Paulo Knapp

Fundamentos, modelos conceituais, aplicações e pesquisa da terapia cognitiva

OBJECTIVE There is growing interest in the cognitive model of psychotherapy stimulated by an extensive body of research findings demonstrating its effectiveness for a varied set of psychiatric disorders and medical conditions. This review article aims to give an overview of the historical and philosophical background to contemporary cognitive and cognitive-behavioral approaches to psychotherapy, pointing out similarities across and differences between them. A presentation of the cognitive model as designed by Aaron Beck, and some of the cognitive and behavioral techniques used in emotional disorders will be discussed. Outcome studies and meta-analyses contemplating the efficacy of cognitive and cognitive-behavioral therapies in various psychological and medical conditions will be briefly depicted. METHOD Through review of articles and textbooks, especially the works of Aaron Beck from which this review article has heavily borrowed, the origins and foundations of the cognitive-behavioral approaches to the treatment of psychiatric and medical conditions are described. Through Medline, the search of randomized controlled trials and meta-analyses has pointed out the evidence-based efficacy of this psychotherapeutic approach. RESULTS AND CONCLUSIONS Cognitive-behavioral therapies in general and Beckian cognitive therapy in particular hold a theoretical foundation and a varied set of techniques, whose evidence-based efficacy was demonstrated for the treatment of diverse mental and physical conditions.OBJECTIVE: There is growing interest in the cognitive model of psychotherapy stimulated by an extensive body of research findings demonstrating its effectiveness for a varied set of psychiatric disorders and medical conditions. This review article aims to give an overview of the historical and philosophical background to contemporary cognitive and cognitive-behavioral approaches to psychotherapy, pointing out similarities across and differences between them. A presentation of the cognitive model as designed by Aaron Beck, and some of the cognitive and behavioral techniques used in emotional disorders will be discussed. Outcome studies and meta-analyses contemplating the efficacy of cognitive and cognitive-behavioral therapies in various psychological and medical conditions will be briefly depicted. METHOD: Through review of articles and textbooks, especially the works of Aaron Beck from which this review article has heavily borrowed, the origins and foundations of the cognitive-behavioral approaches to the treatment of psychiatric and medical conditions are described. Through Medline, the search of randomized controlled trials and meta-analyses has pointed out the evidence-based efficacy of this psychotherapeutic approach. RESULTS AND CONCLUSIONS: Cognitive-behavioral therapies in general and Beckian cognitive therapy in particular hold a theoretical foundation and a varied set of techniques, whose evidence-based efficacy was demonstrated for the treatment of diverse mental and physical conditions.

A Randomized Clinical Trial to Examine Enhancing Cognitive-Behavioral Group Therapy for Obsessive-Compulsive Disorder with Motivational Interviewing and Thought Mapping

BACKGROUND Obsessive-compulsive disorder (OCD) is characterized by repeated and persistent attempts to control thoughts and actions with rituals. These rituals are used in order to prevent feared or personally distressing outcomes. Cognitive behavioral group therapy (CBGT) has been reported to be effective for treating OCD patients. However, about one-third (30%) of patients do not benefit from CBGT. Some of these patients do not show significant improvement and continue to use rituals following CBGT, partially because they fail to complete the exposure and ritual prevention (ERP) exercises. Consequently, it is important to motivate patients to fully engage in CBGT treatment and complete the ERP exercises. AIMS A randomized behavioral trial examined 12 weeks of manual directed CBGT, with the addition of individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM), and compared treatment outcome to the effectiveness of CBGT group alone. METHOD Subjects were randomized (n=93) into a CBGT group or a CBGT group with MI+TM. RESULTS When the two groups were compared, both groups reduced OCD symptoms. However, symptom reduction and remission were significantly higher in the MI+TM CBGT group. Positive outcomes were also maintained, with additional symptom reduction at the 3-month follow-up for the MI+TM CBGT group. CONCLUSIONS Adding two individual sessions of MI and TM before CBGT successfully reduced OCD symptoms and was more effective than using CBGT group alone.

Adding motivational interviewing and thought mapping to cognitive-behavioral group therapy: results from a randomized clinical trial

OBJECTIVE Recent factor-analytic studies of obsessive-compulsive disorder identified consistent symptom dimensions. This study was designed in order to observe which obsessive compulsive symptom dimensions could be changed by adding two individual sessions of motivational interviewing and thought mapping of cognitive-behavioral group therapy using a randomized clinical trial. METHOD Forty outpatients with a primary diagnosis of obsessive-compulsive disorder were randomly assigned to receive cognitive-behavioral group therapy (control group) or motivational interviewing+thought mapping plus cognitive-behavioral group therapy. To evaluate changes in symptom dimensions, the Dimensional Yale-Brown Obsessive-Compulsive Scale was administered at baseline and after treatment. RESULTS At post-treatment, there were statistically significant differences between cognitive-behavioral group therapy and motivational interviewing+thought mapping+cognitive behavioral group therapy groups in the mean total Dimensional Yale-Brown Obsessive-Compulsive Scale score, and in the contamination and aggression dimension score. Hoarding showed a statistical trend towards improvement. CONCLUSION These findings suggest that adding motivational interviewing+thought mapping to cognitive-behavioral group therapy can facilitate changes and bring about a decrease in the scores in different obsessive-compulsive disorder symptom dimensions, as measured by the Dimensional Yale-Brown Obsessive-Compulsive Scale. Nonetheless, additional trials are needed to confirm these results.

