evidence based on the internal structure of the instrument. ISEP provides reasonable measures for research and professional practice in Psychology. Further research with more extensive and diverse samples is necessary to refine the instrument and, especially its guide.(AU)
O Modelo de Componentes da Parentalidade (MCP) da perspectiva evolucionista propõe seis sistemas - contato corporal, estimulação corporal, contato face a face, estimulação por objeto, envelope narrativo e cuidado primário - universais e filogeneticamente evoluídos, e dois estilos parentais - distal e proximal - oriundos da combinação de alguns desses sistemas. Para analisar propriedades psicométricas de uma medida de parentalidade, o Inventário de Sistemas e Estilos Parentais (ISEP) foi aplicado em contexto escolar e hospitalar, em 70 cuidadores primários de crianças com idade média de 24,44 meses. O ISEP, construído para este estudo, apresenta 26 situações cotidianas e solicita que cuidadores indiquem a prática parental mais comumente adotada em cada uma delas, e cada resposta foi classificada em um dos sistemas do MCP por um Guia de Codificação de Práticas Parentais. A concordância entre juízes com a codificação variou entre 84,67% e 95,55%, e os coeficientes de correlação intraclasse foram significativos para todos os sistemas de parentalidade, representando uma evidência de validade por processo de resposta do inventário. As análises indicaram a ocorrência de todos os sistemas parentais, com predominância de envelope narrativo e estimulação corporal. Uma análise de cluster formou dois conglomerados, um derivando o estilo proximal e outro o estilo distal, de acordo com a interação entre os sistemas, constituindo uma evidência de validade baseada na estrutura interna do instrumento. O ISEP mostrou ser uma medida promissora para a pesquisa e a prática profissional em Psicologia. Outras pesquisas com amostras mais amplas e diversificadas são necessárias para refinamento do instrumento e do guia.(AU)
El Modelo Componencial del Parentaje (MCP), desde una perspectiva evolutiva, propone seis sistemas (contacto corporal, estimulación corporal, contacto cara a cara, estimulación con objetos, envoltura narrativa y atención primaria), universales y filogenéticamente evolucionados, así como dos estilos parentales (distal y proximal) que se originan combinando algunos de ellos. Para analizar las propiedades psicométricas de una medida parental, se aplicó el Inventario de Estilos y Sistemas de Crianza (ISEP), en el contexto escolar y hospitalario, a 70 cuidadores primarios de niños con una edad media de 24,44 meses. El ISEP fue construido para el presente estudio, presenta 26 situaciones cotidianas y crianza los cuidadores deben indicar la práctica parental más común adoptada en cada una de ellas. Una Guía de Codificación de Prácticas Parentales permite clasificar cada respuesta en uno de los sistemas del MCP. La concordancia entre los jueces con la codificación varió entre 84,67% y 95,55% y los coeficientes de inter-correlación en todos los sistemas parentales fueron significativos, evidenciando su validez por el proceso de respuesta al inventario. Los análisis indicaron la ocurrencia de todos los sistemas parentales, con predominio de envoltura narrativa y estimulación corporal. Un análisis de clusters formó dos conglomerados, derivando el estilo proximal y el estilo distal, según la interacción entre los sistemas, constituyendo evidencia de validez basada en la estructura interna del instrumento. El ISEP demostró ser una medida valida y fiable para la investigación y la práctica profesional en Psicología. Se necesita más investigación con muestras más grandes y diversificadas para perfeccionar el instrumento.(AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Psicometria , Criança , Poder Familiar , Relações Pais-Filho , Percepção , Personalidade , Desenvolvimento da Personalidade , Aptidão , Jogos e Brinquedos , Fenômenos Psicológicos , Psicologia , Descanso , Transtorno do Deficit de Atenção com Hiperatividade , Mudança Social , Meio Social , Ciências Sociais , Sociologia , Comportamento , Comportamento e Mecanismos Comportamentais , Terapia Comportamental , Ciências do Comportamento , Behaviorismo , Custódia da Criança , Adaptação Psicológica , Atitude , Caráter , Cuidado da Criança , Desenvolvimento Infantil , Orientação Infantil , Linguagem Infantil , Educação Infantil , Proteção da Criança , Higiene , Saúde da Criança , Competência Mental , Cuidadores , Entrevista , Comunicação , Corpo Humano , Assistência Integral à Saúde , Vida , Manifestações Neurocomportamentais , Disciplinas e Atividades Comportamentais , Choro , Cultura , Início da Vida Humana , Crescimento e Desenvolvimento , Educação não Profissionalizante , Emoções , Acolhimento , Estudos Populacionais em Saúde Pública , Estudos de Avaliação como Assunto , Face , Expressão Facial , Nutrição da Criança , Relações Familiares , Fantasia , Dieta Saudável , Sobrevivência , Análise de Dados , Funcionamento Psicossocial , Representação Social , Esforço de Escuta , Desenvolvimento Humano , Imaginação , Renda , Individualidade , Inteligência , Aprendizagem , Atividades de Lazer , Acontecimentos que Mudam a Vida , Memória , Atividade MotoraRESUMO
