Manual de intervención en dilemas implicativos

The notion that human beings face internal conflicts is very old in the field of psychotherapy. Also, it is common the idea that symptoms could be derived from those conflicts. However, attempts for developing ways of appraising those conflicts so that they can be measured and tested empirically are almost inexistent. Precisely, the Multi- Centre Dilemma Project is aimed at investigating the role of those conflicts, termed implicative dilemmas or dilemmatic constructs, in health using the Repertory Grid Technique as a method to identify them. So far, a higher presence of those conflicts has been found in a variety of clinical problems (depression, social phobia, somatic problems, etc.) in comparison to non-clinical samples. Therefore, it seems convenient to develop a form of intervention aimed to dealing and resolving these conflicts. In this paper a therapy manual focused on implicative dilemmas resolution is presented. It consists of a structured intervention for 15 sessions, designed mainly for research and training in psychotherapy, and based on Personal Construct Psychotherapy

A Autoimagem, Regulação Emocional, Ansiedade, Stress e Depressão em Sujeitos com Obesidade, submetidos a Cirurgia Bariátrica

Introdução: A obesidade é uma doença crónica de proporções epidémicas, representando um grave problema de saúde pública a nível mundial. A obesidade é um fator de risco significativo para numerosas comorbilidades tanto psicológicas, como físicas, que estão associadas ao aumento global da mortalidade e à diminuição da esperança de vida em dez anos. Estudos indicam uma forte a relação entre obesidade e saúde mental, com o aparecimento de quadros depressivos, ansiosos e de stress. Estudos corroboram que, os tratamentos para a obesidade passam por dois conjuntos, consoante as comorbilidades e histórico individual de cada paciente. O primeiro corresponde ao tratamento de primeira linha e compreende intervenções ao nível geral do estilo de vida de cada paciente, dieta adaptada, exercício físico, intervenção psicológica e medicação e o tratamento de última linha, surge a realização de cirurgia bariátrica, que tem como objetivos a redução do peso corporal, a melhoria das comorbilidades e também a melhoria da qualidade de vida dos pacientes. Objetivos: Este estudo pretendeu explorar as variáveis psicológicas potencialmente associadas ao excesso de peso e obesidade. Com uma caracterização das variáveis psicológicas no que respeita à sintomatologia de depressão, stress, ansiedade e das dimensões da regulação emocional e da imagem corporal. Assim como, testar a hipótese de haver diferenças significativas nas variáveis psicológicas mencionadas, entre os três grupos de sujeitos: normoponderais, excesso de peso sem cirurgia e excesso e peso com cirurgia. Amostra e Métodos: A amostra foi constituída por 407 indivíduos, 363 (89.2%) do sexo feminino e 44 (10.8%) do sexo masculino. A idade foi compreendida entre os 18 e 60 anos. Os participantes preencheram um questionário de dados sociodemográficos e completaram quatro instrumentos de autorresposta que avaliaram a regulação emocional (DERS-SF), os sintomas de depressão, ansiedade e stress (DASS-21), a imagem corporal (BIS-18) e a presença de sintomas psicopatológicos (BSI-18). Resultados: Entre a amostra total do grupo conclui-se que 108 (26.5%) tinham excesso de peso sem realizar cirurgia bariátrica, 165 (40.5%) tinham excesso de peso com cirurgia bariátrica realizada e 134 (32.9%) eram considerados normoponderais através do IMC. Através de análises de variância, revelou que existiam diferenças significativas na variável impulsos da regulação emocional, no grupo de excesso de peso com cirurgia bariátrica. Na sintomatologia depressiva, ansiosa e stress, não houve diferença significativa entre os grupos. Na forma como visionam o corpo foram considerados resultados significativos entre o grupo normoponderal, mostrando um maior cuidado corporal. Na somatização dos sintomas, não foram encontrados resultados significativos. No entanto os resultados das regressões lineares múltiplas para os sujeitos com IMC ≥25, correlacionaram-se positivamente, sugerindo que a idade mais jovem, a imagem corporal, a não-aceitação, proteção corporal, clareza e objetivos poderão ser possíveis preditores de sintomatologia depressiva, ansiosa e do stress ligada à obesidade. Conclusão: A presente investigação foi desenvolvida com o propósito de contribuir para o enriquecimento de estudos atuais, referentes à saúde mental, apresentado uma melhor caracterização psicológica da população obesa e bariátrica, assim como, conhecer as variáveis por ela influenciadas e que