Emociones autoconscientes relacionadas con el cuerpo y la apariencia y sintomatología de trastornos de la conducta alimentaria en una muestra de hombres adultos / Body and appearance-related self-conscious emotions and eating disorder symptoms in a sample of adult men

Abstract: In recent years, the number of men suffering from an Eating Disorder (ED) has increased. However, very few studies on ED have been conducted in samples of men. This paper aims to shed some light on this issue by exploring the following questions in a sample of adult men: 1) to analyse the relationships between body and appearance-related self-conscious emotions and ED symptomatology and, 2) to study the differences between a group of men who are at risk of developing an ED and another group of men who are not at risk of developing an ED in body and appearance-related self-conscious emotions. A total of 207 Spanish or Latin American men aged 18-50 years participated. Men who were at risk of developing an ED had more body shame and body guilt than those who were not at risk. However, no statistically significant differences were found between the two groups in body pride. These findings show that, unlike in women, body pride does not seem to play as important a role in these disorders as body shame or body guilt.

Resumen: En los últimos años, ha aumentado el número de hombres que padecen un Trastorno de la Conducta Alimentaria (TCA). Sin embargo, apenas se han realizado estudios sobre TCA con muestras de hombres. Este trabajo pretende arrojar algo de luz a este respecto, explorando las siguientes cuestiones en una muestra de hombres adultos: 1) analizar las relaciones entre las emociones autoconscientes asociadas al cuerpo y a la apariencia y la sintomatología de TCA y, 2) estudiar las diferencias entre un grupo de hombres que están en riesgo de desarrollar un TCA y otro grupo de hombres que no presentan dicho riesgo en las emociones autoconscientes asociadas al cuerpo y a la apariencia. Participaron 207 hombres de entre 18 y 50 años de nacionalidad española o latinoamericana. Los hombres que estaban en riesgo de desarrollar un TCA presentaron más vergüenza corporal y culpa corporal que aquellos que no tenían dicho riesgo. Sin embargo, no se encontraron diferencias estadísticamente significativas entre ambos grupos en el orgullo corporal. Estos hallazgos muestran que, a diferencia de lo que ocurre en mujeres, el orgullo corporal no parece desempeñar un papel tan relevante en estos trastornos como el que tienen la vergüenza corporal o la culpa corporal.

Muito além do trauma: uma investigação sobre o papel das reações peritraumáticas sobre o transtorno de estresse pós-traumático / Beyond the trauma: an investigation of the role of peritraumatic reactions on posttraumatic stress disorder

O Transtorno de Estresse Pós-Traumático (TEPT) é uma condição debilitante que impacta significativamente a qualidade de vida dos seus portadores. Dentre vários fatores de risco para o TEPT, as reações peritraumáticas (RP), como a imobilidade tônica peritraumática (ITP), dissociação (DP) e reações físicas de pânico (RFP), estão entre as mais investigadas. No entanto, a maioria dos estudos avaliou essas RP separadamente, e o elo entre elas e o TEPT ainda não foi bem compreendido. Portanto, essa tese teve como objetivos: (i) estimar simultaneamente o efeito das três RP sobre o TEPT utilizando um instrumento validado; e (ii) avaliar se há efeito indireto da ITP sobre o TEPT mediado pelo sentimento de culpa/vergonha. Utilizamos modelagem de equações estruturais para analisar dados de 3211 participantes do Rio de Janeiro e de São Paulo. Tratamos as RP como variáveis latentes, selecionando desconfundidores específicos para cada reação. Nossas exposições foram as RP, sendo TEPT o desfecho. Calculamos odds ratios e intervalos de confiança de 95%. Utilizamos o Bayesian Information Criterion para comparar o ajuste de modelos não aninhados. Quando analisadas separadamente, todas as RP alcançaram significância estatística. No entanto, apenas DP (ORDP=1,8; IC95%:1,3-2,4) e RFP (ORRFP=2,5; IC95%:1,8-3,4) permaneceram estatisticamente significativas quando incluímos as três reações em um modelo com seus respectivos desconfundidores e correlações entre elas. Os resultados sugeriram um possível efeito da ITP sobre o TEPT (ORITP=1,4; IC95%:1,0-1,9). As interações entre as RP não foram estatisticamente significativas. Ao investigarmos o sentimento de culpa/vergonha como mediador entre ITP e TEPT, o efeito indireto alcançou apenas significância estatística limítrofe (ORITP(TNIE)=1,1; IC95%:1,0-1,2). Os efeitos direto (ORITP(PNDE)=1,3; IC95%: 0,8-1,8) e total (ORITP(TE)=1,4; IC95%:0,9-1,9) para ITP perderam significância quando todas as RP, seus desconfundidores e correlações entre elas fizeram parte do mesmo modelo. As demais RP, no entanto, permaneceram estatisticamente significativas (ORDP=1,7; IC95%:1,3-2,3 e ORRFP=2,5; IC95%:1,8-3,4). Nossos resultados mostraram que a DP e as RFP aumentaram o risco de TEPT mesmo quando consideradas em conjunto. A ITP pode ter efeito sobre o risco de TEPT, mas esse achado deve ser interpretado com cautela devido a significância limítrofe dessa RP em nosso modelo final. Também não identificamos uma mediação significativa entre ITP e TEPT pelos sentimentos de culpa/vergonha. Contudo, a significância limítrofe encontrada para o efeito indireto demanda investigações adicionais. Nossos achados reforçam a ideia de que as reações peritraumáticas devem ser analisadas e compreendidas como ocorrências simultâneas. Também seria oportuno que estudos envolvendo culpa/vergonha, ITP e TEPT focalizassem traumas caracterizados por aprisionamento e impossibilidade de escapar, dado que estas experiências são apontadas como mais susceptíveis para desencadear a ITP. (AU)

