Efetividade da prevenção de recaídas baseada em mindfulness como adjunto ao tratamento de transtorno por uso de substâncias: um ensaio clínico controlado e randomizado
Data
2023-04-26
Autores
Felix-Junior, Itamar José [UNIFESP]
Orientadores
Noto, Ana Regina [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O transtorno por uso de substância (TUS) tem como característica, pela sua condição complexa e crônica, episódios recorrentes de recaídas e que geralmente estão atreladas a fatores clínicos, como raiva, depressão, ansiedade e impulsividade. Tida como uma Intervenção Baseada em Mindfulness, a Prevenção de Recaídas Baseada em Mindulnfess (MBRP) visa proporcionar, por meio de práticas de meditação e discussões uma autoconsciência sobre gatilhos internos e externos que podem levar à recaída. As Comunidades Terapêuticas (CTs) oferecem tratamento por internação, podendo oportunizar práticas adjuvantes ao tratamento, como o MBRP. Objetivo: Avaliar a efetividade do MBRP em comparação ao tratamento usual em serviços de internação para transtorno por uso de substâncias para redução ou cessação do consumo de substâncias 12 meses após a aplicação da intervenção. Métodos: Trata-se de um ensaio clínico controlado e randomizado 1:1, sem cegamento, para verificar a efetividade do MBRP associado ao tratamento usual (MBRP+TAU) comparado a apenas o tratamento usual (TAU) no modelo de tratamento de CTs. Foram verificadas as diferenças entre os grupos em relação aos desfechos utilizando escalas de autopreenchimento assistido com medidas quantitativas avaliadas em até 12 meses após a intervenção, em 4 tempos distintos: antes da intervenção (T0 – linha de base), imediatamente após a intervenção (T1), seis meses (T2) e 12 meses (T3) após a intervenção Para obtenção dos dados foram realizadas 6 coortes, na qual, após a aplicação dos questionários 165 participantes foram sorteados para o grupos, sendo 85 para o grupo MBRP+TAU e 80 para o grupo TAU. Resultados: Para os dados do seguimento em 6 e 12 meses após intervenção, os participantes do grupo MBRP relataram uma percepção de menor consumo de álcool após o tratamento, contudo não houve diferença estatística a respeito das recaídas. Os resultados para os desfechos clínicos demonstraram efeitos do grupo MBRP, observados pelo parâmetro de grupo versus tempo com diferença estatisticamente significante para depressão, autocompaixão total e para o manejo de raiva, na qual foram observados efeitos para as subescalas de controle de raiva para fora, controle de raiva para dentro e índice de expressão de raiva. Acerca do modelo de mediação, os resultados demonstraram que o nível de mindfulness, após oito semanas de MBRP, mediou a diminuição do índice de 18 expressão de raiva. Por fim, a prática que os participantes do grupo MBRP mais realizaram foi o PARAR – espaço para respirar e com frequência semanal de práticas. Considerações finais: O protocolo MBRP como adjunto ao tratamento do TUS em CTs diminuiu a percepção de consumo de álcool sem relevância estatística para recaídas. O protocolo se mostrou viável, contudo algumas adaptações são necessárias. São necessários também mais estudos que possam explorar efeitos em longo prazo, bem como a avaliação da efetividade em CTs para diferentes públicos.
