Cognitive behavior

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Effectiveness of a cognitive-behavior therapy protocol for posttraumatic stress disorder and implications for trauma memory narratives

Effectiveness of a cognitive-behavior therapy protocol for posttraumatic stress disorder and implications for trauma memory narratives

Posttraumatic Stress Disorder (PTSD) is a mental disorder developed after the exposure to a traumatic event. People suffering from PTSD usually presents symptoms of re- experiencing, avoidance, hyperarousal, shame, and guilty. Several theories try to explain how PTSD is developed, but there is relative consensus about the influence of an impaired memory processing. Literature points out many types of treatments that aim to regulate this memory impairment and, therefore, reduce PTSD symptoms. Cognitive-Behavior Therapy (CBT) is considered a gold-standard treatment for PTSD. However, most studies about CBT for PTSD are developed in the military context or in developed countries. As far as we know, there is a limited number of studies exploring this subject in Brazil, even with evidence suggesting Brazilian CBT therapists have different treatment approaches when compared with American CBT therapists. Our study aimed to verify the efficacy of an adapted CBT treatment for PTSD in Brazilians regarding PTSD symptoms, cognitions, depression and trauma memory content. This dissertation is composed by (1) a brief introduction, explaining the main concepts we used to develop the study; (2) a theoretical section composed by a systematic review about CBT techniques for PTSD treatment; (3) an empirical section composed by two papers, being one regarding the efficacy of adapted CBT protocol for PTSD symptoms, cognitions and depression, another about memory content in PTSD before and after exposure tasks; and (4) final considerations summarizing our main findings. Results show that our CBT protocol successfully reduces PTSD symptomatology, patient’s memory seems to be less fragmented and they tend to include less psychophysiological sensations of fear and anxiety in their trauma memory narratives after therapy. The results suggest our CBT protocol is effective on the treatment of PTSD in Brazilians and it helps patients to organize and attribute a more functional meaning to their traumatic experiences.
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Cognitive-Behavior Therapy-Online in OCD patient with hoarding symptoms

Cognitive-Behavior Therapy-Online in OCD patient with hoarding symptoms

Obsessive-Compulsive Disorder is known as a disorder that is frequently very incapacitating, which affects the social, familiar, professional, and affective aspects of daily life. The present letter concerns the successful Cognitive-Behavior Therapy-Online of an OCD patient with hoarding symptoms. The use of internet/computer and CBT is a feasible treat- ment for obsessive-compulsive disorder with a comparable outcome as f2f therapy when the therapist is specialized in CBT and OCD. 1,2 There is suggestive evidence that online

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Personality change following internet-based cognitive behavior therapy for severe health anxiety.

Personality change following internet-based cognitive behavior therapy for severe health anxiety.

Persons with severe health anxiety, in the present study defined as meeting the DSM-IV criteria for hypochondriasis, have a persistent fear of developing serious somatic disease [1]. If untreated, severe health anxiety is chronic for a majority of the affected and leads do functional disability and substantial suffering [2, 3, 4, 5]. In the treatment of severe health anxiety, cognitive behavior therapy (CBT) has been shown to yield large and long-term enduring effects [6, 7, 8, 9]. We recently conducted a randomized controlled trial of therapist guided Internet-based CBT (ICBT) for severe health anxiety which showed that CBT based on exposure and response prevention can lead to large improvements when delivered via the Internet with 80 percent of participants in remission at 6-month follow-up [10]. Internet-based treatments of this type generally entails no real time contact between patient and therapist but relies heavily on extensive self-help texts which the patient gets gradual access to through an Internet-based treatment platform [11]. Communication between patient and therapist is mainly through an email like online messaging system and throughout the treatment the patient is expected to go through the same behavioral change as would be the case in face-to-face treatment. Previous studies investigating ICBT for other disorders have shown that the effects can be on par with those of face-to-face treatment [12, 13].
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Mediators in internet-based cognitive behavior therapy for severe health anxiety.

Mediators in internet-based cognitive behavior therapy for severe health anxiety.

