O papel de processos relacionados com a regulação emocional e da vergonha associada à doença crónica nos sintomas de depressão, ansiedade e stress de pessoas com doença celíaca
DOI:
https://doi.org/10.31211/rpics.2020.6.1.162Palavras-chave:
Doença celíaca, Regulação emocional, Sintomas psicopatológicos, Vergonha associada à doença crónicaResumo
Objetivo: O presente estudo, de carácter exploratório, teve como principal objetivo examinar o papel preditor de processos relacionados com a regulação emocional (fusão cognitiva, evitamento experiencial, autocompaixão e autojulgamento) e da vergonha associada à doença nos sintomas psicopatológicos de depressão, ansiedade e stress em pacientes com diagnóstico de doença celíaca. Método: Através de uma associação de pacientes, foram recrutados 67 sujeitos com diagnóstico de doença celíaca autorreportado, os quais completaram online um questionário sociodemográfico e clínico e um conjunto de instrumentos de autorresposta, mais precisamente as Escalas de Ansiedade, Depressão e Stress – 21 (EADS-21), o Cognitive Fusion Questionnaire – Chronic Illness (CFQ-CI), o Acceptance and Action Questionnaire-II (AAQ-II), a Self-Compassion Scale (SCS), e a Chronic Illness-related Shame Scale (CISS). O papel mediador dos processos relacionados com a regulação emocional e da vergonha associada à doença crónica foi analisado através do cálculo de regressões lineares múltiplas hierárquicas. Resultados: O índice compósito de autojulgamento (autocriticismo, isolamento e sobreidentificação) revelou-se como o único preditor significativo dos sintomas de depressão, ansiedade e stress em pessoas com doença celíaca. Conclusões: Nas intervenções psicológicas dirigidas a pacientes com doença celíaca a avaliação e integração do autojulgamento enquanto processo de regulação emocional poderá ser relevante para a obtenção de ganhos terapêuticos no que se refere aos sintomas emocionais negativos de depressão, ansiedade e stress.
Downloads
Referências
Addolorato, G. (2001). Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: A longitudinal study. Scandinavian Journal of Gastroenterology, 36(5), 502–506. https://doi.org/10.1080/00365520119754
Addolorato, G., De Lorenzi, G., Abenavoli, L., Leggio, L., Capristo, E., & Gasbarrini, G. (2004). Psychological support counselling improves gluten-free diet compliance in coeliac patients with affective disorders. Alimentary Pharmacology and Therapeutics, 20(7), 777–782. https://doi.org/10.1111/j.1365-2036.2004.02193.x
American Psychiatric Association. (2014). Manual de diagnóstico e estatística das perturbações mentais (5a ed.). Climepsi Editores.
Associação Portuguesa de Celíacos. (2019). Prevalência e incidência [Prevalence and incidence]. https://www.celiacos.org.pt/o-que-e/
Bai, D., Brar, P., Holleran, S., Ramakrishnan, R., & Green, P. H. R. (2005). Effect of gender on the manifestations of celiac disease: Evidence for greater malabsorption in men. Scandinavian Journal of Gastroenterology, 40(2), 183–187. https://doi.org/10.1080/00365520510011498
Berking, M., Wupperman, P., Reichardt, A., Pejic, T., Dippel, A., & Znoj, H. (2008). Emotion-regulation skills as a treatment target in psychotherapy. Behaviour Research and Therapy, 46(11), 1230–1237. https://doi.org/10.1016/j.brat.2008.08.005
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007
Brenner, R. E., Heath, P. J., Vogel, D. L., & Credé, M. (2017). Two is more valid than one: Examining the factor structure of the Self-Compassion Scale (SCS). Journal of Counseling Psychology, 64(6), 696–707. https://doi.org/10.1037/cou0000211
Butterworth, J., & Los, L. (2019). Coeliac disease. Medicine, 47(5). 314–319. https://doi.org/10.1016/j.mpmed.2019.02.003
Carvalho, S. A., Trindade, I. A., Gillanders, D., Pinto‐Gouveia, J., & Castilho, P. (2019). Cognitive fusion and depressive symptoms in women with chronic pain: A longitudinal growth curve modelling study over 12‐months. Clinical Psychology & Psychotherapy, 26(5), 616-625. https://doi.org/10.1002/cpp.2386
Castilho, P., & Gouveia, J. P. (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, (54), 203–230. https://impactum-journals.uc.pt/psychologica/article/view/1106
