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No. of bitstreams: 1 LUCAS_ANDRE_SCHUSTER_DE_SOUZA_DIS.pdf: 2261551 bytes, checksum: 6d2ae6206b912e63a5477cc83923cef8 (MD5) Previous issue date: 2018-03-08 / Introduction: Obesity is a complex and multifactorial condition that represents a risk factor for several other health problems and reductions in quality of life. The high prevalence and growing incidence of obesity in the world makes it necessary to identify the predisposing factors and effective intervention strategies for its treatment. One of the most important aspects in the treatment of obesity is the promotion of more adaptive eating behaviors and the reduction of problematic eating behaviors. It is currently recognized that emotional regulation is an important element in the etiological equation and maintenance of problematic eating behaviors in obesity and in some eating disorders related to obesity, especially binge eating. Dialectical Behavioral Therapy (DBT) is a behavioral therapeutic approach whose effectiveness has been demonstrated for a wide range of psychopathological conditions in which difficulties with emotional regulation are present. Although there are already several studies demonstrating DBT's efficacy in the context of eating disorders and obesity, in Brazil, research with DBT is still scarce and there are no empirical studies to date about its application to eating disorders. Considering this scenario, two studies were proposed to identify the effectiveness and maintenance of the effects of a group intervention based on the training of TCD Skills for obese people. Goals: To verify the maintenance of effects on problematic and adaptive eating behaviors after a group intervention based on Dialectic Behavioral Therapy for obese people, and to explore relevant aspects of the participants' experience with the intervention. Method: sequential quantitative and qualitative design, using self-report measures and semi-directed interviews. On the quantitative stage, self-report measures of problematic eating behaviors (Binge Eating Scale - BES, Emotional Eating Scale - EES) and adaptive (Mindful Eating Eating Questionnaire - MEQ, Intuitive Eating Scale 2 - IES-2) were used. An intention-to-treat analysis (n = 121) was used with all participants who were assigned for the intervention. Measures were taken at pretest, post-test and 3 and 8 months follow-up. Descriptive analyzes and hierarchical linear modeling were used to verify the effectiveness and stability of the effects of the intervention. In the qualitative phase, semi-directed interviews were conducted with 3 participants who concluded the intervention, focusing on the experience with the intervention, perceived effects, 31 facilitators and difficulties with the participation and implementation of the strategies developed in the treatment. The interviews were analyzed by four researchers, using inductive thematic analysis. Results: There was a significant reduction in problematic eating behaviors after the intervention, with stable results at the three-month follow-up and slight return towards baseline at 8-month follow-up. As for adaptive eating behavior, there was improvement after the intervention, which was maintained at three months follow-up and tended to return to baseline at 8 months follow-up. Analysis of the interviews revealed that participants identified improvements in various aspects of their life after the intervention, especially in interpersonal functioning and in the ability to regulate their own behavior. They point the identification with other group members and the presence of a supportive family and social environment as facilitators of participation in the intervention. Experiences of anxiety and aversive emotions during the group and difficulty in maintaining skills practice outside the sessions were pointed out as obstacles to the effectiveness of the intervention. Discussion: Quantitative results are consistent with other literature findings on DBT interventions in the context of eating disorders and demonstrate that a brief intervention based on DBT and adapted to the Brazilian context may be effective in reducing problematic eating behaviors and promoting more adaptive behaviors in the short and medium term for obese people, however they are not conclusive as to the maintenance of these changes for 8 months or longer. Data from the qualitative study replicated in part other findings in the literature on DBT for people with emotional dysregulation and borderline personality disorder, stressing the importance that clinicians be attentive to aversive emotional experiences during the group and provide support as well as identify opportunities for application of the skills during the group sessions. In addition, the perception of improvement in interpersonal relationships reflects the importance of the interpersonal dimension in obesity and binge eating, highlighting the strong relationship between interpersonal aspects and emotional responses to which maladaptive coping strategies such as overeating may follow. / Introdu??o: A obesidade ? uma condi??o complexa e multifatorial