The treatment was based on a cognitive behavioral model for health anxiety, emphasizing the role of avoidance and safety behaviors, internal focus, and interpretations of bodily sensations as signs of serious illness as maintaining factors of health anxiety [16,30]. The main component of the treatment was exposure and response prevention. The treatment also included mindfulness training as a means of acquiring the skill to experience bodily sensations without trying to control them or seek reassurance. This was done to facilitate exposure and to lessen attempts to divert attention from aversive bodily sensations, a potential form of safety behavior that may counteract exposure [17,31]. Particular benefits of mindfulness training in cognitive therapy for severe health anxiety have been shown recently [32,33]. Of note, mindfulness in the present study was not used as a stand-alone intervention but was used specifically to optimize effectiveness of exposure and response prevention exercises. In brief, modules 1 and 2 comprised psychoeducation about CBT and health anxiety and introduced mindfulness training, module 3 focused on cognitive processes in health anxiety, the main component of modules 4-10 was exposure to health anxiety stimuli and response prevention, and modules 11 to 12 were focused on maintaining treatment gains and relapse prevention. The treatment protocol was developed by our research group and it has been validated in a trial investigating the effects of group CBT for severe health anxiety [34].
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Einstein (São Paulo)  vol.14 número2

Einstein (São Paulo) vol.14 número2

INT-GSH: internet-based guided self-help; BIB-GSH: conventional guided bibliotherapy; BN: bulimia nervosa; ED: eating disorders; ESM training: emotional and social mind training; CBT: cognitive behavior therapy; ERP: exposure with response pre- vention; B-ERP: pre-binge exposure with response prevention; P-ERP: pre-purge exposure with response prevention; DSM-III-R: 3rd ed. of the Diagnostic and Statistical Manual of Mental Disorders; RCT: randomized controlled trials; DSM-IV: 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders; DBT: dialectical behavior therapy; AF-DBT: appetite focused dialectical behavior therapy; iCBT: Internet-based cognitive-behavioural therapy; EDNOS: eating disorder not otherwise specified; WL/DTC: waiting list/delayed treatment control; CCP: client-centered psychotherapy; GSH: guided self help; FTF-CBT: face-to-face cognitive behavior therapy: TV-CBT: cognitive behavior therapy via telemedicine: EDE: Eating Disorder Examination; OR: odds ratio; FBT-BN: family-based treatment for bulimia nervosa; FBT: family-based treatment; SPT: supportive psychotherapy: FT: family therapy; SCL-90R: Symptom Checklist; EDI-2: Eating Disorder Inventory; AN: anorexia nervosa; CBT-BN: cognitive behavior therapy for bulimia nervosa; RTI-UNC EPC: RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
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Rev. Bras. Psiquiatr.  vol.36 suppl.1 rbp 2013 36 S1 S21

Rev. Bras. Psiquiatr. vol.36 suppl.1 rbp 2013 36 S1 S21

In the context of diagnostic classification in DSM-IV-TR and ICD-10, and now also DSM-5 (see below), hypo- chondriasis is considered a somatoform disorder, 1,5,14 but it has always been at the crossroads of different categories (Table 1). The fact that the presence of somatic symptoms is not a diagnostic requirement for hypochondriasis is arguably inconsistent with its classi- fication within the somatoform disorders. Moreover, given that the key clinical features (preoccupation, anxiety, bodily hypervigilance, and avoidance behaviors) and the most effective treatment strategy (cognitive behavior therapy, mostly including exposure in vivo with response prevention) in hypochondriasis largely overlap with those for anxiety disorders such as panic disorder, social anxiety disorder, generalized anxiety disorder (GAD), and OCD, classification within the anxiety disorders category or the OCRD category would be more consis- tent with the more recent conceptualizations of the disorder. 2
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Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review.

Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review.