Catassi, C., & Lionetti, E. (2020). Celiac disease. In E. J. Kuipers (Ed.), Encyclopedia of gastroenterology (2nd ed., pp. 447–452). https://doi.org//10.1016/B978-0-12-801238-3.65624-6
Celiac Disease Foundation. (2019). What is celiac disease?. https://celiac.org/about-celiac-disease/what-is-celiac-disease/
Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871–890. https://doi.org/10.1002/jclp.20400
Cossu, G., Carta, M. G., Contu, F., Mela, Q., Demelia, L., Elli, L., & Dell’Osso, B. (2017). Coeliac disease and psychiatric comorbidity: Epidemiology, pathophysiological mechanisms, quality-of-life, and gluten-free diet effects. International Review of Psychiatry, 29(5), 489–503. https://doi.org/10.1080/09540261.2017.1314952
Costa, J., Marôco, J., Pinto‐Gouveia, J., Ferreira, C., & Castilho, P. (2016). Validation of the psychometric properties of the Self-Compassion Scale. Testing the factorial validity and factorial invariance of the measure among borderline personality disorder, anxiety disorder, eating disorder and general populations. Clinical Psychology & Psychotherapy, 23(5), 460–468. https://doi.org/10.1002/cpp.1974
Cuppage, J., Baird, K., Gibson, J., Booth, R., & Hevey, D. (2018). Compassion focused therapy: Exploring the effectiveness with a transdiagnostic group and potential processes of change. British Journal of Clinical Psychology, 57(2), 240–254. https://doi.org/10.1111/bjc.12162
Dahl, J., Lundgren, T., Plumb, J., & Stewart, I. (2009). The art and science of valuing in psychotherapy: Helping clients discover, explore, and commit to valued action using Acceptance and Commitment Therapy. New Harbinger Publications.
Dinis, A., Carvalho, S., Gouveia, J. P., & Estanqueiro, C. (2015). Shame memories and depression symptoms: The role of cognitive fusion and experiential avoidance. International Journal of Psychology and Psychological Therapy, 15(1), 63–86. https://www.redalyc.org/articulo.oa?id=56038720004
Dowd, A. J., Jung, M. E., Chen, M. Y., & Beauchamp, M. R. (2015). Prediction of adherence to a gluten-free diet using protection motivation theory among adults with coeliac disease. Journal of Human Nutrition and Dietetics, 29(3), 391–398. https://doi.org/10.1111/jhn.12321
Galhardo, A., Cunha, M., Pinto-Gouveia, J., & Matos, M. (2013). The mediator role of emotion regulation processes on infertility-related stress. Journal of Clinical Psychology in Medical Settings, 20(4), 497–507. https://doi.org/10.1007/s10880-013-9370-3
Gilbert, P. (2002). Body shame: A biopsychosocial conceptualization and overview with treatment implications. In P. Gilbert & J. Miles (Eds.), Body shame: Conceptualization, research and treatment (pp. 3–47). Routledge.
Gilbert, P. (2007). The evolution of shame as a marker for relationship security. In J. L. Tracy, R. W. Robins, & J. P. Tangney (Eds.), The self-conscious emotions: Theory and research (pp. 283–309). Guilford Press.
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043
Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., Kerr, S., Tansey, L., Noel, P., Ferenbach, C., Masley, S., Roach, L., Lloyd, J., May, L., Clarke, S., & Remington, B. (2014). The development and initial validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45(1), 83–101. https://doi.org/10.1016/j.beth.2013.09.001
Hall, N. J., Rubin, G., & Charnock, A. (2009). Systematic review: Adherence to a gluten‐free diet in adult patients with coeliac disease. Alimentary Pharmacology & Therapeutics, 30(4), 315–330. https://doi.org/10.1111/j.1365-2036.2009.04053.x
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006x.64.6.1152
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
Judge, L., Cleghorn, A., McEwan, K., & Gilbert, P. (2012). An exploration of group-based compassion focused therapy for a heterogeneous range of clients presenting to a community mental health team. International Journal of Cognitive Therapy, 5(4), 420–429. https://doi.org/10.1521/ijct.2012.5.4.420
Kane, N. S., Hoogendoorn, C. J., Tanenbaum, M. L., & Gonzalez, J. S. (2018). Physical symptom complaints, cognitive emotion regulation strategies, self‐compassion and diabetes distress among adults with Type 2 diabetes. Diabetic Medicine, 35(12), 1671–1677. https://doi.org/10.1111/dme.13830
Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). Guilford Press.