que representa um fator de risco para diversos outros problemas de sa?de e preju?zos ? qualidade de vida. A elevada preval?ncia e crescimento da quantidade de casos de obesidade no mundo, torna necess?rio que se identifiquem os fatores predisponentes e estrat?gias de interven??o eficazes para seu tratamento. Um dos aspectos mais importantes no tratamento da obesidade consiste na promo??o de comportamentos alimentares mais adaptativos e redu??o dos comportamentos alimentares problem?ticos. Reconhece-se atualmente que a regula??o emocional ? um elemento de grande import?ncia na equa??o etiol?gica e na manuten??o dos comportamentos alimentares problem?ticos na obesidade e em alguns transtornos alimentares correlatos da obesidade, em especial a compuls?o alimentar. A Terapia Comportamental Dial?tica (TCD) ? uma abordagem terap?utica de base comportamental cuja efic?cia vem sendo demonstrada para uma ampla gama de condi??es psicopatol?gicas nas quais est?o presentes dificuldades com a regula??o emocional. Apesar de j? haver diversos estudos demonstrando efic?cia da TCD no contexto dos transtornos alimentares e da obesidade, no Brasil, ainda ? escassa a investiga??o com aplica??es da TCD, e inexistente no caso de estudos emp?ricos sobre sua aplica??o a dist?rbios relacionados ao comportamento alimentar. Em face de tal cen?rio, prop?s-se a realiza??o de dois estudos com objetivo de identificar a efetividade e manuten??o dos efeitos de uma interven??o em grupo baseada no treinamento de Habilidades da TCD para pessoas obesas. Objetivos: verificar manuten??o dos efeitos sobre comportamentos alimentares problem?ticos e adaptativos ap?s uma interven??o em grupo baseada na Terapia Comportamental Dial?tica para pessoas obesas, e explorar aspectos relevantes da experi?ncia dos participantes com a interven??o. M?todo: desenho sequencial quantitativo e qualitativo, utilizando medidas de autorrelato e entrevista semidirigida. Na etapa quantitativa, utilizaram-se medidas de autorrelato de comportamentos alimentares problem?ticos (Escala de Compuls?o Alimentar Peri?dica - ECAP; Emotional Eating Scale - EES) e adaptativos (Mindful Eating Questionnaire - MEQ; Intuitive Eating Scale 2 - IES-2). Utilizou-se uma an?lise intention-to-treat (n=121) com participantes 28 selecionados para a interven??o. Foram realizadas medidas de pr?-teste, p?s-teste e seguimento de 3 e de 8 meses ap?s a interven??o. An?lises descritivas e modelagem linear hier?rquica foram utilizadas para verificar a efetividade e estabilidade dos efeitos da interven??o. Na fase qualitativa, entrevistas semidirigidas foram conduzidas com 3 participantes que conclu?ram a interven??o, enfocando a experi?ncia com a interven??o, efeitos percebidos, facilitadores e dificuldades com a participa??o e implementa??o das estrat?gias desenvolvidas no tratamento. As entrevistas foram analisadas por quatro pesquisadores, utilizando o procedimento de an?lise tem?tica indutiva. Resultados: verificou-se uma redu??o significativa nos comportamentos alimentares problem?ticos logo ap?s a interven??o, com resultados est?veis no seguimento de tr?s meses e levemente elevados no seguimento de 8 meses. Quanto ao comportamento alimentar adaptativo, houve melhora logo ap?s a interven??o, com resultados tamb?m est?veis aos tr?s meses de seguimento e tendendo a retornar aos valores iniciais aos 8 meses de seguimento. As entrevistas revelaram que os participantes identificaram melhoras em diversos aspectos de sua vida ap?s a interven??o, especialmente no funcionamento interpessoal e na capacidade de regular o pr?prio comportamento. Apontam a identifica??o com outros membros do grupo e a presen?a de um ambiente familiar e social suportivo como facilitadores da participa??o na interven??o. Experi?ncias de ansiedade e emo??es aversivas durante o grupo e dificuldade de manter a pr?tica das habilidades fora das sess?es foram apontadas como obst?culos para a efetividade da interven??o. Discuss?o: os resultados quantitativos s?o coerentes com outros achados da literatura sobre interven??es de TCD no contexto de dist?rbios da alimenta??o, e demonstram que uma interven??o breve baseada na TCD e adaptada ao contexto brasileiro pode ser efetiva para reduzir comportamentos alimentares problem?ticos e promover comportamentos mais adaptativos em curto e m?dio prazo, no entanto n?o s?o conclusivos quanto ? manuten??o em prazos superiores a 8 meses. Os dados do estudo qualitativo replicaram em parte outros achados da literatura sobre a TCD para pessoas com desregula??o emocional e transtorno limite de personalidade, ressaltando a import?ncia de que os cl?nicos estejam atentos ?s experi?ncias emocionais aversivas durante o grupo, oferecendo suporte e identificando oportunidades de aplica??o das habilidades treinadas durante o o pr?prio grupo. 29 Ademais, a percep??o de melhora nas rela??es interpessoais reflete a import?ncia da dimens?o interpessoal na problem?tica da obesidade e da compuls?o alimentar, dando realce ? forte rela??o entre aspectos interpessoais e respostas emocionais ?s quais podem se seguir estrat?gias maladaptativas de enfrentamento como a sobreingesta de alimentos.