Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-06-30T14:29:19Z No. of bitstreams: 1 TES_IGOR_DA_ROSA_FINGER_PARCIAL.pdf: 733625 bytes, checksum: d08e4c6a78d2ad4bd39b9b1e02d3dca8 (MD5) / Made available in DSpace on 2017-06-30T14:29:19Z (GMT). No. of bitstreams: 1 TES_IGOR_DA_ROSA_FINGER_PARCIAL.pdf: 733625 bytes, checksum: d08e4c6a78d2ad4bd39b9b1e02d3dca8 (MD5) Previous issue date: 2017-01-25 / Overweight and its consequences cause several physical and mental health problems. A reduction of caloric ingestion and an increase in physical activity are recommended to weight adequacy. However, the adhesion and maintenance of these practices continue being a limitation in the care of overweight and obese people. There are evidences of the effectiveness of therapies that involve the incentive to lifestyle changes through topographic alterations of behavior and thought. Unlike these interventions, the Acceptance and Commitment Therapy (ACT) does not focus on the topographic modification of behavior, but on the alteration of its function. It is aimed, with this thesis, to evaluate the effect of the use of an intensive psychological intervention, based in ACT, in comparison to a Psychoeducational and CBT intervention in overweight and obese people. This thesis, is divided in three studies. The first one aimed to identify the processes of psychological inflexibility (PI) associated to the body mass index (BMI), depression, anxiety and stress symptoms and binge eating in overweight and obese people. A cross-sectional study was conducted in 243 people with BMI 25 and higher and ages 18 to 60 years. The data was analysed through a One-Way ANOVA and t test. There were no differences found in the PI mediums in relation to BMI. There were significant differences found in PI in relation to binge eating and depression, anxiety and stress symptoms, being that the most severe the symptom, the higher the PI medium. The second study aimed to evaluate the predictive factors of the participation of overweight and obese people in an intensive psychosocial program, of 8 hours of duration in one day. This is a cross-sectional quantitative study in which 82 people (77 of them, women) with BMI 25 and higher and ages from 18 and 60 years answered to a recruiting and confirmed participation. A multivariate binary logistic regression was conducted. The variables with some degree of prediction in the adhesion to the intervention were the ones of behavior related to diet and physical activity (OR: 1,342; IC: 95%: 0,970- 1,857), psychological flexibility (OR:1,078; IC 95%: 1,009-1,152) and, more specifically, the psychological process of cognitive fusion (OR: 1,078; IC: 95%: 0,969 - 1,069). The last study aimed to investigate the effects of an intervention based in ACT, in comparison to one based in Psychoeducation and CBT, in the objective measures (weight and BMI) and in the ones of self-repot (depression, anxiety and stress symptoms, binge eating and psychological flexibility) in overweight and obese people. 72 people were randomly assigned to one of the groups. The ACT group showed differences in the development of cognitive defusion and eating conscience - emotional response, as well as it helped more in the modification of binge eating intensity. Other results did not present a significant difference between the groups. Considering that the Psychoeducational/CBT intervention is the chosen intervention nowadays, the results of this thesis show that an intervention in ACT can have at least the same outcomes as the intervention of choice. / O excesso de peso e suas consequ?ncias causam diversos problemas ? sa?de f?sica e mental. Redu??o da ingesta cal?rica e aumento das atividades f?sicas s?o recomendados para adequa??o do peso. Por?m, a ades?o e a manuten??o dessas pr?ticas seguem sendo um limitador no aux?lio ?s pessoas com sobrepeso ou obesidade. H? evid?ncias de efetividade em terapias que envolvem o est?mulo ? mudan?a do estilo de vida atrav?s da altera??es topogr?ficas do comportamento e do pensamento. Diferente da interven??o anterior, a Terapia de Aceita??o e Compromisso (ACT) n?o foca na modifica??o topogr?fica do comportamento, mas na altera??o da fun??o dele. Objetiva-se, com essa tese, avaliar o efeito da utiliza??o de uma interven??o psicol?gica intensiva, baseada na ACT, em