Esta pesquisa qualitativa objetivou compreender, fenomenologicamente, a experiência vivida por psicoterapeutas e crianças no acontecer clínico da ludoterapia humanista. Foram realizados 26 encontros dialógicos individuais com nove psicoterapeutas e sete crianças, registrados pela pesquisadora na forma de Narrativas Compreensivas que incluíram suas impressões impactadas subjetivamente pelas falas e expressões corporais dos participantes. A análise fenomenológica culminou com a escrita de uma Narrativa Síntese. Os resultados indicam que a relação psicoterapêutica é percebida como: facilitadora do crescimento psicológico da criança; intensificadora do fluxo de mudanças ao dinamizar os processos pessoais infantis; geradora de motivação na criança para a relação interpessoal, a partir do envolvimento subjetivo do terapeuta; potencializadora da tomada de consciência com base na corporeidade; propiciadora da integração de experiências por meio do brincar; reveladora das singularidades individuais, catalisando o desenvolvimento; e, por fim, benéfica à atualização de significados e sentidos da experiência pessoal e relacional. Evidenciou-se, entre os psicoterapeutas, uma concepção da ludoterapia humanista que prioriza a compreensão dirigida ao estilo próprio de cada cliente em relação aos modos de sentir e expressar-se no mundo e à estruturação do processo psicoterapêutico a partir do relacionamento com a criança. Concluiu-se, assim, que a experiência desse tipo de relação interpessoal facilita a constituição na criança de singularidades que imprimem um sentido existencial próprio ao seu mundo de relações e historicidade. A relevância do processo psicoterapêutico para o crescimento psicológico da criança apresentou-se também pelo seu caráter psicoprofilático, reverberado no encadeamento de processos associados à experiência pessoal dela.(AU)
This qualitative research aimed to understand, phenomenologically, the lived experience of psychotherapists and children in the clinical event of humanistic play therapy. A total of 26 individual dialogical encounters were held with nine psychotherapists and seven children, registered in the form of Comprehensive Narratives by the researcher, which included her subjectively impacted impressions about the participants' speeches and body expressions. The phenomenological analysis culminated in a Synthesis Narrative. The results demonstrate that the psychotherapeutic relationship is perceived as: facilitating the child's psychological growth; intensifying the flow of change by streamlining children's personal processes; generating motivation for the child to get involved with interpersonal relationship, based on the subjective involvement of the therapist; potentiating awareness raising based on the corporeality; enabling the integration of experiences by playing; revealing the uniqueness, catalyzing development; and, finally, benefiting the updating of meanings and senses of personal and relational experience. A conception of humanistic play therapy became evident among the psychotherapists, which prioritizes the understanding directed to the own way of each client regarding how to feel and express themselves in the world and the structuring of the psychotherapeutic process based on the relationship with the child. Thus, it was concluded that the experience of this interpersonal relationship facilitates the constitution in the child of singularities that bring their own existential meaning to their world of relationships and historicity. The relevance of the psychotherapeutic process for the child's psychological growth was also shown by the psycho-prophylactic character reverberated in the processes associated with the child's personal experience.(AU)
Esta investigación cualitativa tuvo por objetivo comprender, fenomenológicamente, la experiencia vivida por psicoterapeutas y niños en ludoterapia de orientación humanista. La investigadora desarrolló 26 conversaciones dialógicas individuales con nueve psicoterapeutas y siete niños, registradas como narrativas comprensivas que incluyeron sus impresiones impactadas subjetivamente por los discursos y expresiones corporales de los participantes. El análisis fenomenológico culminó con una síntesis narrativa. Los resultados demuestran que la relación psicoterapéutica se percibe como facilitadora del crecimiento psicológico del niño; intensificadora del flujo de cambio, optimizando su procesos personales; generadora de motivación para que el niño se involucre en la relación interpersonal a partir del envolvimiento subjetivo del terapeuta; potenciadora de la toma de conciencia a partir de la corporeidad; propiciadora de la integración de las experiencias por medio del juego; reveladora de singularidades individuales al catalizar el desarrollo; y beneficiosa para actualizar los significados y sentidos de la experiencia personal e relacional. Entre los psicoterapeutas se hizo evidente una concepción de ludoterapia humanista que prima por comprender la forma propia del cliente de sentirse y expresarse y la estructuración del proceso psicoterapéutico a partir de la relación con el niño. Se concluyó que la vivencia de este tipo de relación facilita la constitución en el niño de singularidades que le aportan un sentido existencial a su mundo de relación e historicidad. La relevancia del proceso psicoterapéutico para el crecimiento psicológico también se mostró por su carácter psicoprofiláctico, que reverberó en la cadena de procesos asociados con la experiencia personal del niño.(AU)