Terapia Cognitivo-Comportamental em Grupo: Estratégia de Psicoeducação com Estudantes de Enfermagem / Group Cognitive Behavioral Therapy: Strategy for Psychoeducation with Nursing Students / Terapia Cognitivo-Conductual en Grupo: Estrategia para la Psicoeducación con Estudiantes de Enfermeira

Este estudo teve por objetivo apresentar os resultados de um grupo psicoterápico psicoeducativo desenvolvido junto a estudantes de Enfermagem. Foram realizados seis encontros com cinco estudantes de uma universidade pública do Estado de São Paulo. Os encontros foram audiogravados, transcritos e submetidos à análise temático-reflexiva. Os resultados encontrados permitiram a construção de cinco categorias temáticas: (1) Desafios da adaptação ao ensino superior; (2) Concepções sobre saúde mental na universidade; (3) Autocuidado e equilíbrio entre a vida universitária e pessoal; (4) Relações interpessoais e vida universitária; (5) Perspectivas e expectativas sobre a formação. O processo de integração à universidade requer mobilização cognitiva, afetiva e social, sendo que as relações com os pares, professores e familiares foram destacadas como importantes para essa adaptação. As participantes destacaram conhecer a importância do cuidado em saúde mental, mas admitiram dificuldades de promoverem o autocuidado. O espaço grupal foi utilizado como ambiente de escuta, estabelecimento de vínculo e autocuidado. Os grupos psicoeducativos demonstraram ser importantes para a construção de estratégias de enfrentamento e um espaço para o acolhimento de demandas que emergem nessa etapa do desenvolvimento.

This study aimed to present the results of a psychoeducational psychotherapy group developed with Nursing students. Six meetings were held with five students from a public university in the state of São Paulo. The meetings were audio-recorded, transcribed and submitted to a reflexive-thematic analysis. The results found allowed the construction of five thematic categories: (1) Challenges of adapting to higher education; (2) Conceptions about mental health at the university; (3) Self-care and balance between university and personal life; (4) Interpersonal relationships and university life; (5) Perspectives and expectations about training. The process of integration into the university requires cognitive, affective and social mobilization, and relationships with peers, teachers and family members were highlighted as important for this adaptation. The participants highlighted knowing the importance of mental health care, but also admitted difficulties in promoting self-care. The group space was used as a listening environment, bonding and self-care. Psychoeducational groups proved to be important for the construction of coping strategies and a space for the reception of emerging demands.

Este estudio tiene como objetivo presentar los resultados de un grupo de psicoterapia psicoeducativa desarrollado con estudiantes de Enfermería. Se realizaron seis reuniones con cinco estudiantes de una universidad pública del Estado de São Paulo. Las reuniones fueron grabadas en audio, transcritas y sometidas a un análisis temático-reflexivo. Los resultados encontrados permitieron la construcción de cinco categorías temáticas: (1) Desafíos de la adaptación a la educación superior; (2) Concepciones sobre la salud mental en la universidad; (3) Auto cuidado y conciliación de la vida universitaria y personal; (4) Relaciones interpersonales y vida universitaria; (5) Perspectivas y expectativas sobre la formación. El proceso de integración universitaria requiere de una movilización cognitiva, afectiva y social, y las relaciones con pares, docentes y familiares son importantes para la adaptación. Los participantes destacan conocer la importancia del cuidado de la salud mental, pero admiten que tienen dificultad para promover el auto cuidado. El espacio grupal fue utilizado como ambiente de escucha, vinculación y auto cuidado. Los grupos psicoeducativos demostraron ser importantes para la construcción de estrategias de afrontamiento y un espacio de recepción de demandas emergentes.

Efficacy and cost-effectiveness of internet-based cognitive behavioral therapy for obsessive-compulsive disorder / 上海交通大学学报（医学版）

Objective • To compare the therapeutic effect, cost, cost-effectiveness and utility between internet-based cognitive behavioral therapy (ICBT) and cognitive behavioral group therapy (CBGT) in the patients with obsessive-compulsive disorder (OCD). Methods • Twenty-eight patients who met the OCD diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) were assigned to ICBT group (n=16) and CBGT group (n=12) according to the patients' willingness. Both groups were treated for 6 weeks. The study compared differences in the severity of OCD and symptoms of anxiety and depressive at baseline, during treatment and after treatment, as well as differences in cost, cost-effectiveness and utility between two groups. Results • There was no significant difference in the scores of Yale-Brown Obsessive Compulsive Scale (YBOCS), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Visual Analog Scale (VAS) [a component of EuroQol Five Dimensions Questionnaire, (EQ-5D)] between the two groups at baseline (P=0.291, P=0.114, P=0.478, P=0.799). After treatment, the YBOCS scores decreased compared to pre-treatment in two groups. There was no statistical difference in subtraction rate of YBOCS between the two groups (P=0.291). The SDS scores of ICBT group also decreased after treatment compared to pre-treatment (P=0.003). The average cost per patient in ICBT group was 2 710.50 yuan less than that in CBGT group. When one YBOCS score per patient reduced, ICBT group spent 281.33 yuan less than CBGT group. The VAS scores were significantly improved after 6-week treatment and ICBT group has a more significant improvement. Conclusion • ICBT and CBGT have comparable and significant efficacy. And ICBT is a lower cost and more cost-effectiveness and utility treatment than CBGT.

