Análise Qualitativa de uma intervenção adaptada de Treinamento de Habilidades da Terapia Comportamental Dialética para mulheres com obesidade

The present study aimed to explore the perceptions about the experience of participating in an intervention based on Dialectical Behavior Therapy (DBT) Skills Training. Three participants with obesity of an intervention group agree to answer a semi-structured interview two month after the group. The semi structured interview focused on three areas: (1) experience of participating in an adapted DBT protocol; (2) treatment impact; (3) helpful or unhelpful aspects. The interviews were transcribed, and a thematic analysis was performed by three independent judges to evaluate treatment outcome in the sample. The results of the thematic analysis are divided in three domains: group experience, perceived effects and skills. Participants perceived impact on interpersonal environment and personal changes in self-control, dialectic vision, self-awareness and attention to eating context. The experience of group sharing is perceived as validating, however participants also referred anxiety in the group, especially regarding learning the skills. Recommendations on conductions of Skills Training groups for this population are discussed.Keywords: Dialectical Behavior Therapy; Qualitative Study; Obesity.O presente estudo tem como objetivo explorar as percepções sobre a experiência de participar em uma intervenção adaptada do Treinamento de Habilidades da Terapia Comportamental Dialética (TCD). Três participantes com obesidade de um grupo de intervenção concordaram em responder uma entrevista semiestruturada dois meses após o término do grupo. A entrevista semiestruturada focou em três áreas: (1) experiência de participar em um protocolo adaptado da TCD; (2) impacto do tratamento; (3) aspectos que ajudaram ou não ajudaram. As entrevistas foram transcritas e uma análise temática foi conduzida por três juízes independentes para avaliar os efeitos do treinamento na amostra. Os resultados da análise temática estão divididos em três domínios: experiência no grupo, efeitos percebidos e habilidades. As participantes perceberam impactos do treinamento no ambiente interpessoal e mudanças pessoais no autocontrole, visão dialética, autoconsciência e atenção ao contexto da alimentação. A experiência de compartilhar em grupo foi percebida como validante, porém as participantes também referiram ansiedade no grupo, especialmente em relação a aprendizagem das habilidades. Recomendações para a condução de grupos de Treinamento de Habilidades são discutidas.Palavras-chave: Terapia Comportamental Dialética; Estudo Qualitativo; Obesidade

Problematic and adaptive eating in people with obesity after a DBT-based skills training intervention : 3- and 8-month follow-up and mediation analysis

Background: Dialectical behavior therapy conceptualizes problematic behaviors as attempts to regulate emotions that occur when the individual lacks effective skills with which to manage his or her emotions and cope with distress. Problematic eating behaviors, e.g., binge and emotional eating, may serve to alleviate aversive emotional states, being highly associated with overweight and obesity. Dialectical behavior therapy skills training has been proven effective in reducing binge eating in several clinical studies. However, few studies reveal the effects of DBT on adaptive eating behaviors or the stability of outcomes. Objectives: This study aimed to test the effect of a brief DBT-based skills training intervention, and the stability of outcomes at 3- and 8-month follow-ups. Methods: Self-report measures of binge eating, emotional eating, intuitive eating, and mindful eating were taken on 5 timepoints before and after a 10-session DBT skills training intervention (2 baseline measures, 1 post-test, and 2 follow-ups). Data were analyzed using a mixed-model intention-to-treat approach and mediation analysis was conducted with path analysis. Results: After the intervention, intuitive eating and mindful eating scores were significantly higher than before the intervention, while emotional eating and binge eating scores were lower. The results remained stable during the follow-up period, with minor fluctuations and small trends towards returning to baseline values for binge eating and emotional eating. Mindful eating partially mediated the improvements in all outcomes. Limitations: Given that results are entirely based on self-report measures and that some instruments showed poor reliability, in addition to the high attrition rates, the results should be interpreted as preliminary. Conclusions: The results provide evidence that a brief DBT intervention is effective not only in reducing problematic eating but also in increasing adaptive eating, achieving reasonably stable results. Also, the mediation analysis results support the hypothesis that mindful eating partially explains the effects of the intervention on binge and emotional eating. Future research should address the limitations of this study by investigating a more diverse sample, triangulating different measurement strategies, and including other putative mediators

Attention deficit hyperactivity disorder and crack cocaine: what does the comparison between a group of users and non-users indicate?

