Efeitos da vergonha em sintomas depressivos em pessoas com e sem doença física crónica: Os papéis mediadores da autocompaixão e da ação comprometida
DOI:
https://doi.org/10.31211/rpics.2019.5.2.153Palavras-chave:
Autocompaixão, Ação comprometida, Doença crónica, Sintomatologia depressiva, VergonhaResumo
Objetivo: O presente estudo teve como objetivo testar o potencial efeito mediador da autocompaixão e da ação comprometida na relação entre vergonha e sintomatologia depressiva, em pessoas sem e com diagnóstico de doença física crónica. Adicionalmente, foram exploradas as diferenças em relação a essas variáveis entre os dois grupos. Método: A amostra foi constituída por 453 participantes (223 com e 230 sem diagnóstico de doença física crónica), os quais responderam numa plataforma online a um protocolo de medidas de autorrelato de vergonha, autocompaixão, ação comprometida e sintomas depressivos. Resultados: Os participantes com diagnóstico de doença crónica apresentaram níveis significativamente (p < 0,05) superiores de vergonha e sintomatologia depressiva, e níveis inferiores de ação comprometida, comparativamente aos participantes sem doença física crónica. Contudo, não foram encontradas diferenças significativas entre os dois grupos relativamente às competências autocompassivas. As análises de correlação revelaram que a vergonha se associa negativamente à autocompaixão e ação comprometida e positivamente á sintomatologia depressiva, tanto no grupo sem como no grupo com diagnóstico de doença física crónica. Os resultados da path analysis indicaram que sentimentos de vergonha têm um impacto significativo, explicando 41% da variância da sintomatologia depressiva, parcialmente via menores níveis de autocompaixão e de ação comprometida. Os resultados da análise multigrupos demonstraram que o modelo testado é plausível nos dois grupos em estudo. Conclusões: Este estudo parece fornecer importantes contributos para a compreensão do impacto protetor das competências autocompassivas e da adoção de ações comprometidas para a saúde mental, tanto para pessoas sem como com diagnóstico de doença física crónica. De facto, os resultados sugerem que estes processos de regulação emocional são importantes mecanismos mediadores da relação entre vergonha e sintomas depressivos. Finalmente, estes dados parecem suportar o desenvolvimento de abordagens mais eficazes para a promoção da saúde psicológica para pessoas sem e com doença crónica.
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Referências
Arbuckle, J. L. (2013). IBM SPSS Amos 22: User´s Guide. Chicago, IL: IBM SPSS.
Benda, J., Kadlečík, P., & Loskotová, M. (2018). Differences in self-compassion and shame in patients with anxiety disorders, patients with depressive disorders and healthy controls. Československá Psychologie, 62(6), 529–541. https://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=0&sid=cd1dc0cd-402b-4187-b6a0-ea1e77a0612e%40pdc-v-sessmgr05
Byrne, B. M. (2010). Structural equation modeling with AMOS: Basic concepts, applications, and programming (2nd ed.). New York, NY: Routledge.
Casati, J., Toner, B. B., De Rooy, E. C., Drossman, D. A., & Maunder, R. G. (2000). Concerns of patients with inflammatory bowel disease: A review of emerging themes. Digestive Diseases and Sciences, 45(1), 26–31. https://doi.org/10.1023/a:1005492806777
Castilho, P., & Pinto-Gouveia, J. (2011). Auto-compaixão: Estudo da validação da versão portuguesa da Escala da Auto-Compaixão e da sua relação com as experiências adversas na infância, a comparação social e a psicopatologia [Self-compassion: Study of the validation of the Portuguese version of the self-compassion scale and its relationship with adverse childhood experiences, social comparison and psychopathology]. Psychologica, 2011(54), 203–230. http://doi.org/10.14195/1647-8606_54_8
Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
Costa, J., & Pinto-Gouveia, J. (2011). Acceptance of pain, self-compassion and psychopathology: Using the chronic pain acceptance questionnaire to identify patients' subgroups. Clinical Psychology and Psychotherapy, 18(4), 292–302. https://doi.org/10.1002/cpp.718
Coutinho, M., Trindade, I. A., & Ferreira, C. (2019). Experiential avoidance, committed action, and quality of life: Differences between college students with chronic illness and their healthy peers. Manuscript accepted for publication.
Ferreira, C., Moura-Ramos, M., Matos, M., & Galhardo, A. (2018). A new measure to assess external and internal shame: Development, factor structure and psychometric properties of the external and internal shame scale. Manuscript submitted for publication.