melhorias poderão ser feitas em estudos futuros na população portuguesa. Assim como contribuir para repensar em protocolos clínicos de avaliação e seguimento desta população. Contudo é reconhecível a importância de dar continuidade a estudos com esta população, dado que, mesmo com os conhecimento e estudo dos variáveis preditores da obesidade, não obstem de, neste processo, haver propensa a contrair perturbações patologias, tais são as mudanças na vida destes sujeitos. Seria importante uma avaliação psicossocial destes pacientes, assim como um racional de todo o processo para o sucesso terapêutico destes sujeitos e o estudo de todas as variáveis do indivíduo para resultados e planos mais individualizados e robustos. / Introduction: Obesity is a chronic disease of epidemic proportions, representing a major public health problem worldwide. Obesity is a significant risk factor for numerous comorbidities both psychological and physical, which are associated with increased overall mortality and decreased life expectancy in ten years. Studies indicate a strong relationship between obesity and mental health, with the onset of depression, anxiety, and stress. Studies corroborate that treatments for obesity go through two sets, depending on the comorbidities and individual history of each patient. The first corresponds to the first-line treatment and includes interventions at the general level of each patient's lifestyle, adapted diet, physical exercise, psychological intervention, and medication. The last-line treatment is bariatric surgery, which aims to reduce body weight, improve comorbidities, and also improve the quality of life of patients. Objectives: This study aimed to explore the psychological variables associated with overweight and obesity. With a characterization of the psychological variables regarding the symptoms of depression, stress, anxiety and the dimensions of emotional regulation and body image. As well as, to test the hypothesis of having significant differences in the psychological variables mentioned, between the three groups of subjects: healthy, overweight without surgery and overweight with surgery. Sample and Methods: The sample consisted of 407 subjects, 363 (89.2%) female and 44 (10.8%) male. The age was between 18 and 60 years. Participants completed a questionnaire of sociodemographic data and completed four self-report instruments that assessed emotion regulation (DERS-SF), symptoms of depression, anxiety and stress (DASS-21), body image (BIS-18) and the presence of psychopathological symptoms (BSI-18). Results: Among the total group sample it was concluded that 108 (26.5%) were overweight without bariatric surgery, 165 (40.5%) were overweight with bariatric surgery performed, and 134 (32.9%) were considered healthy by BMI. Through variance analysis, it was revealed that there were significant differences in the variable emotional regulation impulses in the overweight group with bariatric surgery. In depressive, anxious, and stress symptoms, there were no significant differences between the groups. In the way they view their bodies, significant results were found among the healthy group, showing greater body care. In the somatization of symptoms, no significant results were found. However, the results of multiple linear regressions for subjects with BMI ≥25 correlated positively, suggesting that younger age, body image, non-acceptance, body protection, clarity, and goals may be possible predictors of depressive, anxiety, and stress symptoms linked to obesity. Conclusion: This research was developed with the purpose of contributing to the studies regarding mental health, presenting a better psychological characterization of the obese population psychological characterization of the obese and bariatric population, as well as to know the variables influenced by it and what improvements may be made in future studies in the Portuguese population. Portuguese population. As well as contribute to rethink clinical protocols of evaluation and follow-up of this population. However, the importance of continuing studies with this population is recognizable, since, even with the knowledge and study of the predictor variables of obesity, it doesn't prevent, in this process, there is a propensity to contract pathologies, such are the changes in the life of these subjects. A psychosocial evaluation of these patients would be important, as well as a rationale of the entire process for the therapeutic success of these subjects and the study of all the variables of the individual for more individualized and robust results and plans

Replication stress and chromatin context link ATM activation to a role in DNA replication

