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      Aliança Terapêutica nas Terapias Cognitivo-comportamentais por Videoconferência: uma Revisão da Literatura Translated title: Therapeutic Alliance in Cognitive Behavior Therapy for Videoconferencing: A Literature Review Translated title: Alianza Terapéutica en la Terapia Cognitivo-conductual por Videoconferencia: una Revisión de Literatura

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          Abstract

          Resumo Nos últimos anos houve um aumento do número de usuários da internet no Brasil e no mundo, enquanto as intervenções por videoconferência surgiram como formas de tratamento para diversos transtornos mentais. Sabe-se que a aliança terapêutica é um componente essencial para se implementar a prática psicoterapêutica, porém, não há um consenso sobre sua formação na psicoterapia por videoconferência. Portanto, o presente artigo teve como objetivo realizar uma revisão de literatura acerca da formação e papel da aliança terapêutica nas Terapias Cognitivo-comportamentais (TCC) por videoconferência. Para isso, foi realizada uma busca em quatro bases de dados, Pubmed, Psycarticles, Lilacs e SciELO, com descritores específicos dos dicionários de cada base. No total, foram encontrados 365 artigos, mas apenas nove preencheram os critérios de inclusão baseados no objetivo deste estudo. Observou-se que a maioria dos artigos indicou que a aliança foi alta no decorrer das sessões de TCC por videoconferência, podendo ser comparada com a aliança formada na terapia presencial, e que poucos artigos avaliaram a aliança como fator preditivo de resultados e de adesão. Apesar deste indicativo, este estudo discute as limitações metodológicas dos artigos e indica a necessidade de estudos que tornem mais claras as evidências sobre a formação da aliança e o o seu papel nesta modalidade alternativa de tratamento.

          Translated abstract

          Abstract Recent years have seen an increase in the number of Internet users in Brazil and in the world, while videoconferencing interventions have emerged as forms of treatment for various mental disorders. It is known that the therapeutic alliance is a key component to implement the psychotherapeutic practice; however, there is no consensus about psychotherapeutic practice and training in psychotherapy by videoconference. Therefore, this article aims to conduct a review of literature about training and the role of therapeutic alliance in Cognitive Behavior Therapy (CBT) by videoconference. For this, a search in four databases (Pubmed, Psycarticles, Lilacs and SciELO) was performed, with specific descriptors of the dictionaries of the bases. In total, 365 articles were found, but only 9 met the inclusion criteria based on the objective of this study. It was observed that most of the articles indicated that the alliance was high during the CBT sessions by videoconference and this can be compared with the alliance formed in face-to-face therapy; it was also observed that few articles evaluated the alliance as a predictor of outcomes and adherence. Despite this indicative, this study discusses the methodological limitations of the articles and indicates the need for studies that clarify the evidence about the formation of the alliance and its role in this alternative treatment modality.

          Translated abstract

          Resumen En los últimos años ha habido un aumento en el número de usuarios de Internet en Brasil y en el mundo, mientras las intervenciones por videoconferencia surgieron como formas de tratamiento para diversos trastornos mentales. Se sabe que la alianza terapéutica es un componente clave para aplicar la práctica psicoterapéutica, pero no hay consenso acerca de su formación en psicoterapia por videoconferencia. Por lo tanto, este trabajo tiene como objetivo realizar una revisión de la literatura sobre la formación y el papel de la alianza terapéutica en la terapia cognitivo-conductual (TCC) para la videoconferencia. Para esto, se realizó una búsqueda en cuatro bases de datos, Pubmed, Psycarticles, Lilacs y SciELO, con descriptores específicos de los diccionarios de las bases. En total se encontraron 365 artículos, pero solo 9 cumplieron con los criterios de inclusión basados en el objetivo de este estudio. Se observó que la mayor parte de los artículos señalan que la alianza fue alta durante las sesiones de TCC por videoconferencia, pudiendo ser comparada con la alianza formada en la terapia presencial, y que pocos artículos evaluaron la alianza como un factor predictor de resultados y adherencia. A pesar de esta indicación, este estudio analiza las limitaciones metodológicas de los artículos e indica la necesidad de estudios que hagan más claras las evidencias entre la formación de la alianza y su papel en esta modalidad de tratamiento alternativo.