Hazard ratio from Kaplan-Meier analysis, but number of deaths per group not provided for follow-up study (Glassman AH, Bigger JT,Jr, Gaffney M. Psychiatric characteristics associated with long-term mortality among 361 patients having an acute coronary syndrome and major depression: Seven-year follow-up of SADHART participants. Arch Gen Psychiatry. 2009 Sep;66:1022–9). BDI = Beck Depression Inventory; BDI-II = Beck Depression Inventory – II; CBT = cognitive behavior therapy; CM = clinical management; CGI-I = Clinical Global Impression-Improvement; CGI-S = Clinical Global Impression-Severity; CI = confidence interval; CREATE = Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy trial; ENRICHD = Enhancing Recovery in Coronary Heart Disease Patients; HAMD-17 = 17- item Hamilton Depression Rating Scale; HAMD-24 = 24-item Hamilton Depression Rating Scale; HAMD-31 = 31-item Hamilton Depression Rating Scale;
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ISSN 0100-879X CLINICAL INVESTIGATION

ISSN 0100-879X CLINICAL INVESTIGATION

Bipolar disorder (BD) can have an impact on psychosocial functioning and quality of life (QoL). Several studies have shown that structured psychotherapy in conjunction with pharmacotherapy may modify the course of some disorders; however, few studies have investigated the results of group cognitive behavior therapy (G-CBT) for BD. Our objective was to evaluate the effective- ness of 14 sessions of G-CBT for BD patients, comparing this intervention plus pharmacotherapy to treatment as usual (TAU; only pharmacotherapy). Forty-one patients with BD I and II participated in this study and were randomly allocated to each group (G-CBT: N = 27; TAU: N = 14). Thirty-seven participants completed the treatment (women: N = 66.67%; mean age = 41.5 years). QoL and mood symptoms were assessed in all participants. Scores changed significantly by the end of treatment in favor of the G-CBT group. The G-CBT group presented significantly better QoL in seven of the eight sub-items assessed with the Medical Outcomes Survey SF-36 scale. At the end of treatment, the G-CBT group exhibited lower scores for mania (not statistically significant) and depression (statistically significant) as well as a reduction in the frequency and duration of mood episodes (P < 0.01). The group variable was significant for the reduction of depression scores over time. This clinical change may explain the improvement in six of the eight subscales of QoL (P < 0.05). The G-CBT group showed better QoL in absolute values in all aspects and significant improvements in nearly all subscales. These results were not observed in the TAU control group.
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Computer-Based Cognitive Programs for Improvement of Memory, Processing Speed and Executive Function during Age-Related Cognitive Decline: A Meta-Analysis.

Computer-Based Cognitive Programs for Improvement of Memory, Processing Speed and Executive Function during Age-Related Cognitive Decline: A Meta-Analysis.

Our positive results concur with previous reviews [10,19]. The last review conducted by Kueider and his colleagues concluded that computerized training was an effective, less labor intensive alternative compared with traditional, paper-and-pencil cognitive training [19]. However, it was only a qualitative review with both RCTs and non-RCTs published from 1986 to 2011. Any strictly qualitative approach may be problematic because it is more subjective than a meta-analysis. In our review, 12 moderate to high quality RCTs were included [14– 18,22–28]. Detailed subgroup meta-analyses were conducted based on the different outcome measures. The aggregated results indicated that CCP improved memory performance and pro- cessing speed. Furthermore, there was a long-term enhancement in memory performance. Consequently, the current review provides stronger evidence of CCP beneficial effects on age- related cognitive decline.
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Complexity, variation and meaning: an integrated view on language and cognition

Complexity, variation and meaning: an integrated view on language and cognition

language as a complex dynamic system. Following up, we observe that to this same dynamic and complex idea there is, on the one hand, prototypicality – or prototype-based categorization – and other manifestations of the variability of linguistic meaning and, on the other hand, the situated embodiment or sociocultural situatedness of human cognition. We later identify different types of meaning variation, namely, semasiological variation (prototypicality and polysemy) and onomasiological variation (near-synonymy and synonymy), and we show, based on the semantic analysis of special expressions, that perception, action and interaction are dimensions of linguistic meaning. In the following section, we address the social aspects of linguistic meaning and the necessary integration of intralinguistic or lectal (dialectal, sociolectal, idiolectal) variation in the cognitive perspective of language. Finally, we advance the argument for the need of quantitative and multivariate advanced methods that can adequately approach language as a complex dynamic system and the multidimensionality of linguistic meaning.
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Profiles of ageing in the South of Portugal: education and cognitive functioning in elderly persons living in institutionalized and community contexts

