Tudatosság és önreflexió

Korunkban az elhízás drámai terjedésének alapvetően fontos tényezője az, hogy a túlélés szempontjából a korábban adaptív mechanizmusok a modern korban maladaptívvá váltak. Az emberi személyiség — evolúciós szempontból — ilyen rövid idő alatt nem képes alkalmazkodni a XX. században megváltozott makroszociális környezethez és hatalmas társadalmi változásokhoz, amely az urbanizációval, a tömegközlekedés megjelenésével és a mozgásszegény, ülő életmóddal, valamint a fogyasztói társadalom által kínált folyamatos túlingerléssel, a könnyen és azonnal hozzáférhető ételekkel jellemezhető. Nyilvánvaló, hogy a posztmodern korban új készségekre van szükség az adaptív evési szokások kialakításához. A túlsúly, az enyhe és a középsúlyos obezitás kezelésében ma már egyértelműen a kognitív viselkedésterápiás intervencióknak van meghatározó szerepük, kiegészítve dietetikai edukációval és mozgástudatos életforma kialakításával. A vizsgálatok tanúsága szerint azonban öt év elmúltával a résztvevők kb. 80%-a visszanyeri eredeti testsúlyát. Az elhízásra és a hatékony súlymegtartásra irányuló újabb kutatások felhívták a figyelmet a végrehajtó funkciók károsodására, az elhízott személyeknek az átlagosnál nagyobb jutalomérzékenységére, a maladaptív érzelemszabályozás szerepére, valamint a figyelemzavar lehetőségére, amely tényezők mind szerepet játszanak a visszahízásban. Ennek alapján egyre inkább előtérbe kerülnek a tudatosság növelésére irányuló ún. mindfulness módszerek: a tudatos jelenlét alapú stresszcsökkentés, az evéstudatossági tréning, valamint az elfogadásra irányuló intervenciók. A tanulmányban részletesen bemutatjuk a hatékonyabb testsúlykontroll érdekében kidolgozott ún. evéstudatossági tréninget, amely ígéretes lehetőséget jelent a testsúly hosszútávú megtartásában, a jól megalapozott kognitív viselkedésterápiás intervenciók kiegészítőjeként. Végül ismertetjük a klinikai elhízás fennmaradásának (COMM) modelljét, amely a testsúlyszabályozásban szerepet játszó tényezők integrálására tesz kísérletet. | By the end of the twentieth century one of the most important reasons of the obesity epidemic is that eating habits which were adaptive so far have become maladaptive in the modern and postmodern age. From evolutionary perspective the human personality has been unable to cope with the macrosocial changes of the 20th century in such a short time. The rising epidemic reflects the profound changes in society, in behavioural patterns of communities and in the worldwide nutrition transition. Economic growth, modernization, urbanization, sedentary lifestyle as well as quick availability of fast food are further factors. One needs to develop new skills and new eating habits to cope with the challenges of the postmodern age. It is well-established that cognitive behavioural therapy is the treatment of choice in the treatment of overweight, mild and moderate obesity. However, appr. 80%- of participants return to their original weight after five years. Recent research concerning weight management called attention to deficits of executive functions, to increased reward sensitivity, to dysfunctional emotion regulation skills as well as to possible attention deficits of obese persons. Based on these recognitions mindfulness interventions were introduced in order to support long term weight control such as MBSR, eating awareness training as well as self-compassion methods. In this paper we describe the promising approach of eating awareness training which was developed to accomplish more effective weight control additive to cognitive behaviour therapy. Finally, the clinical maintenance model of obesity is presented

Szociális szorongás és önértékelés: a "Félelem a negatív megítéléstől" (FÉLNE) kérdőív hazai adaptációja