Terapia cognitiva do transtorno de estresse pós-traumático

The authors describe the clinical presentation of Posttraumatic Stress Disorder (PTSD) according to the cognitive-behavioral model. The vulnerability factors for the development of PTSD are discussed. The foundations of the cognitive approach to PTSD are presented and guidelines on the contends and duration of the psychotherapy is proposed.

Training of evidence-based assessment and intervention approaches in cross-cultural contexts: challenges and solutions

Dissemination of evidence-based assessment and intervention approaches for child and adolescent with behavioral and/or emotional problems is now a priority in the field worldwide. However, developing staff competence in evidence-based assessment and intervention approaches in different countries is complicated by some environmental and economic constraints. In this paper a distance training/supervision model is discussed. We describe seven specific challenges encountered and solutions used for overcoming the obstacles in order to implement evidence-based assessment and intervention approaches in different sites in Brazil, Egypt, Israel, and Lebanon.

[Cognitive-behavioral therapy in the treatment of mental disorders].

The cognitive-behavioral model has appeared in the end of the 1950’s with the works of Albert Ellis, and more especially cognitive therapy (CT) in the beginning of the 1960’s with Aaron T. Beck. Since then, it has been exerting a strong impact both on the formulation of new etiological models for mental disorders and on their treatment. Beck, a psychiatrist with a psychoanalytical training, while doing research with depressed patients, having as his reference the psychoanalytical model for depression, had his attention turned to the fact that in this disorder, patients have a distorted and negative appraisals of themselves, of their surrounding world and of the future. He then formulated the hypothesis that such a negative cognitive triad would stem from negative, rigid and non realistic cognitive schemas, formed during childhood due to the interactions with the environment, that would be the critical elements for the development, maintenance and recurrence of depression.1 Coherently with this theoretical model, he developed a set of techniques aiming at correcting these distorted beliefs and, therefore, relieving the depressive symptoms. CT has thus appeared as a new explanatory model for the origins and maintenance of depressive symptoms and their treatment. Controlled clinical trials have subsequently found that CT had a similar efficacy of that observed with the use of antidepressants in the treatment of depression.2,3 Explanatory hypotheses based on the more general cognitive model have been suggested for anxiety disorders, such as obsessive-compulsive disorder, generalized anxiety, panic disorder and social anxiety, chemical dependency, eating and personality disorders. The explanatory models of all these disorders propose a role for the errors in the processing of information as predisposing factors for a cognitive vulnerability, which, associated with genetic, neurobiological and environmental factors interact in the development and maintenance of symptoms. Currently, cognitive models are being investigated for other disorders, such as schizophrenia and bipolar disorders, among others, aiming to integrate them with the recent breakthroughs on molecular neurobiology, neuropsychology and genetics. Neuroimaging studies have demonstrated the neurobiological correlates of the action of CT in the brain.4 The more comprehensive term “cognitive-behavioral therapy” (CBT) is the most usual nowadays, as it simultaneously uses the typical interventions of the cognitive model, such as the techniques for the correction of dysfunctional beliefs and thoughts and incorporates behavioral techniques of the behavioral therapy, such as exposure and the use of reinforcers, among others. The great acceptance of the cognitive and cognitive behavioral model is due to several factors: 1) the proposition of models with high heuristic value, which enable a more comprehensive vision of the psychopathology of mental disorders, as they incorporate, to the traditional etiological models, the role of dysfunctional thoughts and beliefs, besides erroneous learning; 2) the proposition of models and hypotheses which are Editorial

P01-146 - Defense mechanisms changes after cognitive-behavior group therapy plus motivational interviewing and thought mapping for obsessive-compulsive disorder

Objectives Studying defensive styles is typically associated with dynamic theory and therapy. The present study was designed to examine the efficacy of adding two individual sessions of Motivational Interviewing (MI) and Thought Mapping (TM) to cognitive-behavioral group therapy (CBGT) to promote changes in the use of defense mechanisms among obsessive-compulsive disorder (OCD) patients. Methods Forty outpatients meeting OCD DSM-IV criteria were randomly assigned to either a MI+TM group or a control group, before 12 weekly CBGT sessions. To evaluate changes in defense mechanisms, the Defense Style Questionnaire (DSQ) was administered before and after treatment. Results The use of the mature defense mechanisms increased in the MI+TM group at post-treatment, and there were significant differences in the decrease of use of the neurotic defense mechanisms. In addition, patients who achieved full remission differed in the use of the immature defense mechanisms. The control group presented no significant decrease in the use of any defense mechanisms. Conclusions These findings suggest that adding two individual sessions of MI and TM to CBGT can facilitate changes in use of defense mechanisms in OCD adult outpatients, as measured by a specific instrument.