A eficácia da Terapia do Sandplay versus Terapia Cognitiva Comportamental
um estudo comparativo
Palavras-chave:
Terapia cognitivo comportamental, Violência doméstica, Terapia do Sandplay, Terapia breveResumo
Objetivo
Esta pesquisa tem como objetivo comparar a efetividade da terapia de sandplay com a terapia cognitiva comportamental na redução de sintomas clínicos ou limítrofes em crianças e adolescentes.
Método
Os participantes foram 21 vítimas de violência doméstica com sintomas clínicos ou limítrofes nas escalas Child Behavior Checklist ou Young Self Report. Os participantes foram também testados com a escala abreviada de inteligência Wechsler (T0) e designados randomicamente para os grupos de tratamento e controle. Os participantes foram testados novamente em T1 (20 sessões/20 semanas) e em T2 (6 meses).
Resultados
Para as crianças, não houve mudança entre os grupos, mas uma melhora nos problemas internalizantes no grupo de sandplay e nos problemas externalizantes e total de problemas no grupo de terapia cognitiva comportamental. Para os adolescentes, houve uma melhora significativa nos problemas externalizantes no grupo de sandplay e no total de problemas no grupo de terapia cognitiva comportamental.
Conclusão
Os resultados desta pesquisa não permitem concluir que uma técnica é melhor que outra, pois não tivemos uma diferença significativa consistente entre os grupos. Esses resultados podem ser devidos às diferentes abordagens das técnicas. Enquanto a Sandplay Therapy oferece um espaço livre e protegido para permitir que os participantes expressem seus sentimentos por meio de imagens e histórias, a Cognitive Behavioral Therapy segue um programa que se concentra mais em promover a adaptação do comportamento ao mundo exterior. A aplicação deste desenho de pesquisa a uma grande população e com mais sessões permitirá observar a consistência destes resultados, proporcionando terreno sólido para escolher qual técnica seria mais eficiente para cada caso específico.
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Referências
Achenbach, T. M. (2015). Achenbach System of Empirically Based Assessment (ASEBA). In R. L. Cautin & S. O. Lilienfeld (Eds.), The Encyclopedia of Clinical Psychology. John Wiley & Sons, Inc. https://doi:10.1002/9781118625392.wbecp150
Baldwin, J. R., Reuben, A., Newbury, J. B., & Danese A. (2019). Agreement between prospective and retrospective measures of childhood maltreatment: a systematic review and meta-analysis. JAMA Psychiatry, 76(6), 584-593. https://doi.org/10.1001/jamapsychiatry.2019.0097
Bartlett, J. D., Griffin, J. L., Spinazzola, J., Fraser, J. G., Noroña, C. R., Bodian, R., Todd, M., Montagna, C., & Barto, B. (2018). The impact of a statewide trauma-informed care initiative in child welfare on the well-being of children and youth with complex trauma. Children and Youth Services Review, 84, 110-117. https://doi.org/10.1016/j.childyouth.2017.11.015
Bland, V. J., Lambie, I., & Best, C. (2018). Does childhood neglect contribute to violent behavior in adulthood? A review of possible links. Clinical Psychology Review, 60, 126-135. https://doi.org/10.1016/j. cpr.2018.02.001
Bratton, S. C., Rhine, T., & Jones, L. (2005). The efficacy of play therapy with children: a meta-analytic review of treatment outcomes. Professional Psychology: Research and Practice, 36(4), 376-390. https://doi.org/10.1037/0735-7028.36.4.376
Cecil, C. A. M., Viding, E., Fearon, P., Glaser, D., & McCrory, E. J. (2017). Disentangling the mental health impact of childhood abuse and neglect. Child Abuse and Neglect, 63, 106-119. http://dx.doi.org/10.1016/j.chiabu.2016.11.024
Cicchetti, D., & Toth, S. L. (2016). Child maltreatment and developmental psychopathology: a multilevel perspective. In D. Cicchetti (Ed.), Developmental psychopathology (Vol. 3, pp. 457-512). Wiley.
Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2018). Trauma -focused cognitive behavioral therapy for children and families. Psychotherapy Research, 28(1), 47-57. https://doi.org/10.1080/10503307.2016.1208375
D’Andrea, W. D., Ford, J., Stolbach, B., Spinazzola, J., Van der Kolk, B. A. (2012). Understanding interpersonal trauma in children: why We need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187-200.
Fosha, D. (2003). Dyastic regulation and experiential work with emotion and relatedness in trauma and disorganized attachment. In M. F. Salomon & D. J. Siegel (Eds.), Healing trauma attachment, mind, body and brain (pp. 221-281). W.W. Norton & Company.
Freedle, L. R., Altschul, D. B., & Freedle, A. (2015). The role of Sandplay therapy in the treatment of adolescents and young adults with co-occurring substance use disorders and trauma. Journal of Sandplay Therapy, 24(2), 127-145.
Friedman, H., & Mitchell, R. (1994). Sandplay: past, present and future. Routledge.
Gutermann, J., Schreiber, F., Matulis, S., Schwartzkopff, L., Deppe, J., & Steil, R. (2016). Psychological treatments for symptoms of posttraumatic stress disorder in children, adolescents and young adults: a meta-analysis. Clinical Child and Psychology Review, 19(2), 77-93.
Han, Y., Lee, Y., & Suh, J. H. (2017). Effects of a sandplay therapy program at a childcare center on children with externalizing behavioral problems. Arts in Psychotherapy, 52, 24-31. https://doir.org/10.1016/j.aip.2016.09.008
Herrmann, S. B. (2011). Transformation of violence: the case of Jacob. Journal of Sandplay Therapy, 20(1), 117-132.
Kalff, D. M. (2003). Sandplay: a psychotherapeutic approach to the psyche. Temenos Press.
Knox, J. (2011). Self-Agency in psychotherapy (Attachment, autonomy and intimacy). Routledge.
Kreuze, L. J., Pijnenborg, G. H. M., Jonge, Y. B., & Nauta, M. H. (2018). Cognitive-behavior therapy for children and adolescents with anxiety disorders: a meta-analysis of secondary outcomes. Journal of Anxiety Disorders, 60, 43-57. https://doi.org/10.1016/j.janxdis.2018.10.005
Lee, Y. R., Jang, M., & Shim, J. (2018). The Effectiveness of group Sandplay therapy on quality of peer relationships and behavioral problems of Korean-Chinese children in China. Journal of Symbols & Sandplay Therapy, 9, 69-93. https://doi.org/10.12964/jsst.18008
Lourenco, L., Baptista, M. N., Nunes, M., Senra, L. X., Basilio, C., & Bhona, F. M. C. (2013). Consequences of exposure to domestic violence for children: a systematic review of the literature. Paidéia (Ribeirão Preto), 23(55), 263-271. https://doi.org/10.1590/1982-43272355201314
Manly, J. T., Oshri, A., Lynch, M., Herzog, M., & Wortel, S. (2013). Child neglect and the development of externalizing behavior problems: associations with maternal drug dependence and neighborhood crime. Child Maltreatment, 18(1), 17-29. https://doi.org/10.1177/1077559512464119
Matta, R. M., & Ramos, D. R. (2021). The effectiveness of Sandplay therapy in children who are victims of maltreatment with internalizing and externalizing behavior problems. Estudos de Psicologia (Campinas), 38, e200036. https://doi.org/10.1590/1982-0275202138e200036
McCrory, E., Brito, S. A., & Viding, E. (2010). Research review: the neurobiology and genetics of maltreatment and adversity. Journal of Child Psychology and Psychiatry, 51(10), 1079-1095.
Morina, N., Koerssen, R., & Pollet, T. (2016). Interventions for children and adolescents with posttraumatic stress disorder: a meta-analysis of comparative outcome studies. Clinical Psychology Review, 47, 41-54.
