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Caracterização desenvolvimentista de significações de doença e de confronto em mulheres com cancro da mama
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INTRODUÇÃO: Os estudos científicos sobre as consequências psicológicas do
cancro da mama nas mulheres permitem retirar quatro conclusões genéricas: (a) as
significações pessoais sobre a doença ou a forma como a pessoa avalia o seu
processo de doença e de tratamento estão intimamente ligadas ao tipo e à
intensidade das reacções emocionais; (b) as reacções emocionais típicas das
pacientes com cancro da mama são as reacções de ansiedade, ligadas a
significações de ameaça e de incerteza e as reacções de tristeza ou depressão,
associadas a significações de perda percebida; (c) os processos de confronto
psicológico influenciam não apenas a qualidade da adaptação ao processo de
doença, podendo aumentar ou diminuirá intensidade das reacções; emocionais, mas
também parecem ter alguma influência no tempo de sobrevivência'; (d) a qualidade
de vida é uma dimensão importante e deve ser valorizada e promovida durante o
tempo de vida das doentes. Contudo, estes estudos podem criticar-se a dois níveis:
(1) apresentam uma grande diversidade de conceitos para se referirem às
significações e aos processos de confronto das mulheres, tornando difícil fazer
estudos comparativos e, (2) em geral carecem de um enquadramento teórico que
permita compreender melhor o que está em jogo, no processo de vivência da
doença, do ponto de vista cognitivo. Assim, neste trabalho será apresentada uma
conceptualização cognitivista e desenvolvimentista das significações de doença e
dos processos de confronto concomitantes. Procura-se, fazer uma integração destas
significações em modelos cognitivos e desenvolvimentistas, que emergiram no
âmbito da Psicologia da Saúde, da Psicoterapia Cognitiva e da Psicologia do
Desenvolvimento sócio-cognitivo.
OBJECTIVOS: 1) aceder às significações de doença, avaliadas de acordo com os
atributos de representação de doença de Leventhal (i.e., identidade, causas, curso
temporal, consequências e controlabilidade); 2) analisar os conteúdos ou temas de
significação, relacionados com reacções emocionais de ansiedade e de depressão, e
sua distribuição na amostra; 3) ordenar as significações de doença de acordo com
critérios do desenvolvimento sócio-cognitivo e propor sequências hierárquicas de
significação; 4) aceder às significações de confronto ou operações dialécticas
utilizadas pelas mulheres com cancro da mama e analisar correspondências entre
aquelas e os níveis de significação da doença; 5) analisar correlações entre
operações dialécticas, reacções emocionais, e dimensões de qualidade de vida,
auto-avaliadas em questionário nos dois momentos de avaliação (no momento da
entrevista e 6 meses depois); 6) analisar correlações entre níveis de significação da doença, reacções emocionais, e dimensões de qualidade de vida, auto-avaliadas em
questionário nos dois momentos de avaliação.
MÉTODO: Foram seleccionadas aleatoriamente 52 pacientes com cancro da mama
da Consulta Multidisciplinar de Cirurgia da Mama do Hospital S. José em Lisboa.
Para aceder às significações das pacientes, foi efectuada uma entrevista individual
semi-estruturada e avaliada a ansiedade, depressão e qualidade de vida através de
escalas clínicas (Self Anxiety Scale, Self Rating Depression Scale, e MOS-Short
Form). As transcrições das entrevistas foram submetidas a uma análise de conteúdo
temática e desenvolvimentista das significações de doença, e os dados qualitativos
e quantitativos foram submetidos a uma análise estatística para testar as hipóteses
colocadas.
