Abstract Introduction Burnout syndrome (BS) in healthcare professionals (HCP) has been a major concern, and even more so during the coronavirus disease 2019 (COVID-19) pandemic. The need for adequate tools to assess BS is urgent. The objective of this study was to validate the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in HCP. Methods The sample comprised 1,054 Brazilian HCP. Data were collected for 1 month (May-2020 to June-2020) using an online self-administered questionnaire. Results All three CBI dimensions demonstrated optimal reliability. All consistency measures attained values > 0.90. Split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: personal burnout (PB) and work-related burnout (WB) items were associated with factor 1, and client-related burnout (CB) items were associated with factor 2. Conclusion Our study corroborates the validity of the Brazilian Portuguese version of the CBI, pointing to a close relation between PB and WB in HCP. A public domain tool with evidence quality to ensure sufficient content validity can aid in burnout evaluation and encourage both expansion of the research field and accurate detection and treatment of this syndrome in Brazilian HCP.

Abstract Objectives There are no validated instruments to measure education-related stress in Brazilian university students. Thus, we aimed to translate and test the internal reliability, convergent/discriminant validity, and measurement equivalence of the Higher Education Stress Inventory (HESI). Methods The translation protocol was carried out by two independent translators. The instrument was culturally adapted after a pilot version was administered to 36 university students. The final version (HESI-Br) was administered to 1,021 university students (mean age = 28.3, standard deviation [SD] = 9.6, 76.7% female) via an online survey that lasted from September 1 to October 15, 2020. The factor structure was estimated using exploratory factor analysis (EFA) on the first half of the dataset. We tested the best EFA-derived model with confirmatory factor analysis (CFA) on the second half. Convergent/discriminant validity was tested using the Depression, Anxiety and Stress Scale (DASS-21). Sex, age groups, period of study, family income and area of study were used to test measurement equivalence. Results EFA suggested five factors: career dissatisfaction; faculty shortcomings; high workload; financial concerns; and toxic learning environment. CFA supported the five-factor model (15 items), but not a higher order factor, suggesting multidimensionality. All five factors presented acceptable internal reliabilities, with Cronbach’s α ≥ 0.72 and McDonald’s ω ≥ 0.64. CFA models indicated that the HESI-Br and DASS-21 assess different but correlated underlying latent constructs, supporting discriminant validity. Equivalence was ascertained for all tested groups. Conclusion The 15-item HESI-Br is a reliable and invariant multidimensional instrument for assessing relevant stressors among university students in Brazil.

Abstract Introduction Mental health in training physicians is a growing issue. The aim of this study was to investigate emotional distress in psychiatry residents. Method This web-based survey evaluated 115 (62%) psychiatry residents in training in the Brazilian State of Rio Grande do Sul. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult, the Patient Health Questionnaire-2, the Alcohol Use Disorders Identification Test-concise, and the Maslach Burnout Inventory were all administered. Linear regression models were estimated with burnout dimensions as dependent variables. Result Positive screening rates were 53% for anxiety, 35.7% for somatization, 16.5% for depression, and 7% for suicidal ideation. Half of the male residents were at risk of alcohol abuse and dependence. Regarding burnout, 60% met criteria for emotional exhaustion, 54.8% for depersonalization, and 33% for low personal accomplishment. The most consistent risk factors were the nature of the relationships with preceptors, relations to the institutions themselves, age, and the quality of relationships with family. Conclusion Besides disconcerting rates of psychiatric symptoms, the study revealed that characteristics of the workplace (i.e., the nature of relationships with preceptors and relations to the institution) can be regarded as potential targets for development of interventions aimed at improving mental health during training periods.

Abstract Introduction The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. Objective The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. Method This study is a narrative review of the literature on social isolation in the context of the COVID-19 pandemic. Results 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. Conclusions It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families.

