Sara Costa Cabral Mululo

Resistência ao tratamento nos transtornos de ansiedade: fobia social, transtorno de ansiedade generalizada e transtorno do pânico

OBJECTIVES: Anxiety disorders are common psychiatric conditions that cause significant disability, poor quality of life and enormous social cost. Although treatments with demonstrable efficacy are available a great number of patients fail to respond or remains with clinically significant residual symptoms after treatment. The objective of this study is to review aspects related to treatment resistance and pharmacological strategies to deal with anxiety disorders resistant to treatment. METHOD: Narrative review. RESULTS: We discuss conceptual aspects related to treatment resistance or refractoriness, predictors of poor treatment outcome, and finally, some strategies to deal with anxiety disorders (including social anxiety disorder, generalized anxiety disorder and panic disorder) that do not respond to standard therapeutic interventions. CONCLUSION: Treatment resistance in anxiety disorders remains a challenge to clinical practice going from non standardized concepts of response and resistance to a paucity of controlled studies concerning therapeutic strategies.

A review on predictors of treatment outcome in social anxiety disorder

OBJECTIVE This article aims to review the clinical features and therapeutic characteristics that may predict treatment response in patients with social anxiety disorder (SAD). METHODS A systematic review of trials identified through databases of ISI, Medline, PsycInfo, Cochrane, LILACS, Current Controlled Trials, and in references of previously selected articles published in English up to December 2010. In our literature search, we used the words prediction/predictors and social anxiety disorder or social phobia. RESULTS Early onset, greater disease severity, comorbidity with other anxiety disorders (including generalized anxiety disorder and simple phobia), and high expectations about the role of the therapist emerged as potential predictors of less effective treatment in SAD. CONCLUSIONS Knowledge of various clinical and treatment features may help professionals to predict possible responses to therapeutic interventions in patients with SAD. However, given the diversity of measures used to assess response, further studies should be performed with standardized methods to investigate the aspects related to treatment resistance in SAD.

Terapias cognitivo-comportamentais, terapias cognitivas e técnicas comportamentais para o transtorno de ansiedade social

CONTEXTO: Pacientes com transtorno de ansiedade social respondem de forma distinta a diferentes tipos de terapias cognitivas e/ou comportamentais, o que motiva a avaliacao das melhores tecnicas para o tratamento desse transtorno. OBJETIVO: Realizar uma revisao sistematica de estudos controlados que avaliaram a eficacia das tecnicas cognitivo e/ ou comportamentais na reducao do transtorno de ansiedade social. METODO: Analise sistematica de ensaios clinicos randomizados indexados nas seguintes bases de dados: PubMed/MedLine, PsycINFO, Registro Cochrane de Ensaios Controlados, LILACS, ISI/Web of Science e em artigos relacionados. RESULTADOS: Nao se encontrou consenso sobre a eficacia da associacao da terapia cognitiva com tecnicas comportamentais. Novas tecnicas (tratamento por realidade virtual, tarefa de casa via computador e autoterapia com assistencia terapeutica) demonstraram ser tao eficazes quanto aquelas utilizadas na terapia cognitivo-comportamental (TCC) padrao. A associacao da TCC com evitacao de comportamentos de seguranca e com o treino de habilidades sociais apresentou vantagem adicional em relacao ao modelo convencional. Entre as tecnicas comportamentais, o treino em tarefa de concentracao e a exposicao foram as estrategias mais eficazes. O tratamento individual foi mais efetivo do que em grupo e o modelo de sessoes semanais foi mais eficaz do que sessoes no minimo quinzenais. CONCLUSAO: Os estudos avaliados confirmaram que tanto tecnicas cognitivas quanto comportamentais (convencionais e inovadoras) sao eficazes no tratamento do transtorno de ansiedade social.

Eficácia do tratamento cognitivo e/ou comportamental para o transtorno de ansiedade social