Posttraumatic stress disorder (PTSD) is a debilitating condition that greatly impacts quality of life. Among several PTSD risk factors, peritraumatic reactions (PR) such as peritraumatic tonic immobility (PTI), dissociation (PD) and physical panic reactions (PPR) are some of the most investigated. However, several studies have assessed these PR separately, and the pathway connecting them to PTSD is not well understood. Therefore, this thesis aimed to: (i) simultaneously estimate the effect of the three PR on PTSD using a validated instrument; and (ii) assess if there is an indirect effect of PTI on PTSD mediated by feelings of guilt/shame. We used structural equation modelling to analyse data from 3211 participants from Rio de Janeiro and São Paulo. We treated the PR as latent variables and selected specific confounders for each reaction. Our exposures were the PR, and PTSD was the outcome. We calculated odds ratios and 95% confidence intervals for each analysis. We also employed the Bayesian Information Criterion to compare the goodness of fit between non-nested models. Separately, all PR achieved statistically significant results. However, only PD (ORPD=1.8; 95%CI:1.3-2.4) and PPR (ORPPR=2.5; 95%CI:1.8-3.4) remained statistically significant when all three were included in a model with their respective confounders and correlations among all PR. Our findings suggested a possible effect of PTI on PTSD (ORPTI=1.4; 95%CI:1.0-1.9). Interactions between the PR were not statistically significant. When we investigated feelings of guilt/shame as the mediator between PTI and PTSD, the indirect effect achieved a borderline statistical significance (ORPTI(TNIE)=1.1; 95%CI:1.0-1.2). Direct (ORPTI(PNDE)=1.3; 95%CI:0.8-1.8) and total (ORPTI(TE)=1.4; 95%CI:0.9-1.9) effects lost their significance when all PR, their confounders and correlations were included in the same model. The other PR remained statistically significant (ORPD=1.7; 95%CI:1.3-2.3 and ORPPR=2.5; 95%CI:1.8-3.4). Our findings showed PD and PPR to increase the risk of PTSD even when considered in tandem. PTI could have an effect on PTSD, but this must be considered cautiously, as this PR only reached borderline significance in our final model. Feelings of guilt/shame did not significantly mediate PTI's effect on PTSD. However, a borderline statistical significance in the indirect effects warrants further investigation. Our findings reinforce the hypothesis that peritraumatic reactions should be analysed and understood as simultaneous occurrences, not as separate entities. It would also be appropriate for studies concerning guilt/shame, PTI and PTSD to focus on traumas characterized by imprisonment and feelings of inescapability, given that these experiences are allegedly more likely to trigger PTI. (AU)

"morrer de vergonha": uma investigação psicanalítica sobre vergonha, humilhação e abjeção na migração de retorno / "die of shame": a psychoanalytic investigation of shame, humiliation and abjection in return migration

RESUMO: A migração de retorno se tornou apenas recentemente objeto de pesquisas no campo da saúde mental. A experiência do migrante de retorno em sua comunidade de origem o expõe aos olhares de alteridade que apontam para a fragilidade tanto de seus ideais egóicos como daqueles partilhados com o grupo cultural, particularmente quando o retorno se faz "com as mãos abanando". Com duas vinhetas clínicas tiradas de uma pesquisa conduzida no Senegal entre 2014 e 2019, abordamos esse cenário no qual os sujeitos enfrentam vergonha, humilhação e abjeção quando retornam, ficando condenados a um espaço marginal de entre-dois migratório.