Absztrakt: Bevezetés: Noha a szociális szorongás a harmadik leggyakoribb pszichés megbetegedés, sokszor nem kerül felismerésre. Legfontosabb jellemzői az alacsony önértékelés, a magas szintű önkritika és félelem mások negatív megítélésétől. Nagyfokú komorbiditást mutat a hangulatzavarokkal, az alkoholfogyasztással és az evészavarokkal. Célkitűzés: A nemzetközileg legismertebb mérőeszköz, a Félelem a negatív megítéléstől (FÉLNE) skála hazai adaptálása, belső és külső validitásvizsgálata. Módszer: Résztvevők: 255 szorongásos, illetve hangulatzavarral diagnosztizált páciens töltötte ki a kérdőíveket. Mérőeszközök: „Félelem a negatív megítéléstől” (FÉLNE) kérdőív 30, 12 és 8 itemes változat, Rosenberg Önértékelési Skála, Beck Szorongás Leltár, Szociális Kogníció kérdőív. Eredmények: Mindhárom FÉLNE kérdőív erős belső validitással rendelkezik (α>0,83); az alacsony önértékeléssel, a negatív szociális kogníciókkal és az általános szorongással közepesen erős összefüggést mutat. A legrövidebb kérdőív a FÉLNE-8 validitása bizonyult a legerősebbnek a szociális fóbia elkülönítésére más pszichés megbetegedésektől. Következtetések: A FÉLNE-8 alkalmazása elősegítheti a számos betegség hátterét jelentő szociális szorongás gyors felismerését, a páciensek adekvát pszichoterápiás ellátás felé irányítását az egészségügyi ellátás bármely szintjén. Orv Hetil. 2017; 158(22): 843–850. | Abstract: Introduction: Although social anxiety disorder (SAD) is the third most frequent emotional disorder with 13–15% prevalence rate, it remains unrecognized very often. Social phobia is associated with low self-esteem, high self-criticism and fear of negative evaluation by others. It shows high comorbidity with depression, alcoholism, drug addiction and eating disorders. Aim: To adapt the widely used “Fear of Negative Evaluation” (FNE) social phobia questionnaire. Method: Anxiety and mood disorder patients (n = 255) completed the Fear of Negative Evaluation Scale (30, 12 and 8 item-versions) as well as social cognition, anxiety and self-esteem questionnaires. Results: All the three versions of the FNE have strong internal validity (α>0.83) and moderate significant correlation with low self-esteem, negative social cognitions and anxiety. The short 8-item BFNE-S has the strongest disciminative value in differentiating patients with social phobia and with other emotional disorders. Conclusions: The Hungarian version of the BFNE-S is an effective tool for the quick recognition of social phobia. Orv Hetil. 2017; 158(22): 843–850

Az alacsony intenzitású, bizonyítottan hatékony kognitív viselkedésterápia Crohn-betegségben

Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, problem-solving training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low- intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363-369

Mindfulness Meditation: A Preliminary Study on Meditation Practice During Everyday Life Activities and its Association with Well-Being

Past research has shown that mindfulness meditation is useful for the attenuation of psychological and physical suffering in clinical populations. In structured mindfulness-based interventions, patients engage in meditation exercises to refine their attentional skills and to learn to purposefully relate to the present moment experience in a non-judgemental manner. Following the development of such interventions, mindfulness has also received considerable attention in academic psychology, where it has been incorporated in the self-determination theory (SDT). According to SDT, the cultivation of mindfulness may warrant effective need gratification and consequently yield enhanced well-being in healthy individuals. In this context, in the current study, we examined the association between mindfulness meditation, self-reported trait mindfulness and their predictive value for psychological well-being in a non-clinical sample. Individuals who engaged in mindfulness meditation regularly (N = 30) were compared to individuals without meditation experience (N = 30) on various scales which assessed trait mindfulness and psychological well-being. Meditators reported higher emotional well-being, which was predicted by frequency and duration of practice. Especially those practitioners, who made efforts to implement mindfulness practice in activities of everyday life showed enhanced emotional adjustment. In an explorative analysis, mindfulness was identified as a putative partial mediator of the relationship between meditation practice and well-being. Despite methodological constraints, results of the current study suggest that mindfulness meditation, in a non-clinical context, is associated with increased psychological well-being, and as such worth to be explored in more detail by future research. The study and its results might be relevant for the clinical sector as well, since they provide some information on how individuals with e.g., subclinical residual symptoms can protect themselves complementarily to CBT, but without participating in a completely structured mindfulness-based intervention

Adaptation of the Beck Hopelessness Scale in Hungary

Hopelessness Scale (BHS) developed by Aaron Beck is an internationally accepted measure in the prediction of suicide. Our study focusssed on the adaptation of the scale in Hungary and its psychometric analysis. From the 1950s Hungary has always been among the top ten countries with the highest suicide rates in the world therefore a valid and reliable measure as a screening instrument in suicide prevention has utmost importance. Three different Hungarian samples (depressed patients with and without suicide attempt as well as control subjects) participated in the research. Results showed that the Hungarian version of BHS is a valid and reliable measure