RESUMO: Quinze por cento da população mundial apresenta algum tipo de deficiência. Isso pode ser caracterizado por vários tipos de condições, cada uma com sua complexidade específica. Assim sendo, esta revisão da literatura objetiva identificar recentes estudos científicos, no quinquênio 2014-2019, que descrevem cuidados psicoterapêuticos com pessoas com deficiência. Foram consultados: PubMed, EMBASE, Web of Science, PsycINFO (APA), BVS (Bireme/LILACS) e SciELO. Encontrou-se um total de 1.330 artigos. Após dois processos de seleção, 26 pesquisas corresponderam aos critérios de inclusão. A metodologia de pesquisa predominante foi ensaio clínico randomizado, seguido por estudos de caso e estudos descritivos/qualitativos. Pessoas com deficiência intelectual e/ou física, deficiência visual e/ou auditiva e autismo foram as populações mais estudadas. As técnicas comportamentais prevalecem nos estudos incluídos, com menor incidência de técnicas psicodinâmicas. A psicoterapia favorece inclusive o enfrentamento de situações adversas impostas na vida de qualquer ser humano. Pessoas com deficiência também podem apresentar necessidades psicoterápicas, uma vez que, na realidade de suas vidas, incluem complexidades além de sua deficiência. Existem fortes evidências para o uso da psicoterapia como recurso eficaz para a elaboração terapêutica de problemas relacionados à saúde, à educação e à vida social de pessoas com deficiência, independentemente do tipo de intervenção psicoterápica.

ABSTRACT: Fifteen percent of the world’s population has some form of disability. This can be characterized by several types of conditions, each with its specific complexity. Thus, this literature review aims to identify recent scientific studies, in the 2014-2019 five-year period, which describe psychotherapeutic care for people with disabilities. PubMed, EMBASE, Web of Science, PsycINFO (APA), BVS (Bireme/LILACS) and SciELO were consulted. It was found a total of 1,330 articles. After two selection processes, 26 research met the inclusion criteria. The predominant research methodology was the randomized clinical trial, followed by case studies and descriptive/qualitative studies. People with intellectual and/or physical disabilities, visual and/or hearing disabilities and autism were the most studied populations. Behavioral techniques prevail in the studies included, with a lower incidence of psychodynamic techniques. Psychotherapy also favors coping with adverse situations imposed on the life of any human being. People with disabilities may also have psychotherapeutic needs, since, in the reality of their lives, they also include complexities in addition to their disability. There is strong evidence for the use of psychotherapy as an effective resource for the therapeutic elaboration of problems related to health, education and social life of people with disabilities, regardless of the type of psychotherapeutic intervention.

Abstract Introduction Eating disorders (EDs) affect up to 13% of young people and are associated with significant morbidity and mortality. Nevertheless, important, internationally recognized instruments for brief ED screening (Sick Control One Stone Fat Food Questionnaire [SCOFF]), symptom severity assessment and diagnosis (Eating Disorder Examination Questionnaire [EDE-Q]) and assessment of ED-associated psychosocial impairment (Clinical Impairment Assessment Questionnaire [CIA]) were not yet available in Brazilian Portuguese. Our objective was to perform the cross-cultural adaptation and translation into Brazilian Portuguese of the instruments SCOFF, EDE-Q and CIA. Method The process involved a series of standardized steps, as well as discussions with experts. First, the relevance and adequacy of the scales’ items to our culture and population were extensively discussed. Then, two independent groups translated the original documents, creating versions that were compared. With the participation of external ED experts (i.e., who did not take part in the translation process), synthesized versions were produced. The syntheses were then applied to a focal group of patients with ED (n = 8). After that step, a preliminary version of the three scales in Brazilian Portuguese was produced and sent for back-translation by two English native speakers, who worked independently. A synthesis of the back-translations, along with the preliminary versions in Brazilian Portuguese, were sent to the original authors. Results The Brazilian Portuguese versions of SCOFF, EDE-Q and CIA were approved by the original authors and are now available for use. Conclusion This study provides important tools for the ED research field in Brazil.

Abstract Introduction Physician burnout is considered an epidemic. In 2019, 44% of U.S. physicians reported feeling burned out. The work environment is a central risk factor for this. The aim of this study is to develop and test an instrument to evaluate work environment factors in medical training courses. Method After focus groups, an initial pool of 14 items was generated and tested in a pilot study (n = 66). Face validity was verified, and small adjustments were made. The resulting version was administered to a sample of 115 psychiatry residents. Eleven items were selected based on the correlations between them, principal component analysis, and theoretical reasons, and then tested for internal and construct validity. Results The final version had high reliability (Cronbach’s alpha = 0.898) and comprised three dimensions: relations with the institution; with colleagues; and with preceptors. Both total scores and dimensions correlated significantly with burnout scores (p < 0.01). Cutoffs defining the environment as healthy (>32 points); risky (23-31 points); or toxic (<22 points) were suggested and related to the risk of burnout. Conclusion Several authors have emphasized the importance of approaching institutional factors as an effective strategy for coping with the increased prevalence of burnout. This instrument should contribute to these efforts.