El objetivo de este estudio es analizar la relación entre el consumo de cocaína crack y el diagnóstico de Trastorno por Déficit de Atención y Hiperactividad. Se analizaron asociaciones entre el grupo clínico de los consumidores de cocaína crack y no clínico de la población general de una muestra de 971 participantes que completaron el Adult Self-Report (ASR). Diferencias significativas fueron encontradas en relación al diagnóstico de Trastorno por Déficit de Atención y Hiperactividad (p = 0,001), como más problemas de atención (p = 0,001), que pueden estar vinculados a una mayor búsqueda de situaciones gratificantes, como el uso de sustancias. Esto, junto a la impulsividad en ambos trastornos, es digno de directrices específicas para maximizar la eficacia del tratamiento.The objective in this study was to analyze the relation between the use of crack-cocaine and the diagnosis attention deficit hyperactivity disorder. Associations were analyzed between the clinical group of crack-cocaine users and the non-clinical group, taken from the general population, through a sample of 971 participants who answered the Adult SelfReport. Significant differences were found in the presence of the attention deficit hyperactivity disorder diagnosis (p=0.001), such as attention problems (p=0.001), which can be related to changes associated with the search for rewarding situations, such as substance use. This, allied with the impulsiveness in both disorders, would make this association worthy of formulating specific guidelines to maximize the treatment efficacy.O objetivo, neste estudo, foi analisar a relação entre o uso de cocaína-crack e o diagnóstico de transtorno de déficit de atenção com hiperatividade. Foram analisadas associações entre o grupo clínico de usuários de cocaína-crack e o não clínico, proveniente da população geral, de amostra de 971 participantes, que responderam ao Adult Self-Report. Foram encontradas diferenças significativas relacionadas à presença do diagnóstico de transtorno de déficit de atenção e hiperatividade (p=0,001), como problemas de atenção (p=0,001) que podem estar relacionados a alterações associadas à busca por situações recompensadoras, como o uso de substâncias. Isso, aliado à impulsividade, nos dois transtornos, tornaria tal associação digna de formulação de diretrizes específicas a fim de maximizar a eficácia do tratamento

Antisocial behavior in crack-cocaine users

Comorbidades associadas ao uso de cocaína-crack são um desafio para quem trabalha em serviços psiquiátricos com esta população, entretanto poucos estudos analisam o efeito destas comorbidades nos usuários. Objetivo: Comparar usuários de cocaína-crack com a população geral em relação ao comportamento antissocial. Método: Estudo transversal, quantitativo e descritivo com uma amostra de 971 adultos de 18-59 anos, escolhidos por conveniência, divididos em dois grupos – usuários de cocaína-crack e população geral. Para acessar aspectos psicopatológicos foi utilizado a escala Adult Self-report (ASR). Resultados: Uma análise estatística de associação realizada através do teste Qui Quadrado mostra uma relação significativa entre usuários de cocaína-crack e comportamento antissocial (p = 0.001). Uma análise de regressão logística binária pelo método backward gerou um modelo com características associadas à gravidade do uso de cocaína-crack: homens, adultos com idades entre 30 e 39 anos, com baixa escolaridade e classificação clínica para problemas de personalidade antissocial (OR = 14.466). Conclusões: Os resultados encontrados enfatizam a importância da detecção precoce do comportamento antissocial em associação com o uso de cocaína-crack para uma possível melhora do tratamento e um melhor prognóstico. Palavras-chave: cocaína-crack, comportamento antissocial, psicopatologia.Comorbidities associated with crack-cocaine use are one of the major challenges for those who provide psychiatric services to this population, however, there are few studies examining these comorbidities fees on users of crack-cocaine. Objective: To compare users of crack-cocaine with the general population in relation in antisocial behavior. Methods: Cross-sectional, quantitative and descriptive study, with a sample of 971 adults 18-59 years, chosen for convenience, divided into two groups – users of crack-cocaine and general population. To assess psychopathological aspects the Adult Self -report (ASR) was used. Results: A statistical analysis association through the chi-square test shows significant relationship between crack-cocaine users and antisocial behavior (p = .001 ). The binary logistic regression analysis by the backward conditional method has generated conditional adjusted variables for the gravity model for crack-cocaine use: male, adults in their 30s and 39 years, with low education and being in the clinical classification for problems with antisocial personality (OR = 14.466). Conclusions: The results found emphasize the importance of early detection of antisocial behavior associated with crack-cocaine users, which might improve the treatment and get better prognosis.Keywords: crack-cocaine, antisocial behavior, psychopathology

