Resiliência e Mecanismos de Defesa em Pacientes com Câncer em Quimioterapia Ambulatorial / Resilience and Defense Mechanisms in Patients with Cancer Outpatient Chemotherapy / Resiliencia y Mecanismos de Defensa en Pacientes con Cáncer en Quimioterapia Ambulatorial

Introdução: A capacidade de enfrentamento de situações adversas, que é definida como resiliência, auxilia o paciente a superar as dificuldades do tratamento. Entretanto, ainda são poucos os estudos que avaliam a resiliência em pacientes com câncer que realizam quimioterapia ambulatorial. Objetivo: Avaliar a resiliência de pacientes com câncer em tratamento quimioterápico ambulatorial e verificar a correlação com os mecanismos de defesa, sintomas depressivos e de ansiedade. Método: Estudo observacional, de correlação e prospectivo, com pacientes com diagnóstico de câncer, de ambos os sexos, maiores de 18 anos, alfabetizados e em início de tratamento com quimioterapia ambulatorial. Os seguintes instrumentos foram aplicados no primeiro dia de tratamento quimioterápico e após 30 a 45 dias: Escala de Resiliência, Defense Style Questionnaire (DSQ-40), Inventário de Depressão de Beck e Inventário de Ansiedade de Beck. Resultados: Um total de 55 participantes foi incluído, sendo 32 (58%) do sexo feminino, com média e desvio-padrão (DP) de idade de 54,1 (DP=12,2) anos. Os diagnósticos mais frequentes foram câncer colorretal, 15 (27%) e câncer de mama, 12 (22%). Observou-se correlação negativa significativa entre sintomas depressivos e de ansiedade com os níveis de resiliência tanto na primeira (p<0,001) como na segunda avaliação (p<0,05). Os mecanismos de defesa maduros (humor e racionalização) apresentaram correlação positiva significativa e os imaturos (atuação e cisão) demonstraram correlação negativa. Conclusão: Os resultados confirmaram que a maior capacidade de resiliência se correlaciona com o uso de mecanismos de defesa adaptativos e com menores níveis de sintomas depressivos e de ansiedade em pacientes durante a quimioterapia ambulatorial

Introduction: The ability to cope with adverse situations, defined as resilience, helps patients to overcome difficulties in their treatment. However, there are still few studies assessing resilience in cancer patients undergoing outpatient chemotherapy. Objective: To assess resilience in cancer patients undergoing outpatient chemotherapy and to verify its correlation with defense mechanisms, as well as with symptoms of depression and anxiety. Method: Observational, correlational and prospective study with patients of both sexes, diagnosed with cancer, over 18 years old, literate and beginning treatment with outpatient chemotherapy. The following instruments were applied on the first day of chemotherapy treatment and then again after 30 to 45 days: Resilience Scale, Defense Style Questionnaire (DSQ-40), Beck's Depression Inventory and Beck's Anxiety Inventory. Results: A total of 55 participants were included in the study, 32 (58%) of which were female, with an average age and standard deviation (SD) of 54.1 (SD=12.2) years. The most frequent diagnoses were colorectal cancer, 15 (27%) and breast cancer, 12 (22%). There was a significant negative correlation between symptoms of depression or anxiety and resilience levels both in the first (p<0.001) and in the second evaluation (p<0.05). Mature defense mechanisms (mood and rationalization) showed a significant positive correlation with resilience, while immature ones (performance and split) showed a negative correlation. Conclusion: The results confirmed that a greater capacity for resilience correlates with the use of adaptive defense mechanisms and with lower levels of depressive symptoms and anxiety in patients while receiving outpatient chemotherapy