Sensibilidade à ansiedade e transtorno de pânico: avaliação do impacto da terapia cognitivo-comportamental em grupo / Anxiety sensitivity and panic disorder: assessment of the impact of group cognitive behavioral therapy

O transtorno de pânico (TP) é caracterizado pela presença de ataques súbitos de ansiedade e sensação de medo intenso. Embora haja tratamento efetivo com medicações e terapia cognitivo-comportamental (TCC), muitos pacientes tratados apresentam resposta parcial e tendem à cronicidade. A sensibilidade à ansiedade (SA) é um constructo multidimensional que expressa preocupações físicas, sociais e cognitivas da ansiedade, considerada uma tendência específica a reagir com medo aos sintomas de ansiedade. A SA tem sido associada à gênese e à manutenção dos sintomas do TP, porém ainda são escassos estudos que avaliam se a TCC em grupo (TCCG) modifica tal condição. Os objetivos deste estudo foram: 1) avaliar o impacto da TCCG na SA em pacientes com TP; 2) verificar a associação entre as características sociodemográficas e clínicas (comorbidades, uso de medicação, gravidade do TP) relacionadas à SA; 3) verificar as variáveis clínicas relacionadas à mudança da SA após a TCCG; 4) analisar a SA e suas dimensões como preditor de resposta à TCCG. Trata-se de um ensaio clínico controlado para avaliação da SA em pacientes com TP que realizaram 12 sessões de TCCG comparados ao grupo controle sem a intervenção. A gravidade dos sintomas foi avaliada antes e depois da TCCG no grupo intervenção e uma vez no grupo controle. Utilizou-se a Escala de gravidade do TP (PDSS), a Impressão Clínica Global (CGI), a Hamilton Ansiedade (HAM-A), o Inventário de Ansiedade de Beck (BAI) e o Inventário de Depressão de Beck (BDI). Para avaliar a SA, foi utilizada a Escala de Sensibilidade à Ansiedade-Revisada (ESA-R) com quatro fatores: fator 1 − medo de sintomas respiratórios e cardiovasculares; fator 2 − medo de descontrole cognitivo; fator 3 − medo de que as reações à ansiedade sejam observadas publicamente; fator 4 − medo de sintomas gastrintestinais. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre (nº 14-0379). Os pacientes assinaram o termo de consentimento livre e esclarecido (TCLE). A amostra foi composta por 89 sujeitos, com média de idade de 37,9 (DP=10,6) anos. Observou-se associação significativa entre a SA mais elevada em pacientes com comorbidade com agorafobia e sintomas mais elevados de ansiedade e de depressão. Um total de 37 (42%) pacientes participou do grupo intervenção e 52 (58%) pacientes do grupo controle. Houve melhora significativa em todos os sintomas específicos do TP, da ansiedade geral e dos sintomas depressivos. A SA também sofreu redução significativa em todos os fatores após a intervenção quando comparada aos escores iniciais, com tamanho de efeito (TE) de moderado a grande. Quando comparada a SA do grupo controle e do grupo intervenção após a TCCG, os escores da ESA-R diminuíram significativamente em todos os fatores e no total. Ou seja, a SA modifica-se com a TCCG tanto em termos de intragrupo intervenção quanto em termos de escores do grupo controle. Os resultados deste estudo confirmaram que a relação entre a SA é maior em pacientes com TP mais graves. Também foi evidenciada a eficácia da TCCG na redução das dimensões física, cognitiva e social da SA, confirmando a hipótese do impacto positivo da TCCG para a modificação desse quadro.