Efeitos de uma interven??o baseada no treinamento de habilidades da terapia comportamental dial?tica em indiv?duos com obesidade

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS ([email protected]) on 2017-03-13T17:07:58Z No. of bitstreams: 1 DIS_ANA_CAROLINA_MACIEL_CANCIAN_PARCIAL.pdf: 4587496 bytes, checksum: 6f4f9817c3f6be552d04cc767313741f (MD5)Made available in DSpace on 2017-03-13T17:07:58Z (GMT). No. of bitstreams: 1 DIS_ANA_CAROLINA_MACIEL_CANCIAN_PARCIAL.pdf: 4587496 bytes, checksum: 6f4f9817c3f6be552d04cc767313741f (MD5) Previous issue date: 2016-11-29Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESOver the past 30 years, the prevalence of obesity in the world has doubled, and according to national surveys, about 18% of Brazilians are obese. Obesity is associated with risks to physical and psychological health and a great share of prevention and modification of this multifactorial condition relies on behavior changes. However, some psychological aspects may be barriers to successful treatments, especially when eating is associated with regulation of aversive emotional states. The Dialectical Behavior Therapy (DBT) is an approach that conceptualize problem behaviors as effective attempts to regulate emotions in the short term, but not effective in the long-term. Therefore, it is a central goal in DBT that individuals learn a new repertoire of skills that help to deal with emotions. Section 1 of this study analyzes the effects of a 10 session intervention based on DBT Skills Training on emotion regulation, psychiatric symptoms and dysfunctional and adaptive eating behaviors in obese adults who were randomly assigned to intervention group or to a waiting list comparison condition. This study had measures at pre and posttest, and was quasi experimental. Inclusion criteria were (a) BMI equal to or over 30, (b) adults aged 18 to 59 and (c) at least 8 years of formal study. Participants were excluded if they presented (a) psychotic symptoms, (b) active suicidal ideation or attempted suicide over the last year, (c) the use disorders substances and (d) that had already received any treatment with DBT components. The scales used in the pretest and posttest were Difficulties in Emotion Regulation Scale (DERS), Binge Eating Scale (BES), Emotional Eating Scale (EES), Intuitive Eating Scale (IES-2), Mindful Eating Questionnaire (MEQ) and Depression, Anxiety and Stress Scale (DASS-21). The sample consisted of 31 obese subjects divided into intervention group (n = 14) and waiting list (n = 17). Based on the large effects sizes, the results show that the intervention based on DBT skills training might be effective in reducing the severity of binge eating, improving depressive symptoms and increasing adaptive eating behaviors such as intuitive eating, that is, eating more connected with physiological signals of hunger and satiety. However, the study lacks statistical power to support strong conclusions. These results are therefore preliminary and require replications with larger samples. Section 2 aimed to analyze the semantic equivalence of the DERS for Brazilian Portuguese. For that, it was utilized a five-step adaptation process: (1) translation; (2) back translation; (3) correction and semantic adaptation with the author of the original instrument; (4) content validation by expert judges (n = 10) and; (5) assessment by the general population through a numeric verbal scale (n = 28). The results show that the final version had satisfactory semantic equivalence, with good comprehensibility by expert judges and general population and final approval of the author of the original instrument.Nos ?ltimos 30 anos, a preval?ncia da obesidade no mundo dobrou e de acordo com levantamentos nacionais, cerca de 18% dos brasileiros est?o obesos. A obesidade traz riscos ? sa?de f?sica e psicol?gica e grande parte da preven??o e modifica??o desta condi??o multicausal depende de modifica??es no comportamento. Entretanto, alguns aspectos psicol?gicos podem ser entraves para tratamentos bem-sucedidos, j? que o comer as vezes pode estar associado a fun??o de regular estados emocionais aversivos. A Terapia Comportamental Dial?tica (TCD) ? uma abordagem que sugere que comportamentos problema podem ser tentativas efetivas a curto prazo para regular emo??es, por?m trazendo preju?zos a longo prazo. Por isto, ? central na TCD que os indiv?duos aprendam um novo repert?rio de habilidades que auxiliem a lidar com as emo??es. Na Se??o 1 deste estudo foi avaliado o efeito de uma interven??o de 10 sess?es baseada no Treinamento de Habilidades da TCD sobre a regula??o emocional, sintomas psiqui?tricos e comportamentos disfuncionais e adaptativos em obesos adultos que foram randomizados para a condi??o interven??o ou para uma lista de espera. Foi utilizado um delineamento quase experimental longitudinal, com medidas no pr?-teste e p?s-teste. Os crit?rios de inclus?o foram (a) IMC igual ou acima de 30, (b) adultos com idade entre 18 e 59 anos e (c) pelo menos 8 anos de estudo formal. Foram exclu?dos participantes que possu?ssem (a) sintomas psic?ticos, (b) idea??o suicida ativa ou tentativa de suic?dio ao longo do ?ltimo ano, (c) os transtornos por uso de subst?ncias e (d) que j? haviam recebido qualquer tratamento com componentes da TCD. Os instrumentos utilizados no pr?-teste e p?s-teste foram a Difficulties in Emotion Regulation Scale (DERS), Escala de Compuls?o Alimentar Peri?dica (ECAP), Emotional Eating Scale (EES), Intuitive Eating Scale (IES-2), Mindful Eating Questionnaire (MEQ) e Depression, Anxiety and Stress Scale (DASS-21). A amostra foi composta por 31 indiv?duos obesos divididos em Grupo Interven??o (n = 14) e lista de espera (n = 17). Com base nos grandes tamanhos de efeito, os resultados mostraram que uma interven??o baseada no treinamento de habilidades da TCD pode ser eficaz na redu??o da gravidade da compuls?o alimentar, na melhora de sintomas depressivos e no aumento de comportamentos alimentares adaptativos, como o comer intuitivo, mais conectado com sinais fisiol?gicos de fome e saciedade. No entanto, o estudo n?o possui poder estat?stico para conclus?es fortes. Estes resultados s?o, portanto, preliminares e exigem repeti??es com amostras maiores. A Se??o 2 teve objetivo analisar a equival?ncia sem?ntica da DERS para o portugu?s brasileiro. Para isto um processo de adapta??o foi realizado em cinco etapas: (1) tradu??o; (2) tradu??o reversa; (3) corre??o e adapta??o sem?ntica com a autora do instrumento original; (4) valida??o de conte?do por ju?zes especialistas (n = 10) e; (5) avalia??o pela popula??o geral atrav?s de uma escala verbal num?rica (n = 28). Os resultados apontam que a vers?o final manteve equival?ncia sem?ntica satisfat?ria, com bons n?veis de compreensibilidade pelos ju?zes especialistas e popula??o geral e aprova??o final da autora do instrumento original