compara??o a uma interven??o Psicoeducativa e TCC em pessoas com sobrepeso e obesidade. Essa tese ? dividida em tr?s estudos. O primeiro objetivou identificar os processos de inflexibilidade psicol?gica (IP) associados ao ?ndice de massa corporal (IMC), sintomas de depress?o, ansiedade, estresse e comer compulsivo em pessoas com sobrepeso e obesidade. Realizou-se um estudo transversal em 243 pessoas com IMC a partir de 25 e idade entre 18 e 60 anos. Analisou-se os dados com ANOVA one-way e teste t. N?o foram encontradas diferen?as entres as m?dias de IP em rela??o ao IMC. Foram encontradas diferen?as significativas na IP em rela??o ao comer compulsivo e aos sintomas de depress?o, ansiedade e estresse, sendo que quanto mais grave o sintoma, maior a m?dia de IP. O segundo estudo objetivou avaliar os fatores preditivos da participa??o de pessoas com sobrepeso e obesidade em um programa psicossocial intensivo, de 8h de dura??o em um dia. Este ? um estudo quantitativo transversal em que 82 pessoas (77 delas, mulheres) com IMC a partir de 25 e idade entre 18 e 60 anos responderam ao recrutamento e confirmaram a participa??o. Realizou-se uma regress?o log?stica bin?ria. As vari?veis com algum grau de predi??o na ades?o ? interven??o foram as de comportamento relacionados ? dieta e atividade f?sica (OR: 1,342; IC 95%: 0,970-1,857), flexibilidade psicol?gica (OR: 1,078; IC 95%: 1,009-1,152) e, mais espec?fico, o processo psicol?gico de fus?o cognitiva (OR: 1,018; IC 95%: 0,969-1,069). O ?ltimo estudo objetivou investigar os efeitos de uma interven??o baseada na ACT, em compara??o a uma baseada em Psicoeduca??o e TCC, nas medidas objetivas (peso e ?ndice de massa corporal - IMC) e de auto-relato (sintomas depressivos, ansiosos e de estresse, compuls?o alimentar e flexibilidade psicol?gica) em pessoas com sobrepeso ou obesidade. 72 pessoas foram designadas aleatoriamente para um dos grupos. O grupo ACT apresentou diferen?a no desenvolvimento da desfus?o cognitiva e consci?ncia alimentar ? resposta emocional, bem como auxiliou mais na modifica??o da intensidade da compuls?o alimentar. Os demais resultados n?o apresentaram diferen?a significativa entre os grupos. Considerando-se que a interven??o Psicoeducativa/TCC ? a interven??o de escolha atualmente, os resultados dessa tese mostram que uma interven??o em ACT pode ter, no m?nimo, os mesmos desfechos que a interven??o de escolha.

Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-09-13T12:24:35Z No. of bitstreams: 1 DIS_PATRICIA_ARIANE_GUEDES_PARCIAL.pdf: 3965418 bytes, checksum: 2706b87cf2c984ce569ea0dbf88ce595 (MD5) / Made available in DSpace on 2017-09-13T12:24:35Z (GMT). No. of bitstreams: 1 DIS_PATRICIA_ARIANE_GUEDES_PARCIAL.pdf: 3965418 bytes, checksum: 2706b87cf2c984ce569ea0dbf88ce595 (MD5) Previous issue date: 2017-06-30 / The consequences of obesity and overweight can be analyzed by matters of mental and physical health, quality of life and social impacts. When this condition is already instated, it is necessary to act with treatments that bring benefits. The goal of the present dissertation is to report an intervention based on the Acceptance and Commitment Therapy (ACT), as well as identifying the results on the Psychological Flexibility in people with obesity or overweight. In order to achieve that, the inclusion criteria were being between 18 and 59 years of age, presenting a BMI 25 or above, and having studied at least eight years, The exclusion criteria were the presence of diagnosis of Borderline Personality Disorder, Bipolar Mood Disorders (in active episode), Depressive Disorder (in active episode) and Substance Abuse Disorders. Instruments used: Depression, Anxiety and Stress Scale (DASS-21), Binge Eating Scale (BES), Acceptance and Action Questionnaire II (AAQ-II), Acceptance and Action Questionnaire for Weight (AAQ-W), Values of Life Questionnaire (VLQ), Cognitive Fusion Questionnaire - Body Image (CFQ-BI) and Mindful Eating Questionnaire (MEQ). They were applied in three moments: before the intervention, right after the intervention, and five months after the intervention. The present study was done with 39 subjects, ages between 21 and 58, with an average of 40.9. The majority of the participants was single (35.7%) and had a college degree, either completed or not (66.7%). The participants presented a