Effects of Promove - Saúde da Mulher on anxiety, depression, social skills, and satisfaction: A single-subject design

Terapia Analítico-Comportamental (TAC) (in English, behavioral-analytic therapy, behavior therapy, or clinical behavior analysis) is a possible intervention for cases of anxiety and depression, but it still has much to advance in terms of efficacy and clinical utility evidence. This article aims to describe the effects of a semi-structured intervention in the model of TAC regarding anxiety and depression, behavior, complaints, and satisfaction indicators. Participants included three women with children, marital relationships, and work, aged between 34 and 41 with complaints compatible with anxiety and depression disorders. The intervention used Promove - Saúde da Mulher (PSM) (in English, Promote Women's Health), which included 17 topics, most of them related to social skills. Instruments included the GAD-7 for anxiety, PHQ-9 for depression, IHS-2 Del Prette for social skills, a Complaints Checklist for monitoring clinical demands, and an Evaluation of the Therapeutic Process to describe clients' satisfaction rates. The results from the standardized instruments were statistically analyzed via the JT method. All three participants showed reliable improvements in anxiety and/or depression, improvement in most complaints, and satisfaction with the intervention and its outcomes. Acquisition of social skills occurred in two cases. One participant dropped out and another one relapsed at follow-up. The efficacy criteria were used to evaluate the internal validity of the present study. The study collected the first evidences of outcome and satisfaction for PSM, thus enabling future investigations on the efficacy and clinical utility of this intervention program. (AU)

Consciência, coragem e amor: análise behaviorista de objetivos da psicoterapia analítica funcional / Consciencia, coraje y amor: análisis behaviorista de objetivos de la psicoterapia analítica funcional / Awareness, courage and love: behavioral analysis of targets for functional analytic psychotherapy

RESUMO. A Psicoterapia Analítica Funcional é uma abordagem clínica baseada em uma análise funcional comportamental do ambiente terapêutico típico. Seus objetivos e técnicas terapêuticas podem ser descritos em diferentes termos, privilegiando ou não a linguagem utilizada na análise experimental do comportamento. Na formulação original, é destinada a diminuir a frequência de comportamentos clinicamente relevantes (CCRs) problemáticos e aumentar a dos de progresso e de interpretação pela técnica das cinco regras: observar CCRs, evocar CCRs, reforçar CCRs, observar os efeitos da intervenção e implementar a generalização. Sob a influência da Ciência Contextual Comportamental, estes mesmos elementos passaram a ser descritos com o rótulo de 'Modelo Consciência, Coragem e Amor' (ACL, do inglês Awareness, Courage and Love). O objetivo deste trabalho foi identificar se a linguagem da nova proposição era compatível com a usada por B. F. Skinner. O método foi uma revisão destes termos, ou seus sinônimos, em importantes livros da obra de B. F. Skinner, notadamente uma literatura caracterizada por sua derivação dos achados de laboratório em pesquisas sobre o comportamento operante. Os livros consultados foram Ciência e comportamento humano, Sobre o behaviorismo, O comportamento verbal, Walden II e Questões recentes na análise comportamental. A revisão permitiu concluir que os termos consciência, coragem e amor já haviam sido explorados na literatura skinneriana, oferecendo análises funcionais e mostrando que seu uso é compatível com o sistema comportamental.

RESUMEN. La Psicoterapia Analítica Funcional es un enfoque clínico basado en un análisis funcional del comportamiento del ambiente terapéutico típico. Sus objetivos y técnicas terapéuticas pueden ser descritos en diferentes términos, privilegiando o no el lenguaje utilizado en el análisis experimental del comportamiento. En la formulación original, está destinada a disminuir la frecuencia de comportamientos clínicamente relevantes (CCR) problemáticos y aumentar la de los de progreso y de interpretación por la técnica de las cinco reglas: observar CCRs, evocar CCRs, reforzar CCRs, observar los efectos de la intervención e implementar la generalización. Bajo la influencia de la Ciencia Contextual Comportamental, estos mismos elementos pasaron a ser descritos con el rótulo 'Modelo Consciencia, Coraje y Amor' (ACL, del inglés Awareness, Courage and Love). El objetivo de este trabajo fue identificar si el lenguaje de la nueva proposición era compatible con la usada por B. F. Skinner. La metodología fué una revisión de estos términos, o sus sinónimos, en importantes libros de la obra de B. F. Skinner, notable por ser una literatura caracterizada por su derivación de los hallazgos de laboratorio en investigaciones sobre el comportamiento operante. Los libros consultados fueron Ciencia y comportamiento humano, Sobre el conductismo, El comportamiento verbal, Walden II y Cuestiones recientes en el análisis de la conducta. La revisión permitió concluir que los términos conciencia, coraje y amor ya habían sido explorados en la literatura skinneriana, ofreciendo análisis funcionales y demostrando que su uso es compatible con el sistema conductual.