Abstract: Return migration has only recently become subject of research in the field of mental health. The experience of the returning migrant in his community of origin exposes him to the eyes of otherness that point to the fragility of both his ego ideals and those shared with the cultural group, particularly when the return is made "with empty hands". With two clinical vignettes taken from a survey conducted in Senegal between 2014 and 2019, we approach this scenario in which the subjects face shame, humiliation and abjection when they return, being condemned to a "migratory between-two" marginal space.

Psychometric Evaluation of the Personal Feelings Questionnaire-2 (PFQ-2) Shame Subscale Among Spanish-Speaking Female Sex Workers in Mexico.

Shame may increase HIV risk among stigmatized populations. The Personal Feelings Questionnaire-2 (PFQ-2) measures shame, but has not been validated in Spanish-speaking or nonclinical stigmatized populations disproportionately affected by HIV in resource-limited settings. We examined the psychometric properties of the Spanish-translated PFQ-2 shame subscale among female sex workers in two Mexico-U.S. border cities. From 2016 to 2017, 602 HIV-negative female sex workers in Tijuana and Ciudad Juarez participated in an efficacy trial evaluating a behavior change maintenance intervention. Interviewer-administered surveys collected information on shame (10-item PFQ-2 subscale), psychosocial factors, and sociodemographics. Item performance, confirmatory factor analysis, internal consistency, differential item functioning by city, and concurrent validity were assessed. Response options were collapsed to 3-point responses to improve item performance, and one misfit item was removed. The revised 9-item shame subscale supported a single construct and had good internal consistency (Cronbach's α = .86). Notable differential item functioning was found but resulted in a negligible effect on overall scores. Correlations between the revised shame subscale and guilt (r = .79, p < .01), depression (r = .69, p < .01), and emotional support (r = -.28, p < .01) supported concurrent validity. The revised PFQ-2 shame subscale showed good reliability and concurrent validity in our sample, and should be explored in other stigmatized populations.

Hopelessness and shame in relation to suicide attempts by Cuban adolescents.

Youth suicide rates in Cuba are very high compared with most other countries, despite considerable improvement in recent years. The purpose of our study was to determine whether hopelessness and shame distinguish adolescent suicide attempters from non-attempters, over and above the effects of depression and suicidal ideation. Participants were 844 Cuban adolescents from the province of Holguin in Eastern Cuba. The attempter groups included 38 participants being treated for suicide attempts in a day hospital and 82 participants in the community who self-reported a previous suicide attempt. The other participants were non-attempter controls. All participants were asked to complete measures of depression, hopelessness, shame and suicidal ideation. As expected, attempters scored higher than non-attempters on the control variables of depression and suicidal ideation. In addition, attempters self-reported greater shame, especially behavioral and characterological shame, than non-attempters. Contrary to our hypothesis, there was no significant difference in hopelessness between attempters and non-attempters. The results are inconsistent with the considerable narrative lore about hopelessness as a reason for suicide in Cuba and other socialist countries. However, some collective socialization practices may lead to shame.

Trabajos originales

Resumo: A teoria da objetificação propõe que as experiências de objetificação sexual vivenciadas pelas mulheres levam à auto-objetificação: uma preocupação excessiva e prejudicial com a própria aparência em detrimento dos estados e competências corporais. A pesquisa teve como objetivo investigar as propriedades psicométricas de uma escala de auto-objetificação corporal para universitárias brasileiras. A amostra foi composta por 400 mulheres, com idades entre 17 e 53 anos (M = 21,65; DP = 5,46), sendo a maioria graduandas do curso de psicologia (49%, n = 196). Análises fatoriais exploratórias (AFE) e confirmatórias (AFC) foram realizadas para verificar a estrutura do modelo. Os resultados suportaram uma estrutura com 13 itens e duas dimensões: Vigilância corporal e Vergonha Corporal, mostrando bons indicadores para validade e confiabilidade interna. Não houve diferenças significativas entre graduandas em psicologia e estudantes de outros cursos. Discute-se futuras aplicações do instrumento e possibilidades frente a investigação da auto-objetificação em contextos variados.