Leaviss, J., & Uttley, L. (2014). Psychotherapeutic benefits of compassion-focused therapy: An early systematic review. Psychological Medicine, 45(5), 927–945. https://doi.org/10.1017/s0033291714002141
Leonard, M. M., Sapone, A., Catassi, C., & Fasano, A. (2017). Celiac disease and nonceliac gluten sensitivity. JAMA, 318(7), 647–656. https://doi.org/10.1001/jama.2017.9730
Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J. (2014). Examining psychological inflexibility as a transdiagnostic process across psychological disorders. Journal of Contextual Behavioral Science, 3(3), 155–163. https://doi.org/10.1016%2Fj.jcbs.2014.06.003
Lovibond, P., & Lovibond, S. (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
Ludvigsson, J. F., Card, T., Ciclitira, P. J., Swift, G. L., Nasr, I., Sanders, D. S., & Ciacci, C. (2015). Support for patients with celiac disease: A literature review. United European Gastroenterology Journal, 3(2), 146–159. https://doi.org/10.1177/2050640614562599
Mariné, M., Farre, C., Alsina, M., Vilar, P., Cortijo, M., Salas, A., Fernández-Banãres, F., Rosinach, M., Santaolalla, R., Loras, C., Marquès, T., Cusí, V., Hernández, M. I., Carrasco, A., Ribes, J., Viver, J. M., & Esteve, M. (2011). The prevalence of coeliac disease is significantly higher in children compared with adults. Alimentary Pharmacology & Therapeutics, 33(4), 477–486. https://doi.org/10.1111/j.1365-2036.2010.04543.x
Masuda, A., Mandavia, A., & Tully, E. C. (2014). The role of psychological inflexibility and mindfulness in somatization, depression, and anxiety among Asian Americans in the United States. Asian American Journal of Psychology, 5(3), 230–236. https://doi.org/10.1037/a0034437
Matos, M., & Pinto-Gouveia, J. (2010). Shame as a traumatic memory. Clinical Psychology and Psychotherapy, 17(4), 299–312. https://doi.org/10.1002/cpp.659
Melicharova, J., Slavik, M., & Cervinkova, M. (2016). Psychological aspects in celiac disease: Step by step from symptoms to daily life with celiac disease. International Journal of Celiac Disease, 4(2), 64–67. http://pubs.sciepub.com/ijcd/4/2/3/index.html
Nachman, F., del Campo, M. P., González, A., Corzo, L., Vázquez, H., Sfoggia, C., Smecuol, E., Pinto-Sánchez, M. I. P., Niveloni, S., Sugai, E., Maurino, E., & Bai, J. C. (2010). Long-term deterioration of quality of life in adult patients with celiac disease is associated with treatment noncompliance. Digestive and Liver Disease, 42(10), 685–691. https://doi.org/10.1016/j.dld.2010.03.004
Neff, K. (2003). 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. (2019). Setting the record straight about the Self-Compassion Scale. Mindfulness, 10(1), 200–202. https://doi.org/10.1007/s12671-018-1061-6
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 adaptation study of the Portuguese adaptation of the Lovibond and Lovibond Depression, Anxiety and Stress Scales (EADS) with 21 items]. Psicologia, Saúde & Doenças, 5(2), 229–239. https://bit.ly/3eDt5gg
Pallant, J. (2013). SPSS survival manual: A step by step guide to data analysis using IBM SPSS (5th ed.). Allen & Unwin.