Profiles of ageing in the South of Portugal: education and cognitive functioning in elderly persons living in institutionalized and community contexts

As a first analysis of a sample of older people living in Algarve, the present research has several limitations such as the possible bias of some results due to limitations of the instruments, lack of representativeness of the sample or the absence of inferential statistics. Otherwise, from our point of view, various implications of this study are related with the necessity of integrated policies and approaches at regional and community level able to meet the needs of a very differentiated population as the elderly. In a time of scarce resources and social and economic crisis it is necessary to optimize all available means with the aim of facilitating normal or successful ageing profiles. Continuing education programmes interconnected with the specific needs of elderly persons and with the support of local authorities is an adequate strategy to prevent cognitive decline and enhance the continuous exercise of social practices in the elderly.
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Modeling collective animal behavior with a cognitive perspective: a methodological framework.

Modeling collective animal behavior with a cognitive perspective: a methodological framework.

Researchers equally involved in the understanding of collective dynamics in animals may as well conclude from the same facts that further observational data are required as soon as they are interested in the analysis of individual behaviors at the level of details of neuronal and cognitive processes for a particular species in a given (ecological) context. However, choosing an adequate experimental protocol to decipher between alternative models often proves to be a very difficult task. For instance, a model of the formation of the dominance order in social wasps based on threshold reinforcement has first been experimentally verified from dominance behaviors measured at the individual scale [38,39]. However, some years later, the same authors questioned the occurrence of this reinforcement mechanism because the empirical data may as well be explained by preexisting differences among individuals [40]. The available experimental behavioral data were therefore not discriminative, even at the individual scale. All this illustrates that we are still today at the stage of methodological reflections and regularly have to go back to quite basic questions: When attempting to identify components of the individual behavior, what are the respective roles of collective observational data and more specific experimental protocols in terms of model validation and function / parameter estimation? Are there criteria that can guide the design of an experimental protocol? The aim of this paper is to address these questions in the particular case where laboratory experiments can be designed providing observational data that are fully independent of the initial collective observations. This means that we leave aside the more difficult question of designing individual observation protocols based on the very same experiments (or field observa- tions) as those allowing collective quantitative measurements. We start from a published experimental study on object clustering in ants. Six different individual behavioral models are constructed, with rules in terms of statistical responses to the relevant stimuli, that all reproduce satisfyingly the collective patterns. It is then theoretically established that two of these models, despite being clearly distinct in terms of individual behaviors, cannot be discriminated using collective scale observational data, whatever their accuracy and amount. We then address the methodological questions associated to the design of additional individual-based experimental protocols, as well as the use of the corresponding data for model validation and inversion of free parameters. A sequence of methodological steps is proposed and practically illustrated using the same object clustering example and the expected benefits are discussed.
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Rev. bras. geriatr. gerontol.  vol.19 número5

Rev. bras. geriatr. gerontol. vol.19 número5

the present study, it was possible to investigate the sources of evidence of content validity through the assessment of structural aspects of the training (by participants and examiners). Concerning the pilot study and the aim of determining the impact of the training on the mental performance of the elderly individuals, the different performance levels recorded in the pre-test (between the EG and the CG) for the subtests codes, arithmetic and matrix reasoning, as well as the different education levels found between the two groups, represent limitations. For future research, the authors intend to develop the following studies: 1) a clinical randomized trial with an experimental design to increase the power of inference on the effects of the cognitive training developed; 2) a study of structural validity, to analyze the performance of the sample in training tasks and to ascertain if the factorial structure subjacent to the protocol corroborates its theoretical model (concentrated attention, processing speed, episodic memory and working memory).
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Cognitive systems evolution: immigrant last generations and cognitive mapping

