Intervenção baseada na Terapia de Aceitação e Compromisso para Manejo do Estigma relacionado aos Transtornos por uso de Substâncias
Palavras-chave:
Atenção à saúde, Pessoal de saúde, Intervenção psicossocial, Estigma social, Transtornos relacionados ao uso de substânciasResumo
Objetivo
O estigma dos profissionais dos serviços de saúde direcionado às pessoas com transtornos por uso de substâncias compromete seriamente a qualidade do cuidado. Uma agenda mundial aponta como é fundamental investir em intervenções baseadas em evidências para lidar com o estigma. Este estudo teve como objetivo descrever o desenvolvimento de um protocolo de intervenção inovador para manejo do estigma baseado na Terapia de Aceitação e Compromisso.
Método
Este é um estudo empírico qualitativo. Fase 1: eixos norteadores da literatura baseada em evidências para definir os componentes ativos. Fase 2: versão preliminar do protocolo e apresentação baseada no Template for Intervention Description and Replication. Fase 3: juízes especialistas para validação de conteúdo.
Resultados
Apresentamos 10 componentes ativos contemplados por meio de uma intervenção presencial de 12 horas, avaliada por juízes especialistas.
Conclusão
Esta intervenção mostrou-se notável em termos de cobertura, acurácia e adequação para profissionais de saúde e promissora para implementação e replicações.
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Referências
Avery, J. D. (2019). The stigma of addiction in the medical community. In J. D. Avery & J. J. Avery (Eds.), The stigma of addiction: an essential guide (pp. 81-92). Springer.
Corrigan, P. W., Schomerus, G., & Smelson, D. (2017). Are some of the stigmas of addictions culturally sanctioned? British Journal of Psychiatry, 210(3), 180-181. https://doi.org/10.1192/bjp.bp.116.185421
Corrigan, P. W., Schomerus, G., Shuman, V., Kraus, D., Perlick, D., Harnish, A., Kulesza, M., Kane-Willis, K., Qin, S., & Smelson, D. (2017). Developing a research agenda for reducing the stigma of addictions. Part II: lessons from the mental health stigma literature. American Journal on Addictions, 26(1), 67-74. https://doi.org/10.1111/ajad.12436
Crapanzano, K. A., Hammarlund, R., Ahmad, B., Hunsinger, N., & Kullar, R. (2018). The association between perceived stigma and substance use disorder treatment outcomes: a review. Substance Abuse and Rehabilitation, 10, 1-12. https://doi.org/10.2147/SAR.S183252
Donabedian, A. (1990). The seven pillars of quality. Archives of Pathology & Laboratory Medicine, 114(11), 1115-1118
Gronholm, P. C., Henderson, C., Deb, T., & Thornicroft, G. (2017). Interventions to reduce discrimination and stigma: the state of the art. Social Psychiatry and Psychiatric Epidemiology, 52(3), 249-258. https://doi.org/10.1007/s00127-017-1341-9
Hawk, M., Coulter, R. W. S., Egan, J. E., Fisk, S., Friedman, M. R., Tula, M., & Kinsky, S. (2017). Harm reduction principles for healthcare settings. Harm Reduction Journal, 14, e70. https://doi.org/10.1186/s12954-017-0196-4
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of processbased care. World Psychiatry, 16(3), 245-246. https://doi.org/10.1002/wps.20442
Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., Masuda, A., Pistorello, J., Rye, A. K., Berry, K., & Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835. https://doi.org/10.1016/S0005-7894(04)80022-4
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2016). Acceptance and commitment therapy: the process and practice of mindful change (2nd ed.). The Guilford Press.
Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., Altman, D. G., Barbour, V., McDonald, H., Johnston, M., Lamb, S. E., Dixon-Woods, M., McCulloch, P., Wyatt, J. C., Chan, A.-W., & Michie, S. (2014). Better reporting of interventions: Template for Intervention Description and Replication (TIDieR) Checklist and Guide. British Medical Journal, 348, g1687. https://doi.org/10.1136/bmj.g1687
Kemp, C. G., Jarrett, B. A., Kwon, C-S., Song, L., Jetté, N., Sapag, J. C., Bass, J., Murray, L., Rao, D., & Baral, S. (2019). Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review. BMC Medicine, 17(6), 1-18. https://doi.org/10.1186/s12916-018-1237-x
Knaak, S., Modgill, G., & Patten, S. (2014). Key ingredients of anti-stigma programs for health care providers: a data synthesis of evaluative studies. Canadian Journal of Psychiatry, 59, S19-S26. https://doi.org/10.1111/acps.12612
Krafft, J., Ferrell, J., Levin, M. E., & Twohig, M. P. (2018). Psychological inflexibility and stigma: a meta-analytic review. Journal of Contextual Behavioral Science, 7, 15-28. https://doi.org/10.1016/j.jcbs.2017.11.002
Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: model, manual development, and pilot outcomes. Addiction Research & Theory, 16(2), 149-165. https://doi.org/10.1080/16066350701850295
Masuda, A., Hill, M. L., Morgan, J., & Cohen, L. L. (2012). A psychological flexibility-based intervention for modulating the impact of stigma and prejudice: a descriptive review of empirical evidence. Psychology, Society & Education, 4(2), 211-223. https://doi.org/10.25115/psye.v4i2.492
Michie, S., West, R., Sheals, K., & Godinho, C. A. (2018). Evaluating the effectiveness of behavior change techniques in health-related behavior: a scoping review of methods used. Translational Behavioral Medicine, 8(2), 212-224. https://doi.org/10.1093/tbm/ibx019
Nyblade, L., Stockton, M. A., Giger, K., Bond, V., Ekstrand, M. L., Lean, R. M., Mitchell, E. M. H., Neslon, L. R. E., Sapag, J. C., Siraprapasiri, T., Turan, J., & Wouters, E. (2019). Stigma in health facilities: why it matters and how we can change it. BMC Medicine, 17(1), 25. https://doi.org/10.1186/s12916-019-1256-2
Polit, D. F. (2015). Assessing measurement in health: beyond reliability and validity. International Journal of Nursing Studies, 52(11), 1746-53. https://doi: 10.1016/j.ijnurstu.2015.07.002
Ramaswamy, R., Reed, J., Livesley, N., Boguslavsky, V., Garcia-Elorrio, E., Sax, S., Houleymata, D., Kimble, L., & Parry, G. (2018). Unpacking the black box of improvement. Journal of the International Society for Quality in Health Care, 30(1), 15-19. https://doi.org/10.1093/intqhc/mzy009
Rao, D., Elshafei, A., Nguyen, M., Hatzenbuehler, M. L., Frey, S., & Go, V. F. (2019). A systematic review of multilevel stigma interventions: state of the science and future directions. BMC Medical, 17(41). https://doi.org/10.1186/s12916-018-1244-y
Ronzani, T. M., Noto, A. R., & Silveira, P. S. (2014). Reducing stigma among drug users: guide for professionals and managers. Editora UFJF.
Silveira, P. S., Tostes, J. G. A., Wan, C., Ronzani, T. M., & Corrigan, P. W. (2018). The stigmatization of drug use as mechanism of legitimation of exclusion. In T. M. Ronzani (Org.), Drugs and social context: social perspectives on the use of alcohol and other drugs (pp. 15-25). Springer.
Souza, A. C., Alexandre, N. M. C., & Guirardello, E. B. (2017). Psychometric properties in instruments evaluation of reliability and validity. Epidemiologia e Serviços de Saúde, 26(3), 649-659. https://doi: 10.5123/S1679-49742017000300022
Stangl, A. L., Earnshaw, V. A., Logie, C. H., van Brakel, W., C Simbayi, L., Barré, I., & Dovidio, J. F. (2019). The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17(1), 31. https://doi.org/10.1186/s12916-019-1271-3
Tostes, J. G. A., Dias, R. T., Reis, A. A. S., Silveira, P. S., & Ronzani, T. M. (2020). Interventions to reduce stigma related to people who use drugs: systematic review. Paidéia (Ribeirão Preto), 30, e3022. https://doi.org/10.1590/1982-4327e33022
United Nations Office on Drugs and Crime. (2019). World Drug Report 2019. Global Overview of Drug Demand and Supply. United Nations Publication. https://reliefweb.int/sites/reliefweb.int/files/resources/WDR19_Booklet_2_DRUG_DEMAND.pdf
Varra, A. A., Hayes, S. C., Roget, N., & Fisher, G. (2008). A randomized control trial examining the effect of acceptance and commitment training on clinician willingness to use evidence-based pharmacotherapy. Journal of Consulting and Clinical Psychology, 76(3), 449-458. https://doi.org/10.1037/0022-006X.76.3.449
Westrup, D., & Wright, M. J. (2017). Learning ACT for Group treatment: an acceptance and commitment therapy skills training manual for therapists. Context Press.
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Copyright (c) 2025 Joanna Gonçalves de Andrade Tostes, Pollyanna Santos Silveira, Leonardo Fernandes Martins, Stephanie Knaak, Telmo Mota Ronzani
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