Ferreira, C., Pinto-Gouveia, J., & Duarte, C. (2013). Self-compassion in the face of shame and body image dissatisfaction: Implications for eating disorders. Eating Behaviors, 14(2), 207–210. https://doi.org/10.1016/j.eatbeh.2013.01.005
Folkman, S., & Moskowitz, J. T. (2000). Stress, positive emotion, and coping. Current Directions in Psychological Science, 9(4), 115–118. https://doi.org/10.1111/1467-8721.00073
Galán, S., Roy, R., Solé, E., Racine, M., Vega, R., Jensen, M. P., & Miró, J. (2019). Committed action, disability and perceived health in individuals with fibromyalgia. Behavioral Medicine, 45(1), 62–69. https://doi.org/10.1080/08964289.2018.1467370
Gilbert, P. (1998). What is shame? Some core issues and controversies. In P. Gilbert & B. Andrews (Eds.), Shame: Interpersonal behavior, psychopathology and culture (pp. 3–38). New York: Oxford University Press.
Gilbert, P. (2000). The relationship of shame, social anxiety and depression: The role of the evaluation of social rank. Clinical Psychology and Psychotherapy, 7(3), 174–189. https://doi:10.1002/1099-0879(200007)7:3<174::aid-cpp236>3.0.co;2-u
Gilbert, P. (2002). Body shame: A biopsychosocial conceptualization and overview, with treatment implications. In P. Gilbert & Miles (Eds.), Body shame: Conceptualisation, research and treatment (pp. 3–54). London: Brunner.
Gilbert, P. (2007). The evolution of shame as a marker for relationship security: A biopsychosocial approach. In J. L. Tracy, R. W. Robins, & J. P. Tangney (Eds.), The self-conscious emotions: Theory and research (pp. 283–309). New York: Guilford Press.
Gilbert, P., & Irons, C. (2005). Focused therapies and compassionate mind training for shame and self-attacking. In P. Gilbert (Ed.), Compassion: Conceptualisations, research and use in psychotherapy (pp. 263–325). London: Routledge.
Gilbert, P., & Irons, C. (2009). Shame, self-criticism, and self-compassion in adolescence. In N. B. Allen & L. B. Sheeber (Eds.), Adolescent emotional development and the emergence of depressive disorders (pp. 195–214). London: Cambridge University Press.
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13(6), 353–379. https://doi.org/10.1002/cpp.507
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976–1002. https://doi.org/10.1177/0011000012460836
Hu, L.-T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
Kim, S., Thibodeau, R., & Jorgensen, R. S. (2011). Shame, guilt, and depressive symptoms: A meta-analytic review. Psychological Bulletin, 137(1), 68–96. https://doi.org/10.1037/a0021466
Kline, R. B. (2005). Principles and practice of structural equation modelling (3rd ed.). New York, NY: Guilford Press.
Krieger, T., Altenstein, D., Baettig, I., Doering, N., & Holtforth, M. G. (2013). Self-compassion in depression: Associations with depressive symptoms, rumination, and avoidance in depressed outpatients. Behavior Therapy, 44(3), 501–513. https://doi.org/10.1016/j.beth.2013.04.004
Körner, A., Coroiu, A., Copeland, L., Gomez-Garibello, C., Albani, C., Zenger, M., & Brähler, E. (2015). The role of self-compassion in buffering symptoms of depression in the general population. PLoS ONE, 10(10), e0136598. https://doi.org/10.1371/journal.pone.0136598
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-u
MacBeth A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552. https://doi.org/10.1016/j.cpr.2012.06.003
MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. Mahwah, NJ: Lawrence Erlbaum Associates.
