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Alexitimia e toxicodependência : contributos para o estudo de processos emocionais, da regulação afectiva e das interacções parentais precoces em indivíduos toxicodependentes
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Resumo(s)
A literatura tem pontuado ao longo de várias décadas a existência de perturbações da
regulação das emoções e do afecto, em geral, nos indivíduos toxicodependentes. Numa
discussão inacabada em torno da etiologia de tais dificuldades, as formulações
subjacentes a diferentes modelos têm variado entre paradigmas de causalidade
psicossocial, de tipo desenvolvimentista, situando predominantemente o défice em
padrões sócio-emocionais precoces de fraco apoio afectivo e rejeição; e outras, que
fundamentam os défices comportamentais e cognitivo-experienciais a nível emocional em
paradigmas marcadamente neurobiológicos, tomando-os como consequências estritas do
uso continuado de substâncias com potente reforço a nível central e promotor de efeitos
de neuroplasticidade determinantes do percurso da toxicodependência.
Na procura de um modelo compreensivo integrador, desenvolveu-se um estudo
transversal comparativo de avaliação de défices na identificação, expressão e experiência
emocionais, padrões relacionais percebidos num contexto de vinculação precoce com as
figuras parentais e níveis de reactividade psicofisiológica face a estímulos emocionais. Os
grupos em estudo (99 toxicodependentes integrados em programa de substituição
opiácea; 43 controlos), homogéneos ao nível da idade, sexo e sem a presença de défice
cognitivo, foram avaliados em duas sessões com recurso a medidas psicológicas e
psicofisiológicas validadas. Neste âmbito foi desenvolvida a versão portuguesa da Escala
de Níveis de Consciência Emocional (LEAS) para o estudo científico da consciência
emocional, com qualidades psicométricas bastante adequadas. Os sujeitos foram
entrevistados e avaliados com recurso às seguintes medidas: Exame do Estado Mental,
Escala de Memórias da Infância, Escala de Alexitimia de Toronto, a LEAS, Escala
Hospitalar de Ansiedade e Depressão, Escala de auto-avaliação de Maniquin e Teste de
Nomeação de Emoções do Sistema CATS. A avaliação psicofisiológica decorreu com
recurso ao Dispositivo BioPLUX para investigação e a imagens do Sistema IAPS.
Os resultados para o grupo de toxicodependentes revelaram valores significativamente
superiores de alexitimia e de reactividade cardiovascular face a estimulos emocionais, bem
como valores significativamente inferiores de suporte emocional materno percebido
durante a infância e adolescência, de consciência emocional e no reconhecimento de
emoções a partir de expressões faciais.
A estatística inferencial aponta para que as dificuldades no contacto com os estados
emocionais denunciadas pelo grupo clínico correspondam a um fenómeno de natureza
bidimensional. O padrão alexitímico encontrado parece ser determinado por relatos de
rejeição parental precoce, sendo moderado por níveis de ansiedade na dimensão paterna.
A alexitimia correlacionou-se fortemente com parâmetros de reactividade psicológica e
fisiológica periférica face a estímulos emocionais, quer com uma menor reactividade
electrodérmica, quer com apreciações menos finas da valência dos estímulos. Os níveis de
consciência emocional encontrados, sendo compatíveis com os níveis mais elevados de
alexitimia, não se associaram estatísticamente a esses, à presença de afecto negativo ou
aos parâmetros fisiológicos de reactividade. Associaram-se contudo a variáveis do
percurso de consumos e tratamento (idade do primeiro consumo, anos de consumos,
dose de metadona prescrita) e a défices de reconhecimento de emoções a partir de
expressões faciais. O modelo de equações estruturais desenvolvido parece evocar essa
bidimensionalidade na perturbação nos processos emocionais dos toxicodependentes, de
acordo com as variáveis descritas. Discutem-se as implicações dos resultados para um
modelo integrador de compreensão dos défices emocionais nas toxicodependências e
para uma perspectiva de tratamento.
