Veća izraženost disfunkcionalnih stavova i uverenja i veća netolerancija frustracije kod žena sa neuspešnim gubitkom telesne mase
Sažetak
Uvod/Cilj. Gojaznost je hronično i relapsirajuće oboljenje, a od skoro se smatra i globalnom epidemijom. U trenutnim smernicama za trojno lečenje gojaznosti ističe se program modifikacije životnog stila koji obuhvata medicinsku nutritivnu terapiju, aerobne vežbe i bihejvioralnu intervenciju. Cilj rada bio je da se proceni da li specifični psihološki faktori (opšti stavovi i uverenja i tolerancija na frustraciju) mogu biti prediktori uspešnog gubitka telesne mase, odnosno faktori na koje je moguće uticati u integrativnom terapijskom pristupu. Metode. Ukupno 84 konsekutivne predgojazne i gojazne ispitanice, bez pridruženih bolesti ili stanja, homogene po godinama, obrazovanju, bračnom i profesionalnom statusu, dobile su jednak program medicinske nutritivne terapije, kao jedinu terapijsku intervenciju tokom šest meseci. Pre početka lečenja primenjene su Skala opštih stavova i uverenja (General Attitude and Belief Scale – GABS) i Upitnik frustracione netolerancije (Frustration Discomfort Scale – FDS). Ispitanice su podeljene u dve grupe: uspešnu (grupa A) i neuspešnu (grupa B). Grupa A, odnosno uspešna grupa [ispitanice sa srednjom vrednošću indeksa telesne mase (ITM) ± standardna devijacija (SD) 24,1 ± 5,81 kg/m2] sastojala se od 40 ispitanica koje su dostigle odgovarajući gubitak, tj.
izgubile ≥ 10% početne telesne mase (TM). Grupa B, odnosno neuspešna grupa (ispitanice sa srednjom vrednošću ITM ± SD 28,51 ± 2,74 kg/m2) sastojala od 44 ispitanice koje nisu dostigle odgovarajući gubitak, tj. izgubile su < 10% početne TM. Rezultati. Ispitanice u grupi B imale su značajno više skorove (p < 0,05) na subskalama GABS Potreba za priznanjem, Potreba za komforom i Obezvređivanje drugih osoba. Statistički značajna razlika između grupa (p < 0,05) pokazana je za FDS subskale Emocionalna netolerancija, Pravednost i Frustracije vezane za postignuća. Zaključak. Rezultati našeg istraživanja su pokazali da su ispitanice koje su bile neuspešne u sprovođenju medicinske nutritivne terapije imale viši nivo disfunkcionalnih stavova i uverenja i više skorove frustracione netolerancije u poređenju sa onima koje su bile uspešne u tome. Preporuka, bazirana na našim rezultatima, mogla bi biti da se u integrativni model lečenja gojaznosti uključe i psihoterapijske tehnike, usmerene na kognitivne promene i povećanje tolerancije na frustraciju.
Reference
American Medical Association House of Delegates. Recognition of obesity as a disease. Resolution 420 (A-13) [Internet]. Nation-al Public Radio; 2013 [accessed 2023 July 15; cited on 2024 Jan 19]. Available from: https://media.npr.org/documents/20
/jun/ama-resolution-obesity.pdf
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii, 1–253.
Mannan M, Mamun A, Doi S, Clavarino A. Prospective associa-tions between depression and obesity for adolescent males and females – A systematic review and meta-analysis of longitudi-nal studies. PLoS One 2016; 11(6): e0157240.
Lazarus E, Ortiz-Pujols S. Increasing clinical awareness of obe-sity as a serious, chronic, relapsing, and treatable disease. Am J Manag Care 2022; 28(15 Suppl): S271–8.
Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352(11): 1138–45.
Rozjabek H, Fastenau J, LaPrade A, Sternbach N. Adult obesity and health-related quality of life, patient activation, work productivity, and weight loss behaviors in the United States. Diabetes Metab Syndr Obes 2020; 13: 2049–55.
Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, et al. Joint international consensus statement for ending stigma of obesity. Nat Med 2020; 26(4): 485–97.
Cornier MA. A review of current guidelines for the treatment of obesity. Am J Manag Care 2022; 28(15 Suppl): S288–96.
Chopra S, Malhotra A, Ranjan P, Vikram NK, Singh N. Life-style-related advice in the management of obesity: A step-wise approach. J Educ Health Promot 2020; 9: 239.