Abstract: The objectification theory proposes that experiences of sexualization lead to self-objectification in women: a harmful concern for their appearance at the expense of body states and skills. The research aimed to investigate the psychometric properties of the Body Objectification Consciousness Scale for female Brazilian university students. The sample was composed by 400 women, aged between 17 and 53 years old (M = 21.65; SD = 5.46), the majority of them were undergraduate psychology students (49%, n = 196). Exploratory (AFE) and confirmatory (AFC) factor analyzes were performed to verify the model's structure. The results supported a structure with 13 items and two dimensions: Body Surveillance and Body Shame, showing good indicators for internal validity and reliability. There were no significant differences between undergraduate psychology students and students from other courses. Future applications of the instrument and possibilities regarding the investigation of self-objectification in different contexts are discussed.

Resumen: La teoría de la objetivación propone que las experiencias de objetivación sexual vividas por las mujeres conducen a la auto-objetivación: una preocupación excesiva y dañina por su apariencia a expensas de los estados y competencias corporales. La investigación tuvo como objetivo investigar las propiedades psicométricas de una escala de auto-objetivación corporal en una muestra de estudiantes universitarias brasileñas. Participaron 400 mujeres, de entre 17 y 53 años (M = 21.65; DT = 5.46), la mayoría egresadas de la carrera de psicología (49%, n = 196). Se realizaron análisis factoriales exploratorios (AFE) y confirmatorios (AFC) para verificar la estructura del modelo. Los resultados apoyaron un modelo con 13 ítems y dos dimensiones: Vigilancia corporal y Vergüenza corporal, mostrando buenos indicadores de validez interna y confiabilidad. No hubo diferencias significativas entre los estudiantes de psicología y los estudiantes de otros cursos. Se discuten futuras aplicaciones del instrumento y posibilidades en la investigación de la auto-objetivación en diferentes contextos.

Body and appearance-related self-conscious emotions and exercise addiction in Brazilian adolescents: A person-centred study.

The present study aimed to identify profiles of adolescents based upon body and appearance-related self-conscious emotions, and to examine whether these profiles differed from each other in terms of their exercise addiction (EA) symptoms. A sample of 703 Brazilian adolescents (41% girls) completed a self-report questionnaire. The results from a two-step cluster analysis identified four profiles: prideful (19.5%), low self-consciousness (31.7%), moderately high self-consciousness (29.2%), and shameful-guilty (19.6%). The prideful profile was characterized by a greater presence of boys, as well as by higher frequency/intensity levels of exercise than the remaining groups. The shameful-guilty profile was characterized by a greater presence of girls and by higher levels of BMI compared to the remaining groups. Regarding EA symptoms, the results from the ANCOVA/MANCOVA analyses revealed that the prideful profile showed (i) higher salience and tolerance levels than the low-level balanced self-consciousness profile, and (ii) higher salience and lower conflict compared to the shameful-guilty profile. Additionally, the moderately high self-consciousness profile showed (i) higher salience and tolerance levels than the low self-consciousness profile, and (ii) higher salience levels than the shameful-guilty profile. Identifying subgroups on the basis of body appearance-related self-conscious emotions contributes to explaining different EA symptoms in adolescents.

Psychometric properties of the body and appearance self-conscious emotions scale in Brazilian adolescents.

This study examined the psychometric properties of the Body and Appearance Self-Conscious Emotions Scale in Brazilian adolescents. A sample of 827 adolescents (55% boys) filled out a questionnaire comprising the Body and Appearance Self-Conscious Emotions Scale and instruments assessing social physique anxiety, positive/negative affect, and self-esteem. After removing one item originally proposed for the guilt factor (Item 7), the results supported a 4-factor structure that was invariant across gender and weight status. Evidence supporting the internal consistency, temporal stability, and convergent validity of the Body and Appearance Self-Conscious Emotions Scale cores were also obtained. These results support the Body and Appearance Self-Conscious Emotions Scale as a psychometrically robust instrument to assess body and appearance self-conscious emotions in Brazilian adolescents.