The literature has emphasized throughout the decades the presence of emotional regulation and affect regulation deficits, in general, among substance dependents. In an ongoing discussion about the etiology of those difficulties, different theoretical models have formulated considerations varying between paradigms of psychosocial causality with a developmental perspective, in which the deficit results from early interaction patterns of low emotional support and rejection; and others through markedly neurobiologically determined paradigms, sustaining that disturbed behavioral and cognitive dimensions of emotional functioning result strictly from the long-term use of drugs, which promotes a strong impact on the central nervous system and neuroplasticity effects which determine the drug addiction pathway. Towards a comprehensive and integrative model, a comparative cross-sectional study was carried out in order to assess deficits on emotional identification, expression and experience, perceived parental rearing interactions occurred in an early attachment context and psychophysiological reactivity levels when faced with emotional stimuli. The studied groups (99 drug addicted outpatients from opioid substitution programs; 43 controls), homogenous in age, gender and without cognitive deficit, were assessed in two sessions with well-validated psychological and psychophysiological measures. In this context the Portuguese version of The Levels of Emotional Awareness Scale (LEAS) was developed, allowing for the scientific study of emotional awareness and showing very adequate psychometric properties. Subjects were interviewed and assessed with the Mini Mental State Examination, the Inventory for Assessing Memories of Parental Rearing Behaviour, the Toronto Alexithymia Scale, the LEAS, the Hospital Anxiety and Depression Scale, the Self-Assessment Maniquin and the CATS nominating emotions test. Psycophysiological assessment was provided by a BioPLUX research device and IAPS pictures. The drug dependents group showed significantly higher levels of alexithymia and cardiovascular reactivity in contact with emotional stimuli; and significantly lower levels of perceived emotional support from the mother in their childhood and adolescence, emotional awareness and abilities in recognizing facially expressed emotions. The inferential statistics suggested that difficulties to assess with the inner emotional states in this clinical group correspond to a two-dimensional phenomenon. The alexithymic pattern seems to be determined by self-reported early parental rejection, in which the paternal dimension is moderated by anxiety. Alexithymia correlated strongly with psychological and autonomic parameters of reactivity to emotional stimuli, with both less accurate reports of emotional valence and less electrodermal activity. The levels of emotional awareness were compatible with the higher levels of alexithymia but did not relate to them, as well as the presence of negative affect and physiological reactivity parameters. Nevertheless they were associated with drug use and treatment variables (onset age of drug use, years of drug use, prescribed methadone dose) and deficits in recognizing facially expressed emotions. A structural equations model was carried, suggesting this two-dimensionality in characterizing disturbed emotional processes in opiate dependents, taking into account the studied variables. Implications for an eclectic and comprehensive model of emotional deficits in drug addiction and for a treatment perspective are discussed.
The literature has emphasized throughout the decades the presence of emotional regulation and affect regulation deficits, in general, among substance dependents. In an ongoing discussion about the etiology of those difficulties, different theoretical models have formulated considerations varying between paradigms of psychosocial causality with a developmental perspective, in which the deficit results from early interaction patterns of low emotional support and rejection; and others through markedly neurobiologically determined paradigms, sustaining that disturbed behavioral and cognitive dimensions of emotional functioning result strictly from the long-term use of drugs, which promotes a strong impact on the central nervous system and neuroplasticity effects which determine the drug addiction pathway. Towards a comprehensive and integrative model, a comparative cross-sectional study was carried out in order to assess deficits on emotional identification, expression and experience, perceived parental rearing interactions occurred in an early attachment context and psychophysiological reactivity levels when faced with emotional stimuli. The studied groups (99 drug addicted outpatients from opioid substitution programs; 43 controls), homogenous in age, gender and without cognitive deficit, were assessed in two sessions with well-validated psychological and psychophysiological measures. In this context the Portuguese version of The Levels of Emotional Awareness Scale (LEAS) was developed, allowing for the scientific study of emotional awareness and showing very adequate psychometric properties. Subjects were interviewed and assessed with the Mini Mental State Examination, the Inventory for Assessing Memories of Parental Rearing Behaviour, the Toronto Alexithymia Scale, the LEAS, the Hospital Anxiety and Depression Scale, the Self-Assessment Maniquin and the CATS nominating emotions test. Psycophysiological assessment was provided by a BioPLUX research device and IAPS pictures. The drug dependents group showed significantly higher levels of alexithymia and cardiovascular reactivity in contact with emotional stimuli; and significantly lower levels of perceived emotional support from the mother in their childhood and adolescence, emotional awareness and abilities in recognizing facially expressed emotions. The inferential statistics suggested that difficulties to assess with the inner emotional states in this clinical group correspond to a two-dimensional phenomenon. The alexithymic pattern seems to be determined by self-reported early parental rejection, in which the paternal dimension is moderated by anxiety. Alexithymia correlated strongly with psychological and autonomic parameters of reactivity to emotional stimuli, with both less accurate reports of emotional valence and less electrodermal activity. The levels of emotional awareness were compatible with the higher levels of alexithymia but did not relate to them, as well as the presence of negative affect and physiological reactivity parameters. Nevertheless they were associated with drug use and treatment variables (onset age of drug use, years of drug use, prescribed methadone dose) and deficits in recognizing facially expressed emotions. A structural equations model was carried, suggesting this two-dimensionality in characterizing disturbed emotional processes in opiate dependents, taking into account the studied variables. Implications for an eclectic and comprehensive model of emotional deficits in drug addiction and for a treatment perspective are discussed.
Descrição
Tese de Doutoramento, Ciências e Tecnologias da Saúde (Desenvolvimento Humano), Universidade de Lisboa, Faculdade de Medicina, 2013
Palavras-chave
Toxicodependência Alexitimia Consciência Sintomas afectivos Teses de doutoramento - 2013