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Introdução: Já é conhecido o papel (geralmente positivo) da religiosidade e espiritualidade (R/E) sobre a saúde física e mental dos indivíduos, porém, mesmo com evidências robustas, não existe um consenso científico com relação aos conceitos de R/E, podendo levar a: instrumentos não acurados, ampliação ou "redução" dos conceitos a outros constructos que não necessariamente são R/E. Objetivo: avaliar de forma qualitativa os principais atributos que os conceitos de R/E possuem em uma amostra clínica e não clínica do contexto brasileiro. Métodos: 14 sujeitos, pacientes e acompanhantes de 2 hospitais gerais de Juiz de Fora-MG foram sorteados a partir de uma amostra prévia (estudo quantitativo) e responderam a um questionário semi-estruturado (10 questões) sobre os conceitos de R/E. Análise de conteúdo foi utilizada para as interpretações. Resultados: percebe-se insegurança para a definição dos conceitos (especialmente o de espiritualidade), a palavra 'fé' presente em muitos discursos, a importância dos aspectos religiosos privados na vida dos respondentes, a associação que os alguns participantes fizeram entre espiritualidade e espiritismo e a maioria acreditar haver algo além do mundo material, especialmente após a morte. Conclusão: fé, religiosidade não organizacional, religiosidade intrínseca e coping religioso espiritual foram as principais dimensões associadas aos conceitos de R/E.
Introduction: The role of religiousness and spirituality (R/S) on the physical and mental health of individuals is already known (usually positive), but even with robust evidence among these associations, there is no scientific consensus regarding the concepts of R/S, a fact that leads to implications as: non-accurate measures, the extension, or "reduction" of the concepts to other constructs that are not necessarily R/S, besides clinical aspects that can confuse R/S with psychopathological aspects. Objective: to evaluate in a qualitative way, the main attributes that the concepts of religiousness and spirituality have in a clinical, and in a non-clinical sample of the Brazilian context. Methods: 14 subjects, patients and caregivers from 2 general hospitals of Juiz de Fora-MG were sorted out from a previous sample (quantitative study) and responded to a semi-structured questionnaire about the concepts of religiosity and spirituality. Content analysis was used for interpretations. Results: the definition of the concepts (especially of spirituality) was confuse, the word 'faith' was present in many discourses, the importance of private religious aspects in respondents' lives, the association of spirituality with spiritism, and to believe there is something beyond the material world was very frequent. Conclusion: faith, aspects of private religiousness (non-organizational religiousness), intrinsic religiosity and spiritual religious coping, were the main dimensions of R/S associated with the concepts of religiosity and spirituality.
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Resumen Este estudio analizó la asociación de las dimensiones adaptativa y desadaptativa del perfeccionismo con la presencia de trastornos de la conducta alimentaria (TCA), de riesgo de TCA, y algunas características inherentes a estos trastornos. Participaron 246 mujeres adolescentes, de 13 a 19 anos de edad, divididas en tres grupos: con TCA (n = 59), con riesgo de TCA (n = 17) y sin TCA o riesgo (n = 170); esto definido a través de la entrevista para Examinación de Trastornos Alimentarios (EDE). Las participantes completaron el Inventario de Trastornos Alimentarios (EDI-3) y la Escala Casi Perfecta-Revisada (APS-R). En congruencia con los modelos que sostienen la existencia de dos dimensiones bien delimitadas del perfeccionismo, las adolescentes con TCA y riesgo presentaron mayores puntuaciones que aquellas sin TCA en Discrepancia (dimensión desadaptativa), pero no en Altos estándares (dimensión adaptativa). Además se hallaron asociaciones positivas entre Discrepancia y todas las subescalas del EDI-3, excepto Miedo a madurar. No obstante, en el grupo con TCA también se hallaron asociaciones positivas de los Altos estándares y el Orden con la Búsqueda de delgadez, resultado que no permite afirmar el valor adaptativo de estas dos últimas dimensiones del perfeccionismo entre las adolescentes con TCA.
Abstract This study analyzed the association of adaptive and maladaptive dimensions of perfectionism in women with eating disorders (ED), risk of ED, and inherent features of ED. The sample included 246 women aged between 13 and 19 years divided into three groups: with ED (n = 59), in risk of ED (n = 17), and without ED or risk (n = 170); for group assignation participants were interviewed with the Eating Disorder Examination (EDE). Participants completed the Eating Disorders Inventory (EDI-3) and the Almost Perfect Scale-Revised (APS-R). According to the models that state the existence of two well defined dimensions of perfectionism, adoles cents in risk of ED and with ED got higher scores in Discrepancy (maladaptive dimension), but not in High standards (adaptive dimension). Besides positive associations were found between Discrepancy and all scales of EDI-3, except for Maturity fears; however also in the ED group positive associations were found between High standards and Order with Drive for thinness, result that do not allow to confirm the adaptive value of these two latter dimensions of perfectionism among adolescents with ED.
