Firefighters are considered a high-risk group for the development of PTSD and other stress-related diseases. More than the exposure to potentially traumatic events, personal and occupational characteristics have been pointed out as interfering in the perception of stress, which may lead to the emergence of mental and physical symptoms. This study aimed to analyze the relationship between the main factors that contribute to stress-related diseases in firefighters. A systematic review was conducted in order to identify original articles focusing on risk and protective factors for stress in this population. Personality traits, training, experience in extreme situations and social and organizational support influence the perception of stress and, consequently, the choice of coping strategies, which may protect against or potentiate the stress reactions. The findings of this study allow us to draw a relational model that represents the dynamics among the factors related to stress in firefighters. The development of PTSD and other stress-related diseases depends on a host of pre-trauma and post-trauma factors and, although training is an important protective factor, being prepared to face extreme situations does not mean being immune to traumatic stress.

In Portugal, forest fires are responsible for disasters that tend to be repeated annually, leading to dramatic consequences, such as those that have occurred in 2017, with the destruction of hundreds of houses and the deaths of dozens of people. Firefighters who are exposed to these potentially traumatic events are considered a high-risk group for the development of stress-related disorders. The aim of this study was to monitor the progress of two firefighters with symptoms of post-traumatic stress disorder (PTSD) treated through dynamic psychotherapy (DP) and to assess the feasibility of implementing this intervention within fire departments. A female firefighter and a male firefighter, with similar sociodemographic characteristics and PTSD symptom severity, were selected to verify the treatment applicability for both genders. The symptomatology changes were assessed through a set of instruments (PHQ-15, PCL-5, BSI, DASS, and CALPAS-P) applied every three months over 15 months (including pre-treatment, treatment period, and post-treatment). DP seemed to be an effective treatment for PTSD symptoms, with patients showing a state of increasing improvement even after the end of treatment. The acceptability to firefighters, the treatment adherence, the therapeutic alliance, and the reduction in PTSD symptoms suggest feasibility for implementing this intervention inside the Portuguese fire departments.

Dynamic Psychotherapy (DP) was developed to overcome the limitations of traditional psychoanalysis, responding to a broader demand of patients who seek help to cope with specific problems in the short term, such as Obsessive-Compulsive Disorder (OCD). OCD is a chronic disabling mental disorder that leads to substantial distress, functional disability and severe occupational and social impairments. Recognizing the literature gap in this field, and the improvements reported by dynamic therapists who have dealt with patients suffering from OCD, a study on the treatment of these patients was conducted in order to discuss the effects of this technique. The method involved a narrative literature review and the analysis of two clinical cases to discuss therapeutic processes, which include the specificities of OCD patients and the mechanisms adopted in the treatment through DP. The therapist’s active stance seemed to be essential to encourage the patient to face feared situations and identify the core conflict. Both patients who were treated through DP presented similarities, such as high anxiety, feelings of guilt and inhibition of aggressive and sexual impulses. Through emotional exploration, confrontation of defensive functioning and interpretative interventions of inner conflicts, patients had reached awareness of their hidden feelings and experiences, and their symptoms and feelings of guilt decreased. They also showed significant improvements in their interpersonal relationships. Although both treatments do not fit into short-term therapies, this technique has led to long-term results, providing evidence that DP may produce favorable outcomes in the treatment of OCD.

(1) Background: Functional somatic symptoms (FSS) are physical symptoms that cannot be fully explained by medical diagnosis, injuries, and medication intake. More than the presence of unexplained symptoms, this condition is associated with functional disabilities, psychological distress, increased use of health services, and it has been linked to depressive and anxiety disorders. Recognizing the difficulty of diagnosing individuals with FSS and the impact on public health systems, this study aimed to verify the concomitant incidence of psychopathological symptoms and FSS in Portugal. (2) Methods: For this purpose, 93 psychosomatic outpatients (91.4% women with a mean age of 53.9 years old) and 101 subjects from the general population (74.3% women with 37.8 years old) were evaluated. The survey questionnaire included the 15-item Patient Health Questionnaire, the 20-Item Short Form Survey, the Brief Symptom Inventory, the Depression, Anxiety and Stress Scale, and questions on sociodemographic and clinical characteristics. (3) Results: Increases in FSS severity were correlated with higher rates of depression, anxiety, and stress symptoms. The findings also suggest that increased rates of FSS are associated with lower educational level and female gender. (4) Conclusion: Being aware of the relationship between FSS and psychopathological symptoms and the need to explore psychosocial issues during clinical interviews may favor early detection of these cases. The early detection of mental disorders is essential for individuals’ adherence to treatments, reflecting on healthcare costs.

A perturbação de stress pós‐traumático (PSPT) é uma doença psiquiátrica comum, geralmente crónica, com severas implicações na qualidade de vida da pessoa afetada e da sua família, e que tem vindo a apresentar um crescente reconhecimento enquanto problema de Saúde Pública. Nas últimas duas décadas, estudos clínicos com 3,4‐metilenodioximetanfetamina (MDMA) têm vindo a demonstrar o seu papel promissor enquanto potencializador psicoterapêutico em doentes com PSPT, tendo a psicoterapia assistida por MDMA inclusivamente recebido em 2017 a designação de breakthrough therapy. Estes estudos têm vindo a ser replicados em vários locais do mundo, segundo estritos protocolos, estando atualmente asua aprovação para uso clínico prevista para 2023. Em maio de 2021, foram publicados os primeiros resultados de estudos de fase III, nos quais os participantes que receberam psicoterapia assistida por MDMA experienciaram uma redução significativa e duradoura nos sintomas de PSPT. Os efeitos pró‐sociais e interpessoais agudos do MDMA têm demonstrado melhorar significativamente a qualidade da aliança terapêutica, potenciando a adesão ao tratamento da PSPT e o seu outcome. Os clínicos sugerem que o MDMA pode catalisar o processamento terapêutico, permitindo que os pacientes permaneçam emocionalmente envolvidos enquanto revisitam experiências traumáticas sem se tornarem oprimidos.Tendo em conta a prevalência da PSPT e as limitações encontradas com os tratamentos atualmente disponíveis, foi realizada uma revisão narrativa da literatura com o objetivo de examinar a utilização da psicoterapia assistida por MDMA na perturbação de stress pós‐traumático, apresentando uma contextualização histórica desta molécula, os seus potenciais efeitos nos diferentes sintomas desta patologia e identificando áreas prioritárias para intervenção e investigações futuras.