Resumo Introdução Diferentes instrumentos e formas de medir fatores relacionados ao progresso e à efetividade da psicoterapia psicodinâmica (PDT) têm sido amplamente discutidos na literatura. No entanto, não há diretrizes estabelecidas sobre o tempo apropriado para que essas medidas sejam realizadas. Objetivos O objetivo deste estudo é problematizar qual o momento apropriado para medir resultados iniciais (sintomas, relações interpessoais e papel social) e fatores de processo (aliança) nos estágios iniciais da PDT. Métodos Realizou-se estudo de coorte naturalista que acompanhou 304 pacientes durante os primeiros seis meses de psicoterapia. A aliança terapêutica foi avaliada após quatro sessões; sintomas, relações interpessoais e papel social foram avaliados na entrevista de entrada e após 12 e 24 sessões. Resultados Nossos resultados indicam que quatro sessões foram suficientes para medir a dimensão do vínculo da aliança terapêutica, enquanto que é necessário mais tempo para medir adequadamente outros aspectos da aliança terapêutica, como tarefas e objetivos. No entanto, 12 sessões de tratamento revelaram-se suficientes para detectar melhora em todas as dimensões dos instrumentos de resultados com tamanhos de efeito moderados, e esses ganhos se mostraram estáveis na 24ª sessão. Conclusão De acordo com nossos achados, 12 sessões parecem ser suficientes para acessar os ganhos iniciais na PDT, porém mais estudos são necessários para avaliar o tempo apropriado de medir todos os aspectos da aliança terapêutica. São necessários mais estudos para avaliar o tempo apropriado para avaliar os ganhos intermediários e de longo prazo em relação a sintomas, função interpessoal e função social.

Abstract Introduction Different instruments and methods for measuring factors related to the progress and effectiveness of psychodynamic psychotherapy (PDT) have been widely discussed in the literature. However, there are no established guidelines on the most appropriate time to perform these measurements. Objectives The aim of this study is to problematize what is the appropriate time to measure the initial outcomes (symptoms, interpersonal relationships, quality, and social role) and process factors (alliance) in the early stages of PDT. Methods A naturalistic cohort study was conducted, following 304 patients during the first six months of psychotherapy. The therapeutic alliance was evaluated after four sessions; symptoms, interpersonal relationships, and social role were evaluated at intake and after 12 and 24 sessions. Results Our results indicate that four sessions were sufficient to measure the bond dimension of the therapeutic alliance, while more time is probably needed to adequately measure other aspects of the therapeutic alliance, such as tasks and goals. However, 12 sessions of treatment proved sufficient to detect improvements in all dimensions of the outcome instruments with moderate effect sizes, and those gains were stable at the 24th session. Conclusion According to our findings, 12 sessions seem to be sufficient to assess initial gains in PDT, although more studies are needed to evaluate the appropriate time to assess all aspects of the therapeutic alliance. Further studies are also required to evaluate the appropriate time to assess intermediate and long-term progress with regard to symptoms, interpersonal relations, social role and personality reorganization.