ABSTRACT. Functional Analytic Psychotherapy is a clinical approach based on a behavioral functional analysis of the typical therapeutic setting. Its objectives and therapeutic techniques can be described in different terms, privileging or not the language used in the experimental analysis of behavior. In its original formulation, this approach aims to decrease the frequency of problematic clinically relevant behaviors (CRBs) and to increase those of progress and interpretation by the five-rules technique: observe CRBs, evoke CRBs, reinforce CRBs, observe the effects of the intervention, and implement generalization. Under the influence of the Behavioral Contextual Science, these same elements came to be described with the label 'Awareness, Courage and Love Model' (ACL Model). The goal of this study was to identify whether the language of this new proposition was compatible with that used by B. F. Skinner. The method was a review of these terms, or their synonyms, using important books of the work of B. F. Skinner, notably a literature characterized by its derivation of laboratory findings in research on operant behavior. The books consulted were Science and human behavior, About behaviorism, Verbal behavior, Walden II and Recent issues in the analysis of behavior. This review made it possible to conclude that the terms awareness, courage and love had already been explored in the Skinnerian literature, offering functional analyses and showing that their use is compatible with the behavioral system.

Activación Conductual en formato grupal para ansiedad y depresión: una revisión sistemática / Behavioral Activation in group format for anxiety and depression: a systematic review

Resumen Dada la alta prevalencia de los Trastornos Mentales Comunes (TMC), la aplicación grupal de la Activación Conductual (AC) puede ser un abordaje eficaz, efectivo y más eficiente. El objetivo del presente trabajo es revisar los estudios publicados sobre la utilidad de la AC grupal para el tratamiento de la ansiedad y/o depresión. Método: Revisión sistemática. Resultados: Se incluyeron 17 estudios. Los pacientes que recibieron AC experimentaron mejoras en ansiedad y/o depresión y se informa de una mayor eficacia de AC frente a grupos control sin intervención. Conclusiones: La AC es útil para la prevención y el tratamiento de trastornos emocionales. No obstante, la heterogeneidad y limitaciones de los estudios impiden determinar los ingredientes terapéuticos exactos, y si éstos son específicos del enfoque y procedimiento de esta terapia. Sería necesario más investigación, de mayor calidad metodológica, y que evalúe los cambios en los patrones de activación/evitación objeto de intervención.

Abstract Given the high prevalence of Common Mental Disorders (CMD), group-based Behavioral Activation (BA) could be an efficacious, effective and more efficient approach. The objective of this work is to review the published studies about the usefulness of group-based BA for the treatment of anxiety and/or depression. Method: Systematic review. Results: 17 studies were included in the review. Patients who received BA experienced improvements in anxiety and/or depression and studies reported a greater efficacy of BA compared with no-intervention control groups. Conclusions: BA is useful for the prevention and treatment of emotional disorders. However, heterogeneity and limitations of the studies make it impossible to determine the exact therapeutic elements, and if they are specific to the approach and procedure of this therapy. More research would be necessary of a higher methodological quality to evaluate changes in the activation/avoidance patterns, which are the object of the intervention.

Brazilian consensus in enuresis-recomendations for clinical practice

ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Association between enuresis and obesity in children with primary monosymptomatic nocturnal enuresis

ABSTRACT Objective The purpose of this study was to determine whether the presence of obesity was related with symptoms of nocturnal enuresis (NE) and the efficacy of behavioral intervention in the treatment of NE. Materials and Method The patients diagnosed with primary monosymptomatic nocturnal enuresis (PMNE) were studied retrospectively. NE severity was classified as mild, moderate, and severe according to the frequency of enuresis. The children were divided into three groups, namely normal weight (5th-84th percentile), overweight (85th-94th percentile), and obesity (≥95th percentile), according to their Body Mass Index (BMI) percentage. The relationship between obesity level and enuresis severity was analyzed. After three months of behavioral therapy, the efficacy of treatment among normal, overweight, and obese groups were evaluated. Moreover, the predictive risk factors for treatment failure were investigated. Results The rates of severe enuresis in patients with normal weight, overweight, and obesity were 63.9%, 77.5%, and 78.6%, respectively. Obese children depicted higher odds of having severe enuresis compared with normal-weight children (OR: 1.571; 95% confidence interval [CI]: 1.196-2.065; P=0.001). The odds of presenting with severe enuresis were 1.99 times higher in children who are obese or overweight compared to children with normal weight (OR: 1.994; 95% CI: 1.349-2.946; P=0.001). The complete response of the normal group was higher than those of the overweight and obese groups (26.8% vs. 14.0%, P=0.010; 26.8% vs. 0.0%, P=0.000). Overweight children showed higher complete response than obese ones (14.0% vs. 0.0%, P=0.009). Logistic regression analysis revealed that obesity level and enuresis frequency were significantly related to the treatment failure of behavioral intervention. Conclusions Obesity is associated with severe enuresis and low efficacy of behavioral therapy in children with nocturnal enuresis.

