Cognitive Behavioral Therapy: state of the art, a review / Terapia cognitiva comportamental: estado da arte

Protocols in Cognitive-Behavioral Therapy applied for individual or group for the treatment of anxiety and mood disorders has been found to be effective. Case conceptualization is relevant and essential in Cognitive-Behavioral Therapy because it describes and explains patient presentations in ways that inform interventions. Yet the evidence base challenges the claimed benefits of case conceptualization. A systematic review of the literature has been conducted based on data from ISI Web of Knowledge and PubMed. Articles relating to Cognitive-Behavioral Therapy Protocols in both individual and group therapy procedures were selected. We reviewed 366 articles; we discarded 141, which were not in English, 86, which were reviews and 93 because of inadequate titles. After reading the abstracts a further 18 articles were excluded, leaving 28 to be fully evaluated. Finally, 19 were selected for the final review. These articles that describe Cognitive-Behavioral Therapy treatment for panic disorder, which were effective when patients were also treated by a psychiatrist. Depressive symptoms were only mildly reduced with cognitive therapy in patients seeking the acquisition of coping skills requiring deliberate efforts and reflective thought. Actually, changes in despair thoughts and behaviors require less rumination of negative interpretation of depressive patients. Finally, the Unified Protocol is an efficient procedure for group treatment in cases of generalized anxiety and mood disorders.

Protocolos de Terapia Cognitivo-Comportamental quando aplicados em grupo ou individualmente para tratamento de transtornos de ansiedade e de humor têm eficácia. A conceituação de caso é relevante e essencial na Terapia Cognitivo-Comportamental. Ela tem como função a descrição e explicação da história de vida de cada paciente, favorecendo assim como um guia informativo quanto às escolhas do terapeuta sobre as respectivas intervenções clínicas. Desta forma, o terapeuta ao conceituar o caso tem facilidade em alcançar as metas propostas na terapia com base em evidências. Uma revisão sistemática da literatura foi realizada com base em dados do ISI Web of Knowledge e PubMed. Foram selecionados artigos relativos à Terapia Cognitivo-Comportamental em protocolos terapêuticos individuais e de grupo. Encontramos 366 artigos; descartamos 141 artigos que não estavam em Inglês, 86 que eram revisões e 93 por apresentarem títulos inadequados. Após consulta aos resumos outros 18 artigos foram excluídos, deixando 28 para avaliação do texto integral. Finalmente, 19 foram selecionados para a inclusão. Todos estes artigos relatam tratamento por meio da Terapia Cognitivo-Comportamental. O protocolo para o transtorno do pânico mostra eficácia quando associado ao uso de medicamentos psiquiátricos. Os sintomas depressivos são levemente reduzidos pela Terapia Cognitiva por meio de aquisição das novas habilidades de enfrentamento que exigem esforços na atitude e na reflexão de pensamentos dos pacientes. Na verdade, os pacientes depressivos ruminam menos seus pensamentos quando os interpretam de forma negativa do que nos momentos em que estão completamente sem esperança. Finalmente, o Protocolo Unificado é um procedimento eficiente para o tratamento em grupo ou individual nos transtornos de ansiedade generalizada e de humor.

Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study.

OBJECTIVE: This study aims to investigate the prevalence of psychiatric disorders, i.e., the presence of signs and symptoms of anxiety and depression in type 1 diabetic patients, as well as to investigate the prevalence of psychiatric disorders in insulin dependent patients. METHODS: A cross-sectional observational study of 110 diabetic outpatients (mean = 58.3, SD = 14.5; 50 male and 60 female) was conducted in a public health clinic with patients diagnosed with diabetes mellitus who were under the medical supervision of an endocrinologist. The patients were evaluated through the Mini International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale(HADS). RESULTS: With respect to anxiety symptoms, we found a prevalence of 60% (n = 66) among patients, while in depression symptoms we found a prevalence of 53.6% (n = 59) concerning the 110 patients evaluated. More specifically, we found 28.2% (n = 31) of patients without depression or anxiety, 13.6% (n = 15) of patients with depression, 16.4% (n = 18) of patients with anxiety and 41.8% (n = 46) of patients with depression combined with anxiety. The most remarkable data were generalized anxiety disorder (22.7%), dysthymia (18.2%), panic disorder (8.2%) and social phobia (5.5%). CONCLUSION: The need for accurate assessments about the presence of symptoms related to psychopathology in patients with type 1 diabetes is evident.