Panic disorder (PD) is characterized by the presence of sudden attacks of anxiety and intense fear sensation. Although there are effective treatments with medications and cognitivebehavioral therapy (CBT), many treated patients present partial response and tend to chronicity. Anxiety sensitivity (AS) is a multidimensional construct that expresses physical, social and cognitive anxiety concerns, considered a specific tendency to react with fear to the symptoms of anxiety. AS has been associated with the genesis and maintenance of PD symptoms, but there are still few studies evaluating whether CBT in group (CBT-G) modifies such condition. The objectives of this study were: 1) to evaluate the impact of CBT-G on AS in patients with PD; 2) to verify the association between sociodemographic and clinical characteristics (comorbidities, medication use, severity of PD) related to AS; 3) to verify the clinical variables related to the change in AS after CBT-G; 4) to analyze AS and its dimensions as a predictor of response to CBT-G. This is a controlled clinical trial for the evaluation of AS in patients with PD who performed 12 sessions of CBT-G compared to the control group without the intervention. The severity of the symptoms was evaluated before and after the CBT-G in the intervention group and once in the control group. We used the PD Severity Scale (PDSS), Clinical Global Impression (CGI), Hamilton Anxiety (HAM-A), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). In order to evaluate the AS, the Anxiety Sensitivity Index-Revised (ASI-R) was used with four factors: factor 1 - fear of respiratory and cardiovascular symptoms; factor 2 - fear of cognitive uncontrol; factor 3 - fear that reactions to anxiety could be publicly observed; factor 4 - fear of gastrointestinal symptoms. The study was approved by the Research Ethics Committee of the Hospital de Clínicas of Porto Alegre (nº 14-0379). Patients signed the informed consent form (TCLE). The sample consisted of 89 subjects, with a mean age of 37.9 (SD = 10.6) years. A significant association was observed between the highest AS in patients with comorbidity with agoraphobia and higher anxiety and depression symptoms. A total of 37 (42%) patients participated in the intervention group and 52 (58%) patients in the control group. There was a significant improvement in all the specific symptoms of PD, general anxiety and depressive symptoms. AS also had a significant reduction in all factors after the intervention when compared to the initial scores, with moderate to large effect size (ES). When compared to AS of the control group and the intervention group after the CBT-G, ASI-R scores decreased significantly in all factors and in the total. That is to say, AS is modified with CBT-G both in terms of intragroup intervention and in terms of scores of the control group. The results of this study confirmed that the relationship between AS is higher in patients with more severe PD. The effectiveness of CBT-G in reducing the physical, cognitive and social dimensions of AS was also evidenced, confirming the hypothesis of the positive impact of CBT-G for the modification of this condition.

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

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

An Application Study on the Cognitive-Behavioral Group Therapy in Medical Students with Social Anxiety / 中国医学伦理学

Objective:To explore the effects of cognitive-behavioral group therapy on relieving social anxiety of medical students and thus improve the communication ability of medical students. Methods: The medical students with social anxiety in our school were randomly divided into two groups. The subjects in the control group and the experiment group were given with the routine mental health education and the cognitive-behavioral group therapy respectively. The cognitive, emotional, and behavioral levels were measured before and after intervention using Interaction Anxious-ness Scale ( IAS ) , Fear of Negative Evaluation Scale ( FNE ) , Social Avoidance and Distress Scale ( SAD) , and in order to evaluate the effects of cognitive-behavioral group therapy. Results:After the intervention of cognitive-behavioral group therapy in medical students, all the three levels of anxiety were im-proved significantly in the experimental group than those in the control group ( P<0 . 05 ) . Conclusion:Cognitive-behavioral group therapy could effectively decrease the level of social anxiety for medical students.

The Effect of Korean-Type Cognitive-Behavioral Group Therapy for Social Anxiety Disorder / 신경정신의학

OBJECTIVES: The aim of this study was to evaluate the therapeutic effect of Korean-type cognitive behavioral group therapy (CBGT) in the treatment of social anxiety disorder (SAD). METHODS: Twenty-nine patients with SAD completed the Korean-type CBGT for SAD. The Korean-type CBGT for SAD is characterized by Korean-culture specific methods such as paradoxical intention, video feedback, and Korean cultural receptivity process on the classical CBGT course. The main outcome measure was a self-report version of the Liebowitz Social Anxiety Scale (LSAS-SR). RESULTS: After the treatment, the total score on the LSAS-SR had significantly improved (15.80+/-29.14, p=0.006, cohen's d=0.69), with both fear and avoidance subscales decreased (7.60+/-13.94, p=0.006 vs. 8.30+/-16.31, p=0.009, respectively). We also found significant correlation between the effect of the Korean-type CBGT (r=0.414, p=0.026) and the educational level of subjects. Accompanying pharmacotherapy for SAD did not elicit any differences in the treatment response. CONCLUSION: Our study showed that the Korean-type CBGT was effective in the treatment of SAD patients in reducing both fear and avoidance symptoms.