Perspectiva histórica do tratamento clínico da doença do refluxo gastroesofágico / Historical perspective of gastroesophageal reflux disease clinical treatment

ABSTRACT BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal diseases. GERD generates significant impairment in patients' quality of life and it is associated to relevant medical resources utilization. A better understanding of GERD pathophysiology in the past five decades has favored the evolution of therapeutic strategies from non-drug interventions and antacids to more efficacious and safer alternatives. OBJECTIVE: To summarize data about the historical evolution of GERD management in Brazil, focusing on medical therapy and addressing evidence on efficacy and safety of drug classes currently recommended. METHODS: A narrative review was conducted by systematizing information about discoveries on GERD pathophysiology. We also addressed efficacy and safety of medications currently used to reduce symptoms and improve endoscopic healing of esophageal lesions. A structured search on Pubmed was performed to identify systematic reviews and meta-analysis investigating GERD outcomes positively impacted by proton pump inhibitors (PPIs), the first choice of pharmacotherapy for the disease. RESULTS: The chronological development of therapeutic measures for GERD in Brazil evolved from lifestyle interventions with relative poor effect on symptoms related to esophageal acid exposure, particularly heartburn, to effective and safe pharmacological interventions such as histamine H2-receptor antagonists and PPIs. In the present days, some drug classes play a minor role in disease management, namely prokinetics and antacids, due to their reduced efficacy and relevant safety concerns (particularly with prokinetics). The main challenge for prescribers and researchers seems to be finding long-acting acid suppressants strategies able to ameliorate patients' symptoms and quality of life, thereafter, reducing medical resource consumption. The dual delayed-release PPI dexlansoprazole seems to respond for some of the limitations other PPIs have. CONCLUSION: Recognizing the historical evolution of GERD management can help care providers to better understand therapeutic options for their patients, as well as focus on unmet needs that deserve further attention. PPIs are still the first choice therapy, with good evidence in favor of their efficacy, despite some safety concerns. However, as with any medical intervention, it is recommended to prescribe PPIs for patients with clear indication, using adequate dosing and monitoring for adverse events.

RESUMO CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é uma das doenças gastrointestinais mais prevalentes, resultando em limitações significativas na qualidade de vida dos pacientes e, também, relevante utilização de recursos médicos. Um melhor entendimento da fisiopatologia da doença nas últimas cinco décadas tem favorecido a evolução das estratégias de tratamento, desde intervenções não farmacológicas e antiácidos, a alternativas mais eficazes e seguras. OBJETIVO: Resumir os dados sobre a evolução histórica do manejo da DRGE no Brasil, focando na terapia medicamentosa e abordando evidências sobre a eficácia e segurança de classes medicamentosas atualmente recomendadas. MÉTODOS: Uma revisão narrativa foi conduzida para sistematizar informações sobre descobertas na fisiopatologia da DRGE e, também, sobre a eficácia e segurança de medicamentos utilizados atualmente para reduzir os sintomas e melhorar a cicatrização endoscópica de lesões esofágicas. Uma busca estruturada na base de dados Pubmed foi realizada para identificar revisões sistemáticas e metanálises que investigassem desfechos da doença impactados positivamente pelos inibidores da bomba de prótons (IBPs), a primeira escolha farmacológica para a doença. RESULTADOS: O desenvolvimento cronológico das medidas terapêuticas para a DRGE no Brasil evoluiu de modificações no estilo de vida que demonstraram relativamente pouco efeito sobre os sintomas relacionados à exposição esofágico ao ácido, particularmente a azia, a intervenções farmacológicas eficazes e seguras como os anti-histamínicos H2 e os IBPs. Atualmente, algumas classes de medicamentos exercem um papel menor no manejo da doença, procinéticos e antiácidos por exemplo, devido à sua eficácia reduzida e a preocupações relevantes quanto a segurança (particularmente com os procinéticos). O principal desafio para os prescritores e pesquisadores parece ser encontrar estratégias supressoras de ácidos de longa duração capazes de melhorar os sintomas e a qualidade de vida dos pacientes, reduzindo assim o consumo de recursos médicos. O dexlansoprazol, um IBP de liberação retardada dupla, parece responder a algumas limitações que outros IBPs têm. CONCLUSÃO: O reconhecimento da evolução histórica do manejo da DRGE pode auxiliar aos profissionais assistentes a melhor entender as opções terapêuticas para seus pacientes, assim como focar em necessidades não atendidas que necessitem de maior atenção. IBPs ainda são a terapia de escolha inicial, com boas evidências a favor de sua eficácia, apesar algumas questões acerca da segurança de seu uso. No entanto, assim como para qualquer intervenção medicamentosa, é recomendada a prescrição dos IBPs para pacientes com indicação clara, utilizando doses adequadas e monitorando a ocorrência de eventos adversos.