Acontecimento e ato: reflexões da psicanálise sobre as repercussões de Maio de 1968 / Event and act: reflections of psychoanalysis on the repercussions of May 1968 / Événement et acte: réflexions de la psychanalyse sur les répercussions de mai 1968 / Acontecimiento y acto: reflexiones del psicoanálisis sobre las repercusiones de Mayo del 1968

Resumo O artigo surge da inquietação de psicanalistas diante do sucesso ou fracasso dos movimentos sociais como resposta à atual crise institucional, política e social. Destacamos o dilema epistemológico e político presente na indagação que percorreu o movimento de Maio de 1968: as estruturas descem ou não para a rua? O caminho adotado é examinar os efeitos do movimento e cotejá-los com as concepções teóricas de Lacan. O saldo que obtemos desse balanço crítico foi considerar Maio de 1968 como um acontecimento que nos lembra de que é possível estruturar uma nova forma de política. Nomear a vergonha dos excessos nos laços sociais de nosso tempo pode conferir dignidade ao significante e produzir um ponto de basta pela dimensão da ética e da singularidade. Tal posição produz giro discursivo, incitado pela coragem de ter uma idéia e a possibilidade de reinvenção do laço social por sucessivas subversões e revoluções.

Abstract Our article results from the concern of psychoanalysts about the success or failure of social movements as a response to the current institutional, political and social crisis. We emphasize the epistemological and political dilemma present in the question that went through the May 1968 movement: after all, do structures reflect on the streets or not? To answer this question, we examined the effects of the movement a posteriori and compared them with Lacan's theoretical work. Based on this critical balance, we consider May 68 as a reminder that structuring a new form of politics is possible. Naming the shame of excesses in the social ties of our time may confer dignity to the signifier and produce a sufficient point by the dimension of ethics and uniqueness. Such a position produces a discursive twist, incited by the courage to have an idea and the possibility of reinventing the social bond by successive subversions and revolutions.

Résumé L'article découle de la préocupation des psychanalystes face au succès ou à l'échec des mouvements sociaux en réponse à la crise institutionnelle, politique et sociale actuelle. Nous soulignons le dilemme épistémologique et politique dans la question qui a traversé le mouvement de mai 1968: enfin, les structures descendent ou non dans la rue? La voie adoptée consiste à examiner les effets du mouvement a posteriori et à les comparer avec les conceptions théoriques de Lacan. Le résultat que nous obtenons de ce bilan critique a été de considérer mai 1968 comme un événement qui nous rappelle qu'il est possible de structurer une nouvelle politique. Nommer la honte des excès dans les liens sociaux de notre temps peut donner de la dignité au signifiant et produire un point de suffisance pour la dimension de l'éthique et de singularité. Une telle position produit un tournant discursif, encouragé par le courage d'avoir une idée et la possibilité de réinventer le lien social par des subversions et des révolutions successives.

Resumen El artículo surge de la inquietud de psicoanalistas frente al éxito o fracaso de los movimientos sociales como una respuesta a la actual crisis institucional, política y social. Se destaca el dilema epistemológico y político presente en la indagación que recorrió el movimiento de Mayo del 68: ¿las estructuras descienden o no a la calle? Para ello, se examinan los efectos del movimiento bajo la luz de las concepciones teóricas de Lacan. De ese balance crítico se considera el Mayo del 68 como un acontecimiento que recuerda que es posible estructurar una nueva forma de política. Al nombrar la vergüenza de los excesos en los lazos sociales de nuestro tiempo se puede conferir dignidad al significante y producir un basta por medio de la dimensión de la ética y de la singularidad. Esto produce un giro discursivo, incitado por el coraje de tener una idea y la posibilidad de reinventar el lazo social por sucesivas subversiones y revoluciones.