Mueller, I., & Tronick, E. (2019). Early life exposure to violence: developmental consequences on brain and behavior. Frontiers in Behavioral Neuroscience, 13, 1-7. https://doi.org/10.3389/fnbeh.2019.00156
Mulder, T. M., Kuiper, K. C., Van der Put, C. E., Stams, G. J. J. M., & Assink, M. (2018). Risk factors for child neglect: a meta-analytic review. Child Abuse & Neglect, 77, 198-210. http://dx.doi.org/10.1016/j. chiabu.2018.01.006
Neelakantan, L., Hetrick, S., & Michelson, D. (2019). Users’ experiences of trauma-focused cognitive behavioural therapy for children and adolescents: a systematic review and metasynthesis of qualitative research. European Child & Adolescent Psychiatry, 28, 877-897. https://doi.org/10.1007/s00787-018-1150-z
Oud, M., Winter, L., Vermeulen-Smit, E., Bodden, D., Stone, L.; Heuvel, M., Taher, R., Graaf, I., Kendall, T., Engels, R., & Stikkelbroek, Y. (2019). Effectiveness of CBT for children and adolescents with depression: a systematic review and meta-regression analysis. European Psychiatry, 57, 33-45. https://doi. org/10.1016/j.eurpsy.2018.12.008
Pattis, E. (2011). Sandplay Therapy in vulnerable communities, a Jungian approach. Routledge.
Paul, E., & Eckenrode, J. (2015). Childhood psychological maltreatment subtypes and adolescent depressive symptoms. Child Abuse & Neglect, 47, 38-47. http://dx.doi.org/10.1016/j.chiabu.2015.05.018
Paul, O. (2019). Perceptions of family relationships and post-traumatic stress symptoms of children exposed to domestic violence. Journal of Family Violence, 34, 331-343. https://doi.org/10.1007/s10896-018-00033-z
Ramos, D. G., & Matta, R. M. (2008). Sandplay: a method for data analysis. Journal of Sandplay Therapy, 17(2), 93-115.
Rocha, M. M., Pereira, R. F., Arantes, M. C., & Silvares, E. F. M. (2010). Guia para profissionais da saúde mental sobre o Sistema Achenbach de Avaliação Empiricamente Baseada (ASEBA). USP.
Roesler, C. (2019). Sandplay therapy: an overview of theory, applications and evidence base. The Arts in Psychotherapy, 64, 84-94. http://dx.doi.org/10.1016/j.aip.2019.04.001
Schore, A. N. (2007). Psychoanalytic research: progress and process. developmental affective neuroscience and clinical practice. Psychologist-Psychoanalyst, 27(3), 6-15.
Silk, J. S., Tan, P. Z., Ladouceur, C. D., Meller, S., Siegle, G. J., McMakin, D. L., Forbes, E. E., Dahl, R. E., Kendall, P. C., Mannarino, A., & Ryan, N. D. (2018). A randomized clinical trial comparing individual cognitive behavioral therapy and child-centered therapy for child anxiety disorders. Journal of Clinical Child & Adolescent Psychology, 47(4), 542-554. https://doi.org/10.1080/15374416.2016.1138408
Slade, M. K., & Warne, R. T. (2016). A meta-analysis of the effectiveness of trauma- focused cognitive-behavioral therapy and play therapy for child victims of abuse. Journal of Young Investigators, 30(6), 36-43. https://creativecommons.org/licenses/by-sa/4.0/
Toth, S. L., & Manly, J. T. (2019). Developmental Consequences of child abuse and neglect: implications for Intervention. Child Development Perspectives, 13(1), 59-64. https://doi.org/10.1111/cdep.12317
Valentino, K., Cicchetti, D., Rogosch, F., & Toth, S. L. (2011). Mother-child play and maltreatment: a longitudinal analysis of emerging social behavior from infancy to toddlerhood. Developmental Psychology, 47, 1280-1294. https://doi-org.ez95.periodicos.capes.gov.br/10.1037/a0024459
Van Der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: the empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389-399. https://doi.org/10.1002/jts.20047
Warwick, H., Reardon, T., Cooper, P., Murayama, K., Reynolds, S., Wilson, C., & Creswell, C. (2017). Complete recovery from anxiety disorders following Cognitive Behavior Therapy in children and adolescents: a meta-analysis. Clinical Psychology Review, 52, 77-91. https://doi.org/10.1016/j.cpr.2016.12.002
Wechsler, D. (2014). Wechsler abbreviated scale of intelligence, (WASI): adaptação e padronização brasileira. Casa do Psicólogo.
Weinrib, E. (1993). Imagens do Self: o processo terapêutico na caixa de areia. Summus
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