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RESUMO Objetivo: Na prática clínica, é importante diferenciar problema e conflito, porque os passos sugeridos na técnica de resolução de problemas costumam não ser suficientes para auxiliar o cliente a lidar com conflitos. Esta revisão sistemática teve como objetivos: investigar como a terapia cognitivo-comportamental (TCC) pode auxiliar na resolução de problemas e na mediação de conflito; sugerir uma estratégia que favoreça a melhor capacidade de mediar conflitos (QPD). Métodos: Foi realizada uma busca nas bases de dados: PubMed, PsycINFO, Web of Science (ISI) e Scopus. O método prisma foi utilizado, e foram selecionados para leitura na íntegra artigos experimentais. Resultados: Trezentos e sessenta e quatro ensaios clínicos aplicaram a resolução de problemas, apontando a eficácia dessa técnica juntamente com outras estratégias/intervenções da TCC. Livros-guias de TCC: não diferenciam problema e conflito; descrevem detalhadamente passos para resolução de problemas, focando na perspectiva do cliente, no momento presente e no uso da razão lógica; não abordam a mediação de conflitos pela TCC. Sugerimos uma estratégia que pode ajudar na mediação de conflitos: auxiliando na coleta/organização de informações; melhorando a comunicação - empática e assertiva; favorecendo escolhas com o intuito de causar o menor dano possível a todas as partes envolvidas no conflito. Conclusões: Para treinar terapeutas para aplicarem a resolução de problemas, há descrição detalhada dos passos a serem seguidos. Entretanto, para capacitar os terapeutas para mediarem conflitos, práticas clínicas que têm sido frequentemente descritas/utilizadas nas terapias cognitivas contextuais podem ser necessárias: aceitação psicológica, mindfulness , entender valores individuais, vivenciar/considerar a emoção em tomadas de decisão, ativar a compaixão/autocompaixão.
ABSTRACT Objective: It is important to differentiate between problem and conflict in clinical practice, because the steps suggested in the problem-solving technique are usually not enough to help patients deal with conflicts. This systematic review aimed to: investigate how cognitive-behavioral therapy (CBT) can help in problem solving and conflict mediation; suggest a strategy that can improve conflict mediate skills (QPD). Methods: A search was performed in the following databases: PubMed, PsycINFO, Web of science (ISI) and Scopus. Prisma flow diagram was used and experimental articles were selected for full reading. Results: Three hundred and sixty four clinical trials applied problem solving, showing the effectiveness of this technique with other CBT strategies/interventions. CBT guide books: do not differentiate between problem and conflict; describe in detail problem solving steps, focusing on the customer's perspective, the present moment and the use of logical reason; do not explore conflict mediation in the CBT. We suggest a strategy that can help in the mediation of conflicts: assisting in the collection/organization of information; improving communication - empathic and assertive; favoring choices that can cause the least possible harm to all parties in the conflict. Conclusions: There is detailed description of the steps to train therapists to apply problem solving. However, to improve therapeutic skills to mediate conflicts, clinical practices that have been frequently described/used in the contextual cognitive behavioral therapies may be necessary: psychological acceptance, mindfulness, understanding personal values, experiencing/considering emotion in decision making, activating compassion/self-compassion.
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Objective: To investigate the reactions of women with driving phobia to a therapeutic program of scheduled virtual reality exposure treatment (VRET) sessions. Methods: The study intervention consisted of a computer game with car-driving scenarios that included several traffic situations. We investigated the participants' sense of presence, subjective distress, and physiological responses during eight virtual-reality exposures. We also evaluated clinical characteristics, driving cognitions, and quality of life in the participants. Results: Thirteen women were selected. Eight were able to complete the protocol. After VRET, there was a decrease in the frequency of distorted thoughts and state anxiety scores, as well as a slight improvement in quality of life. Subjective discomfort scores, heart rate variation, and sense of presence scores confirmed that there was sense of presence in the virtual reality environment. Conclusion: All patients showed some degree of improvement and demonstrated different levels of anxiety in subsequent in vivo driving experiences. Our findings suggest that VRET could be used to facilitate in vivo exposure, because it can induce presence/immersion and reduce anxiety in patients with specific phobia. Furthermore, VRET is not associated with any type of risk.