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Problematic and adaptive eating in people with obesity after a DBT-based skills training intervention : 3- and 8-month follow-up and mediation analysis

Background: Dialectical behavior therapy conceptualizes problematic behaviors as attempts to regulate emotions that occur when the individual lacks effective skills with which to manage his or her emotions and cope with distress. Problematic eating behaviors, e.g., binge and emotional eating, may serve to alleviate aversive emotional states, being highly associated with overweight and obesity. Dialectical behavior therapy skills training has been proven effective in reducing binge eating in several clinical studies. However, few studies reveal the effects of DBT on adaptive eating behaviors or the stability of outcomes. Objectives: This study aimed to test the effect of a brief DBT-based skills training intervention, and the stability of outcomes at 3- and 8-month follow-ups. Methods: Self-report measures of binge eating, emotional eating, intuitive eating, and mindful eating were taken on 5 timepoints before and after a 10-session DBT skills training intervention (2 baseline measures, 1 post-test, and 2 follow-ups). Data were analyzed using a mixed-model intention-to-treat approach and mediation analysis was conducted with path analysis. Results: After the intervention, intuitive eating and mindful eating scores were significantly higher than before the intervention, while emotional eating and binge eating scores were lower. The results remained stable during the follow-up period, with minor fluctuations and small trends towards returning to baseline values for binge eating and emotional eating. Mindful eating partially mediated the improvements in all outcomes. Limitations: Given that results are entirely based on self-report measures and that some instruments showed poor reliability, in addition to the high attrition rates, the results should be interpreted as preliminary. Conclusions: The results provide evidence that a brief DBT intervention is effective not only in reducing problematic eating but also in increasing adaptive eating, achieving reasonably stable results. Also, the mediation analysis results support the hypothesis that mindful eating partially explains the effects of the intervention on binge and emotional eating. Future research should address the limitations of this study by investigating a more diverse sample, triangulating different measurement strategies, and including other putative mediators