Introducción: La capacidad de afrontar situaciones adversas, que se define como resiliencia, ayuda al paciente a superar las dificultades del tratamiento. Sin embargo, todavía hay pocos estudios que evalúen la resiliencia en pacientes con cáncer sometidos a quimioterapia ambulatoria. Objetivo: Evaluar la resiliencia de los pacientes oncológicos sometidos a quimioterapia ambulatoria y verificar la correlación con los mecanismos de defensa y con síntomas depresivos o de ansiedad. Método: Estudio observacional, correlacional y prospectivo con pacientes de ambos sexos, diagnosticados con cáncer, mayores de 18 años, alfabetizados e iniciando tratamiento con quimioterapia ambulatoria. Los siguientes instrumentos se aplicaron el primer día de tratamiento de quimioterapia y otra vez después de 30 a 45 días: Escala de resiliencia, Cuestionario de estilo de defensa (DSQ-40), Inventario de depresión de Beck e Inventario de ansiedad de Beck. Resultados:Se incluyeron 55 participantes en la investigación, 32 (58%) de los cuales eran mujeres, con una edad promedio y desviación estándar (DE) de 54,1 (DE=12,2) años. Los diagnósticos más frecuentes fueron cáncer colorrectal, 15 (27%) y cáncer de mama, 12 (22%). Se encontró una correlación negativa significativa entre síntomas depresivos o de ansiedad y los niveles de resiliencia tanto en la primera (p<0,001) como en la segunda evaluación (p<0,05). Los mecanismos de defensa maduros (estado de ánimo y racionalización) mostraron una correlación positiva significativa y los inmaduros (rendimiento y división) mostraron una correlación negativa. Conclusión: Los resultados confirmaron que una mayor capacidad de resiliencia se correlaciona con el uso de mecanismos de defensa adaptativos y con menores niveles de síntomas depresivos y ansiedad en pacientes durante la quimioterapia ambulatoria

Anxiety Sensitivity and Panic Disorder: Evaluation of the Impact of Cognitive-Behavioral Group Therapy.

Anxiety sensitivity (AS) is a multidimensional construct associated with the etiology and maintenance of panic disorder (PD) symptoms. However, only a few studies have evaluated whether cognitive-behavioral group therapy (CBGT) can modify the condition. The objective of this study was to evaluate the impact of CBGT on AS in patients with PD and to analyze AS and its dimensions as predictors of response to CBGT. In the present clinical trial, an intervention group (n = 37) attended 12 CBGT sessions, while a control group (n = 52) did not receive any intervention. The severity of symptoms and of AS were evaluated before and after CBGT in the intervention group and once in the control group. Significant improvement occurred in all specific PD symptoms and in general anxiety and depressive symptoms. Furthermore, AS scores reduced significantly after intervention. This study confirmed that AS is higher in patients with more severe PD. The effectiveness of CBGT for reducing the physical, cognitive, and social dimensions of AS was also observed, supporting the hypothesis of a positive impact of therapy.

Tradução, adaptação e avaliação das propriedades psicométricas da Arousal Predisposition Scale em crianças e adolescentes / Translation, adaptation and evaluation of the psychometric properties of the Arousal Predisposition Scale in children and adolescents / Traducción, adaptación y evaluación de las propiedades psicométricas de la Arousal Predisposition Scale en niños y adolescentes

A Arousal Predisposition Scale (APS) é um instrumento com 12 itens, elaborado para mensurar o nível de arousal de um indivíduo. O termo arousal, traduzido para o português falado no Brasil, significa excitação, isto é, a resposta do organismo frente a um estímulo externo ou estresse ambiental. A escala visa abordar o arousal como uma predisposição ou característica individual de excitação diante de um estressor ambiental. O objetivo deste estudo foi realizar tradução, adaptação e avaliação das propriedades psicométricas da APS para crianças e adolescentes. O estudo foi realizado com 189 alunos, de ambos os sexos, de escolas públicas, com idade entre 10 e 17 anos. A pesquisa foi dividida em duas etapas: a primeira foi a adaptação transcultural e a segunda etapa envolveu a avaliação das propriedades psicométricas da versão final. Os resultados apresentaram uma consistência interna dos itens aceitável para os grupos pré-adolescentes e adolescentes (alfa de Cronbach > 0,700). Não houve diferença significativa entre a escala total em médias de teste-reteste e uma correlação significativa de moderada a forte de validade de critério. A APS foi traduzida, adaptada e validada no Brasil para o grupo etário de 11 anos de idade. Destaca-se ainda a importância da utilização dessa escala por diferentes setores de saúde e da educação, em escolas de ensino fundamental e médio, contribuindo para identificar precocemente problemas de comportamento.

Arousal Predisposition Scale (APS) is a 12-item instrument designed to measure the arousal level of an individual. Translated into Brazilian Portuguese arousal means excitement, that is, the body's response to an external stimulus or environmental stress. The scale aims to address arousal as a predisposition or individual characteristic of excitement when facing an environmental stressor. Hence, this study sought to translate, adapt, and evaluate the psychometric properties of the APS for children and adolescents. Data was collected from 189 students, of all genders, from public schools, aged 10 to 17 years. The research was divided into two stages: first, the cross-cultural adaptation, followed by the evaluation of the psychometric properties in the final version. Results showed an acceptable internal consistency of the items for the pre-adolescent and adolescent groups (Cronbach's alpha > 0.700). The findings presented no significant difference between full-scale test-retest means and a significant moderate to strong correlation of criterion validity. The APS was translated, adapted and validated in Brazil for the 11-year-old age group. APS should be used by different health and education sectors in primary and secondary schools to help identify early behavioral problems.