CONCLUSÕES: Ao nível da representação da doença, foi possível, por um lado,
caracterizar um perfil típico do cancro da mama de acordo com os atributos
definidos por Leventhal e, por outro, identificar os temas de significação
relacionados com as reacções emocionais de ansiedade e de depressão. Do ponto de
vista do desenvolvimento sócio-cognitivo foi possível ordenar as significações de
doença das pacientes em diferentes níveis de desenvolvimento, verificando-se que
estas funcionam preferencialmente em níveis inferiores e intermédios de
significação da doença. Foi proposta uma nova hierarquia desenvolvimentista de
significação para o atributo das consequências da doença. Em termos da análise
estatística entre as variáveis propostas nos objectivos, constatou-se uma tendência
para uma correspondência entre níveis superiores de significação da doença e
operações dialécticas de restruturação compensatória, e uma correspondência entre
níveis inferiores e operações dialécticas de destruturação. Em termos da relação
entre níveis de significação e intensidade das reacções emocionais e qualidade de
vida, verificou-se que as mulheres que funcionam em níveis superiores significação
da doença têm tendência a apresentar valores mais baixos de depressão e melhor
qualidade de vida do que as dos níveis inferiores. Finalmente, em termos da
relação entre o tipo de confronto (operação dialéctica) e a intensidade das reacções
emocionais e da qualidade de vida, verificou-se que algumas operações dialécticas
apresentam correspondências com a intensidade das reacções emocionais e a
qualidade de vida.
INTRODUCTION: The scientific studies on the psychological consequences of breast cancer on women allow four general conclusions: a) illness subjective meanings or the way in which the person appraises his/her illness process and treatments are closely tied to the type and intensity of emotional reactions; b) the typical emotional reactions are anxiety reactions, linked to subjective meanings of threat and uncertainty, and depression reactions linked to subjective meanings of perceived loss; c) the psychological coping processes influence not only the quality of adaptation to the illness process, increasing or decreasing the emotional reactions intensity, but also seem to have some influence on survival; d) quality of life is an important dimension and should be valued and promoted during patients lives. However these studies can be criticized at two levels: 1) they use an array of different concepts to refer to the women's subjective meanings and their coping process making it difficult to make comparison studies; 2) in general they are not sustained by a theoretical framework that would enable, a better understanding of what is at stake from a cognitive point of view in the women's experience of facing and dealing with their illness. In this study a cognitive-developmental framework of illness subjective meanings and coping processes is presented. An integration of these subjective meanings into a cognitive-developmental framework that emerged from Health Psychology, Cognitive Psychotherapy and Socio-Cognitive Developmental Psychology it is proposed. OBJECTIVES: 1) To get patients' illness subjective meanings, assessed through Leventhal major attributes of illness representations (i.e., identity, causes, duration, consequences and controllability or cure); 2) analyse the content or themes of subjective meanings concerning emotional reactions of anxiety and depression and its distribution on our sample; 3) to order illness subjective meanings accordingly to socio-cognitive developmental criteria and to propose new hierarchical sequences of subjective meanings; 4) to get coping processes or dialectical actions used by breast cancer women and analyse correspondences between these and the levels of illness subjective meanings; 5) analyse correspondences between dialectical actions, emotional reactions and quality of life dimensions self-assessed by questionnaires on two moments of assessment (on the interview moment and 6 months later); 6) analyse correspondences between levels of illness subjective meanings and emotional reactions and quality of life dimensions. METHOD: Fifty-two breast cancer outpatient women from Breast Surgery Multidisciplinary Team Consultation at Hospital S. José, Lisboa, were randomly selected and submitted to a semi-structured interview to obtain their illness subjective meanings and coping processes and also filled out clinical scales to evaluate anxiety (Zung Self Anxiety Scale), depression (Zung Self Rating Depression Scale) and quality of life (MOS-Short Form). The interview material was submitted to a thematic and developmental content analysis, and the qualitatitive and quantitative data went through a statistical analysis to test the hypothesis. CONCLUSIONS: It was possible to characterize a typical profile of breast cancer representation, following Leventhal major attributes of illness representation, and to identify the themes of the subjective meanings linked with the emotional reactions of anxiety and depression. From a socio-cognitive developmental perspective, it was possible to order patients' illness subjective meanings into different developmental levels, verifying that the majority tend to use mainly low and intermediate levels. It was proposed a new hierarchical developmental sequence for the attribute consequences of illness. In the statistical analysis between the variables we found a tendency for a correspondence between superior levels of illness subjective meanings and restructuring dialectical actions, and a correspondence between lower levels and destructuring dialectical actions. We also found that women that use higher levels of illness subjective meanings tend to have lower levels of depression and better quality of life than the ones that use lower levels. Finally, we found that there are some dialectical actions that have a significant correspondence with the intensity of emotional reactions and quality of life.