Entrevistas preliminares: o caso da jovem homossexual de Sigmund Freud / Preliminary interviews: the case of a young homossexual woman of Sigmund Freud

Ao pesquisarmos sobre o tema das entrevistas preliminares, somos automaticamente levados a pensar na posição do analista e no seu manejo clínico. Alguns pacientes demandam o próprio tratamento, outros nos procuram pelo intermédio de terceiros. É preciso pensar na posição do analista diante da demanda daquele que o procura, ou mesmo se é possível ao analista fazer surgir a demanda em um paciente que foi induzido a seu encontro. A esse respeito, Freud nos apresenta um trabalho clínico publicado sob o título "A psicogênese de um caso de homossexualismo numa mulher". A psicanálise freudiana se apresenta muito à frente de seu tempo ao romper com um discurso heteronormativo diante da temática sobre a escolha por um objeto amoroso, o que nem sempre é benquisto, inclusive nos tempos atuais. O autor foi de extrema generosidade ao expor um caso clínico em que a sua posição, como analista, pode ser contestável.(AU)

Abstract Research on the subject of preliminary interviews often lead us to think of the analyst's role and the clinical management in receiving and interacting with a patient. Some patients seek treatment on their own whereas some patients seek therapy recommended by others. It is important to understand the analyst's role for those who seek treatment and also the possibility for the therapist to create a demand for those patients who were lead to him. In regards to that matter, Freud (1920-1922/1996) published a clinical work entitled The Psychogenesis of a Case of Homosexuality in a Woman. Freudian psychoanalysis is very much ahead of its time by breaking with a heteronormative discourse facing the theme about the choice for a loving object, which is not always well-liked, even in the present times. The author generously discusses a clinical case in which his role as an analyst could be questionable.(AU)

Language, politics and dreams: the challenges of building resilience in refugees.

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language - the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.

Cet article est une étude de cas détaillée d'un homme péruvien de 60 ans, réfugié. L'étude met l'accent sur l'importance de construire en espagnol une résilience émotionnelle, afin de créer un espace pour que le patient apprenne l'anglais - le patient ne parle pas l'anglais après 20 ans de vie en Grande Bretagne. Le travail s'est fait avec la participation d'un interprète, et une partie des écrits concernant le travail avec interprète est examinée. L'article s'appuie aussi brièvement sur d'autre cas cliniques, et aborde de manière générale le voyage du réfugié: un voyage allant du culturellement connu au culturellement inconnu. L'article soulève la question de comment les travaux sur la résilience, qui s'inscrivent clairement dans une perspective développementale occidentale, peuvent s'appliquer aux réfugiés, dont la plupart viennent de cultures de groupe et de cultures familiales dominées par l'idée d'honneur et de honte. L'article aborde brièvement l'impact important de l'attitude du pays d'accueil, selon qu'il offre ou non un espace transitionnel pour les réfugiés qui ont perdu leur « chez eux ¼ (home) et qui recherchent un havre de sécurité dans une culture qui ne leur est pas familière.

El presente trabajo describe en detalle, un estudio de caso de un refugiado Peruano de 60 años, haciendo foco en la importancia de construir resiliencia emocional en el paciente, en idioma Español, para poder crear un espacio para el aprendizaje del idioma Inglés - el paciente no hablaba inglés luego de 20 años de vivir en Gran Bretaña. El trabajo fue llevado a cabo con un intérprete y se discute cierta literatura sobre el trabajar con intérpretes. El artículo se basa también en otros estudios de caso, así como también en la discusión del viaje del refugiado en sentido amplio, el cual es un viaje desde lo conocido cultural hacia lo desconocido cultural. Se discute el modo en que la literatura sobre resiliencia, basada en una perspectiva desarrollista Occidental, puede aplicarse a refugiados, la mayoría de quienes provienen de familias y grupos culturales dominados por ideas de honor y vergüenza. El trabajo también plantea la importancia de que el país receptor posibilite o no, como puede ser el presente caso, un espacio transicional para refugiados que han perdido sus hogares y buscan un refugio seguro en una cultura extraña.

The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial

Abstract Objective Acceptance and commitment therapy has been used to treat anxiety disorders recently. The purpose of this study was to investigate the effectiveness of acceptance and commitment therapy for psychological symptoms in students with social anxiety disorder, including difficulty in emotion regulation, psychological flexibility based on experiential avoidance, self-compassion, and external shame. Methods This study was a semi-experimental clinical trial. Twenty four students with social anxiety disorder were randomly divided into two groups after initial evaluations: an experimental group (12 subjects) and a control group (12 subjects). The experimental group received 12 treatment sessions based on a protocol of acceptance and commitment therapy for anxiety disorders, and the control group was put on a waiting list. Self-Compassion (SCS), Difficulty in Emotion Regulation (DERS), External Shame (ESS), Social Anxiety (SPIN), and Acceptance and Action (AAQ-II) questionnaires were used to assess participants. Data were analyzed using SPSS. Results Acceptance and commitment therapy was shown to be effective at the post-test and follow up stages for reducing external shame, social anxiety, and difficulty in emotion regulation and its components, and for increasing psychological flexibility and self-compassion (p < 0.05). The largest effect size of treatment was for increase of psychological flexibility and the lowest efficacy was for the components "difficulty in impulse control" and "limited access to emotional strategies" at the post-test and follow-up stages, respectively. Conclusion Acceptance and commitment therapy may be an appropriate psychological intervention for reducing the symptoms of students with social anxiety disorder and helping them to improve psychological flexibility. Emotion and related problems can be identified as one of the main targets of this treatment. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT20180421039369N1.