Psychiatric comorbidity in diabetes type 1: a cross-sectional observational study / Comorbidade psiquiátrica no diabetes tipo 1: um estudo transversal observacional

Objective This study aims to investigate the prevalence of psychiatric disorders, i.e., the presence of signs and symptoms of anxiety and depression in type 1 diabetic patients, as well as to investigate the prevalence of psychiatric disorders in insulin dependent patients. Methods A cross-sectional observational study of 110 diabetic outpatients (mean = 58.3, SD = 14.5; 50 male and 60 female) was conducted in a public health clinic with patients diagnosed with diabetes mellitus who were under the medical supervision of an endocrinologist. The patients were evaluated through the Mini International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale(HADS). Results With respect to anxiety symptoms, we found a prevalence of 60% (n = 66) among patients, while in depression symptoms we found a prevalence of 53.6% (n = 59) concerning the 110 patients evaluated. More specifically, we found 28.2% (n = 31) of patients without depression or anxiety, 13.6% (n = 15) of patients with depression, 16.4% (n = 18) of patients with anxiety and 41.8% (n = 46) of patients with depression combined with anxiety. The most remarkable data were generalized anxiety disorder (22.7%), dysthymia (18.2%), panic disorder (8.2%) and social phobia (5.5%). Conclusion The need for accurate assessments about the presence of symptoms related to psychopathology in patients with type 1 diabetes is evident. .

Objetivo Elementos relacionados à saúde mental do paciente diabético tipo 1 são encontrados em várias pesquisas. O objetivo desse estudo é avaliar sinais e sintomas depressivos nesse grupo de pacientes, como também investigar as principais prevalências psiquiátricas que os acometem. Métodos Pesquisa realizada em 110 pacientes diabéticos atendidos em ambulatórios (média = 58.3, D = 14.5; 50 masculinos e 60 femininos) conduzida em Postos de Saúde Pública nos momentos de consulta médica com endocrinologista. A avaliação transcorreu com as escalas Mini International Neuropsychiatric Interview and Hospital Anxiety and Depression Scale (HADS). Resultados Os sintomas de ansiedade tiveram prevalência de 60% (n = 66), enquanto para depressão encontramos resultados de 53.6% (n = 59), considerando que 110 pacientes foram avaliados. Mais especificamente, nós encontramos 28,2 (n. 31) pacientes sem depressão ou ansiedade, 13,6 (n. 15) pacientes com depressão, 16,4 pacientes (n. 18) com ansiedade e 41,8 (n. 46) pacientes com depressão combinada com ansiedade. Outros transtornos comórbidos tiveram prevalência de ansiedade generalizada (22,7%), distimia (18,2%), pânico (8,2%) e fobia social (5,5%). Conclusão Sintomas ansiosos e depressivos são comuns em pacientes diabéticos do tipo 1, porém há prevalência de psicopatologias diversas nesse grupo de pacientes, levando em conta novas necessidades de pesquisas futuras para validar protocolos de tratamentos mais adequados para diabéticos do tipo 1. .

Transdiagnostic treatment using a unified protocol: application for patients with a range of comorbid mood and anxiety disorders.

OBJECTIVE: To evaluate the effectiveness of a unified cognitive-behavioral therapy protocol for group treatment of patients with a range of comorbid mood and anxiety disorders. METHODS: In this open-trial study, the unified protocol was followed for the psychotherapeutic treatment of 16 patients with comorbid mood and anxiety disorders, confirmed by the Mini International Neuropsychiatric Interview. Beck Depression and Anxiety Inventories, the World Health Organization Quality of Life evaluation instrument, and the ARIZONA scale of sexual function were used to evaluate progress in patients throughout the therapeutic process. RESULTS: All patients showed unipolar depressive disorder. Comorbidity with anxiety disorders was distributed as follows: generalized anxiety disorder, 13 (81.3%); panic disorder, 3 (18.8%); social anxiety disorder, 1 (6.3%); and post-traumatic stress disorder, 1 (6.3%). Improvement was observed in the signs and symptoms of depression (F = 78.62, p < 0.001) and anxiety (F = 19.64, p < 0.001), overall quality of life (F = 39.72, p < 0.001), physical domain (F = 28.15, p < 0.001)), psychological variables (F = 9.90, p = 0.007), social functioning (F = 36.86, p < 0.001), environmental variables (F = 27.63, p < 0.001), and sexuality (F = 13.13; p < 0.005). All parameters showed highly significant correlations (p < 0.01). CONCLUSION: An effort to establish one unified treatment protocol for a whole family of emotional disorders (primarily mood and anxiety disorders) showed benefits in the field of clinical psychology and for the treatment of patients. No other data were found in the literature describing the implementation of the unified protocol in a transdiagnostic group. Our results revealed statistically significant improvement in all variables, suggesting that the protocol proposed can become an important tool to improve quality of life, sexuality, and anxiety/depression symptoms in patients with different diagnoses.

