mario francisco juruena, md, msc, dip cbt, mphil, phd · dip cbt beck institute for cognitive...
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[email protected] [email protected]
MarioFranciscoJuruena,MD,MSc,DipCBT,MPhil,PhD
• Prof.DoutordoDepto.deNeurociênciaseCiênciasdoComportamento,FMRPdaUSP.
• FormaçãoemCBTpeloBeckIns4tuteforCogni4veTherapyandResearch,EspecialistaemTCCpelaFBTC
• MestradoemAffecBveNeuroscience–MaastrichtUniversitat,Holanda;ePsicobiologia-UNIFESP-EPM
• PhDemPsiquiatriapelaUniversidadedeLondres
• Prof.HonorariodoInsBtutodePsiquiatria,PsicologiaeNeurociências,King‘sCollegeLondon
PhD at Institute of Psychiatry, King’s College London/University of London MSc at Affective Neuroscience- Universität Maastricht, the Netherlands
MPhil at Psychobiology, Federal University of Sao Paulo, Brazil Dip CBT Beck Institute for Cognitive Therapy and Research, Philadelphia-USA
MD Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Brazil.
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Abordagem Integrada
Ga0lho
Influências
Biológicas
Influências
Comportamentais
InfluênciasCogni0vaseEmocionais
Influências
Sociais
Transtorno
2
DoençaMental
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AFachment
Allen&Badcock.ProgrNeuropsycholBiolPsychiatry,30:815-826,2006
JohnBowlby1907-1990
TeoriadaligaçãoafeBva
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EstressePrecoceABUSO FÍSICO
ABUSO EMOCIONAL
ABUSO SEXUAL
NEGLIGÊNCIA EMOCIONAL
NEGLIGÊNCIA FÍSICA
Situações traumáticas ocorridas
na infância e adolescência
Morte dos pais ou
familiares
Transtornos Psiquiátrico dos
Familiares
Separação - Divórcio NEGLIGÊNCIAS
ABUSOS
Bernsteinetal.,1994;Zavaschietal,2002
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MODELO DO PAPEL DO ESTRESSE PRECOCE NOS TRANSTORNOS PSIQUIÁTRICOS
RAABE&SPENGLER,2013
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.NUTT,DJ.etal.JClinPsychiatry,69(E1):4–7,2008.
Afeto negativo
Afeto positivo
Medo
Ansiedade
Irritabilidade
Culpa
Solidão
Energia
Interesse
Prazer
Auto-confiança
Motivação
Modelobidimensionaldoafetonadepressão
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Vulnerabilidade Genética
Eventos de Vida Precoces Estressantes
Indivíduo Predisposto a depressão EVENTOS
ESTRESSANTES
DEPRESSÃO CLÍNICA
Desencadeantes Mantenedores
19.MELLO,AF.etal.Depressãoeestresse:existeumendofenóBpo?.RevBrasPsiquiatr,23(1):S13-8,2007.
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Rejeiçãodóieaceitaçãoprovocaprazer
Lieberman&Eisenberg.Science,323:890-891,2009
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2o• COMPETÊNCIAEAUTONOMIA• InvesBmentoelibertadedeexplorar
3o• LIMITESREALISTAS• Limitescomafeto
4o• RESPEITOAOSANSEIOSPESSOAIS• Consideraçãoàsescolhas
5o• EXPRESSÃOLEGÍTIMADASEMOÇÕES• Ambientesvalidantesàsemoções
• ACEITAÇÃOEPERTENCIMENTO• Afeto1o
DESENVOLVIMENTO HUMANO Tarefas Evolutivas Básicas
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O MAIOR DE TODOS OS DESASTRES ECOLÓGICOS
Auto-extermínio Suicídio
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Uso Adequado de Mecanismos Defensivos: Estratégias ativas de “coping”.
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“Enfrenteseusdemônios.” “Tomeumremédio.”
BOMTERAPEUTA,MAUTERAPEUTA
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Entendendoasvivênciasdopaciente
Identifique e trabalhe os Fatores Predisponentes Precipitantes Perpetuadores
Mas trabalhe principalmente os Fatores Protetores
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Aaron Temkin Beck § Depression, Causes and Treatment (1967)
§ Cognitive Therapy: Behavior Therapy, 1970
§ Cognitive Therapy and Emotional Disorders (1977)
§ Terapia cognitiva da depressão (1979 / 1981 / 1997)
§ Anxiety disorders and phobias (1985)
§ Terapia cognitiva de transtornos da personalidade (1990)
§ Cognitive therapy of substance disorders(1993)
§ O poder integrador da terapia cognitiva (1997)
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Mais obras de Beck § Prisoners of Hate: The Cognitive Basis of Anger,
Hostility, and Violence (1999)
§ Terapia cognitiva do transtorno bipolar (2002), C. Newman, A.T. Beck, R. Leahy
§ Terapia cognitiva dos transtornos da ansiedade, D.A. Clark e A.T.Beck (2011)
§ Terapia cognitiva da esquizofrenia, Beck, A.T. Rector, N.A., Stolar, N., Grant, P. (2012)
§ Terapia cognitiva para pacientes suicidas Wenzel, A., Brown, G.K. e Beck, A.T. (2012)
§ http://www.beckinstitute.org/
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Terceiras Ondas: TCD, ACT etc.