Implicações da Gestalt-terapia Frente às Relações de Hiperconsumo / Gestalt Therapy Implications for Hyperconsuption Relations / Implicaciones de la Terapia Gestalt para las Relaciones de Hiperconsumo

A hipermodernidade, com suas bases culturais fundamentadas no individualismo e nas relações de consumo, levou o homem a um completo esgotamento frente às expectativas de felicidade a ser obtida por meio da conquista de melhores desempenhos em vários aspectos da existência e em aquisições materiais. Uma vez que o indivíduo está constantemente exposto às consequências do modus vivendi do hiperconsumo, qual seja, o caráter transitório do sucesso que provoca o sentimento de fracasso, são observadas sequelas emocionais que podem se desdobrar em fenômenos psicopatológicos contemporâneos, sendo alguns destes destacados no artigo. O objetivo deste trabalho é apontar como a força do imperativo do sucesso pode intensificar sentimentos como humilhação, vergonha e inveja, assim como sugerir a Gestalt-terapia como oportunidade de libertação da opressora ideologia da superação de si, por ser, pelo encontro dialógico, um instrumento na sustentação da dignidade do sujeito diante das desconfirmações a que é constantemente submetido. (AU)

Hypermodernity, with its cultural foundations based on individualism and consumer relations, led human beings to a complete exhaustion in face of the expectations of happiness to be obtained through the achievement of better performances in various aspects of existence and in material acquisitions. Since the individual is constantly exposed to the consequences of the hyperconsumption modus vivendi, that is, the transitory character of success that causes the feeling of failure, emotional sequelae can be observed that may unfold into contemporary psychopathological phenomena, some of which are highlighted in the article. The aim of this paper is to point out how the strength of the success imperative can intensify feelings such as humiliation, shame, and envy, as well as suggest Gestalt-therapy as an opportunity for liberation from the oppressive ideology of self-overcoming, because, through the dialogical encounter, it is an instrument for sustaining the dignity of the subject in the face of the disconfirmations to which he/she is constantly exposed. (AU)

La hipomordenidad, con su bases culturales fundamentadas en el individualismo y en las relaciones de consumo, ha llevado al hombre a un agotamiento completo ante las expectativas de felicidad a ser obtenida por medio de la conquista de mejores desempeños en diversos aspectos de la existencia y en las adquisiciones materiales. Una vez que el indivíduo está constantemente expuesto a las consecuencias del modus vivendi del hiperconsumo, culquiera que sea, el carácter transitorio del suceso que provoca el sentimiento de fracaso, son observadas secuelas emocionales que pueden desplegarse en los fenómenos psicopatológicos contemporáneos, algunos de los cuales se destacan en el artículo. El objetivo de este trabajo es señalar cómo la fuerza del imperativo del suceso puede intensificar sentimientos como humillación, vergüenza y envidia, así como sugerir que la terapia Gestalt como una oportunidad de liberación de la ideologia opresiva de superación personal, por ser, a través del encuentro dialógico, un instrumento para sostener la dignidad del sujeto frente a las desconfirmaciones a las que está constantemente sometido. (AU)

Psychometric Properties of the OBCS Body Shame Scale in a Sample of Female Residents in Puerto Rico.

The purpose of this study is to analyze the psychometric properties of the Spanish version of the Body Shame scale within the Objectified Body Consciousness Scale (OBCS) in a sample of women living in Puerto Rico. The sample consisted of 117 heterosexual women. A confirmatory factor analysis was conducted to evaluate the structure of the scale and internal consistency was examined. Findings revealed that the 6-item Spanish version of the Body Shame scale shows better model-data fit than the original 8-item version. The results of the study support the use of the final 6-item version of the Body Shame scale in research and practice, given that it demonstrated appropriate structure and internal consistency. In conclusion, the findings support the use of the 6-item version of the Body Shame scale.