Cognitive systems evolution: immigrant last generations and cognitive mapping

Shum, Ki and Leong [29] previously showed the masterity of mandarin speaker’s brainin tasks demanding verbal reasoning features (such as the verbal analogy test) and proved, on the other hand, that Mandarin Speakers had problems to decode phonological information that appears in stimulus sequence different from the native ‘habit’ (which pressuposes a neural system associated by experience and adaptative behavior to encode and recognize sequences) in their home language. So, the words and isolated sounds recall would be likely a gap for the Chinese early L2 beginners in languages such as Portuguese. These cognitive (memory and attention) indicators from this specific trial study (students were instructed regarding each task during the assessment period) are explained by ethnic and nationality differences which was not expected according to the evidence of previous analyses [30] that outline race and ethnicity as not predictors of cognitive differences.However we believe that these groups’ specificities are able to determine cognitive differences – neural or brain structure based - as well is well-known that those differences explain other behaviours – in the same neural basis argument - besides the cognition [31]. Along the cognitive or neural structure factor, we argue that the present data is based also in the educational type factor – the culture and resources of instruction - that students recently experienced in their countries of origin. The cognitive processing in these recall tasks might be biased also considering other factor: the parents’ vocabulary and language used at home [33]. This topic should be further examined in similar studies to understand more factors that explain cognitive processing differences and recall abilities.
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Interplay of Cognitive Efficiency, Cognitive Ability and Motivation

Interplay of Cognitive Efficiency, Cognitive Ability and Motivation

Another theory is Selective engagement hypothesis [23] which argues that there is more selectivity in older adults’ engagement of cognitive resources. Selectivity is determined by personal relevance, meaningfulness of a situation – that is, older adults would allocate more cognitive resources into tasks with more personal meaning. Hess, Rosenberg and Walters [26] used impression formation task to examine ageing-related selectivity. By varying personal relevance of two motivational variables; the context and behavioral information, they influenced the recall of consistent and inconsistent behaviors of older adults. Elderly were better in recalling inconsistent over consistent behaviors when they were expected to be held accountable for their impression. In experiment of impression formation, in situation where message relevance was high, older adults’ attitude toward a lawmaker was independent of his likability. Hess et. al. [26] concluded that older adults’ thinking reflected a type of heuristic processing which reflects selective engagement in the task and not necessarily reduction in resources and skills. They have also shown that inconsistency effect in recall of older adults is associated with their resource-consuming elaborative processing of behaviors incongruent with expectations.
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Montreal Cognitive Assessment for cognitive assessment in chronic

Montreal Cognitive Assessment for cognitive assessment in chronic

Introduction: There is evidence in the literature that cognitive impairment is more prevalent in individuals with chronic kidney disease (CKD) than in the general population. The Montreal Cognitive Assessment (MoCA) is an ins- trument with a good application profile for cognitive evaluation of patients with CKD-like impairments. The objective of this study is to perform a systematic review of MoCA use in the context of CKD. Method: The keywords "Mon- treal Cognitive Assessment", "Kidney Disease" and "Chronic Kidney Disease" were used to search the databases. The inclusion criteria were: a) empirical ar- ticles; b) approach to cognitive impair- ment in CKD; c) papers in Portuguese and English. Results: The studies were mostly cross-sectional, published in medical journals, with research carried out mostly in Europe. About 45% of the studies had samples of less than 150 participants and variations in the pre- valence of cognitive impairment were found ranging from 28.9% to 74.6%. The cutoff point for the identification of the impairment presented variation between the studies. Discussion: The re- sults’ analysis demonstrates the need for more complete studies on MoCA sco- ring and adaptation in its different ver- sions. We recommend to the health pro- fessionals who will use the results in the clinical setting that the interpretation of the results be made in the light of studies more related to the context lived by the patients. Conclusions: The instrument is efficient to be used in several stages and treatment modalities of the disease. We point to the need to adapt a cut-off point for the instrument in the different translations of the instrument.
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J. Aerosp. Technol. Manag.  vol.6 número4