Problematic and adaptive eating in people with obesity after a DBT-based skills training intervention: 3- and 8-month follow-up and mediation analysis

Abstract Background: Dialectical behavior therapy conceptualizes problematic behaviors as attempts to regulate emotions that occur when the individual lacks effective skills with which to manage his or her emotions and cope with distress. Problematic eating behaviors, e.g., binge and emotional eating, may serve to alleviate aversive emotional states, being highly associated with overweight and obesity. Dialectical behavior therapy skills training has been proven effective in reducing binge eating in several clinical studies. However, few studies reveal the effects of DBT on adaptive eating behaviors or the stability of outcomes. Objectives: This study aimed to test the effect of a brief DBT-based skills training intervention, and the stability of outcomes at 3- and 8-month follow-ups. Methods: Self-report measures of binge eating, emotional eating, intuitive eating, and mindful eating were taken on 5 timepoints before and after a 10-session DBT skills training intervention (2 baseline measures, 1 post-test, and 2 follow-ups). Data were analyzed using a mixed-model intention-to-treat approach and mediation analysis was conducted with path analysis. Results: After the intervention, intuitive eating and mindful eating scores were significantly higher than before the intervention, while emotional eating and binge eating scores were lower. The results remained stable during the follow-up period, with minor fluctuations and small trends towards returning to baseline values for binge eating and emotional eating. Mindful eating partially mediated the improvements in all outcomes. Limitations: Given that results are entirely based on self-report measures and that some instruments showed poor reliability, in addition to the high attrition rates, the results should be interpreted as preliminary. Conclusions: The results provide evidence that a brief DBT intervention is effective not only in reducing problematic eating but also in increasing adaptive eating, achieving reasonably stable results. Also, the mediation analysis results support the hypothesis that mindful eating partially explains the effects of the intervention on binge and emotional eating. Future research should address the limitations of this study by investigating a more diverse sample, triangulating different measurement strategies, and including other putative mediators.

Intervenciones breves para promover cambios conductuales en el ámbito de la atención primaria: revisión de su efectividad en consumo de tabaco, alcohol y sedentarismo / Brief interventions to promote behavioral change in primary care settings, a review of their effectiveness for smoking, alcohol and physical inactivity

La intervención breve en salud es una estrategia terapéutica, sugerida para abordar cambios conductuales asociados a factores de riesgo de enfermedades crónicas no transmisibles. Existe amplia evidencia sobre su efectividad. Sin embargo, esta evidencia se sustenta en distintas definiciones de intervención breve, lo que dificulta su aplicación clínica. Este artículo de revisión de literatura, se propuso realizar una búsqueda de revisiones sistemáticas en la base de datos Epistemonikos con el fin de identificar factores comunes en su definición y resumir algunas estrategias de intervención breve usadas con frecuencia en la atención primaria de salud. Asimismo, se busca describir su efectividad en este contexto clínico, para tres factores de riesgo: tabaco, alcohol y actividad física.

The brief intervention is a therapeutic strategy suggested to address behavioral changes associated with risk factors for chronic non-communicable diseases and there is ample evidence of its effectiveness. However, this evidence is sustained by various definitions of "brief intervention", a fact that makes the clinical application of this strategy difficult. This literature review article aimed to conduct a search for systematic reviews in the Epistemonikos database in order to identify common factors in the definition of "brief intervention" and summarize some brief intervention strategies frequently used in primary health care. It also seeks to describe their effectiveness, for three risk factors: tobacco, alcohol and physical activity, within this clinical context

Can the success of structured therapy for giggle incontinence be predicted?

ABSTRACT Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities. Material and methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment. Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities. Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.

Community versus clinical cognitive-behavioral intervention in young-adult Spanish population with generalized social phobia / Intervención cognitivo-conductual comunitaria versus intervención clínica en jóvenes adultos españoles con fobia social generalizada

Ei objetivo del estudio es mejorar los resultados informados por las revisiones sobre el tratamiento de adultos con Fobia social generalizada. La muestra la integraron 91 participantes con Fobia social generalizada (EM: 19.90 años; DT: 1.05) asignados aleatoriamente a tres condiciones experimentales, evaluados antes y después del tratamiento, y a los 6, 12, y 24 meses en los grupos tratados. Los resultados muestran (a) la efectividad de la detección en el contexto comunitario versus la intervención clínica, en el corto y medio plazo, y (b) una mejora significativa de los efectos del tratamiento, frente a los de las revisiones de las intervenciones clínicas ad hoc, tanto en los abandonos como en las tasas de recuperación. Ello permite concluir que esta modalidad de aplicación del tratamiento cognitivo-conductual puede ser una estrategia complementaria a la convencional con la que mejorar los resultados actuales de la intervención psicológica en este trastorno.

The study investigates how to improve the results reported by the reviews on the effects of clinical interventions in adults with Generalized social phobia. The sample was composed of 91 participants (median age = 19.90 years, SD = 1.05) randomly assigned to three experimental conditions. The evaluations were conducted before and after treatment in all three groups and at 6-, 12-, and 24-month follow-up for the treatment groups. The results show (a) the effectiveness of the cognitive-behavioral strategy of detection and intervention, in a community context, versus clinical intervention both for the short and medium term; and (b) a significant improvement over the percentages of dropouts and of rates of complete recovery from the disorder. These findings allow us to conclude that the cognitive-behavioral strategy of detection and intervention, in a community context is shown to be a complementary intervention to the conventional and with high efficiency ratios.