La Arousal Predisposition Scale (APS) es un instrumento que consta de 12 ítems para estimar el nivel de arousal de un individuo. El término arousal significa excitación en portugués de Brasil, es decir, una respuesta del organismo frente a un estímulo externo o estrés ambiental. La escala pretende abordar el arousal como una predisposición o característica individual de excitación frente a un estrés ambiental. El objetivo de este estudio fue realizar la traducción, la adaptación, la evaluación y la valoración de las propiedades psicométricas de la APS para niños y adolescentes. Se realizó un estudio con 189 alumnos, de ambos sexos, de escuelas públicas, con edades de entre los 10 y 17 años. La investigación constó de dos etapas: la primera realizó la adaptación transcultural; y la segunda, la evaluación de las propiedades psicométricas de la versión final. Los resultados mostraron una consistencia interna de los ítems aceptable para los grupos de preadolescentes y adolescentes (alfa de Cronbach > 0,700). No hubo diferencias significativas entre la escala total en las medias de prueba-reprueba y una correlación significativa de moderada a fuerte como validez de criterio. Se realizó la traducción, la adaptación y la validación de la APS en Brasil para el grupo de edad de los 11 años. Se señala la importancia de la utilización de esta escala para los diferentes sectores de salud y de la educación, en la primaria y la secundaria, al contribuir a la identificación de problemas de comportamiento.

Brief antibullying intervention for adolescents in public schools.

OBJECTIVES: To assess the results of a brief antibullying intervention for adolescents in public schools. METHOD: This was a controlled experimental study whose subjects were 1,043 students in 5th through 9th grades from public schools in Porto Alegre/State of Rio Grande do Sul, conducted between April and November 2015. Adolescents and school teachers randomly assigned to the intervention group participated in two meetings focused on educative aspects of bullying. Outcome was assessed using the Bullying Questionnaire - victim and perpetrator version. Generalized Estimating Equations was used to evaluate the effect of the intervention. RESULTS: Average age of subjects was 12.5 (SD=1.62) years. A total of 613 (58.7%) adolescents participated in interventions. They were compared to 430 (41.3%) participants in the control group. The study did not observe any significant difference in bullying scores after the intervention. CONCLUSIONS: This study indicates the usefulness of clarifying precisely what bullying is in schools as part of an initial approach to an educative strategy on this topic.

Results of the Nursing Outcomes Classification/NOC for patients with obsessive-compulsive disorder.

OBJECTIVE: To analyze the application of nursing outcomes and indicators selected from the Nursing Outcomes Classification (NOC) to evaluate patients with obsessive-compulsive disorder (OCD) in outpatient follow-up. METHOD: Outcome-based research. First, a consensus was achieved between nurses specialized in mental health (MH) and in the nursing process to select NOC-related outcomes and indicators, followed by the elaboration of their conceptual and operational definitions. Then, an instrument was created with these, which was tested in a pilot group of six patients treated at a MH outpatient clinic. The instrument was applied to patients with OCD undergoing Group Cognitive Behavioral Therapy (GCBT). The study was approved by the Research Ethics Committee of the institution. RESULTS: Four NOC outcomes and 17 indicators were selected. There was a significant change in the scores of nine indicators after CBGT. CONCLUSION: The study showed feasibility for evaluating symptoms of patients with OCD through NOC outcomes and indicators in an outpatient situation.

Brief antibullying intervention for adolescents in public schools / Intervención breve antibullying para adolescentes en escuelas públicas / Intervenção breve antibullying para adolescentes em escolas públicas

ABSTRACT Objectives: To assess the results of a brief antibullying intervention for adolescents in public schools. Method: This was a controlled experimental study whose subjects were 1,043 students in 5th through 9th grades from public schools in Porto Alegre/State of Rio Grande do Sul, conducted between April and November 2015. Adolescents and school teachers randomly assigned to the intervention group participated in two meetings focused on educative aspects of bullying. Outcome was assessed using the Bullying Questionnaire - victim and perpetrator version. Generalized Estimating Equations was used to evaluate the effect of the intervention. Results: Average age of subjects was 12.5 (SD=1.62) years. A total of 613 (58.7%) adolescents participated in interventions. They were compared to 430 (41.3%) participants in the control group. The study did not observe any significant difference in bullying scores after the intervention. Conclusions: This study indicates the usefulness of clarifying precisely what bullying is in schools as part of an initial approach to an educative strategy on this topic.