Substance use disorder (SUD) is characterized by its complex and chronic condition, recurrent episodes of relapses, which are usually linked to clinical factors such as anger, depression, anxiety and impulsivity. Considered as a MindfulnessBased Intervention, MindfulnessBased Relapse Prevention (MBRP) aims to provide, through meditation practices and discussions, selfawareness about internal and external triggers that can lead to relapse. The Therapeutics Communities (TCs) offer inpatient treatment, and may provide adjuvant treatment practices, such as the MBRP. Objective: To assess the effectiveness of the MBRP compared to usual care in inpatient substance use disorder services for reducing or stopping substance use 12 months after intervention. Methods: This is a 1:1 randomized, nonblinded, controlled clinical trial to verify the effectiveness of MBRP plus treatment as usual (MBRP+TAU) compared to treatment as usual alone (TAU) in the treatment model for TCs. Differences between groups regarding outcomes were verified using assisted selfreported scales with quantitative measures evaluated within 12 months after the intervention, at 4 different times: before the intervention (T0 baseline), immediately after the intervention (T1), six months (T2) and 12 months (T3) after the intervention. Six cohorts were carried out, in which, after applying the questionnaires, 165 participants were randomly assigned to the groups, 85 to the MBRP+TAU group and 80 for the TAU group. Results: For followup data at 6 and 12 months after intervention, participants in the MBRP group reported a perceived lower alcohol consumption after treatment, however there was no statistical difference regarding relapses. The results for clinical outcomes showed effects of the MBRP group, observed by the parameter of group versus time with statistically significant difference for depression, total selfcompassion and for anger management, in which effects were observed for the anger control subscales for outside, inside anger control, and anger expression index. Regarding the mediation model, the results showed that the level of mindfulness, after eight weeks of MBRP, mediated the decrease in the anger expression index. Finally, the practice that the participants of the MBRP group performed the most was SOBER – space to breathe and with a weekly frequency of practices. Conclusions: The MBRP protocol as an adjunct to the treatment of SUD in TCs reduced the alcohol consumption perception and had no xviii effect on relapses. The protocol proved to be feasible, however some adaptations are necessary. More studies are also needed that can explore longterm effects, as well as the evaluation of effectiveness in TCs for different audiences.
Substance use disorder (SUD) is characterized by its complex and chronic condition, recurrent episodes of relapses, which are usually linked to clinical factors such as anger, depression, anxiety and impulsivity. Considered as a MindfulnessBased Intervention, MindfulnessBased Relapse Prevention (MBRP) aims to provide, through meditation practices and discussions, selfawareness about internal and external triggers that can lead to relapse. The Therapeutics Communities (TCs) offer inpatient treatment, and may provide adjuvant treatment practices, such as the MBRP. Objective: To assess the effectiveness of the MBRP compared to usual care in inpatient substance use disorder services for reducing or stopping substance use 12 months after intervention. Methods: This is a 1:1 randomized, nonblinded, controlled clinical trial to verify the effectiveness of MBRP plus treatment as usual (MBRP+TAU) compared to treatment as usual alone (TAU) in the treatment model for TCs. Differences between groups regarding outcomes were verified using assisted selfreported scales with quantitative measures evaluated within 12 months after the intervention, at 4 different times: before the intervention (T0 baseline), immediately after the intervention (T1), six months (T2) and 12 months (T3) after the intervention. Six cohorts were carried out, in which, after applying the questionnaires, 165 participants were randomly assigned to the groups, 85 to the MBRP+TAU group and 80 for the TAU group. Results: For followup data at 6 and 12 months after intervention, participants in the MBRP group reported a perceived lower alcohol consumption after treatment, however there was no statistical difference regarding relapses. The results for clinical outcomes showed effects of the MBRP group, observed by the parameter of group versus time with statistically significant difference for depression, total selfcompassion and for anger management, in which effects were observed for the anger control subscales for outside, inside anger control, and anger expression index. Regarding the mediation model, the results showed that the level of mindfulness, after eight weeks of MBRP, mediated the decrease in the anger expression index. Finally, the practice that the participants of the MBRP group performed the most was SOBER – space to breathe and with a weekly frequency of practices. Conclusions: The MBRP protocol as an adjunct to the treatment of SUD in TCs reduced the alcohol consumption perception and had no xviii effect on relapses. The protocol proved to be feasible, however some adaptations are necessary. More studies are also needed that can explore longterm effects, as well as the evaluation of effectiveness in TCs for different audiences.
Descrição
Citação
FÉLIX-JUNIOR, Itamar. Efetividade da prevenção de recaídas baseada em mindfulness como adjunto ao tratamento de transtorno por uso de substâncias: um ensaio clínico controlado e randomizado. 2023. 148 f. Tese (Doutorado em Psicobiologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.