Resumo Objetivo Este estudo objetivou identificar e analisar as estruturas de interação (interaction structures [ISs]) (padrões de interação recíproca entre a dupla paciente-terapeuta) que caracterizam o processo de uma psicoterapia psicodinâmica de longa duração (28 meses) de uma paciente com doenças crônicas (lúpus e fibromialgia) e sintomas somáticos. Métodos As 113 sessões foram filmadas e analisadas alternadamente (n = 60) por juízes independentes usando o Psychotherapy Process Q-Set. A confiabilidade entre avaliadores variou de 0.60 a 0.90, com média de r = 0.71 (correlação de Pearson). Por meio de uma análise fatorial exploratória do componente principal, foram identificadas quatro ISs. Resultados Os padrões de interação entre paciente e terapeuta mostraram validade clínica (ou seja, foram facilmente interpretáveis no contexto do caso em estudo). As ISs foram não lineares e mais ou menos proeminentes em diferentes sessões e etapas do tratamento. Algumas ISs foram semelhantes às de outros estudos, e outras provavelmente foram exclusivas do presente processo. Além disso, algumas ISs eram independentes, enquanto outras estavam inter-relacionadas ao longo do tempo. Conclusão Estudos de processo como o presente procuram abordar questões sobre as características da interação entre paciente e terapeuta, bem como identificar padrões particulares de interação que são mais proeminentes com um determinado paciente em condições ou momentos específicos. Portanto, esses estudos podem fornecer suporte ao estabelecimento de conhecimentos para a prática clínica, auxiliando na formação de terapeutas, bem como na elaboração de diretrizes gerais para o manejo técnico de pacientes com características específicas.

Abstract Objective This study aimed to identify and analyze the interaction structures (ISs) (patterns of reciprocal interaction between the patient-therapist dyad) that characterize the process of a successful long-term psychodynamic psychotherapy (28 months) of a patient with chronic diseases (lupus and fibromyalgia) and somatic symptoms. Methods The 113 sessions were videotaped and analyzed alternately (n = 60) by independent judges using the Psychotherapy Process Q-Set. Inter-rater reliability ranged from 0.60 to 0.90, with a mean of r = 0.71 (Pearson’s correlation). Through a principal component exploratory factor analysis, four ISs were identified. Result The patterns of interaction between patient and therapist showed clinical validity (i.e., they were easily interpretable in the context of the case under study). The ISs were non-linear and more or less prominent across different treatment sessions and stages. Some ISs were similar to those in other studies, and others were probably unique to the present process. In addition, some ISs were independent, whereas others were interrelated over time. Conclusion Process studies, such as the present one, seek to address questions about the characteristics of the interaction between patient and therapist as well as to identify particular patterns of interaction that are most prominent with a specific patient at a specific condition or time. Therefore, these studies can provide some support in establishing knowledge for clinical practice, assisting in the training of therapists, as well as in the elaboration of general guidelines for the technical management of patients with specific characteristics.

Resumo Objetivo Este artigo se refere à tradução, adaptação transcultural e validação aparente da Trauma and Attachment Belief Scale (TABS), instrumento utilizado para avaliar os efeitos psicológicos das experiências de vida traumáticas e do trauma vicário. Métodos Este estudo envolveu uma revisão de literatura e avaliação da equivalência conceitual e dos itens, empregando grupos de discussão de especialistas, focando na existência e pertinência dos conceitos teóricos subjacentes e na correspondência dos itens dentro de um contexto brasileiro. Duas traduções e respectivas retrotraduções foram realizadas durante a avaliação da equivalência semântica, bem como foi feita uma avaliação considerando a equivalência referencial e geral entre a TABS original e cada versão. Vinte e oito psiquiatras e psicólogos completaram um pré-teste. A versão final foi testada para confiabilidade através do alfa de Cronbach e para compreensão verbal através de uma escala verbal-numérica adaptada [variando de 0 (Eu não entendi nada) a 5 (Eu entendi perfeitamente e não tive qualquer dúvida)] em outros 64 profissionais de saúde. Resultados A adaptação transcultural demonstrou alta equivalência semântica, tanto para o significado geral (>95,0%) quanto referencial (>90,0%). O alfa de Cronbach total foi de 0,9173. Todos os 84 itens foram mantidos e contribuíram favoravelmente para a consistência interna da escala. Os valores médios da escala verbal-numérica adaptada para a compreensão verbal obtidos dos profissionais de saúde variaram de 4,2 a 4,9. Conclusão A versão brasileira da TABS demonstrou equivalência conceitual, de itens e semântica de alta qualidade com o instrumento original, bem como elevada aceitabilidade, consistência interna e compreensão verbal. A escala está atualmente disponível para uso.