RESUMEN Objetivos: Evaluar los resultados de una intervención breve antibullying para adolescentes de escuelas públicas. Método: Se trata de estudio experimental controlado, con 1.043 estudiantes del 5º al 9º año de escuelas públicas de Porto Alegre/RS, realizado entre abril y noviembre de 2015. Los adolescentes y los profesores de las escuelas sorteados para el grupo la intervención participaron de dos encuentros con enfoque en aspectos educativos sobre bullying. Los demás adolescentes participaron del grupo control. El resultado se evaluó utilizando Bullying Questionnaire versión para víctimas y la versión para agresores. Se utilizaron Generalized Estimating Equations para evaluar el efecto de la intervención. Resultados: El promedio de edad fue de 12,5 (DP=1,62) años. Un total 613 (58,7%) adolescentes recibieron la intervención y fueron comparados con 430 (41,3%) participantes del grupo control. No se observó diferencia significativa en los resultados de bullying después de la intervención. Conclusiones: Los resultados indican la utilidad de aclarar en las escuelas precisamente que es el bullying, como una estrategia educativa inicial sobre el tema.

RESUMO Objetivos: Avaliar os resultados de uma intervenção breve antibullying para adolescentes de escolas públicas. Método: Estudo experimental controlado, com 1.043 estudantes do 5º ao 9º ano de escolas públicas de Porto Alegre/RS, realizado entre abril e novembro de 2015. Os adolescentes e os professores das escolas sorteados para o grupo intervenção participaram de dois encontros com foco em aspectos educativos sobre bullying. O desfecho foi avaliado por meio do Questionário de Bullying versão vítima e versão agressor. Utilizou-se o Generalized Estimating Equations para avaliar o efeito da intervenção. Resultados: A média de idade foi de 12,5 (DP=1,62) anos. Um total 613 (58,7%) adolescentes receberam a intervenção e foram comparados com 430 (41,3%) participantes do grupo controle. Não foi observada diferença significativa nos escores de bullying após a intervenção. Conclusões: Os resultados indicam a utilidade de se esclarecer o que é o bullying, como uma estratégia educativa inicial sobre o tema.

Results of the Nursing Outcomes Classification/NOC for patients with obsessive-compulsive disorder / Resultados de la Nursing Outcomes Classification/NOC para pacientes con trastorno obsesivo-compulsivo / Resultados da Nursing Outcomes Classification/NOC para pacientes com transtorno obsessivo-compulsivo

ABSTRACT Objective: To analyze the application of nursing outcomes and indicators selected from the Nursing Outcomes Classification (NOC) to evaluate patients with obsessive-compulsive disorder (OCD) in outpatient follow-up. Method: Outcome-based research. First, a consensus was achieved between nurses specialized in mental health (MH) and in the nursing process to select NOC-related outcomes and indicators, followed by the elaboration of their conceptual and operational definitions. Then, an instrument was created with these, which was tested in a pilot group of six patients treated at a MH outpatient clinic. The instrument was applied to patients with OCD undergoing Group Cognitive Behavioral Therapy (GCBT). The study was approved by the Research Ethics Committee of the institution. Results: Four NOC outcomes and 17 indicators were selected. There was a significant change in the scores of nine indicators after CBGT. Conclusion: The study showed feasibility for evaluating symptoms of patients with OCD through NOC outcomes and indicators in an outpatient situation.

RESUMEN Objetivo: Evaluar la aplicación de resultados e indicadores de enfermería seleccionados en la Nursing Outcomes Classification (NOC) para examinar a los pacientes con Trastorno Obsesivo-Compulsivo (TOC) en seguimiento ambulatorio. Método: Investigación de resultados. Primeramente, se realizó un acuerdo entre enfermeros expertos en salud mental (SM) y en proceso de enfermería para seleccionar los resultados e indicadores de la NOC, seguido de la elaboración de sus definiciones conceptuales y operativas. Después, se construyó un instrumento con las informaciones recolectadas, y lo aplicaron a un grupo piloto con seis pacientes, que recibían atención en el ambulatorio de SM. Se aplicó el instrumento a los pacientes con TOC, sometidos a Terapia Cognitivo-Conductual en Grupo (TCCG). Estudio aprobado por el Comité de Ética en Investigación de la institución. Resultados: Se seleccionaron cuatro resultados y 17 indicadores NOC. Se observó una modificación significativa de los puntajes de nueve indicadores después de la TCCG. Conclusión: El estudio apuntó la viabilidad de evaluación de los síntomas de pacientes con TOC por medio de los resultados e indicadores de la NOC en el ámbito ambulatorio.