INTRODUCTION: The scientific studies on the psychological consequences of breast cancer on women allow four general conclusions: a) illness subjective meanings or the way in which the person appraises his/her illness process and treatments are closely tied to the type and intensity of emotional reactions; b) the typical emotional reactions are anxiety reactions, linked to subjective meanings of threat and uncertainty, and depression reactions linked to subjective meanings of perceived loss; c) the psychological coping processes influence not only the quality of adaptation to the illness process, increasing or decreasing the emotional reactions intensity, but also seem to have some influence on survival; d) quality of life is an important dimension and should be valued and promoted during patients lives. However these studies can be criticized at two levels: 1) they use an array of different concepts to refer to the women's subjective meanings and their coping process making it difficult to make comparison studies; 2) in general they are not sustained by a theoretical framework that would enable, a better understanding of what is at stake from a cognitive point of view in the women's experience of facing and dealing with their illness. In this study a cognitive-developmental framework of illness subjective meanings and coping processes is presented. An integration of these subjective meanings into a cognitive-developmental framework that emerged from Health Psychology, Cognitive Psychotherapy and Socio-Cognitive Developmental Psychology it is proposed. OBJECTIVES: 1) To get patients' illness subjective meanings, assessed through Leventhal major attributes of illness representations (i.e., identity, causes, duration, consequences and controllability or cure); 2) analyse the content or themes of subjective meanings concerning emotional reactions of anxiety and depression and its distribution on our sample; 3) to order illness subjective meanings accordingly to socio-cognitive developmental criteria and to propose new hierarchical sequences of subjective meanings; 4) to get coping processes or dialectical actions used by breast cancer women and analyse correspondences between these and the levels of illness subjective meanings; 5) analyse correspondences between dialectical actions, emotional reactions and quality of life dimensions self-assessed by questionnaires on two moments of assessment (on the interview moment and 6 months later); 6) analyse correspondences between levels of illness subjective meanings and emotional reactions and quality of life dimensions. METHOD: Fifty-two breast cancer outpatient women from Breast Surgery Multidisciplinary Team Consultation at Hospital S. José, Lisboa, were randomly selected and submitted to a semi-structured interview to obtain their illness subjective meanings and coping processes and also filled out clinical scales to evaluate anxiety (Zung Self Anxiety Scale), depression (Zung Self Rating Depression Scale) and quality of life (MOS-Short Form). The interview material was submitted to a thematic and developmental content analysis, and the qualitatitive and quantitative data went through a statistical analysis to test the hypothesis. CONCLUSIONS: It was possible to characterize a typical profile of breast cancer representation, following Leventhal major attributes of illness representation, and to identify the themes of the subjective meanings linked with the emotional reactions of anxiety and depression. From a socio-cognitive developmental perspective, it was possible to order patients' illness subjective meanings into different developmental levels, verifying that the majority tend to use mainly low and intermediate levels. It was proposed a new hierarchical developmental sequence for the attribute consequences of illness. In the statistical analysis between the variables we found a tendency for a correspondence between superior levels of illness subjective meanings and restructuring dialectical actions, and a correspondence between lower levels and destructuring dialectical actions. We also found that women that use higher levels of illness subjective meanings tend to have lower levels of depression and better quality of life than the ones that use lower levels. Finally, we found that there are some dialectical actions that have a significant correspondence with the intensity of emotional reactions and quality of life.
Descrição
Tese de mestrado em Psicologia (Psicoterapia e Psicologia da Saúde) apresentada à Universidade de Lisboa através da Faculdade de Psicologia e de Ciências da Educação, 2002
Palavras-chave
Teses de mestrado - 2002 Cancro da mama Mulheres Consequências psicológicas Reacções emocionais Caracterização desenvolvimentista