Utilização de técnicas da terapia cognitivo-comportamental em grupo para pacientes com sintomas residuais do transtorno de pânico: seguimento de 2 anos / Cognitive-behavioral group therapy techniques in panic disorder patients with residual symptoms: 2-year follow-up

Objetivo: Avaliar a utilização das técnicas aprendidas durante a terapia cognitivo-comportamental em grupo (TCCG) para pacientes com transtorno de pânico (TP) que apresentam sintomas residuais em até 2 anos após o término do tratamento. Métodos: Um total de 64 pacientes completou o protocolo de 12 sessões de TCCG, e 62 (97%) foram encontrados para avaliação 2 anos após o término da terapia. As medidas de desfecho foram avaliadas pelos seguintes instrumentos: Impressão Global Clínica (CGI), Inventário de Pânico e Escala Hamilton para Ansiedade. O uso das técnicas foi avaliado através de entrevista semi-estruturada nas avaliações de seguimento, sendo classificadas em: (a) respiração diafragmática; (b) relaxamento muscular; (c) técnica cognitiva; e (d) exposição. Resultados: Considerando os 62 pacientes avaliados no seguimento, 39 (63%) preencheram o critério de remissão (CGI 9 2 e ausência de ataques de pânico) no primeiro ano e 35 (57%) no segundo ano de seguimento. A despeito dos critérios de remissão, um número grande de pacientes (87%) continuava a utilizar as técnicas aprendidas durante a terapia 1 a 2 anos após o término do protocolo. A técnica mais utilizada em ambos os períodos de seguimento foi a respiração diafragmática. Conclusões: Os resultados sugerem que a TCCG é eficaz para pacientes com sintomas residuais de TP. O uso das técnicas aprendidas durante as 12 sessões foi evidenciado em até 2 anos após o término do tratamento, sugerindo benefícios em longo prazo das habilidades desenvolvidas na TCCG.

Objective: To evaluate the techniques learned by patients with panic disorder (PD) and residual symptoms after cognitivebehavioral group therapy (CBGT) up to a 2-year follow-up. Methods: Sixty-four PD patients were treated with a 12-session CBGT and 62 (97%) were followed for 2 years after the end of the treatment. Outcomes were evaluated by Clinical Global Impression (CGI), Panic Inventory, and Hamilton Anxiety Scale. The tools used by patients were assessed through a semi-structured interview and classified as follows: (a) diaphragmatic breathing, (b) muscle relaxation; (c) cognitive technique; and (d) exposure. Results: Of the 62 patients assessed at the follow-up, 39 (63%) met the remission criteria (CGI 9 2 and no panic attacks) in the first year and 35 (57%) in the second year of follow-up. Despite meeting the remission criteria, 87% of patients kept using the tools learned in CBGT up to 2 years after the treatment. Diaphragmatic breathing was the most used technique in both periods. Conclusion: The results of the present study suggest that CBGT is efficacious for patients with residual symptoms of PD. The techniques learned during the 12 therapy sessions are used by the patients up to 2 years after the treatment, suggesting long-term benefits of the skills learned at CBGT protocols.

Terapia cognitivo-comportamental de grupo no tratamento da fobia social generalizada / Cognitive-behavioral group therapy in the treatment of generalized social phobia

Este estudo teve como objetivo verificar a efetividade da terapia cognitivo-comportamental de grupo em pacientes com fobia social generalizada. Vinte e nove pacientes com diagnóstico de fobia social generalizada foram randomicamente distribuídos em dois grupos de tratamento. Um grupo de terapia cognitivo-comportamental de grupo (TCCG) e outro grupo de controle placebo com credibilidade (CPC). Os pacientes preencheram 3 escalas de avaliaçã (Inventário de Fobia Social, Inventário de Ansiedade Beck e Escala de Impressão Clínica Global) na semana 1 de tratamento e na semana 12. Em todas as medidas de avaliações, ao final de 12 semanas, os pacientes que receberam TCCG apresentaram melhoras superioras ao grupo de CPC. Neste ensaio clínico randomizado, simples-cego, a TCCG foi superior ao CPC no tratamento da fobia social generalizada

The aim of this study is to assess the effectiveness of cognitive-behavioral group therapy in patientswith generalized social phobia. Twenty nine patients with diagnosis of generalized social phobiawere randomly allocated in two groups of treatments. One group of cognitive-behavioral grouptherapy (CBGT) and another group of credible placebo control (CPC). The patients completed 3evaluation scales (Social Phobia Inventory, Beck Anxiety Inventory and Clinical Global ImpressionScale) in the weeks 1 and 12. In all evaluation scales in the week 12 of treatment, the CBGTpatients were rated as more improved than CPC patients. In this randomized single-blind clinicaltrial, the CBGT was superior to a CPC in the treatment of generalized social phobia

The cognitive-behavioral group therapy design on the college students of learing burnout / 中华医学教育探索杂志

Nowadays a large number of domestic researches have shown the degree of learning burnout,the causes,manifestations and the distribution,but there are only one or two cases focusing on empirical research of Group Counseling.In Eriksson's view,the university period is a critical stage to obtain a sense of intimacy and avoid isolation,and the group counseling have great significance in helping students improve the character and get a sense of intimacy.Therefore,based on the literature and interviews,the author use in this study the cognitive-behavioral group therapy to help the students form a new cognitive concepts,behavior and attitude,and improve their self-efficacy.