RESUMO Objetivo: Analisar a aplicação de resultados e indicadores de enfermagem selecionados na Nursing Outcomes Classification (NOC) para avaliar pacientes com Transtorno Obsessivo-Compulsivo (TOC) em acompanhamento ambulatorial. Método: Pesquisa de resultados. Primeiro, realizou-se consenso entre enfermeiros especialistas em saúde mental (SM) e em processo de enfermagem para seleção de resultados e indicadores da NOC, seguido da elaboração das suas definições conceituais e operacionais. Depois, construiu-se um instrumento com estes, que foi testado em grupo piloto de seis pacientes atendidos em ambulatório de SM. O instrumento foi aplicado aos pacientes com TOC submetidos a Terapia Cognitivo-Comportamental em Grupo (TCCG). Estudo aprovado pelo Comitê de Ética em Pesquisa da instituição. Resultados: Foram selecionados quatro resultados e 17 indicadores NOC. Observou-se modificação significativa dos escores de nove indicadores após a TCCG. Conclusão: O estudo apontou viabilidade de avaliação dos sintomas de pacientes com TOC através dos resultados e indicadores da NOC em cenário ambulatorial.

Resilience and coping strategies in cognitive behavioral group therapy for patients with panic disorder.

BACKGROUND: Although resilience and coping are important factors associated with mental health, they are rarely investigated in the treatment of patients with panic disorder (PD). OBJECTIVE: To evaluate the response to four resilience and coping strategy sessions added to the standard cognitive behavioral group therapy (CBGT) protocol for PD. DESIGN: Controlled clinical trial. METHODS: The control group (n = 50) attended 12 CBGT sessions, while the intervention group (n = 50) received four additional resilience and coping strategy sessions, i.e., 16 in total. Symptom severity, resilience, coping strategies, and quality of life were assessed at baseline and post-CBGT. RESULTS: Symptom severity and maladaptive coping strategies decreased significantly in both groups. However, the intervention group had increased resilience and improvement in the environment domain of quality of life. CONCLUSIONS: Additional sessions have potential benefits for coping skills and resilience in PD patients, but these benefits should be evaluated in further long-term studies.

Can Religious Coping and Depressive Symptoms Predict Clinical Outcome and Quality of Life in Panic Disorder? A Brazilian Longitudinal Study.

Few studies have investigated the relationship between spiritual/religious coping (S/R coping) and panic disorder (PD). This Brazilian longitudinal study evaluated if S/R coping and depressive symptoms can predict PD remission and improved quality of life (QoL). There were 101 outpatients with PD who were followed up for 12 to 16 weeks. The prevalence ratio (PR) between positive S/R coping and negative S/R coping and PD remission was assessed, as well as the association between positive S/R coping and negative S/R coping and QoL. After adjusting for confounding factors, positive S/R coping presented an inverse PR with PD remission, which was not statistically significant (0.88; p = 0.075). There was no association between S/R coping and QoL. Depressive symptoms were negatively associated with PD remission (PR = 0.97; p < 0.01) and were not predictive of a better QoL.

Respiratory subtype of panic disorder: Can serum phosphate levels be a possible outcome to group cognitive-behavior therapy?

OBJECTIVE: Panic disorder (PD) respiratory subtype (RS) was described in order to cluster patients according to their symptoms. These patients are characterized by experiencing a relatively high number of noticeable respiratory symptoms during a panic attack (PA) and a higher reactivity to CO2. In this study, we aimed to evaluate the clinical relevance of this diagnostic category, evaluating if there are different responses to cognitive-behavioral therapy in patients with panic disorder RS as compared to those with the non-respiratory subtype (NRS), using serum phosphate as a biological marker. METHODS: Patients were assessed by a clinical interview followed by a structured diagnostic interview (M.I.N.I) and classified as RS or NRS based on symptoms. The severity of PD was evaluated throughout the PDSS, CGI, HAM-A, STAI and the BDI rating scales. All patients underwent 12 structured sessions of group-CBT for PD and had their blood collected at baseline and after treatment to assess phosphate levels. RESULTS: One hundred and thirty-eight patients have been assessed, and 102 were included in this trial. Sixty-nine patients completed the treatment protocol, 42 were classified as RS and 27 as NRS. Both RS and NRS patients improved in all clinical scales (p < 0.001). The mean phosphate levels increased from 2.44 mg/dl ±â€¯0.49 at baseline to 3.38 mg/dl ±â€¯0.52 (p < 0.01) in the RS group as well as from 2.46 mg/dl ±â€¯0.64 at baseline to 3.46 mg/dl ±â€¯0.61 (p < 0.01) in the NSR group. LIMITATIONS: Small sample size and the lack of assessment of other clinical and physiological parameters, such as respiratory variables. CONCLUSION: Our findings suggest that both RS and NRS benefit from group CBT and that there was a change in phosphate levels after effective treatment in both groups. Our data support the idea that there is a reversal of the conditions that promote hypophosphatemia as chronic hyperventilation after CBT treatment, whereas it is in disagreement to the presence of two different PD subtypes based on phosphate levels once their rates did not differ at baseline and had a similar increase after effective treatment.