J. Aerosp. Technol. Manag. vol.6 número4

ABSTRACT: Human Machine Interface (HMI) design is a critical ield of work because no general guidelines or rules have been assessed. In order to aid practitioners to design effective HMIs, different methodologies have been studied. To understand task objectives and plan goal-oriented actions, human operators exploit speciic cognitive processes that have to be supported with advanced interfaces. Including cognitive aspects in HMI design allows generating an information low that reduces user mental workload, increasing his/her situation awareness. This paper focuses on design and test of a Graphical User Interface (GUI) for the telenavigation of a space rover that makes the cognitive process of the user a priority in relation to the other development guidelines. To  achieve this, a Cognitive Task Analysis (CTA) technique, known as Applied Cognitive Work Analysis (ACWA), is combined with a multi-agent empirical test to ensure the GUI effectiveness. The ACWA allows evaluating mission scenarios, i.e. piloting the rover on the Mars surface, in order to obtain a model of the human cognitive demands that arise in these complex work domains. These demands can be used to obtain an effective information low between the GUI and the operator. The multi-agent empirical test, on the other hand, allows an early feedback on the user mental workload aiming to validate the GUI. The result of the methodology is a GUI that eases the information low through the interface, enhancing operator’s performance.
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<b>Análise comparativa entre CAMCOG, Fluência Verbal e o CASI-Short em idosos sem escolaridade<b>

<b>Análise comparativa entre CAMCOG, Fluência Verbal e o CASI-Short em idosos sem escolaridade<b>

ABSTRACT. Several tests exist to diagnose Alzheimer’s Disease (AD) and it is highly important that the disease is discovered as early as possible. Choice of neuropsychological tests may vary according to the patients’ schooling since the latter may affect the cognitive performance. Cognitive Abilities Screening Instrument (CASI) is a brief screening tool for cognitive abilities. CASI-S, which comprises registration, temporal orientation, verbal fluency and word retrieval, is an abridged version of this instrument. Current analysis deals with the cognitive performance of illiterate elderly people for the tests Cambridge Cognitive Examination, Verbal Fluency and an abridged version of CASI. Methods: Thirty-eight illiterate elderly people attended to at the Outpatient Geriatric Clinic in Jundiaí, São Paulo State, Brazil, were evaluated. Casi-S, CAMCOG, Verbal Fluency, GDS and Pfeffer Functional Activities Questionnaire were employed. Correlation test analyses revealed that Casi-S correlated significantly with the CAMCOG test (r = 0.82; p < 0.0001). A moderate and significant coefficient exists between FV test, animal version (r = 0.59; p < 0.0001) and fruit version (r = 0.69; p < 0.0001). Conclusion: Casi-S is advantageous in its application to illiterate elderly people since it is simple to use and does not require reading or writing for its execution. Keywords: elderly people, educational status, neuropsychological tests.
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Tacit Knowledge as a Cognitive Phenomenon

Tacit Knowledge as a Cognitive Phenomenon

The article analyzes the implicit knowledge as a cognitive phenomenon. The article reveals the content of tacit knowledge. The article reveals the contents of the transformation of tacit knowledge into explicit knowledge. This article describes an inductive approach as a cognitive approach. The article introduces the concept of an information structure for communication and information between cognitive processes. The article substantiates the proposition that cognitive methods and procedures for implementing the process of "socialization". The article proves that the process is a prerequisite for the subsequent externalization, that is, the conversion of tacit knowledge into explicit knowledge.
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Montreal Cognitive Assessment for cognitive assessment in chronic kidney disease: a systematic review

Montreal Cognitive Assessment for cognitive assessment in chronic kidney disease: a systematic review

factor to improve patients’ clinical condition, even without being directly related to quality of life. They point out that the reduction in walking speed; ar- terial stiffness and lacunar infarction are important predictors of cognitive decline. Regarding the limi- tations presented in these studies that can influen- ce the results, we stress the use of only one instru- ment to assess cognition and the non-assessment of other factors influencing cognitive impairment. Nonetheless, other factors considered less influential to their objectives are the exclusion of patients with probable dementia and the relatively small sample size, or only one center.
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