• Marsha Linehan: Terapia Comportamental Dialética (1993)
• Jeffrey Young: Terapia do Esquema (1991, 2003)
• Adrian Wells Terapia Metacognitiva (1997, 2009)
• Steven Hayes: Terapia de Aceitação e Compromisso (1999)
• Jon Kabat-Zinn: mindfulness-based stress reduction (MBSR,
1979)
• Irismar Reis de Oliveira: Terapia Cognitiva Processual (2007)
• Robert Leahy: Terapia do Esquema Emocional (2012)
• Paul Gilbert: Terapia Focada na Compaixão (2009)
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Terapia Comportamental Dialética
Marsha Linehan (1993): tratamento do transtorno de personalidade limítofe (borderline) mudança x não mudança aceitação x mudança
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Jon Kabat-Zinn
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TRATAMENTOSBASEADOSEMEVIDÊNCIA
• TerapiaCogni0vo-Comportamental(TCC)(Foaetal,1991;Rothbaum,2005,2006;Schnurr,2003,2007);• TerapiadeReprocessamentoCogni0va(CPT)(Resick&Schnicke,1996);• EMDR(VanderKolketal,2007;Rothbaumetal,2005;Tayloretal,2003;Poweretal,2002);• ExposiçãoProlongadacomesemImaginaçãoModificada(Arntz,2007);• ImaginaçãoModificada(ImageryRescrip0ng)(Arntzetal,2012;Smuckeretal,1995;Hackmannetal,2011;Kracow&Zadra,2006;Arntzetal,2013);• TerapiadeEsquema(Youngetal,2003;Arntz&VanGenderen,2005;Farrell&Shaw,2012;Arntz&Jacob,2011).
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INTERVENÇÕESCLÍNICAS
• ReparentalizaçãoLimitadaapropriadaparaopaciente(Youngetal,2003);
• ImaginaçãoModificada(umdoscomponentesmaisimportantesdeTerapiadeEsquema)comoaprincipalintervençãoclínicaparaTEAeTEPT;
• EnsaioImagina0vo(ImageryRehearsal)depesadelosangus0antesrecorrentes
(Marks,1978;Kracowetal,1995);
• Role-playdeumasituaçãoatualourecente(Arntz&VanGenderen,2009);
• Role-playIntegra0vodePassadoeFuturo(VersãoModificada)(Arntz&VanGenderen,2009);
• TrabalhocomCadeiras(Chairwork)(Kellogg,2013)a)Paratomardecisões(incluibalançodedecisões–DecisionalBalance);b)ParaaumentaraasserBvidade(ensaiocomportamental);c)Parapromoveraautocomprenssãoeabondadeconsigomesmo(Neff,2011).
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TCC no TEPT
• Psicoeducação• Estratégiasdeadesãoaotratamento
• Exercíciosderegulaçãoemocional
• Exposição• ReestruturaçãocogniBva
• Prevençãoàrecaída
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Bibliografia
• Beck,A.T.,Davis,D.D.,&Freeman,A.(2015)CogniBveTherapyofPersonalityDisorders(3rdEd).NY:GuilfordPress.
• Rafaeli,E.,Bernstein,D.P.,&Young,J.(2011).SchemaTherapydisBncBvefeatures.Routledge.
• Safran,J.D.&Segal,Z.V.(1990)InterpersonalProcessinCogniBveTherapy.BasicBooks.
• Young,J.E.,Klosko,J.S.,&Weishaar,M.E.(2003).SchemaTherapy.ApracBoner’sguide.NewYork:TheGuilfordPress.
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“Asdoençasmentaissãodoençascrônicasdascriançasedosjovens”
OrganizaçãoMundialdeSaúde(WHO)[email protected] [email protected]
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hxp://www.intechopen.com/books/clinical-research-and-treatment-approaches-
to-affecBve-disorders
Clinical,ResearchandTreatmentApproachestoAffec0veDisordersEditedbyMarioFranciscoJuruena,ISBN978-953-51-0177-2,Hardcover,364pages,Publisher:InTech,