Contribution of Group Therapeutic Factors to the Outcome of Cognitive-Behavioral Therapy for Patients with Panic Disorder.

BACKGROUND: Investigating the contribution of therapeutic factors arising from the collective nature or group therapy to treat mental disorders may help therapists maximize the outcome of therapy. Studies about the role of therapeutic factors in cognitive-behavioral group therapy (CBGT) for panic disorder (PD) patients are still scarce. OBJECTIVES: To identify the therapeutic factors rated as the most useful by patients during CBGT. Also, we aimed to investigate the relationship between patient rating of therapeutic factors and specific stages of CBGT. DESIGN: Non-controlled clinical trial. METHODS: A 12-session CBGT protocol was set up, covering psychoeducation, techniques for anxiety coping, cognitive restructuring, interoceptive and naturalistic exposure, and live exposure to avoidant behavior. PD symptom severity was assessed before and after the CBGT protocol. Yalom's Curative Factors Questionnaire was self-administered at the end of each session to evaluate the 12 therapeutic factors. RESULTS: The sample consisted of 16 patients, who produced 192 assessments of therapeutic factors. Severity of symptoms improved at the end of CBGT, with a large effect size (>1.0). Different ratings were attributed to therapeutic factors at different phases of CBGT. Seven factors were rated as significantly helpful: altruism, interpersonal learning/input, guidance, identification, family reenactment, self-understanding, and existential factors. CONCLUSIONS: Therapeutic factors are dynamic and interdependent. Therefore, recognizing the impact of these factors during CBGT may potentially contribute to a better understanding of the therapeutic process.

Obsessive-compulsive disorder and family accommodation: A 3-year follow-up.

The present study assessed 3-year maintenance of family accommodation (FA) reduction in a sample from a randomized clinical trial that assessed the impact of 12 sessions of cognitive-behavioral group therapy (CBGT) for obsessive-compulsive disorder (OCD), with the involvement of family members in two sessions. Of the 46 original pairs of patients/family members, 35 were assessed at 3 years. Demographic and clinical characteristics remained similar. Post-CBGT improvement of OCD symptoms remained significant; FA reduced 39% after the therapy and 51% at follow-up. FA reduction remained over time, underscoring the importance of permanently assessing FA and involving family members when treating OCD.

Nursing Outcomes for the Evaluation of Patients During Smoking Cessation.

OBJECTIVES: To select outcomes of the Nursing Outcomes Classification (NOC) and develop operational definitions for their indicators in order to evaluate patients during smoking cessation. METHODS: A consensus study among experts, involving eight nurses. A 100% consensus was required to select the outcomes. Operational definitions were developed based on the literature. RESULTS: Two outcomes were selected, Smoking Cessation Behavior (1625)-with nine indicators, and Substance Withdrawal Severity (2108)-with 11 indicators, for which we developed operational definitions. CONCLUSIONS: Consensus allowed the selection of NOC outcomes and indicators, which will allow us to evaluate patients during smoking cessation using a standardized classification. IMPLICATIONS FOR NURSING PRACTICE: A standardized classification provides a more qualified evaluation of patients during smoking cessation.