BMI between 25.3 and 51.6, with an average of 34.2 (considered obesity). In section I an experience account with patient illustrations was done. The intensive intervention presented aspects connected to ACT concepts such as experiential acceptance, cognitive defusion, Mindfulness, among others, as well as the use of Matrix diagram and the texting of messages in the weeks following. In section 2 the effects of intensive intervention on psychological flexibility, eating compulsion, depression, anxiety and stress symptoms. Of the 478 people who were interested in participating on the intervention, 181 underwent triage. Of those, 39 participated on the intervention and 29 returned for the segment evaluation. As far as results, a significant difference was found in the increase of experiential acceptance (AAQ?II F10,92; p<0,001; AAQ?W F14,94; p<0,001), in the development of cognitive defusion (CFQ F10,96; p<0,001; CFQ-BI F24,45; p<0,001), increase of consciousness and attention in the eating process (MEQ t=-3,75; p=0,001) and there was no significant difference in the importance of life values and how much they can be applicable in actions (VLQ). There was an expressive reduction on eating compulsion related symptoms. Even though they?re preliminary, the results appear to be promising to for the increase in Psychological Flexibility. / As consequ?ncias da obesidade e sobrepeso podem ser analisadas a partir das quest?es de sa?de f?sica, mental, de qualidade de vida e impactos sociais. Quando essa condi??o j? est? instaurada, ? necess?rio atuar a partir de tratamentos que tragam benef?cios. Objetiva-se nessa disserta??o relatar uma interven??o intensiva baseada na Terapia de Aceita??o e Compromisso (ACT), assim como, identificar os resultados na Flexibilidade Psicol?gica em pessoas com sobrepeso e obesidade. Para tanto, os crit?rios de inclus?o foram ter idade entre 18 e 59 anos, apresentar IMC maior ou igual a 25 e ter escolaridade m?nima de oito anos de estudo. J? os crit?rios de exclus?o foram presen?a de diagn?sticos de Transtorno da Personalidade Borderline, Transtornos do Humor Bipolar (em epis?dio ativo), Transtorno Depressivo (em epis?dio ativo) e Transtornos de Uso de Subst?ncias. Instrumentos utilizados: Escala de Depress?o Ansiedade e Estresse (DASS-21), Escala de Compuls?o Alimentar Peri?dica (ECAP), Question?rio de Aceita??o e A??o II (AAQ-II), Question?rio de Aceita??o e A??o para o Peso (AAQ-W), Question?rio de Valores de Vida (VLQ), Question?rio de Fus?o Cognitiva (CFQ), Question?rio de Fus?o Cognitiva ? Imagem Corporal (CFQ-BI) e Mindful Eating Questionnaire (MEQ). Eles foram aplicados em tr?s tempos: antes da interven??o, logo ap?s a interven??o e cinco meses depois da interven??o. O presente estudo foi realizado com 39 indiv?duos, com idades entre 21 e 58 anos, com m?dia de 40,9. A maioria dos participantes era solteiro(a) (35,7%) e tinha Ensino Superior, entre incompleto e completo (66,7%). Os participantes apresentaram IMC entre 25,3 e 51,6, com m?dia 34,2 (considerado obesidade). Na se??o 1 foi realizado um relato de experi?ncia associando com depoimentos dos pacientes. A interven??o intensiva apresentou aspectos ligados a conceitos da ACT tais como aceita??o experiencial, desfus?o cognitiva, Mindfulness, entre outros, assim como o uso do diagrama Matriz e o envio de mensagens de texto nas semanas seguintes. Na se??o 2 foi investigado os efeitos da interven??o intensiva nas medidas de flexibilidade psicol?gica, compuls?o alimentar, sintomas de depress?o, de ansiedade e de estresse. Das 478 pessoas que demonstraram interesse em participar da interven??o, 181 foram triadas. Dessas, 39 pessoas participaram da interven??o e 29 retornaram para a avalia??o de seguimento. Como resultados, encontrou-se diferen?a significativa no aumento da aceita??o experiencial (AAQ?II F10,92; p<0,001; AAQ?W F14,94; p<0,001), no desenvolvimento da desfus?o cognitiva (CFQ F10,96; p<0,001; CFQ-BI F24,45; p<0,001), aumento da consci?ncia e aten??o no processo de comer (MEQ t=-3,75; p=0,001) e n?o houve diferen?a expressiva na import?ncia aos valores na vida e o quanto eles s?o aplic?veis em a??es (VLQ). Houve uma redu??o significativa de sintomas ligados ? compuls?o alimentar. Ainda que preliminares, os resultados parecem promissores para o aumento da Flexibilidade Psicol?gica.