O relacionamento terapeuta-cliente e o transtorno de personalidade borderline / The therapist-client relationship and borderline personality disorder

O Transtorno de Personalidade Borderline é caracterizado pela instabilidade afetiva e pelo comportamento interpessoal incoerente. Essas dificuldades, próprias do transtorno, podem dificultar o atendimento psicoterápico, que é, por definição, um processo interpessoal. O objetivo desse estudo é mostrar como, paradoxalmente, a exploração das dificuldades no relacionamento, podem tornar o tratamento mais eficiente. Foi desenvolvido um estudo de caso com uma cliente pelo método de observação participante. Ferramentas de diferentes terapias comportamentais, a ACT, a TCD e a FAP foram escolhidas para construir uma forma flexível para encarar os desafios do relacionamento com a cliente borderline. A vivência da terapeuta foi monitorada, usando o modelo do matrix. Rupturas do vínculo e respostas emocionais da terapeuta à terapia foram analisadas para auxiliar a cliente a aprender sobre si e seu mundo relacional. Juntas, essas ferramentas permitiram trabalhar diretamente com o que estava ocorrendo na relação terapêutica e permitiram o uso das dificuldades enfrentadas para beneficiar o processo. O estudo sugere que uma integração das contribuições de diversas correntes teóricas envolvendo a terapia comportamental contemporânea pode tornar o tratamento de casos difíceis mais eficientes e ajudar a superar a rigidez paradigmática...

Affective instability and incoherent interpersonal behavior characterize borderline personality disorder. These difficulties, being features of the disorder, can hinder treatment, by definition, an interpersonal process. The aim of the present study is to argue how, paradoxically, the exploration of difficulties in the relationship can help make treatment more efficient. The method was a case study, using participant observation. Tools from different behavioral treatments, ACT, DBT and FAP made a flexible way of dealing with the challenges of the relationship with the borderline client possible. Polk’s matrix helped monitor the experience of the therapist. The analysis of alliance ruptures and the therapist’s emotional responses toward treatment helped the client learn about herself and her relational world. Together, these tools made it possible to work directly with what was occurring in the therapeutic relationship and permitted to harness the difficulties encountered for the benefit of the process. The study suggests that integrating the contributions of diverse theoretical currents in the contemporary behavior therapy movement can make treatment of difficult cases more efficient, aiding to overcome paradigmatic rigidity...

A fisioterapia pélvica no tratamento da vulvodínia: revisão sistemática / Pelvic physiotherapy in the treatment of vulvodynia: systematic review

A Vulvodínia Localizada Provocada (VLP) é um tipo de dor crônica limitante e de interesse clínico, cuja etiologia ainda é obscura e para a qual parece não haver consenso a respeito da terapêutica. O objetivo desta pesquisa foi descrever o papel da fisioterapia pélvica no tratamento da VLP. Para tanto, foi realizada uma Revisão sistemática das bases de dados PubMed, LILACS, PEDro e SciELO a partir das palavras-chave vulvodínia, vestibulodínia e dor vulvar, bem como suas variáveis em inglês, em busca de ensaios clínicos que tratassem de técnicas fisioterapêuticas para esse fim. Foram incluídos ensaios clínicos e estudos observacionais e excluídos os que tratassem de estudos em homens ou cobaias e os que versavam unicamente de tratamento cirúrgico ou medicamentoso. Todos foram analisados e qualificados pelos graus de evidência da Associação Médica Brasileira (AMB). Os resultados mostraram que de um um total de 14 artigos, quatro foram estudos de caso, cinco, ensaios randomizados controlados e os demais, estudos observacionais de coorte, transversais e retrospectivos. Foram descritos tratamentos por eletroestimulação, terapia comportamental e fisioterapia pélvica focada nos exercícios do assoalho pélvico, particularmente de propriocepção e coordenação motora visando à recuperação da capacidade ativa de relaxamento. Houve forte evidência suportando a eficácia da fisioterapia pélvica no alívio do quadro clínico da VLP. Não houve consenso a respeito de qual técnica, dentro do arsenal fisioterapêutico, é a mais eficiente para essas pacientes. Concluiu-se que a fisioterapia pélvica é segura e eficiente no tratamento da VLP e deve encabeçar o algoritmo terapêutico desse tipo de paciente.(AU)

Localized Provoked Vulvodynia (LPV) is a limiting chronic pain of clinical interest, whose etiology is still unclear and for which there is no consensus on the therapy. The aim of this paper was to describe the role of pelvic physiotherapy in the treatment of VLP. It was necessary a systematic review of databases PubMed, LILACS, PEDro and SciELO with the keywords vulvodynia, vestibulodínia and vulvar pain in Portuguese and in English, searching for clinical trials upon the physical therapy techniques for this purpose. It was included clinical trials and excluded those that concerned men or mice or only surgical or drug treatment. All of them were analyzed and qualified by the Associação Médica Brasileira (AMB) evidence scale. The results showed that on a total of 14 articles, four were case reports, five, randomized controlled trials, and the others, retrospective study and cross-sectional study studies. They described electrical stimulation treatments, behavioral therapy and pelvic physical therapy focused on pelvic floor exercises, particularly of proprioception and coordination aimed the recovery of active capacity of relaxation. There was strong evidence supporting the effectiveness of pelvic physiotherapy in relieving the clinical symptoms of LPV. There was no consensus about which technique on the physical therapy arsenal is the most effective. Concludes that pelvic physical therapy is safe and effective in the treatment of LPV, and should be considered as first line therapeutic in the algorithm of this kind of patient.(AU)