Pinto-Gouveia, J., Gregório, S., Dinis, A., & Xavier, A. (2012). Experiential avoidance in clinical and non-clinical samples: AAQ-II Portuguese version. International Journal of Psychology & Psychological Therapy, 12(2), 139–156. https://bit.ly/3bpFKkJ
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
Ruiz, F. J., Suárez-Falcón, J. C., Riano-Hernández, D., & Gillanders, D. (2017). Psychometric properties of the Cognitive Fusion Questionnaire in Colombia. Revista Latinoamericana de Psicología, 49(1), 80–87. https://doi.org/10.1016/j.rlp.2016.09.006
Siniscalchi, M., Iovino, P., Tortora, R., Forestiero, S., Somma, A., Capuano, L., Franzese, M. D., Sabbatini, F., & Ciacci, C. (2005). Fatigue in adult coeliac disease. Alimentary Pharmacology and Therapeutics, 22(5), 489–494. https://doi.org/10.1111/j.1365-2036.2005.02619.x
Sirois, F. M., Molnar, D. S., & Hirsch, J. K. (2015). Self-compassion, stress, and coping in the context of chronic illness. Self and Identity, 14(3), 334–347. https://doi.org/10.1080/15298868.2014.996249
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://www.mdedge.com/jcomjournal/article/146122/role-self-compassion-chronic-illness-care
Smith, D. F., & Gerdes, L. U. (2012). Meta-analysis on anxiety and depression in adult celiac disease. Acta Psychiatrica Scandinavica, 125(3), 189–193. https://doi.org/10.1111/j.1600-0447.2011.01795.x
Sommers-Spijkerman, M. P. J., Trompetter, H. R., Schreurs, K. M. G., & Bohlmeijer, E. T. (2018). Compassion-focused therapy as guided self-help for enhancing public mental health: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 86(2), 101–115. https://psycnet.apa.org/doi/10.1037/ccp0000268
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Pearson Education Inc.
Trindade, I. A. (2018). Emotion regulation and chronic illness: The roles of acceptance, mindfulness and compassion in physical and mental health [Doctoral dissertation, Universidade de Coimbra]. Repositório científico Universidade de Coimbra. https://eg.uc.pt/handle/10316/87592
Trindade, I. A., Ferreira, C., & Pinto-Gouveia, J. (2017). 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. (2018). Assessment of chronic illness-related cognitive fusion: Preliminary development and validation of a new scale with an IBD sample. Journal of Clinical Psychology in Medical Settings, 25(4), 356–366. https://doi.org/10.1007/s10880-017-9536-5
Trindade, I. A., Keefer, L., Portela, F., Ferreira, C., & Pinto-Gouveia, J. (2019). Measuring structural model invariance across internet-recruited and hospital-recruited IBD patients: Experiential avoidance’s effect on psychopathological symptoms. Current Psychology, 1–8. https://doi.org/10.1007/s12144-019-00281-2
Trindade, I. A., Marta‐Simões, J., Ferreira, C., & Pinto‐Gouveia, J. (2018). Chronic illness‐related cognitive fusion explains the impact of body dissatisfaction and shame on depression symptoms in breast cancer patients. Clinical Psychology & Psychotherapy, 25(6), 886–893. https://doi.org/10.1002/cpp.2323
Wierenga, K. L., Lehto, R. H., & Given, B. (2017). Emotion regulation in chronic disease populations: An integrative review. Research and Theory for Nursing Practice, 31(3), 247–271. https://doi.org/10.1891/1541-6577.31.3.247
Zarkadas, M., Cranney, A., Case, S., Molloy, M., Switzer, C., Graham, I. D., Butzner, J. D., Rashid, M., Warren, R. E., & Burrows, V. (2006). The impact of a gluten-free diet on adults with coeliac disease: Results of a national survey. Journal of Human Nutrition and Dietetics, 19(1), 41–49. https://doi.org/10.1111/j.1365-277x.2006.00659.x
Zingone, F., Swift, G. L., Card, T. R., Sanders, D. S., Ludvigsson, J. F., & Bai, J. C. (2015). Psychological morbidity of celiac disease: A review of the literature. United European Gastroenterology Journal, 3(2), 136–145. https://doi.org/10.1177/2050640614560786
Publicado
Como Citar
Edição
Secção
Licença
Direitos de Autor (c) 2020 Melanie Fernandes, Ana Galhardo, Ilda Massano-Cardoso
Este trabalho encontra-se publicado com a Creative Commons Atribuição-NãoComercial 4.0.
Os autores conservam os direitos de autor e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Creative Commons - Atribuição-NãoComercial 4.0 Internacional que permite a partilha do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