Objective: To ascertain whether cognitive and/or behavioral treatment of patients with social anxiety disorder is superior in terms of effi cacy than other types of therapeutic interventions, including pharmacotherapy. Method: Systematic analysis of all randomized clinical trials on cognitive and/or behavioral therapy vs. other forms of treatment, published until March 2009, indexed in the following databases: MEDLINE, PsycINFO, Cochrane Controlled Trials Register, LILACS and ISI Web of Science. Results: The reported results do not suggest signifi cant differences in the effi cacy of cognitive and/or behavioral therapy and pharmacotherapy. Such treatments combined did not show higher effi cacy than interventions alone. Compared with the control group, cognitive and/or behavioral therapy was superior in reducing social anxiety disorder, either in the classic model or in the newest propositions. The only exception was the social skills training, which was not effective for patients with social anxiety disorder. Cognitive and/or behavioral therapy was also superior to other psychotherapeutic interventions. Conclusion: Cognitive and/or behavioral therapy is an effective treatment for patients with social anxiety disorder. However, the heterogeneity of the clinical trials evaluated, with reference to treatment features (time of treatment and different protocols) or characteristics of the patients (severity of their clinical picture and how they were recruited) made comparison of results between different treatments diffi cult. More research on cognitive and/or behavioral treatment and new reviews of these interventions are necessary to better assess our fi ndings.INTRODUCAO: Avaliar a eficacia do tratamento cognitivo e/ou comportamental no transtorno de ansiedade social quando comparado a outras intervencoes terapeuticas, incluindo farmacoterapia. METODO: Realizamos analise sistematica de todos os ensaios clinicos controlados randomizados envolvendo terapia cognitiva e/ou comportamental versus outras formas de tratamento, publicados ate marco de 2009, indexados nas seguintes bases de dados: MEDLINE, PsycINFO, Registro Cochrane de Ensaios Controlados, LILACS e ISI/Web of Science. RESULTADOS: Os estudos avaliados nao demonstraram diferencas significativas entre a terapia cognitiva e/ou comportamental e a farmacoterapia. Esses tratamentos combinados nao apresentaram maior eficacia do que as intervencoes isoladamente. Quando comparada ao grupo controle, a terapia cognitiva e/ou comportamental e eficaz na reducao dos sintomas de ansiedade social, tanto no seu formato padrao quanto nas novas formas de intervencao. A excecao foi o treino em habilidades sociais, que, isoladamente, nao se mostrou eficaz. A terapia cognitiva e/ou comportamental tambem demonstrou ser superior aos outros tipos de psicoterapias. CONCLUSAO: A terapia cognitiva e/ou comportamental mostrou-se eficaz na reducao da ansiedade social em pacientes com transtorno de ansiedade social. No entanto, a heterogeneidade dos estudos avaliados, seja no que diz respeito a aspectos envolvendo o tratamento (duracao do tratamento e protocolos utilizados) ou os pacientes avaliados (gravidade e forma de recrutamento), dificultaram a comparacao dos resultados. Novos estudos de tratamento cognitivo e/ou comportamental e novas revisoes envolvendo essas abordagens sao necessarios para melhor avaliacao de nossos achados.

Viajando com jovens universitários pelas diversas brasileirices: representações sociais e estereótipos

Current paper studies how students’ vision of natives from different Brazilian states contributes to the social representations of Brazil through the study stereotypes. Data were collected by completive sentences. One thousand and twenty-nine private and public 1 and 2 year university students, aged 17 to 24, males and females, from seven states of Brazil, took part in the survey. Analysis of material was made through thematic content analysis. Results indicated that around one third of the students refused to give generalizing and hierarchized answers. This fact probably means that their idea of Brazil is of a single country in spite of its differences. However, even the stereotyped answers suggested an interesting idea of Brazilians and of Brazil, in which a structured field of meanings, knowledge and information which expresses its diversity, its contrasts and inequalities, may be identified.

Viajando con jóvenes universitarios por las diversas naturalidades brasileñas: representaciones sociales y estereotipos

Current paper studies how students’ vision of natives from different Brazilian states contributes to the social representations of Brazil through the study stereotypes. Data were collected by completive sentences. One thousand and twenty-nine private and public 1 and 2 year university students, aged 17 to 24, males and females, from seven states of Brazil, took part in the survey. Analysis of material was made through thematic content analysis. Results indicated that around one third of the students refused to give generalizing and hierarchized answers. This fact probably means that their idea of Brazil is of a single country in spite of its differences. However, even the stereotyped answers suggested an interesting idea of Brazilians and of Brazil, in which a structured field of meanings, knowledge and information which expresses its diversity, its contrasts and inequalities, may be identified.

Traveling with students through Brazilian varieties: social representations and stereotypes

Current paper studies how students’ vision of natives from different Brazilian states contributes to the social representations of Brazil through the study stereotypes. Data were collected by completive sentences. One thousand and twenty-nine private and public 1 and 2 year university students, aged 17 to 24, males and females, from seven states of Brazil, took part in the survey. Analysis of material was made through thematic content analysis. Results indicated that around one third of the students refused to give generalizing and hierarchized answers. This fact probably means that their idea of Brazil is of a single country in spite of its differences. However, even the stereotyped answers suggested an interesting idea of Brazilians and of Brazil, in which a structured field of meanings, knowledge and information which expresses its diversity, its contrasts and inequalities, may be identified.

A constituição histórica do campo psicológico em sua dispersão

O objetivo deste trabalho é tentar compreender a dispersão presente no campo psicológico, explicando porque orientações e práticas tão diversas se sustentam, seja através de um conjunto de práticas sociais, seja através das transformações no campo dos saberes modernos. Utilizamos para isso a análise de fontes primárias (textos clássicos da psicologia) e secundárias (autores que entendem a psicologia a partir de um conjunto de experiências e práticas sociais). Duas questões podem ser colocadas quando se busca demarcar a história da Psicologia: qual seria sua origem histórica, e em que período ela se constituiria como saber? Historiadores clássicos vão privilegiar uma constituição remota da Psicologia, no século XIX, onde sua história se confundiria com a própria história do pensamento ocidental. Uma outra perspectiva pensa a psicologia, irrompendo desde o século XVI, a partir de múltiplas raízes entrelaçadas de experiências, que levariam à busca de uma natureza na interioridade e na individualidade humanas. Entendemos, portanto, que a psicologia teria surgido de várias orientações e experiências diversificadas, que, reordenadas, formariam o mosaico que constitui o campo psicológico. Estas experiências foram tomadas aqui a partir de dois eixos principais: 1) A experiência que constitui uma região de interioridade nos indivíduos, existente segundo Foucault (1984) desde as práticas de confissão cristãs, e que a partir do século XIX, com Kant (1871), passa a ser fundamentada por um transcendental incognoscível. A psicologia passaria a esta-