Intervenção psicológica em grupos: os grupos de ensino e os grupos pós‑cirurgia no Hospital da Prelada

Currently in health system there is a growing interest in the study of psychological intervention in a group context. The group intervention has a great therapeutic power through facilitation of emotional expression, the possibility of feedback, modeling, allowing people a safe space where they can develop more adaptive strategies to cope with their problems. Research in this area shows positive results in the use of group intervention in the treatment of obesity, especially in terms of control of food intake, self‑esteem and psychopathological symptoms. Specifically in the context of surgical treatment of obesity, the group intervention programs, both in pre and post‑surgery, appear to contribute to better adjustment to the new eating patterns and a greater awareness and participation of patients in the process of weight loss.  Actualmente no campo da saúde verifica‑se um crescente interesse pelo estudo da intervenção psicológica em contexto grupal. A intervenção em grupo tem um grande poder terapêutico pela facilitação da expressão emocional, pela possibilidade de troca de feedback, de modelagem, permitindo às pessoas um espaço seguro onde possam desenvolver estratégias mais adaptativas para lidarem com os seus problemas. A investigação nesta área revela resultados positivos na utilização da intervenção em grupo no tratamento da obesidade, nomeadamente ao nível do controlo da ingestão alimentar, auto‑estima e sintomatologia psicopatológica. Especificamente no contexto do tratamento cirúrgico da obesidade, os programas de intervenção grupal, quer na fase pré como pós cirurgia, parecem contribuir para um melhor ajustamento aos novos padrões alimentares e uma maior consciencialização e participação dos doentes no seu processo de emagrecimento.&nbsp

Consulta de Psicologia no per‑operatório da obesidade

Overweight and obesity are a complex chronic condition with a negative health impact, difficult to treat, with a high and increasing prevalence associated with various psychological problems. The main psychological intervention is focused on the individual and based on behaviour changes. It is a fact that bariatric surgery is the only effective treatment of prolonged action demanding and with risk that needs a prior psychological evaluation, action and clear teaching on the entire treatment process and requires a commitment to an active participation of the patient. The technical advice will be drawn between a multidisciplinary team to the evaluation of surgical criteria. The psychological action in the internment is based on educational support behaviour. After surgery and during long follow‑up beyond the psychological need for reassessment, it should be provided regular care of cognitive‑behavioural psychotherapy in order to maximize the capabilities of the individual in their treatment.O excesso de peso e a obesidade constituem uma situação crónica complexa com um impacto negativo na saúde, de difícil tratamento, com uma prevalência elevada e crescente, associada a vários problemas psicológicos. A principal intervenção psicológica é centrada no indivíduo e baseada em alterações no comportamento. O facto de a cirurgia bariátrica ser o único tratamento efectivo de acção prolongada mas exigente e com riscos necessita de uma avaliação psicológica prévia e de acções didácticas claras sobre todo o processo de tratamento e obriga a um compromisso de participação activa do paciente. Dela será elaborado um parecer técnico a apresentar em equipa multidisciplinar a fim da avaliação de critérios cirúrgicos. A acção psicológica no internamento é de apoio educacional do comportamento. Após a cirurgia e na fase longa de seguimento, além da necessidade de reavaliação psicológica, importa prestar cuidados regulares de psicoterapia de cariz cognitivo‑comportamental para maximizar as capacidades do indivíduo no seu tratamento

Tradução, adaptação cultural e validação da escala do poder da comida para utilização por populações de adultos em Portugal