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Abstract: This paper is focused in the coping strategies used by patients with an agoraphobic disorder (AD) when they are forced to confront phobic situations. Traditionally, the coping strategies considered were those used by agoraphobia patients to reduce anxiety and psychological distress: the avoidance behavior (to avoid the phobic stimuli) and the escape behavior (when the phobic stimulus is present). Additionally, behaviors used to try to avoid negative physiological responses similar to those occurring in an anxiety crisis (interoceptive avoidance) are also included. A fourth group of behaviors has received less attention: coping strategies that partially allow agoraphobia patients to confront and resist the presence of phobic stimuli. These are stimuli that they need to or are forced to confront. These partial coping strategies (often rituals behaviors) are behaviors to which patients assign a value in decreasing the anxiety to tolerable levels until they are able to confront and resist the phobic scenes (even partially). These behaviors play a non-adaptative role because they difficult the development of adaptative self-control strategies, interfere with daily living conditions, and support the disorder providing an initial and immediate relief of psychological distress. We prefer to name all these strategies non-adaptative coping behaviors. Despite the relevance of these partial coping strategies in the development and consolidation of agoraphobia, their empiric study has been infrequent (especially when compared to the study of both avoidance and escape behaviors). In that sense, with the present study we try to provide data about the following issues: 1) to know how frequently AP' use non-adaptative coping behaviors compared with a group of patients with other disorders. 2) The differential use of behavioral patterns by agoraphobic patients (AP): avoidance behaviors, interoceptive avoidance, escape behaviors, and, especially, the partial coping strategies. 3) The role of partial coping strategies in the evaluation of therapeutic outcome, according to the clinician opinion. The empirical study was designed in two stages: First, the elaboration of a scale to measure coping strategies of phobic stimuli. For that purpose, we took into account literature on the topic, observational data and clinical histories of patients with agoraphobia. The result was a scale (CAD scale) composed by 87 overt behavior items, and 52 covert behavior items. All of these items allowed for the formation of four behavioural patterns, grouping items according to their functions in coping with phobic stimuli: 1) avoidance behavioral pattern; 2) interoceptive avoidance pattern; 3) escape behavioral pattern; and 4) partial coping behavioral pattern. Second stage: The application of the CAD scale to a clinical simple. A group of psychologists and psychiatrists (from a local mental health service unit) were requested to administrate the scale to their patients, with their informed consent. The final sample (n = 235) was as follows: 40 with agoraphobic disorder (30 women and 10 men); 30 with panic disorder (18 women and 12 men); 30 mixed with anxious-depressive disorder (25 women and 5 men); 40 with depressive disorders (32 women and 8 men); 25 with psychotic disorders (10 women and 15 men). A matched group without any clinical disorders was added later (N = 70, 49 women and 21 men). After analysing the results related to the use of non-adaptative coping behaviors, these may be summarized as follows: In gene ral, the group which used less the CAD strategies was the non-clinical group. The patients with agoraphobia were the ones who used the CAD strategies in a more significant level, compared with both the non-clinical group and the groups with other disorders. This includes the use of partial coping behaviors. Results were similar both to CAD overt strategies and covert strategies. Comparing the differential use of CAD strategies by patients with agoraphobia, results show a more significant use of avoidance behaviors (especially in overt behavior form), followed by escape behaviors. Interoceptive avoidance was the third CAD more frequently used. Partial coping behaviors were less used in contrast with other CAD strategies. According to therapist judgments with respect to the relationship between the use of coping strategies and the therapeutic progress evaluation, the AP sample was divided into two groups: positive progress and non-positive progress (negative, unstable or no progress). The positive progress group shows a significant lower use of avoidance behaviors, interoceptive avoidance, and escape behaviors, but only in the overt behavior form. There were no significant effects for partial coping behavior. In other words, a positive evolution in PA was joined by a decrease in avoidance overt behaviors, interoceptive overt avoidance, and escape overt behaviors, but there were no changes in the use of both cognitive coping strategies and partial coping behaviors. Our findings confirm that CAD strategies are more used by AP. Partial coping behaviours are included among these. It was a well-known fact (and previous data supported it), that agoraphobia patients tended to use more both avoidance and escape strategies as procedures which relieved them from anxiety and psychological distress. But, also, there were few data about the role of strategies allowing AP to confront and resist the phobic scenes: the partial coping behaviors. Our data provide information about this kind of coping. Results support that it is more frequently used by agoraphobia patients. This is true when comparing it with patients with other disorders, and, obviously, in contrast with the normal population. But the use of partial coping behaviors is not commonly compared with "more traditional" behaviors such as avoidance or escape behaviors. It may be said that people with agoraphobia choose to avoid or to escape from phobic situations as the best way for them to reduce anxiety. But there is a group of phobic situations an agoraphobic patient must confront on some occasions (attending a medical service, buying something, etc.). These few occasions represent an opportunity to use partial coping strategies. The limited use of these strategies may be due to the fact that other strategies reduce anxiety in a more effective way. In that sense, they may be considered as behaviors having a low frequency of occurrence and a high intensity. We especially appreciate findings about the role of partial coping strategies in the therapeutic progress when a clinician emits judgments about the improvement of agoraphobia patients. These judgments are linked to a decrease of several non- adaptative overt strategies, but there is no change in cognitive coping strategies and neither in partial coping behaviors. These may be interpretated as imprecise therapist judgments, but also as the role played by this kind of strategies in the latent maintenance of agoraphobic responses. Finally, this paper discusses these results according to the counter-therapeutic role of partial coping strategies, and the need to consider them as a target objective in treatment process.