ATM-mediated signaling in response to DNA damage is a barrier to tumorigenesis. Here we asked whether replication stress could also contribute to ATM signaling. We demonstrate that, in the absence of DNA damage, ATM responds to replication stress in a hypoxia-induced heterochromatin-like context. In certain hypoxic conditions, replication stress occurs in the absence of detectable DNA damage. Hypoxia also induces H3K9me3, a histone modification associated with gene repression and heterochromatin. Hypoxia-induced replication stress together with increased H3K9me3 leads to ATM activation. Importantly, ATM prevents the accumulation of DNA damage in hypoxia. Most significantly, we describe a stress-specific role for ATM in maintaining DNA replication rates in a background of increased H3K9me3. Furthermore, the ATM-mediated response to oncogene-induced replication stress is enhanced in hypoxic conditions. Together, these data indicate that hypoxia plays a critical role in the activation of the DNA damage response, therefore contributing to this barrier to tumorigenesis

Personal reconstruction processes in personal construct therapy for implicative dilemmas

Tese de doutoramento em Psicologia (área de conhecimento em Psicologia Clínica)In a personal construct psychology perspective, human beings are continually construing their experience of themselves and their reality, and continuously reconstructing it to make sense of new events. Psychological disorders represent some failure in this ongoing process, as the individual cannot make sense of the world with their constructions nor change them. Therapeutic change is of itself a form of reconstruction that allows clients to recover their ability to create alternatives. Implicative dilemmas are one kind of blockage in construction, characterized by the association between a problematic construction and some positive dimensions of the self. Thus, change in the problematic areas implies undesired changes in other aspects of the self. Previous research has shown that implicative dilemmas are quite prevalent in general population, but significantly more frequent in people seeking psychotherapy. Implicative dilemmas are crosssectional to clinical syndromes, representing a matter of structure of the construction system more than one of content. It has also been shown that implicative dilemmas tend to diminish with psychotherapeutic intervention. Departing from previous proposals, we have developed a manual for the intentional and systematic treatment of implicative dilemmas, standing on personal constructivist assumptions and techniques. This treatment proposal has been applied to psychotherapy in a university clinic, and eight clients have completed the treatment and research procedures, including a variety of qualitative and quantitative measures of therapeutic process and outcome, assessed at several moments of their treatment. This thesis presents a detailed study of one of those cases, analysed through hermeneutic single case efficacy design, which shows that the treatment proposal was helpful for the treatment of this client, causing significant changes. In addition, we constructed an explanation for the observed changes, in light of personal construct theory. A clinical replication series added seven more cases to that first study in order to refine our explanation of the personal reconstruction processes that occur while resolving an implicative dilemma in personal construct therapy for implicative dilemmas. In addition, it found positive signs of this treatment’s efficacy when applied to clinical practice. In our final study, we tried to identify and understand the processes of personal reconstruction that occur while resolving an implicative dilemma, at the episode level. We focused on significant events identified by clients to create a tentative model of dilemma reconstruction. Our findings were generally consistent with the previous theory, applying it at a micro-analytic level.Na perspectiva da teoria dos construtos pessoais, o ser humano continuamente constrói a sua percepção de si e do mundo, e continuamente a reconstrói para dar sentido às novas experiências. A perturbação psicológica representa uma falha neste processo, já que o indivíduo não é capaz de dar sentido ao mundo com as suas construções, nem de as mudar. A mudança terapêutica é em si mesma uma forma de reconstrução, que permite aos cliente recuperar a sua capacidade de criar alternativas. Dilemas Implicativos são um tipo de bloqueio no processo de construção, caracterizado pela associação entre uma construção problemática e algumas dimensões positivas do self. Assim, mudar nas áreas problemáticas implica mudanças indesejadas em outros aspectos do self. Estudos prévios mostraram que os dilemas implicativos são bastante prevalentes na população geral, mas significativamente mais frequentes em clientes de psicoterapia. Os dilemas implicativos são um fenómeno transversal às diferentes síndromes clínicas, uma vez que se trata mais de uma dimensão de estrutura do sistema de construtos do que de conteúdo. Também tem sido demonstrado que estes dilemas tendem a diminuir com a intervenção psicoterapêutica. A partir de propostas prévias, desenvolvemos um manual para o tratamento intencional e sistemático dos dilemas implicativos, baseado nos pressupostos e técnicas da psicologia dos construtos pessoais. Esta proposta de tratamento foi aplicada à prática numa clínica universitária, e oito clientes completaram o tratamento e procedimentos de investigação, incluindo uma variedade de medidas qualitativas e quantitativas de processo e resultados terapêuticos, avaliados em diferentes momentos do tratamento. Esta tese apresenta o estudo detalhado de um desses casos, analisado através da metodologia hermeneutic single case efficacy design, que demonstrou que o tratamento foi útil para o tratamento desta cliente, causando mudanças significativas. Construímos também um modelo explicativo das mudanças observadas, à luz da teoria dos construtos pessoais. Uma série de replicação clínica considerou mais sete casos, com o objectivo de refinar o nossa explicação dos processos de reconstrução pessoal que ocorrem na resolução de um dilema implicativo em terapia construtivista pessoal centrada em dilemas implicativos. Esta série deu também sinais positivos relativamente à eficácia deste tratamento quando aplicado à prática clínica. O nosso último estudo tenta identificar e compreender os processos de reconstrução pessoal que ocorrem na resolução de um dilema implicativo, ao nível episódico. Centramo-nos em eventos importantes identificados pelos clientes para criar um modelo tentativo de reconstrução dos dilemas. Os resultados foram em geral consistentes com a teoria, aplicando-a ao nível micro-analítico.Fundação para a Ciência e a Tecnologia - Bolsa de Doutoramento SFRH/BD/23846/2005