Abstract Objective This article concerns the translation, cross-cultural adaptation, and apparent validation of the Trauma and Attachment Belief Scale (TABS), an instrument used to assess the psychological effects of traumatic life experiences and vicarious trauma. Methods This study involved literature review and evaluation of conceptual and item equivalences involving expert discussion groups focused on the existence and pertinence of the underlying theoretical concepts and corresponding items in a Brazilian context. Two translations and respective back-translations were performed during the evaluation of semantic equivalence, as well as an evaluation considering the referential and general equivalences between the original TABS and each version. Twenty-eight psychiatrists and psychologists completed a pretest. The final version was tested for reliability through the Cronbach’s alpha and for verbal comprehension through the adapted verbal-numeric scale (ranging from 0 [I didn’t understand anything] to 5 [I understood perfectly and I had no doubt]) in another 64 health professionals. Results The cross-cultural adaptation demonstrated high semantic equivalence for both the general (>95.0%) and the referential (>90.0%) meaning. The total Cronbach’s alpha was 0.9173. All 84 items were maintained, and they favorably contributed to the internal consistency of the scale. The mean values of the adapted verbal-numeric scale for verbal comprehension obtained from health professionals varied from 4.2 to 4.9. Conclusion The Brazilian version of the TABS demonstrated high-quality conceptual, item, and semantic equivalence with the original instrument, as well as high acceptability, internal consistency, and verbal comprehension. The scale is now available for use.

Resumo Introdução Este estudo investigou a associação entre resiliência e transtorno de estresse pós-traumático (TEPT) entre vítimas brasileiras de violência urbana. Comparou os mecanismos de defesa, vínculos parentais e trauma infantil entre vítimas que desenvolveram TEPT e vítimas que não desenvolveram o transtorno. Métodos Estudo de caso-controle transversal que incluiu 66 sujeitos adultos expostos à violência urbana no sul do Brasil. Foram avaliados 33 pacientes com TEPT e 33 controles saudáveis pareados por sexo e idade, que responderam a Escala de Resiliência, Questionário do Estilo Defensivo, Instrumento de Ligação Parental e Questionário sobre Traumas Infantis. Os testes estatísticos utilizados foram o teste de McNemar para variáveis categóricas, teste Wilcoxon para variáveis assimétricas contínuas e teste tde Student pareado para variáveis simétricas contínuas. Resultados O grupo que desenvolveu TEPT apresentou escores totais da Escala de Resiliência mais baixos em relação aos controles (128,4±20,7 versus145,8±13,1, respectivamente; p = 0,01), juntamente com uma menor capacidade em resolver situações e menores índices de valores pessoais que dão sentido à vida (p = 0,019). Também apresentaram taxas mais baixas de uso de mecanismos de defesas maduros (p < 0,001) e maiores taxas de abuso emocional (p = 0,001) e físico (p = 0,003) durante a infância. Conclusão Níveis mais baixos de resiliência, especialmente a capacidade de resolver situações e ter valores pessoais que dão sentido à vida, mecanismos imaturos de defesa e abuso físico e emocional na infância estão associados ao TEPT em adultos vítimas de violência urbana no Brasil.

Abstract Introduction This study investigated the association between resilience and posttraumatic stress disorder (PTSD) among Brazilian victims of urban violence. It also compared defense mechanisms, parental bonding, and childhood trauma between those who developed PTSD and those who did not. Methods This cross-sectional case-control study included 66 adult subjects exposed to recent urban violence in southern Brazil – 33 with PTSD and 33 healthy controls matched by sex and age – who were administered the Resilience Scale, Defense Style Questionnaire, Parental Bonding Instrument, and Childhood Trauma Questionnaire. The statistical tests used were the McNemar test for categorical variables, the Wilcoxon signed-rank test for continuous asymmetric variables, and the paired Student t-test for continuous symmetric variables. Results The PTSD group showed lower total Resilience Scale scores compared with controls (128.4±20.7 vs. 145.8±13.1, respectively; p = 0.01), along with a lower ability to solve situations and lower personal values that give meaning to life (p = 0.019). They also had lower rates of mature defense mechanisms (p < 0.001) and higher rates of emotional (p = 0.001) and physical (p = 0.003) abuse during childhood. Conclusion Lower levels of resilience, especially the ability to solve situations and having personal values that give meaning to life, immature defense mechanisms, and emotional and physical abuse in childhood are associated with PTSD in adult Brazilian victims of urban violence.