Problematic and adaptive eating in people with obesity after a DBT-based skills training intervention: 3- and 8-month follow-up and mediation analysis

Abstract Background Dialectical behavior therapy conceptualizes problematic behaviors as attempts to regulate emotions that occur when the individual lacks effective skills with which to manage his or her emotions and cope with distress. Problematic eating behaviors, e.g., binge and emotional eating, may serve to alleviate aversive emotional states, being highly associated with overweight and obesity. Dialectical behavior therapy skills training has been proven effective in reducing binge eating in several clinical studies. However, few studies reveal the effects of DBT on adaptive eating behaviors or the stability of outcomes. Objectives This study aimed to test the effect of a brief DBT-based skills training intervention, and the stability of outcomes at 3- and 8-month follow-ups. Methods Self-report measures of binge eating, emotional eating, intuitive eating, and mindful eating were taken on 5 timepoints before and after a 10-session DBT skills training intervention (2 baseline measures, 1 post-test, and 2 follow-ups). Data were analyzed using a mixed-model intention-to-treat approach and mediation analysis was conducted with path analysis. Results After the intervention, intuitive eating and mindful eating scores were significantly higher than before the intervention, while emotional eating and binge eating scores were lower. The results remained stable during the follow-up period, with minor fluctuations and small trends towards returning to baseline values for binge eating and emotional eating. Mindful eating partially mediated the improvements in all outcomes. Limitations Given that results are entirely based on self-report measures and that some instruments showed poor reliability, in addition to the high attrition rates, the results should be interpreted as preliminary. Conclusions The results provide evidence that a brief DBT intervention is effective not only in reducing problematic eating but also in increasing adaptive eating, achieving reasonably stable results. Also, the mediation analysis results support the hypothesis that mindful eating partially explains the effects of the intervention on binge and emotional eating. Future research should address the limitations of this study by investigating a more diverse sample, triangulating different measurement strategies, and including other putative mediators

Psychometric properties of the Brazilian version of the Difficulties in Emotion Regulation Scale (DERS)

Abstract Introduction: Emotion regulation can be defined as the process by which individuals manage their emotional experience. It has been demonstrated that deficits in this ability are associated with various psychiatric disorders. In this direction, the Difficulties in Emotion Regulation Scale (DERS) was developed to measure difficulties in emotion regulation. Objective: To examine the psychometric properties of the Brazilian Portuguese version of the DERS. Method: A total of 377 individuals from the general population, selected by convenience, completed a sociodemographic form, the adapted Brazilian Portuguese DERS and the Depression Anxiety Stress Scale (DASS-21). Factor structure, reliability, and concurrent validity of the adapted version of the instrument were investigated. Results: The confirmatory factor analysis replicated the six-factor structure originally proposed for the instrument and confirmed the acceptability of a hierarchical model where all DERS subscales loaded on a general emotion dysregulation factor. Internal consistency indicators had adequate values for the general factor and subscales. The positive association between DERS and DASS-21 scores supports the instrument's concurrent validity. Conclusion: These results suggest that the Brazilian version of the DERS is reliable both as a general measure of difficulties in emotion regulation and as a measure of the constituents of this construct. Future research should investigate the psychometric properties of the scale in clinical and nonclinical populations, with equal gender proportions and diverse backgrounds, and preferably employing longitudinal designs