ABSTRACT
RESUMO Objetivo Validação de protocolo de terapia cognitivo-comportamental breve em grupo para disfunção sexual feminina na pós-menopausa. Métodos Intervenção em grupo com mulheres (n = 14) na pós-menopausa (55 a 75 anos) com disfunção sexual, em acompanhamento ginecológico ambulatorial em um centro especializado para queixas relacionadas ao climatério. As pacientes foram divididas em grupos: o primeiro (Grupo Teste, n = 5) recebeu abordagem cognitivo-comportamental de 12 sessões. Os dois grupos (denominados igualmente Grupo Intervenção - n = 5 e n = 4) foram formados pela divisão dos sujeitos para melhor acomodação física e receberam 10 sessões, resultantes de ajuste e mensuração dos procedimentos do protocolo a partir do Grupo Teste. Foram aplicados a Escala de Índice de Funcionamento Sexual Feminino e o Questionário de Crenças Sexuais Disfuncionais antes e depois da intervenção. Resultados Houve frequente ocorrência de comportamentos/crenças de baixa autoestima, problemas com o parceiro e desinteresse ou dificuldade sexual. A disfunção sexual (problemas com o desejo e/ou lubrificação, orgasmo, satisfação e dor) e as crenças sexuais disfuncionais (conservadorismo, pecado, idade-crenças, imagem corporal, afetividade e maternidade) apresentaram melhora significativa com a aplicação do protocolo. Conclusão Considerando os aspectos particulares das mulheres com disfunção sexual na pós-menopausa, desenvolvemos um protocolo de terapia cognitivo-comportamental em grupo, com significativo potencial terapêutico. Embora não tenha sido utilizado um grupo controle e tenha sido aplicado em número reduzido de participantes, esse protocolo pode ser avaliado e utilizado em casos similares, cabendo novas pesquisas para verificar a aplicabilidade dele para disfunção sexual nesse estágio do desenvolvimento feminino.
ABSTRACT Objective Validation of the protocol of brief cognitive behavioural group therapy for female sexual dysfunction on post menopause. Methods Group intervention with postmenopausal (55-75 years old) women (n = 14) with sexual dysfunction, on gynecological outpatient follow-up in a specialized center for climacteric related complaints. The patients were divided into groups: the first (Test Group, n = 5) received 12 sessions of cognitive-behavioral approach. The two groups (equally named Intervention Group - n = 5 and n = 4) were formed by the division of subjects for bettering physical accommodation and received 10 session, resulting from adjustment and measurement of the protocol procedures starting from the Test Group. The Female Sexual Function Index scale and the Sexual Dysfunctional Beliefs Questionnaire were applied before and after intervention. Results There were frequent reports of behaviors/beliefs of low self-esteem, problems with partner and sexual disinterest or difficulty. Sexual dysfunction (problems with desire and/or lubrication, orgasm, satisfaction and pain) and dysfunctional sexual beliefs (conservatism, sin, age-beliefs, body image, affectivity and maternity) both presented significant improvement with the protocol application. Conclusion Considering the particular aspects of postmenopausal women with sexual dysfunction, we developed a cognitive behavioral group therapy protocol, with significant therapeutic potential. Though a control group was not used and that the application was done in a reduced number of participants, this protocol can be assessed and utilized in similar cases, being fit new researches to verify the applicability of such for sexual dysfunction at this stage of female development.