Matos, M., & Pinto-Gouveia, J. (2010). Shame as a traumatic memory. Clinical Psychology and Psychotherapy, 17(4), 229–312. https://doi.org/10.1002/cpp.659
McCracken, L. M. (2013). Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. The Journal of Pain, 14(8), 828–835. https://doi.org/10.1016/j.jpain.2013.02.009
McCracken, L. M., Chilcot, J., & Norton, S. (2014). Further development in the assessment of psychological flexibility: A shortened Committed Action Questionnaire (CAQ-8). European Journal of Pain, 19(5), 677–685. https://doi.org/10.1002/ejp.589
Michelson, S. E., Lee, J. K., Orsillo, S. M., & Roemer, L. (2011). The role of values-consistent behavior in generalized anxiety disorder. Depression and Anxiety, 28(5), 358–366. https://doi.org/10.1002/da.20793
Neff, K. D. (2003a). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032
Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027
Neff, K. D. (2009). The role of self-compassion in development: A healthier way to relate to oneself. Human Development, 52(4), 211–214. https://doi.org/10.1159/000215071
Pais-Ribeiro, J. L., Honrado, A., & Leal, I. (2004). Contribuição para o estudo da adaptação portuguesa das Escalas de Ansiedade, Depressão e Stress (EADS) de 21 itens de Lovibond e Lovibond [Contribution to the study of the Portuguese adaptation of the Anxiety, Depression and Stress Scales (EADS) of 21 Lovibond and Lovibond items]. Psicologia, Saúde & Doenças, 5(2), 229–239. http://scielo.mec.pt/pdf/psd/v5n2/v5n2a07.pdf
Pinto-Gouveia, J., Duarte, C., Matos, M., & Fráguas, S. (2013). The protective role of self-compassion in relation to psychopathology symptoms and quality of life in chronic and in cancer patients. Clinical Psychology & Psychotherapy, 21(4), 311–323. https://doi.org/10.1002/cpp.1838
Pinto-Gouveia, J., & Matos, M. (2011). Can shame memories become a key to identify? The centrality of shame memories predicts psychopathology. Applied Cognitive Psychology, 25(2), 281–290. https://doi.org/10.1002/acp.1689
Sirois, F. M., & Hirsch, J. K. (2019). Self-compassion and adherence in five medical samples: The role of stress. Mindfulness, 10(1), 46–54. https://doi.org/10.1007/s12671-018-0945-9
Sirois, F. M., & Rowse, G. (2016). The role of self-compassion in chronic illness care. Journal of Clinical Outcomes Management, 23(11), 521–527. https://self-compassion.org/wp-content/uploads/2018/05/Sirois2016.pdf
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston, MA: Pearson Education.
Trindade, I. A., Duarte, J., Ferreira, C., Coutinho, M., & Pinto-Gouveia, J. (2018). The impact of illness-related shame on psychological health and social relationships: Testing a mediational model in students with chronic illness. Clinical Psychology and Psychotherapy, 25(3), 408–414. https://doi.org/10.1002/cpp.2175
Trindade, I. A., Ferreira, C., & Pinto-Gouveia, J. (2017a). Chronic illness-related shame: Development of a new scale and novel approach for IBD patients´ depressive symptomatology. Clinical Psychology & Psychotherapy, 24(1), 255–263. https://doi.org/10.1002/cpp.2035
Trindade, I. A., Ferreira, C., & Pinto-Gouveia, J. (2017b). Shame and emotion regulation in inflammatory bowel disease: Effects on psychosocial functioning. Journal of Health Psychology, 135910531771892. https://doi.org/10.1177/1359105317718925
Trindade, I. A., Marta-Simões, J., Ferreira, C., & Pinto-Gouveia, J. (2018a). Chronic illness-related cognitive fusion explains the impact of body dissatisfaction and shame on depression symptoms in breast cancer patients. Clinical Psychology and Psychotherapy, 25(6), 886–893. https://doi.org/10.1002/cpp.2323
Trindade, I. A., Marta-Simões, J., Ferreira, C., & Pinto-Gouveia, J. (2018b). Developments on committed action: Validity of the CAQ-8 and analysis of committed action’s role in depressive symptomatology in breast cancer patients and healthy individuals. Clinical Psychology and Psychotherapy, 25(1), 42–50. https://doi.org/10.1002/cpp.2125
Trompetter, H. R., Klooster, P. M., Schreurs, K. M. G., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013). Measuring values and committed action with the engaged living scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample. Psychological Assessment, 25(4), 1235–1246. https://doi.org/10.1037/a0033813
Zhang, H., Carr, E. R., Garcia-Williams, A. G., Siegelman, A. E., Berke, D., Niles-Carnes, L. V., … & Kaslow, N. J. (2018). Shame and depressive symptoms: Self-compassion and contingent self-worth as mediators? Journal of Clinical Psychology in Medical Settings, 25(4), 408–419. https://doi.org/10.1007/s10880-018-9548-9
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Direitos de Autor (c) 2019 Daniela Veiga, Inês Trindade, Cláudia Ferreira
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