Adaptação transcultural do Inventory of Callous-Unemotional Traits para avaliação de traços de insensibilidade e afetividade restrita de adolescentes no Brasil / Adaptación transcultural del Inventory of Callous-Unemotional Traits para evaluación de trazos de insensibilidad y afectividad restricta de adolescentes en Brasil / Cross-cultural adaptation of the Inventory of Callous-Unemotional Traits for evaluation of callous-unemotional traits in Brazilian adolescents

RESUMO Objetivo Realizar a adaptação transcultural para o português brasileiro do instrumento Inventory of Callous-Unemotional Traits (ICU) para avaliação de traços de insensibilidade e afetividade restrita de adolescentes. Método Estudo metodológico que envolveu as etapas de tradução, retradução, avaliação por comitê de especialistas e de clareza da versão pré-final do ICU, avaliado por 40 adolescentes, entre 10 e 17 anos, de ambos os sexos, de uma escola pública. Resultados A versão pré-final do ICU foi aprovada pelo comitê de especialistas e pelo autor do instrumento. A avaliação da clareza revelou uma boa compreensão dos itens. Os 10 itens com menor clareza foram modificados conforme as sugestões. Conclusão A versão final do ICU para o português brasileiro mostrou ser similar ao instrumento original no que se refere à equivalência semântica, operacional e conceitual. Recomenda-se a realização de estudos que evidenciem a validade psicométrica do ICU adaptado para o português brasileiro.

RESUMEN Objetivo Realizar la adaptación transcultural para el portugués brasileño del instrumento Inventory of Callous-Unemotional Traits (ICU) para evaluación de trazos de insensibilidad y afectividad restricta de adolescentes. Método Estudio metodológico que abarcó las etapas de traducción, re-traducción, evaluación por comité de expertos y de claridad de la versión pre-final del ICU, evaluado por 40 adolescentes, entre 10 y 17 años, de ambos los sexos, de una escuela pública. Resultados La versión pre-final del ICU ha sido aprobada por el comité de expertos y por el autor del instrumento. La evaluación mostró claramente una buena comprensión de los ítems. Sin embargo, 10 ítems con menos claridad se modificaron como sugerencias. Conclusión La versión final del ICU para el portugués brasileño resultó ser similar a la del instrumento original en lo relativo a la semántica, operacional, así como la equivalencia conceptual. Se recomiendan estudios que revelen la validez psicométrica del ICU adaptado para el portugués brasileño.

ABSTRACT Objective To perform the cross-cultural adaptation of the Inventory of Callous-Unemotional Traits (ICU) for Brazilian Portuguese to evaluate callous-unemotional traits in Brazilian adolescents. Method A methodological study involving the stages of translation, back-translation, expert committee review and assessment of the clarity of the pre-final version of the ICU, tested by 40 adolescents aged 10-17 years, of both sexes, attending a public school. Results The pre-final version of the ICU was approved by the expert committee and by the original developer of the questionnaire. The assessment of clarity showed good understanding of questionnaire items. Ten items found to be the least clear were modified according to the suggestions of the respondents. Conclusion The final Brazilian Portuguese version of the ICU proved to be similar to the original instrument regarding semantic, experiential and conceptual equivalence. Further studies are warranted to evaluate the psychometric properties of the adapted Brazilian Portuguese version of the ICU.

Impact of cognitive-behavioral group therapy for obsessive-compulsive disorder on family accommodation: A randomized clinical trial.

The aim of this study was to assess the impact of cognitive-behavioral group therapy (CBGT) with the brief involvement of family members on family accommodation and to identify predictors of family accommodation reduction (patient and family member characteristics). This randomized clinical trial assessed 98 pairs of patients with obsessive-compulsive disorder (OCD) and their family members: 52 (53.1%) were allocated to the intervention group (12 CBGT sessions - two with the family member), and 46 (46.9%) to a waiting list (control group). Symptom severity and family accommodation were assessed before and after CBGT. There was significant improvement of OCD symptoms and family accommodation scores after CBGT in the intervention group vs. the control group. The following variables were significant predictors of family accommodation reduction after multivariate analysis: patient characteristics - absence of comorbid unipolar disorder, lower obsession score, and higher education level; family member characteristics - higher hoarding score. The model explained 47.2% of the variance in family accommodation scores after treatment. CBGT for patients with OCD and the brief involvement of family members contributed to reduce family accommodation. Both patient and family member characteristics were predictors of family accommodation reduction. This finding can help qualify CBGT protocols.

Patient Rating of Therapeutic Factors and Response to Cognitive-Behavioral Group Therapy in Patients with Obsessive-Compulsive Disorder.