ABSTRACT
A Terapia Cognitivo-Comportamental utiliza de uma formulação de caso específica (Conceitualização Cognitiva). Esse método de avaliação permite, a partir de um modelo baseado em evidências, compreender o funcionamento do indivíduo sob termos cognitivo-comportamentais. Atualmente, o diagrama de Conceitualização Cognitiva ainda avalia sujeitos individualmente sem um modelo específico para a relação conjugal. Todavia, ao se trabalhar com o casal, é fundamental verificar como a díade interage e como os conflitos são instalados nesta interação formulando um modo de processamento cognitivo do casal. Este estudo teórico teve como objetivo fornecer um modelo de Conceitualização Cognitiva para Casais e dar suporte a terapeutas e clientes sobre a compreensão dos conflitos e estratégias que são utilizados para resolução de problemas na conjugalidade. Para isso, explanou, de modo didático, a descrição de cada elemento do modelo e ilustrou o processo de conceitualização com um caso clínico fictício.(AU)
Cognitive-Behavioral Therapy uses a specific case formulation (Cognitive Conceptualization). This method of evaluation allows, from an evidence-based model, to understand the functioning of the individual under cognitive-behavioral terms. Currently, the Cognitive Conceptualization Diagram still evaluates subjects individually without a specific model for the conjugal relationship. However, when working with couple, it is fundamental to verify how the dyad interacts and how the conflicts are installed in this interaction, formulating a model of cognitive processing of the couple. This theoretical study aimed to provide a model of Cognitive Conceptualization for Couples and to support therapists and clients on understanding the conflicts and strategies that are used to solve problems in conjugality. To do this, he explained, in a didactic way, the description of each element of the model and illustrated the process of conceptualization with a fictious clinical case.(AU)
Subject(s)
Cognitive Behavioral Therapy/methods , Cognition , Couples Therapy/methods , Family Relations/psychologyABSTRACT
Se diseñaron dos cursos virtuales auto-aplicados para personas con fibromialgia, basados en técnicas cognitivo-conductuales. Los objetivos fueron: (1) Evaluar los resultados del primer curso sobre estrés percibido e impacto de la fibromialgia. (2) Evaluar los resultados del segundo curso, en la disminución de: fallos cotidianos de memoria, pensamientos negativos, catastrofización, e impacto de la fibromialgia. Y (3) comparar niveles de estrés e impacto en las cuatro mediciones (pre-post, ambos cursos). Participaron 22 mujeres en el primero y 8 en el segundo. Se encontró mejoría en estrés percibido e impacto de la fibromialgia después del primer curso. Después del segundo disminuyeron: pensamientos negativos, catastrofización e impacto. Hubo una recaída en el estrés y el impacto entre ambos cursos disminuyendo nuevamente al concluir el segundo.
Two cognitive-behavioral virtual courses were designed to be self-applied by people with fibromyalgia. The objectives of this study were: to evaluate first course results on perceived stress and fibromyalgia impact. To evaluate second course results on decreasing of memory complains, negative thoughts, pain catastrofization and fibromyalgia impact. And to compare stress level and fibromyalgia impact among the four measurements (pre-post, both courses). 22 women participated in the first course and 8 women in the second. We found improvement after first course. Negative thoughts, pain catastrofization and fibromyalgia impact decreased after second course. Regarding to objective five, stress and fibromyalgia impact diminished after first course, but increased between the courses and diminished over again after concluding second course.