Attentional bias modification based on visual probe task: methodological issues, results and clinical relevance / Modificação de viés atencional com base em tarefa de atenção visual: questões metodológicas, resultados e relevância clínica

Introduction: Attentional bias, the tendency that a person has to drive or maintain attention to a specific class of stimuli, may play an important role in the etiology and persistence of mental disorders. Attentional bias modification has been studied as a form of additional treatment related to automatic processing. Objectives: This systematic literature review compared and discussed methods, evidence of success and potential clinical applications of studies about attentional bias modification (ABM) using a visual probe task. Methods: The Web of Knowledge, PubMed and PsycInfo were searched using the keywords attentional bias modification, attentional bias manipulation and attentional bias training. We selected empirical studies about ABM training using a visual probe task written in English and published between 2002 and 2014. Results: Fifty-seven studies met inclusion criteria. Most (78%) succeeded in training attention in the predicted direction, and in 71% results were generalized to other measures correlated with the symptoms. Conclusions: ABM has potential clinical utility, but to standardize methods and maximize applicability, future studies should include clinical samples and be based on findings of studies about its effectiveness.

Introdução: O viés atencional, definido como a tendência a direcionar ou manter a atenção focada em uma classe específica de estímulos, pode ter um papel importante na etiologia e manutenção dos transtornos mentais. A modificação do viés atencional tem sido estudada como forma adicional de tratamento dirigida ao processamento automático. Objetivos: Esta revisão sistemática da literatura compara e discute questões metodológicas, evidências de resultados positivos e potenciais aplicações clínicas dos estudos sobre a modificação do viés atencional (MVA) baseados em uma tarefa de atenção visual. Métodos: As bases de dados Web of Knowledge, PubMed e PsycInfo foram pesquisadas usando os descritores attentional bias modification, attentional bias manipulation e attentional bias training. Foram selecionados estudos empíricos sobre treinamento para MVA baseados em tarefa de atenção visual escritos em inglês e publicados entre 2002 e 2014. Resultados: Cinquenta e sete estudos atenderam aos critérios de inclusão. A maioria (78%) obteve sucesso no treinamento da atenção na direção prevista, e 71% tiveram seus resultados generalizados a outras medidas correlacionadas com os sintomas. Conclusões: A MVA tem utilidade clínica potencial, mas, para atingir a padronização de métodos e a maximização de sua aplicabilidade, estudos futuros deverão incluir amostras clínicas e ser baseados nos resultados dos estudos sobre sua eficácia.

Impacto del Programa de manejo de la obesidad Bright Bodies aplicado a niños y adolescentes chilenos / Effects of the Bright Bodies Program in Chilean obese children

Background: Yale University’s Bright Bodies Program consists on a lifestyle intervention, in areas such as nutrition and exercise, while focusing on behavior modification and family support. Aim: To evaluate the impact of the Program in Chilean children and adolescents with obesity who participated in the Program during 8 months. Material and Methods: The weight management Program was carried out during 8 months and consisted in weekly sessions directed by dietitians or psychologists and exercise sessions twice per week in charge of physical education teachers. The family component was based on sessions for parents or caregivers to achieve the same goals of children activities. Results: Twenty eight obese children aged 9.5 ± 2 years completed the eight months of intervention. There was a significant 5% reduction of body mass index (BMI), a 15% reduction of BMI z score and a 2.9% reduction of waist circumference. Bioelectrical impedance showed a 9% reduction of percentage body fat and a 7% increase in lean body mass. Blood pressure, blood glucose, total and LDL cholesterol and triglycerides decreased significantly, without changes in HOMA-IR. The frequency of metabolic syndrome decreased from 36% at baseline to 18% at the end of the intervention. A 43% reduction in caloric intake and an improvement in physical condition was also observed. Conclusions: The Bright Bodies Program produced significant and positive changes on anthropometric and metabolic parameters in this group of children.

Activación conductual y depresión: conceptualización, evidencia y aplicaciones en iberoamérica / Behavioral activation and depression: conceptualization, evidence and applications in latin america

La depresión es uno de los problemas en salud mental más prevalentes. En Latinoamérica se constituye como la primera problemática en cuanto a años de vida perdidos por incapacidad, lo que implica que se deben hacer esfuerzos importantes en desarrollar estrategias de intervención eficaces para su intervención. Este artículo tiene como objetivo, en primer lugar, ofrecer una revisión conceptual de la activación conductual, una de las estrategias de intervención que han probado ser eficaces en el tratamiento de la depresión y sus diferentes modalidades, en segundo lugar, examinar el uso que ha tenido en el manejo de la depresión en diferentes poblaciones y por último, revisar la evidencia empírica en Iberoamérica.