Transdiagnostic treatment using a unified protocol: application for patients with a range of comorbid mood and anxiety disorders / Tratamento transdiagnóstico utilizando um protocolo unificado: aplicação em pacientes com diferentes transtornos de humor e ansiedade comórbidos

OBJECTIVE: To evaluate the effectiveness of a unified cognitive-behavioral therapy protocol for group treatment of patients with a range of comorbid mood and anxiety disorders. METHODS: In this open-trial study, the unified protocol was followed for the psychotherapeutic treatment of 16 patients with comorbid mood and anxiety disorders, confirmed by the Mini International Neuropsychiatric Interview. Beck Depression and Anxiety Inventories, the World Health Organization Quality of Life evaluation instrument, and the ARIZONA scale of sexual function were used to evaluate progress in patients throughout the therapeutic process. RESULTS: All patients showed unipolar depressive disorder. Comorbidity with anxiety disorders was distributed as follows: generalized anxiety disorder, 13 (81.3%); panic disorder, 3 (18.8%); social anxiety disorder, 1 (6.3%); and post-traumatic stress disorder, 1 (6.3%). Improvement was observed in the signs and symptoms of depression (F = 78.62, p < 0.001) and anxiety (F = 19.64, p < 0.001), overall quality of life (F = 39.72, p < 0.001), physical domain (F = 28.15, p < 0.001)), psychological variables (F = 9.90, p = 0.007), social functioning (F = 36.86, p < 0.001), environmental variables (F = 27.63, p < 0.001), and sexuality (F = 13.13; p < 0.005). All parameters showed highly significant correlations (p < 0.01). CONCLUSION: An effort to establish one unified treatment protocol for a whole family of emotional disorders (primarily mood and anxiety disorders) showed benefits in the field of clinical psychology and for the treatment of patients. No other data were found in the literature describing the implementation of the unified protocol in a transdiagnostic group. Our results revealed statistically significant improvement in all variables, suggesting that the protocol proposed can become an important tool to improve quality of life, sexuality, and anxiety/depression symptoms in patients with different diagnoses

OBJETIVO: Avaliar a eficácia de um protocolo unificado de terapia cognitivo-comportamental para tratamento em grupo de pacientes com diferentes transtornos de humor e ansiedade comórbidos. MÉTODOS: Neste estudo aberto, o protocolo unificado foi seguido no tratamento psicoterápico de 16 pacientes com transtornos de humor e ansiedade comórbidos, confirmados pelo Mini International Neuropsychiatric Interview. Os Inventários de Depressão e Ansiedade de Beck, o instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde e a escala ARIZONA de função sexual foram utilizados para avaliar o progresso em pacientes ao longo de todo o processo terapêutico. RESULTADOS: Todos os pacientes tinham transtorno depressivo unipolar. A comorbidade com transtornos de ansiedade apresentou a seguinte distribuição: transtorno de ansiedade generalizada, 13 (81,3%); transtorno do pânico, 3 (18,8%); fobia social, 1 (6,3%); e transtorno do estresse pós-traumático, 1 (6,3%). Foi observada melhora nos sinais e sintomas de depressão (F = 78,62, p < 0,001) e ansiedade (F = 19,64, p < 0,001), na qualidade de vida geral (F = 39,72, p < 0,001), no domínio físico (F = 28,15, p < 0,001)), em variáveis psicológicas (F = 9,90, p = 0,007), funcionamento social (F = 36,86, p < 0,001), variáveis ambientais (F = 27,63, p < 0,001) e sexualidade (F = 13,13; p < 0,005). Todos os parâmetros demonstraram correlações altamente significativas (p < 0,01). CONCLUSÃO: O esforço para estabelecer um protocolo unificado de tratamento para toda uma família de transtornos emocionais (especialmente humor e ansiedade) mostrou benefícios na área da psicologia clínica e no tratamento dos pacientes. Não foram encontrados outros dados na literatura descrevendo a implementação do protocolo unificado em um grupo transdiagnóstico. Nossos resultados revelaram uma melhora estatisticamente significativa em todas as variáveis, sugerindo que o protocolo proposto pode se tornar uma ferramenta importante para melhorar qualidade de vida, sexualidade e sintomas de ansiedade/depressão em pacientes com diferentes diagnósticos

Prevalence of psychiatric disorders in patients with diabetes types 1 and 2.

BACKGROUND: Diabetes mellitus, classified into types 1 and 2, is a chronic disease that shows high comorbidity with psychiatric disorders. Insulin-dependent patients show a higher prevalence of psychiatric disorders than do patients with type 2 diabetes. METHODS: This research involved the participation of 200 subjects divided into 2 groups: 100 patients with diabetes type 1 and 100 patients with diabetes type 2. This study used the Mini International Neuropsychiatric Interview for the identification of psychiatric disorders. RESULTS: Of the 200 participants, 85 (42.5%) were found to have at least 1 psychiatric disorder. The most prevalent disorders were generalized anxiety disorder (21%), dysthymia (15%), social phobia (7%), current depression (5.5%), lifelong depression (3.5%), panic disorder (2.5%), and risk of suicide (2%). Other disorders with lower prevalence were also identified. The groups showed a statistically significant difference in the presence of dysthymia, current depression, and panic disorder, which were more prevalent in patients with diabetes type 1. CONCLUSION: The high prevalence of psychiatric disorders in diabetic patients points to the need for greater investment in appropriate diagnostic evaluation of patients that considers mental issues. The difference identified between the groups shows that preventive measures and therapeutic projects should consider the specific demands of each type of diabetes.