HIF-1 alpha-independent hypoxia-induced rapid PTK6 stabilization is associated with increased motility and invasion

© 2014 Landes Bioscience. PTK6/Brk is a non-receptor tyrosine kinase overexpressed in cancer. Here we demonstrate that cytosolic PTK6 is rapidly and robustly induced in response to hypoxic conditions in a HIF-1-independent manner. Furthermore, a proportion of hypoxic PTK6 subsequently re-localized to the cell membrane. We observed that the rapid stabilization of PTK6 is associated with a decrease in PTK6 ubiquitylation and we have identified c-Cbl as a putative PTK6 E3 ligase in normoxia. The consequences of hypoxia-induced PTK6 stabilization and subcellular re-localization to the plasma membrane include increased cell motility and invasion, suggesting PTK6 targeting as a therapeutic approach to reduce hypoxia-regulated metastatic potential. This could have particular significance for breast cancer patients with triple negative disease

Developing an interpretation centre for portuguese design : CIDESP.PT

Considering the lack of importance of the discipline in the Portuguese and international context, this paper aims to present and discuss a museological and museographic project that's in its early stage and started to be developed concerned with Portuguese design history and design studies. The focus on the theme Portuguese design is justified by the extent of the heritage of communication artefacts, equipment and environment, presently dispersed about the country and at risk of disappearing into oblivion.The paper present's an approach based in a new hermeneutical dimension which methodology will be centered on the study of the artefacts based on the 'inverse design' and it will be focused on the morphogenetic study, related with their importance next to the public sphere. Considering the specificity of Portuguese design history the paper refers' some notes on this subject, giving some examples that can be considered as some starting references to proceed with the project. The results of this research it will be declined in augmented interactive representations regarding the importance of the personal narratives related with the selected artifacts. This project seeks to contribute to the minimization of the invisibility of design Portuguese knowledge and to be used as a model to other countries

Humanized medium (h7H) allows long-term primary follicular thyroid cultures from human normal thyroid, benign neoplasm, and cancer