Copyright © Ordem dos Médicos 2015INTRODUCTION: The Power of Food Scale measures appetite for, rather than consumption of, palatable foods - a construct frequently designated as hedonic hunger. The purpose of this study was to examine the psychometric properties of a Portuguese version of the Power of Food Scale, namely reliability and construct validity. MATERIAL AND METHODS: Data was obtained from 1266 adult participants sampled from three different populations in Portugal: two nonclinical samples and one multi-center sample of severely obese candidates for weight-loss surgery. RESULTS: We found that the factor structure of the Portuguese version of the Power of Food Scale is similar to that of the original scale and that the Portuguese version of the Power of Food Scale has good internal structure, test-retest reliability and construct validity. In addition, we provide the first contribution towards defining population norms for Power of Food Scale scores. DISCUSSION: The Portuguese version of the Power of Food Scale proved to have good psychometric properties: it is a valid and reliable tool for measuring hedonic hunger, supporting its use both in clinical and non-clinical samples, as well as in prospective studies. CONCLUSION: Our results show that the Portuguese version of the Power of Food Scale is a useful measure for researchers and clinicians who are interested in exploring the construct of hedonic hunger in Portuguese-speaking populations, including those suffering from obesity.Introdução: A Power of Food Scale é uma escala que avalia um constructo designado por fome hedónica, frequentemente definido como o apetite por alimentos de elevada palatibilidade, mais do que a sua ingestão propriamente dita. Este estudo teve como objetivo a caracterização das propriedades psicométricas de uma versão portuguesa da Power of Food Scale, nomeadamente da sua fiabili¬dade e validade de constructo. Material e Métodos: Os dados foram obtidos de 1266 participantes adultos, provenientes de três amostras distintas: duas amostras não clínicas e uma amostra clínica de indivíduos com obesidade severa, candidatos a cirurgia da obesidade. Resultados: Verificamos que a estrutura factorial da versão portuguesa da Power of Food Scale é semelhante à do questionário original e que apresenta fiabilidade teste-reteste e validade de constructo adequadas. Adicionalmente, apresentamos neste estudo o primeiro contributo para a definição de normas populacionais para os scores da Power of Food Scale. Discussão: A versão portuguesa da Power of Food Scale apresentou boas propriedades psicométricas: é um instrumento válido e fiável para a avaliação do constructo fome hedónica, suportando a sua utilização tanto em amostras clínicas como não clínicas, bem como em estudos longitudinais. Conclusão: Estes resultados demostram que a versão portuguesa da Power of Food Scale é um instrumento útil, tanto em contexto clínico, como de investigação, nomeadamente para o estudo do constructo fome hedónica em populações de língua portuguesa, in¬cluindo populações clínicas de indivíduos com obesidade.This work was supported by Fundação para a Ciência e Tecnologia through a Junior Research and Career Development Award from the Harvard Medical SchoolPortugal Program to AJO-M (HMSP/ICJ/0020/2011). EUROCONSUMERS supported costs related to recruitment of the population sample

Caracterização clínica dos doentes obesos em acompanhamento na consulta de Psicologia do Hospital da Prelada

A Obesidade e actualmente considerada uma prioridade ao nível dos cuidados de saúde devido as proporções epidémicas que assume em todo o mundo (WHO, 2002). Na sua génese  e desenvolvimento podemos encontrar frequentemente a influencia de factores psicológicos, essenciais quando pensamos em intervir nesta problemática. No caso particular da Obesidade Morbida  (OM), o tratamento através  de cirúrgica  bariatrica  exige ao doente uma forte adesão  aos requisitos pós‑cirúrgicos, através de modificações  alimentares e de estilo de vida em geral. Neste sentido, devem ser consideradas algumas variáveis  psicológicas  e sociodemográficas  na avaliação  do doente com OM, que nos permitam compreender o processo de doença  e adaptar as estratégias  de intervenção (Travado et al., 2004). Neste estudo pretende‑se apresentar algumas características sociodemográficas e clinicas de uma amostra de doentes com Obesidade Morbida a aguardar cirúrgica bariatrica em contexto hospitalar. A amostra e constituída por 300 indíviduos (273mulheres; 27 homens), a aguardar cirurgia de colocação  de banda gástrica no Serviço de Cirurgia Geral do Hospital da Prelada. O protocolo de avaliação  psicológica inclui uma entrevista clinica semi‑estruturada e  instrumentos de auto‑relato que pretendem avaliar dimensões como o comportamento alimentar, qualidade de vida, sintomatologia psicopatológica. Neste breve trabalho apenas analisamos os dados da entrevista clinica semi‑estruturada. Os resultados que obtivemos foram os seguintes: A idade dos doentes obesos em acompanhamento na consulta de Psicologia varia entre os 18 e 68 anos (M=40,85; SD=11.56). Relativamente ao estado civil e numero de filhos, 70,2% dos doentes avaliados são casados e 77% tem um ou mais filhos. Quanto a situação  profissional, 16% estão desempregados. No que concerne ao peso dos doentes, este oscila entre os 70kg e os 174kg (M=108,26; SD=17,4), apresentando a amostra um IMC médio  de 41,3 kg/m2 (SD=5,7). Cerca de 53% da amostra refere ter antecedentes familiares (1.o grau) de obesidade. Ao analisar a historia clinica, verificamos que 26% da amostra tem acompanhamento regular de Psiquiatria, estando 46% da mesma a fazer medicação antidepressiva e/ou ansiolítica. Como acontecimentos associados ao aumento de peso, 39% dos doentes avaliados atribui esse aumento a(s) gravidez(es) e 32% aos hábitos alimentares. Como consequências do excesso de peso, cerca de 60% dos doentes avaliados salientam os sintomas físicos e problemas funcionais (e.g. dores, cansaço , dificuldades motoras) e 35% a insatisfação com o corpo e a sua auto‑imagem. Em relação aos tratamentos já efectuados, 88% refere ter feito no passado varias tentativas de perda de peso (dietas e medicação) sem sucesso a médio e a longo prazo. Quanto ao comportamento alimentar, cerca de 80% da amostra no momento da 1.a consulta de Psicologia apresenta um padrão incorrecto, associando um aumento da ingestão  alimentar a situações  de maior stress/estados emocionais negativos. A análise destes resultados permite‑nos perceber que a população  de indivíduos  em acompanhamento na consulta de Psicologia e que recorre a tratamento da Obesidade no Hospital da Prelada e maioritariamente feminina (91%) e com um IMC que indica a presença de Obesidade de Grau III ou OM. Podemos considerar que o tratamento cirúrgico para grande parte destes doentes surge apos um historial de tentativas anteriores de perda de peso sem sucesso e que os principais factores associados ao desenvolvimento deste problema de saúde relacionam‑se com os padrões  alimentares disfuncionais. As consequências, sobretudo físicas, do excesso de peso são  apontadas como o principal motivo que conduziu estes doentes a procura de um novo tratamento. De salientar ainda que uma percentagem bastante significativa da amostra refere acompanhamento psiquiátrico  regular e quase que metade dos doentes em acompanhamento na consulta de Psicologia encontram‑me medicados para a sintomatologia depressiva e ansiosa. A semelhança do que esta descrito na literatura (Wadden et al., 2007), a analise destas variáveis permite uma caracterização clinica e sociodemográfica dos doentes com obesidade, fundamental quando queremos compreender esta patologia e deste modo planear e ajustar as estratégias de tratamento as especificidades de cada caso