Group therapy involves complex mechanisms that rely on certain therapeutic factors to promote improvement. The objective of this study was to assess patient rating of therapeutic factors during cognitive-behavioral group therapy (CBGT) and to investigate the correlation between patient rating and outcome of CBGT for the treatment of obsessive-compulsive disorder (OCD). In the present clinical trial, 15 patients participated in a 12-session CBGT protocol. Severity of symptoms was assessed before and after CBGT with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression (CGI), Hamilton Anxiety Scale (HAM-A), and Beck Depression Inventory (BDI). Yalom's Curative Factors Questionnaire was administered at the end of each session for patient rating of the usefulness of 12 therapeutic factors to treat OCD. There was a significant interaction between improvement in obsessive-compulsive symptoms and patient rating of altruism, universality, interpersonal learning input and output, family re-enactment, self-understanding, and existential factors over time. The results show that group therapeutic factors positively influence the response to CBGT in OCD patients.

Construct validity and reliability of Olweus Bully/Victim Questionnaire ­ Brazilian version

Abstract The Revised Olweus Bully/Victim Questionnaire (OBVQ) is among the few bullying assessment instruments with well-established psychometric properties in different countries. Nevertheless, the psychometric properties of the Brazilian version (Questionário de Bullying de Olweus - QBO) have not been determined. We aimed at verifying the construct validity and reliability of the bully and victim scales of the QBO. To achieve that goal, the victim and bully scales were assessed using polytomous item response theory (IRT). The best fit was obtained with a generalized partial credit model that is capable of measuring the specific discriminating power for each item in these scales. The QBO was administered to 703 public school students (mean age: 13 years; standard deviation = 1.58). Based on IRT analysis, the number of response categories in each item was reduced from four to three. Cronbach reliability scores were satisfactory: α = 0.85 (victim scale) and α = 0.87 (bully scale). In this study, hurtful comments, persecution, or threats had high power to discriminate victims and bullies. For both QBO scales, higher severity parameters were observed for direct bullying items. The results also show that the construct of both QBO scales measures the same construct proposed for the overall instrument. Thus, the QBO can be administered to different Brazilian populations to assess the main characteristics of bullying: repetition of behavior over time and intentionally acting to humiliate, threaten, or harm somebody. (AU)

Temperamento e Caráter na Resposta à Terapia Cognitivo-Comportamental para Transtorno de Pânico / Temperament and Character in Response to Cognitive-Behavioral Therapy for Panic Disorder

RESUMO O estudo investigou o impacto das características de temperamento e caráter na resposta à terapia cognitivo-comportamental (TCC) para pacientes com transtorno de pânico (TP). Um total de 55 pacientes realizou 12 sessões de TCC em grupo (TCCG). A gravidade dos sintomas foi verificada antes e após a intervenção, e o Inventário de Temperamento e Caráter de Cloninger foi aplicado no início do tratamento. Observou-se uma redução significativa na gravidade do TP após a intervenção. Análises de regressão indicaram que as características de temperamento (persistência) e caráter (autodirecionamento e cooperatividade) não se mostraram significativamente relacionadas à melhora da agorafobia e de sintomas depressivos, permanecendo a gravidade inicial desses sintomas como fatores independentes de resposta à TCCG.

ABSTRACT This study investigated the impact of temperament and character traits on the response to cognitive-behavioral therapy (CBT) of patients with panic disorder (PD). A total of 55 patients underwent 12 sessions of CBT in group (CBGT). Symptom severity was assessed before and after the intervention and the Cloninger's Temperament and Character Inventory was applied before CBGT. A significant reduction in the severity of the PD severity of the patients after the intervention was observed. Regression analysis indicated that characteristics of temperament (persistence) and character (self-directedness and cooperativeness) were not significantly related to the improvement of agoraphobia and depression, leaving the initial severity of these symptoms as independent factors of response to CBGT.

Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated (FAS-IR), Brazilian Portuguese version: internal consistency, reliability, and exploratory factor analysis.

OBJECTIVE: To examine the psychometric properties of the Brazilian Portuguese version of the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated (FAS-IR). METHOD: A total of 114 family members of patients with obsessive-compulsive disorder (OCD) were assessed. The following analyses of the FAS-IR were carried out: internal consistency, inter-rater and test-retest reliability, and exploratory factor analysis. RESULTS: The Brazilian Portuguese version of the FAS-IR showed excellent inter-rater reliability (intraclass correlation coefficient [ICC]=0.94) and acceptable test-retest reliability (ICC=0.77), with no significant differences in FAS-IR scores. Factor analysis produced three factors for the scale. However, factor loadings were not well defined within each factor, and the factors did not have distinct constructs. Thus, a global analysis approach was chosen, revealing good internal consistency of the scale as a whole (Cronbach's α=0.805). CONCLUSIONS: The Brazilian Portuguese FAS-IR showed sound psychometric properties for the evaluation of family accommodation, and is, therefore, a reliable instrument for use in research and clinical practice.