Redman LM, Heilbronn LK, Martin CK, Alfonso A, Smith SR, Ravussin E. Effect of calorie restriction with or without exer-cise on body composition and fat distribution. J Clin Endo-crinol Metab 2007; 92(3): 865–72.
McGuire MT, Wing RR, Klem ML, Hill JO. Behavioral strate-gies of individuals who have maintained long-term weight losses. Obes Res 1999; 7(4): 334–41.
Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring) 2014; 22(1): 5–13.
Keesey RE, Hirvonen MD. Body weight set-points: determina-tion and adjustment. J Nutr 1997; 127(9): 1875S–83S.
Lemstra M, Bird Y, Nwankwo C, Rogers M, Moraros J. Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Prefer Adherence 2016; 10: 1547–59.
Jansen A, Houben K, Roefs A. A cognitive profile of obesity and its translation into new interventions. Front Psychol 2015; 6: 1807.
Dalle Grave R, Calugi S, Marchesini G. The influence of cogni-tive factors in the treatment of obesity: Lessons from the QUOVADIS study. Behav Res Ther 2014; 63: 157–61.
Fabricatore AN. Behavior therapy and cognitive-behavioral therapy of obesity: is there a difference? J Am Diet Assoc 2007; 107(1): 92–9.
Cooper Z, Fairburn CG. A new cognitive behavioral approach to the treatment of obesity. Behav Res Ther 2001; 39(5): 499–511.
Dalle Grave R, Sartirana M, Calugi S. Personalized cognitive-behavioural therapy for obesity (CBT-OB): theory, strategies and procedures. BioPsychoSocial Med 2020; 14(1): 5.
Tepšić Ostojić V, Ristić-Medić D, Mraović T, Bukumirić Z, Va-siljević N, Latas M. General psychopathology and impulsivity as pre-treatment predictors of medical nutrition therapy out-come in overweight and obese women. Vojnosanit Pregl 2019; 75(11): 1103–9.
Bernard ME. Validation of the general attitude and belief scale. J Ration Emot Cogn Behav Ther 1998; 16(3): 183–96.
Harrington N. The Frustration Discomfort Scale: development and psychometric properties. Clin Psychol Psychother 2005; 12(5): 374–87.
Repopsi. Repository of psychological instruments in Serbian [Internet]. [cited 2024 Jan 19]. Available from: https://www.re
popsi.f.bg.ac.rs/en
Harrington N. Frustration intolerance as a mulitdimensional concept. J Ration Emot Cogn Behav Ther 2007; 25(3): 191–211.
Silva I. Importance of emotional regulation in obesity and weight loss treatment. Fractal Rev Psicol 2015; 27(3): 286–90.
Bernard ME. Dispute Irrational Beliefs and Teach Rational Be-liefs: An Interview with Albert Ellis. J Ration Emot Cogn Be-hav Ther 2009; 27(1): 66–76.
Martin RC, Dahlen ER. Irrational beliefs and the experience and expression of anger. J Ration Emot Cogn Behav Ther 2004; 22(1): 3–20.
Takahashi M, Fujihara T. Self-control and choice in humans: Effects of type, amount, and delay of reinforces. Learn Motiv 1995; 26(2): 183–202.
Dalle Grave R, Sartirana M, El Ghoch M, Calugi S. Treatment Overview. In: Dalle Grave R, Sartirana M, El Ghoch M, Calugi S, editors. Treating Obesity with Personalized Cognitive Be-havioral Therapy. NY: Springer, Cham; 2018. pp. 13–26.
Ferster CB, Nurnberger JI, Levitt EB. The control of eating. 1962. Obes Res 1996; 4(4): 401–10.
Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall; 1986. p. 617.
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression: a treatment manual. NY: Guilford Press; 1979. p. 425.
Tice DM, Bratslavsky E, Baumeister RF. Emotional distress reg-ulation takes precedence over impulse control: If you feel bad, do it! J Pers and Soc Psychol 2001; 80(1): 53–67.
DiBartolo PM, Frost RO, Chang P, LaSota M, Grills AE. Shed-ding light on the relationship between personal standards and psychopathology: The case for contingent self-worth. J Ration Emot Cogn Behav Ther 2004; 22(4): 241–54.
De Botton A. The consolations of philosophy. London: Penguin; 2000. p. 197.
Ellis A. Discomfort anxiety: A new cognitive behavioral con-struct. Rational Living 1980; 15(1): 25–30.