Depression is nowadays one of the most prevalent mental health problems. In Latin America is the main problem in terms of years of life lost due to disability, implying that major efforts should be made to develop effective intervention strategies for treatment. This article aims, first, to provide a conceptual review of the Behavioral Activation, one of the interventions that have proven to be effective to treat depression and its various forms, secondly, to examine its use to treating depression with different populations and finally, to review the empirical evidence in Latin America.

Efeitos de uma atividade de fantasia em medidas da interação terapêutica / Effects of a fantasy activity in therapeutic interaction measures

Avaliou-se o efeito de uma atividade de fantasia em medidas da interação terapeuta/cliente. Dez sessões psicoterápicas de uma díade terapeuta/cliente foram registradas em vídeo, transcritas e categorizadas por observadores que atingiram os critérios de concordância estipulados. Estas sessões foram divididas em cinco condições - ABABA. Nas condições B, introduziu-se uma atividade de fantasia. Houve diminuição nas categorias da terapeuta de Solicitação de relato e Solicitação de reflexão e aumento das categorias Fornecimento de interpretações, Informações e Recomendações, durante as condições B. Para a cliente, nas condições B, houve aumento da categoria Estabelecer relações entre eventos e diminuição da categoria Relato de eventos. Discutiu-se o aumento do relato de metas e melhoras por parte da cliente nas sessões subsequentes às duas condições B. Estudos foram sugeridos para esclarecer o efeito de intervenções do terapeuta e o efeito de descrições acuradas de contingência nos relatos de melhora e de engajamento na mudança.

The aim of this article is to report a study that has evaluated the effects of a fantasy activity on client-therapist interaction. Ten sessions of a behavioral analysis therapy process were recorded on video, transcripted and coded. Independent coders were trained until reached the agreement criterion. The fantasy activity was introduced on the condition B in a ABABA design. There was decrease on the categories titled Report Request and Reflection Request, and increase on the Interpretation, Information and Recommendation. There were increase in Establishing Relationship Between Events and decrease of Events Reporting. The expressive increase in the reporting of goals and improvements by the client at the sessions following the condition B were discussed. Studies were suggested to clarify the effect of the therapist interventions. Additionally, it was suggested the investigation of the accurate contingent descriptions and the reports about improvement and clinical changes.

Análise de Comportamento Aplicada e Distúrbios do Espectro do Autismo: revisão de literatura / Applied Behavior Analysis and Autism Spectrum Disorders: literature review

OBJETIVO: Realizar uma revisão sistemática da literatura envolvendo as propostas de terapia baseada na análise de comportamento aplicada (ABA) dirigida a pessoas portadoras de distúrbios do espectro do autismo (DEA), contribuindo, dessa forma, para uma prática efetivamente baseada em evidências. ESTRATÉGIA DE PESQUISA: As bases de dados Web of Science, Medline, SciELO e Lilacs foram consultadas para o levantamento das referências bibliográficas publicadas nos últimos cinco anos. CRITÉRIOS DE SELEÇÃO: Foram selecionados os artigos publicados em periódicos com revisão por pares. Foram utilizados como critérios de exclusão o idioma, o tipo de artigo, o tema e os artigos repetidos. Essa seleção resultou em 52 artigos, que foram analisados na íntegra. ANÁLISE DOS DADOS: Foram consideradas as informações referentes a autor, periódico e data; título; tema e abordagem; casuística; critérios de inclusão e exclusão e conclusões. RESULTADOS: Os artigos abordam processos de intervenção, revisões de literatura, formação profissional e a contribuição dos pais no processo de intervenção. Apenas quatro artigos relatam a contribuição dos pais na aplicação dos princípios da ABA no ambiente doméstico. Os estudos sobre formação profissional enfatizam a valorização da formação especializada. A maioria das revisões de literatura conclui que os processos de intervenção são controversos, caros e dependentes de fatores externos. Embora artigos que relatam processos de intervenção envolvam 663 participantes, não é possível a realização de meta-análise devido à ausência de critérios de inclusão e caracterização comparáveis. CONCLUSÃO: Não há evidência suficiente para corroborar a preponderância da ABA sobre outras alternativas.

PURPOSE: Systematic literature review about Applied Behavior Analysis (ABA) proposals directed towards persons with Autistic Spectrum Disorders aiming to contribute to a truly evidence-based practice. RESEARCH STRATEGY: References from the last five years were obtained from the Web of Science, Medline, SciELO and Lilacs databases. SELECTION CRITERIA: Papers published in peer-reviewed journals were selected. Exclusion criteria were language, type of paper, theme and repeated papers. This selection resulted in 52 articles that were completely analyzed. DATA ANALYSIS: Information regarding author, journal and date; title; theme and approach; casuistic; inclusion and exclusion criteria and conclusion was considered. RESULTS: The papers refer to intervention processes, literature reviews, professional education, and parents' contributions to the intervention programs. Only four papers report the parents' role in the use of ABA principles at home. Studies about Professional education emphasize the specialized education. Most of the literature review papers conclude that the intervention programs are controversial, expensive and dependent of external variables. Although the articles describing intervention processes include 663 participants, a meta-analysis is not possible due to the lack of comparable inclusion and characterization criteria. CONCLUSION: There is not enough evidence of ABA's preponderance over other alternatives.