Mechanisms of thyroid physiology and cancer are principally studied in follicular cell lines. However, human thyroid cancer lines were found to be heavily contaminated by other sources, and only one supposedly normal-thyroid cell line, immortalized with SV40 antigen, is available. In primary culture, human follicular cultures lose their phenotype after passage. We hypothesized that the loss of the thyroid phenotype could be related to culture conditions in which human cells are grown in medium optimized for rodent culture, including hormones with marked differences in its affinity for the relevant rodent/human receptor.|The objective of the study was to define conditions that allow the proliferation of primary human follicular thyrocytes for many passages without losing phenotype.|Concentrations of hormones, transferrin, iodine, oligoelements, antioxidants, metabolites, and ethanol were adjusted within normal homeostatic human serum ranges. Single cultures were identified by short tandem repeats. Human-rodent interspecies contamination was assessed.|We defined an humanized 7 homeostatic additives medium enabling growth of human thyroid cultures for more than 20 passages maintaining thyrocyte phenotype. Thyrocytes proliferated and were grouped as follicle-like structures; expressed Na+/I- symporter, pendrin, cytokeratins, thyroglobulin, and thyroperoxidase showed iodine-uptake and secreted thyroglobulin and free T3. Using these conditions, we generated a bank of thyroid tumors in culture from normal thyroids, Grave's hyperplasias, benign neoplasms (goiter, adenomas), and carcinomas.|Using appropriate culture conditions is essential for phenotype maintenance in human thyrocytes. The bank of thyroid tumors in culture generated under humanized humanized 7 homeostatic additives culture conditions will provide a much-needed tool to compare similarly growing cells from normal vs pathological origins and thus to elucidate the molecular basis of thyroid disease.Ministerio de Ciencia e InnovaciónInstituto de Salud Carlos IIIXunta de GaliciaFondo Social Europeo of the European Communit

Manual de intervención en dilemas implicativos

The notion that human beings face internal conflicts is very old in the field of psychotherapy. Also, it is common the idea that symptoms could be derived from those conflicts. However, attempts for developing ways of appraising those conflicts so that they can be measured and tested empirically are almost inexistent. Precisely, the Multi-Centre Dilemma Project is aimed at investigating the role of those conflicts, termed implicative dilemmas or dilemmatic constructs, in health using the Repertory Grid Technique as a method to identify them. So far, a higher presence of those conflicts has been found in a variety of clinical problems (depression, social phobia, somatic problems, etc.) in comparison to non-clinical samples. Therefore, it seems convenient to develop a form of intervention aimed to dealing and resolving these conflicts. In this paper a therapy manual focused on implicative dilemmas resolution is presented. It consists of a structured intervention for 15 sessions, designed mainly for research and training in psychotherapy, and based on Personal Construct Psychotherapy.La idea de que los humanos tenemos conflictos internos y que de ellos se puedan derivar síntomas y/o sufrimiento es muy antigua en el campo de las psicoterapias. Sin embargo, pocos han sido los intentos por apreciar esta cuestión de forma empírica. Precisamente, el objetivo del Proyecto Multicéntrico Dilema ha sido investigar el papel que tienen en la salud estos conflictos, definidos como dilemas implicativos o constructos dilemáticos identificados a través de la Técnica de Rejilla. Se ha detectado una mayor prevalencia de estos conflictos en una gran variedad de problemas clínicos (depresión, fobia social, problemas somáticos, etc.), por lo que parece indicado desarrollar una forma de intervención que permita abordarlos y resolverlos. En este trabajo se presenta un manual de intervención enfocado a la resolución de dilemas implicativos. Se trata de una propuesta de intervención estructurada, de 15 sesiones, destinada principalmente al uso en investigación y en formación de psicoterapeutas, dentro de una perspectiva de Terapia de Constructos Personales

Colaboración terapéutica: Estudio comparativo de un caso de éxito y un caso de fracaso terapéutico de terapia constructivista

A qualidade da interação terapêutica constitui-se como um importante preditor dos resultados terapêuticos e como crucial na decisão dos clientes para se manterem na terapia. O presente estudo teve como objetivo descrever e comparar o desenvolvimento da colaboração terapêutica em dois casos clínicos, um finalizado e um de desistência, ambos de insucesso e seguidos em Terapia Narrativa. Foi utilizado o Sistema de Codificação da Colaboração Terapêutica, que permite distinguir episódios colaborativos, não colaborativos e de ambivalência por referência à Zona de Desenvolvimento Proximal Terapêutica (ZDPT) dos clientes. A codificação foi realizada independentemente por dois pares de juízas, tendo as discrepâncias sido resolvidas por consenso e mediante posterior auditoria. Os resultados mostram que no caso de desistência os episódios não colaborativos foram cinco vezes mais frequentes do que no caso finalizado. Em ambos os casos, verificou-se uma tendência crescente do terapeuta para estimular o movimento das clientes ao longo da ZDPT no sentido da inovação. Contudo, se nas últimas sessões do caso finalizado a cliente foi capaz de com o terapeuta, no caso de desistência ocorreu um aumento de episódios não colaborativos entre a díade