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          The Therapeutic Relationship in E-Therapy for Mental Health: A Systematic Review

          Background E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Objective Our objective in this study was to systematically review the therapeutic relationship in e-therapy. Methods We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. Results From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Conclusions Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.
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            Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial

            Background The present study was designed to evaluate the efficacy of an internet-based therapy (Interapy) for Posttraumatic Stress Disorder (PTSD) in a German speaking population. Also, the quality of the online therapeutic relationship, its development and its relevance as potential moderator of the treatment effects was investigated. Method Ninety-six patients with posttraumatic stress reactions were allocated at random to ten sessions of Internet-based cognitive behavioural therapy (CBT) conducted over a 5-week period or a waiting list control group. Severity of PTSD was the primary outcome. Secondary outcome variables were depression, anxiety, dissociation and physical health. Follow-up assessments were conducted at the end of treatment and 3 months after treatment. Results From baseline to post-treatment assessment, PTSD severity and other psychopathological symptoms were significantly improved for the treatment group (intent-to-treat group × time interaction effect size d = 1.40). Additionally, patients of the treatment condition showed significantly greater reduction of co-morbid depression and anxiety as compared to the waiting list condition. These effects were sustained during the 3-months follow-up period. High ratings of the therapeutic alliance and low drop-out rates indicated that a positive and stable therapeutic relationship could be established online. Significant improvement of the online working alliance in the course of treatment and a substantial correlation between the quality of the online relationship at the end of treatment and treatment outcome emerged. Conclusion Interapy proved to be a viable treatment alternative for PTSD with large effect sizes and sustained treatment effects. A stable and positive online therapeutic relationship can be established through the Internet which improved during the treatment process. Trial registration Australian Clinical Trials Registry ACTRN012606000401550
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              The conceptualization and measurement of therapeutic alliance: an empirical review.

              Therapeutic alliance constitutes a major variable in explaining the outcome of treatment. However, meta-analytic, narrative, and theoretical reviews have all begun to comment on significant deficiencies in both conceptualization and measurement of alliance. While the evidence on the overall impact of alliance on treatment outcomes is impressive, we know much less about its components, modelling and discrete measurement. We review the conceptual and methodological underpinning of current alliance concepts and measures with the aim of identifying the current status of the methods and clarifying the conceptual and measurement tasks ahead. The review makes clear the diversity of concepts and measures available to address treatment alliance; however there is no one current measure of alliance that meets all the predefined criteria in either adult or child populations. We discuss the most successful measures to date, and recommend future developments in the field of alliance, including conceptual and experimental approaches, developmental issues, and analytic techniques.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                pcp
                Psicologia: ciência e profissão
                Psicol. cienc. prof.
                Conselho Federal de Psicologia (Brasília, DF, Brazil )
                1414-9893
                September 2017
                : 37
                : 3
                : 784-798
                Affiliations
                [2] Minas Gerais orgnameUniversidade Federal de Juiz de Fora Brazil
                [1] Minas Gerais orgnameUniversidade Federal de Juiz de Fora Brazil
                Article
                S1414-98932017000300784
                10.1590/1982-3703000832016
                8c1d01e6-3f5d-4d2e-bd73-31854322ad83

                http://creativecommons.org/licenses/by/4.0/

                History
                : 29 February 2016
                : 14 May 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 50, Pages: 15
                Product

                SciELO Brazil


                Videoconferencing,Therapeutic Alliance,Cognitive-Behavioral Therapy,Videoconferência,Aliança Terapêutica,Terapia Cognitivo-Comportamental,Videoconferenci,Alianza Terapéutica,Terapia Cognitivo-Conductual

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