Adaptation of the Beck Hopelessness Scale in Hungary

Hopelessness Scale (BHS) developed by Aaron Beck is an internationally accepted measure in the prediction of suicide. Our study focusssed on the adaptation of the scale in Hungary and its psychometric analysis. From the 1950s Hungary has always been among the top ten countries with the highest suicide rates in the world therefore a valid and reliable measure as a screening instrument in suicide prevention has utmost importance. Three different Hungarian samples (depressed patients with and without suicide attempt as well as control subjects) participated in the research. Results showed that the Hungarian version of BHS is a valid and reliable measure

Mindfulness Meditation: A Preliminary Study on Meditation Practice During Everyday Life Activities and its Association with Well-Being

Past research has shown that mindfulness meditation is useful for the attenuation of psychological and physical suffering in clinical populations. In structured mindfulness-based interventions, patients engage in meditation exercises to refine their attentional skills and to learn to purposefully relate to the present moment experience in a non-judgemental manner. Following the development of such interventions, mindfulness has also received considerable attention in academic psychology, where it has been incorporated in the self-determination theory (SDT). According to SDT, the cultivation of mindfulness may warrant effective need gratification and consequently yield enhanced well-being in healthy individuals. In this context, in the current study, we examined the association between mindfulness meditation, self-reported trait mindfulness and their predictive value for psychological well-being in a non-clinical sample. Individuals who engaged in mindfulness meditation regularly (N = 30) were compared to individuals without meditation experience (N = 30) on various scales which assessed trait mindfulness and psychological well-being. Meditators reported higher emotional well-being, which was predicted by frequency and duration of practice. Especially those practitioners, who made efforts to implement mindfulness practice in activities of everyday life showed enhanced emotional adjustment. In an explorative analysis, mindfulness was identified as a putative partial mediator of the relationship between meditation practice and well-being. Despite methodological constraints, results of the current study suggest that mindfulness meditation, in a non-clinical context, is associated with increased psychological well-being, and as such worth to be explored in more detail by future research. The study and its results might be relevant for the clinical sector as well, since they provide some information on how individuals with e.g., subclinical residual symptoms can protect themselves complementarily to CBT, but without participating in a completely structured mindfulness-based intervention

A munkahelyi stresszel való megküzdés egészségügyi szakdolgozók körében - lehetőségek a kiégés és depresszió megelőzésének szolgálatában

Background: The prevalence of depression and burnout among health care professionals is high in Hungary. However, there is limited empirical data on disease prevention among these populations. Aims: This study aims at evaluating the mediating role of coping mechanisms in preventing depression and burnout. Methods: Cross-sectional survey among 1333 health care professionals. Participants completed self-administered questionnaires about their perception of work stress, burnout and depressive symptoms, as well as their preferred coping strategies. Analyses were performed using structural equation modelling. Results: The prevalence of severe depression and lack of personal accomplishment was 5.6% and nearly 50%, respectively. Work stress predicted symptoms of burnout and depression both directly and indirectly through the mediation by coping strategies. Of the coping strategies, cognitive restructuring, which accentuates the realistic assessment of challenging situations, was found to reduce the probability of the development of burnout and depression symptoms. Conclusions: This study provides further data for the development of cognitive interventional strategies and highlights the significance of these strategies in the prevention of depression and burnout among Hungarian health care professionals. Orv. Hetil., 2013, 154, 449-454

A viselkedésterápia eredményeinek vizsgálata az elhízás kezelésében egy év távlatában.

INTRODUCTION: Treatment of obesity has become one of the most challenging issues. AIM: The aims of the authors were to present the results of standard behavior therapy weight loss program combined with self-help and the results of one-year follow-up. METHOD: The 24-week program involved 41 participants of which 33 subjects participated in the follow-up. Anthropometric data were obtained and the participants were asked to fill questionnaires (the 21 items Three Factor Eating Questionnair Revised 21 items; Physical Exercise: Steps of change [Short Form]. RESULTS: 87.8% of participants achieved a minimum weight loss of 5% which is the rate expected in professional therapies for obesity. Significant changes in maladaptive eating pattern and an increase in the rate of regular exercise were observed. Significant association was found between the increase of cognitive restraint and the rate of weight loss during treatment. At one-year follow-up the majority of participants (75.8%) did keep their minimum weight loss of 5% and they showed significant change in eating pattern. CONCLUSIONS: The results suggest that standard behavior therapy extended with self-help elements may be a cost-effective treatment of obesity. Orv. Hetil., 2014, 155(30), 1196-1202