Psychometric properties of the Portuguese version of the Yale Food Addiction Scale

Purpose Rising rates of obesity have been recently associated to the novel concept of food addiction (FA). The Yale Food Addiction Scale (YFAS) is the most widely used measure for examining FA (1) and analysis of its reliability and validity is expected to facilitate empirical research on the construct. Here, we tested the psychometric properties of a Portuguese version of the YFAS (P-YFAS), establishing its factor structure, reliability and construct validity. Methods Data were obtained from 468 Portuguese individuals, 278 sampled from non-clinical populations, and 190 among obese candidates for weight-loss surgery. A battery of self-report measures of eating behavior was applied. Results Confirmatory factor analysis verified a one-factor structure with acceptable fit, with item analysis suggesting the need to eliminate item 24 from the P-YFAS. Internal consistency (KR-20 = .82) and test-retest stability were adequate. Correlation analyses supported convergent and divergent validity of the P-YFAS, particularly in the clinical sample. Both FA symptom count and diagnosis, according to the P-YFAS, adequately discriminated between samples, with classification of FA met by 2.5 and 25.8% of the participants in the non-clinical and clinical samples, respectively. Conclusions These findings reinforce the use of P-YFAS in non-clinical and clinical populations. Future directions for extending YFAS validation are discussed.Fundação para a Ciência e Tecnologia through a Junior Research and Career Development Award from the Harvard Medical Portugal Program (HMSP/ICJ/0020/2011) to AJO-M and CPUP (UID/PSI/00050/2013) to ST, and a Grant from the BIAL Foundation (176/10) to AJO-Minfo:eu-repo/semantics/publishedVersio

Mediators in Psychological Treatments for Anxiety and Depression in Adolescents and Young People: A Protocol of a Systematic Review

Introduction Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. Aim We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. Methods A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with depression and/or anxiety and that have examined mediators of psychological treatments. A group of 20 reviewers from the COST-Action TREATme (CA16102) divided into 10 pairs independently screen studies for inclusion, extract information from the included studies, and assess the methodological quality of the included studies and the requirements for mediators. The methodological quality will be assessed by The Mixed Methods Appraisal Tool. Extracted data from the included studies will be collected and presented using a narrative approach. Discussion This systematic review will summarize and provide a comprehensive overview of the current evidence on mediators of psychological treatments for anxiety and depression for adolescents and young adults. Results will allow the identification of strategies to optimize intervention to enhance clinical outcomes. Ethics and dissemination Ethics approval is not required. Findings from this systematic review will be published in a peer-reviewed journal and disseminated at conferences and meetings. PROSPERO registration number: CRD42021234641.This review is based upon work from COST Action European Network on Individualized Psychotherapy Treatment of Young People with Mental Disorders (TREATme; CA16102), supported by COST (European Cooperation in Science and Technology) (www.cost.eu)

Theories of Change and Mediators of Psychotherapy Effectiveness in Adolescents With Externalising Behaviours: A Systematic Review

bstract Background Externalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old). Methods A systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis. Results Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent–adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively. Conclusions Family variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified. Ethics and Dissemination Ethical approval was not required. PROSPERO registration number: CRD42021231835

Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review.

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers

Mediators and theories of change in psychotherapy with adolescents: a systematic review protocol

Introduction Approximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The 'European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders', funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents. Method A systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer from a mental disorder or psychological difficulties and receive an intervention that aims at preventing, ameliorating and/or treating psychological problems. Ethics and dissemination Ethical approval is not required for this systematic review as no primary data will be collected. The results will be published in a peer-reviewed journals and at conference presentations and will be shared with stakeholder groups. The whole data set will be offered to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. PROSPERO registration number CRD42020177535