ABSTRACT
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Abstract: Panic disorder is a complex phenomenon according to its biochemical and psychosocial etiology. Therapeutic interventions of panic disorder are aimed to promote effectiveness through the combined use of medication and behavioral cognitive therapy. Anxiety is a normal human response. Moderate levels of anxiety are well accepted because they act as an aid to improve performance, and high levels of anxiety are experienced as normal if they are consistent with the demands of the situation. Persons with anxiety disorders complain of experiencing anxiety too often but they seek help also to overcome fears they recognize as irrational and intrusive. From a psychological point of view, behavioral cognitive techniques -such as hyperventilation control, exposure, and cognitive therapy- and structured problem solving have been successful in the treatment of the symptoms associated to anxiety. It is worth to emphasize that graded exposure is perhaps the most powerful technique assisting patients to overcome fearful situations. Cognitions are also important because it has been found that panic attacks occur when people process information in the external environment, as well as internal somatic stimuli, as though they were threatening experiences. In other words, they feel they have no control over their sensations. Panic attacks prevalence in Mexico City is 1.1% in men and 2.5% in women. It is more frequent among 25-to 34- year old single men and married women, with an average scholarity between 7 and 9 years. From a biological point of view, it is suggested that the etiology of panic attacks involves the participation of the serotonergic and adrenergic neurotransmitter systems, as well as the GABA/ benzodiacepine. Studies based on the noradrenergic theory had lead to conclude that panicking patients have more sensitive brainstem carbon dioxide receptors than normal control subjects. At the same time, other lines of work indicate that serotonergic transmission may also play an important role in the genesis of panic attacks. It has been found that patients with panic disorder may have a lower tolerance threshold to methoclorophenylpiperazine response than control subjects because of hypertensive serotonergic receptors. The accumulated laboratory evidence seems to support the idea that panic attacks begin with the stimulation of irritable foci in one of three brainstem areas: the medullary chemoreceptors, the noradrenergic pontine locus coeruleus, or the serotonergic midbrain dorsal raphe. On the other hand, biofeedback is a psychophysiological intervention that allows in the first place for the external control of some of the physical symptoms involved in this disorder, which is later transferred to internal control of psychophysiological cognitions and behaviors that enable the patient to prevent symptom's occurrence. Based on the principles of the General Systems Theory, biofeedback utilizes the concepts of self regulation and disregulation to describe the conditions under wich normally integrated self-regulatory systems may become imbalanced with regard to their positive and negative feedback loops. Technically, all that a person needs to do is to attend to the signals feedback and not to "try" to control them; the effects of a positive feedback loop should occur automatically, without conscious awareness, as long as the person processes the stimuli. Biofeedback has been effectively used in the treatment of essential hypertension, migraine headaches, Raynaud's disease, tension headaches, temporomandibular joint syndrome, asthma, primary dysmenorrhea, peptic ulcers, fecal incontinence, and conditioning of electroencephalographic rhythms, among other problems. The present study reports data from 32 panic disorder outpatients from the National Psychiatry Institute, Mexico City. They were randomly assigned to: Control Group (N = 14): daily doses of 75 milligrams of imipramine. The participants of this group were required to assist to the psychology department in order to obtain a baseline (pre-test and post-test) with the biofeedback equipment. In addition, every two weeks they visited a psychiatrist who verified that there were no collateral effects from the medicament. Experimental Group (N = 18): besides daily doses of imipramine, and visits to the psychiatrist, these patients went through eight multimodal biofeedback and behavioral cognitive techniques which were assisted with relaxation training sessions. All biofeedback sessions lasted 30 minutes divided in six five-minute trails. The first and final trials served to stabilize the biological responses, and the four middle trials were used to give biofeedback and reinforcement to the response being trained in addition to the verbal explanation of the changes occurring on the screen of the computer. All patients were assessed with the Anxiety Sensitivity Index, and with Beck's Anxiety and Depression Inventories. Results showed that patients in the experimental group reported significant lower scores in the anxiety sensitivity index than the control group. Post-test differences showed that the electromiographic and electrodermic activity from the experimental group was lower than the one from the control group. Diaphragmatic respiration training and progressive muscular relaxation and imagery proved to be effective in reducing the symptoms associated to panic attacks. The overall final result is that all patients improved clinically. They verbally reported that the intensity, frequency and evitative behaviors derived from panic attacks had almost disappeared. However, the cognitive factor of anxiety sensitivity changed significanty only in the experimental group. These findings support the hypothesis that clinical improvement results from a symptom "reattribution" which gives them cognitive skills to cope with stressing stimuli. Further studies should reassess the effectiveness of the combined treatment (imipramine and behavioral cognitive techniques). It is also recommended to expand the study to generalized anxiety disorder and to adjust the experimental design in order to incorporate a second phase with neurofeedback as independent variable. Equally important is to investigate the mechanisms of the hypnotic ability and its impact on the clinical improvement of anxiety disorders.