Mejora en la sensibilidad a la insulina con un programa intensivo de cambio en el estilo de vida para control de obesidad en niños y adolescentes en el primer nivel de atención

El objetivo del estudio fue evaluar el efecto de un programa intensivo de cambio en el estilo de vida para el control de peso sobre la sensibilidad a la insulina en niños y adolescentes en el primer nivel de atención. El estudio incluyó a 42 niños y adolescentes de 9 a17 años (n=23 grupo intensivo, n=19 grupo control) que participaron en un estudio clínico aleatorizado para el tratamiento de obesidad. El programa intensivo de cambio en el estilo de vida incluyó consultas mensuales con el médico del primer nivel de atención, asesoría dietética con el nutriólogo (semanal los primeros 3 meses y luego mensual) y 12 sesiones grupales en un protocolo de cambio de conducta. El grupo control incluyó solamente las consultas médicas mensuales. La sensibilidad a la insulina se estimó por el índice de sensibilidad a la insulina (ISI(0,120)) al inicio y a los 6 meses de intervención. Los niños y adolescentes del programa intensivo mostraron un mayor efecto en la sensibilidad a la insulina a los 6 meses en comparación al grupo control ([media ± DE], + 46.8 ± 56 vs. + 5.6 ± 47, diferencia 41.2 [IC 95%, 8.5, 73.9], p= 0.01) y 65% lograron aumentar la sensibilidad a la insulina >9 unidades vs. 32% en el grupo control (p=0.03). Este estudio muestra evidencia preliminar que un programa intensivo de cambio en el estilo de vida puede ser un modelo alternativo para mejorar la sensibilidad a la insulina en los niños y adolescentes con obesidad en el primer nivel de atención.

Improvement of insulin sensitivity after an intensive lifestyle program for youth´s weight management in the primary care. The aim of this study was to evaluate an intensive lifestyle intervention for weight management among youth in a primary care setting on insulin sensibility, compared to a control group. The study included 42 youths 9-17 years old (n=23 intensive lifestyle intervention, n=19 control group) who completed a randomized trial for weight management in a primary care setting which included an oral glucose tolerance test. The intensive lifestyle intervention included monthly consultations with the primary care physician, nutrition counseling with a registered dietitian (weekly first 3 months and then monthly) and 12 group sessions in a behavioral change protocol. The control group attended monthly consultations with the primary care physician. Insulin sensitivity was estimated by the Insulin Sensitivity Index ISI(0,120) at baseline and 6 months posttreatment. At 6 months, the mean ± DE, increase in insulin sensitivity was greater in the intensive lifestyle intervention than the control group (+46.8 ± 56 vs. +5.6 ± 47, betweengroup difference 41.2 [CI 95%, 8.5, 73.9], p= 0.01). Sixty five percent of youths on the intensive lifestyle intervention increased insulin sensitivity over 9 units vs. 32% in the control group (p=0.03). This study shows preliminary evidence that an intensive lifestyle intervention program can be an alternative model to improve insulin sensitivity among youths in the primary care setting.

Uso de programas de terapia cognitivo conductual computarizada para la prevención y tratamiento de depresión en adolescentes / Use of computerized cognitive behavioral therapy programs for the prevention and treatment of depression in adolescents

La terapia cognitivo conductual computarizada (TCC-c) ha demostrado ser efectiva en depresión en adultos. En adolescentes la investigación en esta área es aún limitada. El objetivo de este trabajo es revisar la literatura sobre el uso de programas de TCC-c para la prevención y tratamiento de depresión en adolescentes. Se realizó una búsqueda en las bases de datos PubMed, LILACS y SciELO. Diez estudios que corresponden a seis diferentes programas fueron analizados. Los programas varían en extensión y grado de contacto con los profesionales. En general, los estudios reportaron buena aceptabilidad y reducción de la sintomatología depresiva. Sin embargo, en su mayoría hubo una alta tasa de abandono. La evidencia preliminar sugiere que la TCC-c es una alternativa útil en la prevención y tratamiento de la depresión en adolescentes. Faltan estudios que apunten a mejorar la adherencia y eficacia de programas con TCC-c.

Computerized cognitive behavioral therapy (cCBT) is a demonstrated effective therapy for depression in the adult population. In the adolescent population, however, little research has been done. The objective of this study is to review the literature about the use of cCBT programs to prevent and treat depression in adolescents. A search was done in the databases PubMed, LILACS, and SciELO. In the end, ten studies, corresponding to six different programs, were analyzed. The programs varied in length and degree of contact with professionals. In general, the studies reported good acceptance and reduced depressive symptomatology; however, the majority of the studies had a high rate of dropouts. Preliminary evidence suggests that cCBT is a useful alternative in the prevention and treatment of depression in adolescents, but additional studies must be done to show improved cCBT program adherence and efficacy.