El propósito de este estudio es analizar las propiedades psicométricas de la versión española de la escala de Vergüenza Corporal en la Objectified Body Consciousness Scale (OBCS). La muestra estuvo compuesta de 117 mujeres heterosexuales que viven en Puerto Rico. Se realizó un análisis factorial confirmatorio para evaluar la estructura de la escala y se examinó la consistencia interna. Los resultados indican que la versión española de 6 items de la escala de Vergüenza Corporal mostró un mejor ajuste de los datos del modelo que la versión original de 8 ítems. Los resultados del estudio respaldan el uso de la versión final de 6 ítems de la escala de Vergüenza Corporal en la investigación y la práctica, dado que demostró una estructura apropiada y una consistencia interna adecuada. En conclusión, los resultados apoyan el uso de la escala de 6 ítems de vergüenza corporal.

Validation of the Brazilian version of the Shame and Stigma Scale (SSS-Br) for patients with head and neck cancers.

OBJECTIVE: To evaluate the psychometric properties of the Brazilian version of the Shame and Stigma Scale (SSS) in a sample of patients with head and neck cancers (HNC). METHODS: This is a validation study carried out in a Brazilian cancer hospital. Patients over 18 years old who knew about their HNC diagnosis were consecutively recruited, answering the SSS, the Functional Assessment of Cancer Therapy (General and Head and Neck supplement) questionnaire, and the University of Washington Quality of Life Questionnaire. Internal consistency, test-retest procedure, convergent validity, and responsiveness analysis were the psychometric properties evaluated. RESULTS: A total of 122 HNC patients were included. The SSS showed appropriate internal consistency (alphas ranging from 0.71 to 0.86), test-retest reliability (higher than 0.92 with exception of the "Regret domain"), and convergent validity. The responsiveness analysis with 38 patients was able to discriminate the scores before and after prosthetic procedures. SIGNIFICANCE OF THE RESULTS: The Brazilian Portuguese version of the SSS may be considered a valid and reliable instrument for the evaluation of Brazilian patients with HNC. Future SSS validation studies are welcome in other developing countries in order to make cancer health providers aware of these negative feelings in their HNC patients.

Shame, Empathy, Coping and School Safety of the Bystanders in Situations of Bullying / Embaraço, Empatia, Confronto e Segurança Escolar do Observadores em Situações de Bullying / Vergüenza, Empatía, Enfrentamiento y Seguridad Escolar de los Observadores en Situaciones de Acoso Escolar

Abstract Unjustified aggression is a problem that exists in schools and represents an obstacle for achieving the goals pursued by education. The goal of this article is to explain how shame, empathy, coping style and school safety discriminate between defensive and reinforcing observers in the face of a hypothetical situation of school bullying. 505 students from public, technical and federal secondary schools of the State of Sonora with ages ranging from 12 to 17 years participated in this study. Of this sample 131 were considered defenders and 374 reinforcers. The results show that the recognition of shame, affective empathy, confrontative coping and school safety explain up to 71.4% the differences between the defensive observers and the reinforcers. It is concluded that the variables considered as predictors can differentiate between the types of observers and represent a valuable contribution in the analysis of bullying as a group process.

Resumo A agressão injustificada é um problema que está presente nas escolas e representa um obstáculo para atingir as finalidades que a educação persegue. O objetivo deste artigo é explicar como a vergonha, a empatia, o tipo de enfrentamento e a segurança escolar discriminam entre observadores defensores y reforçadores perante uma situação hipotética de assédio escolar. Participaram 505 estudantes de secundária de escolas públicas, técnicas e federais do Estado de Sonora com idades que vão desde os 12 até os 17 anos. Deste modo, 131 foram considerados defensores e 374 reforçadores. Os resultados mostram que o reconhecimento da vergonha, a empatia afetiva, o enfrentamento revalorativo e a segurança escolar explicam até em 71.4% as diferenças entre os observadores defensores e os reforçadores. Conclui-se que las variáveis consideradas como preditoras servem para diferenciar entre os tipos de observadores e significam uma contribuição valiosa na análise do assédio como um processo grupal.

Resumen La agresión injustificada es un problema que está presente en las escuelas y representa un obstáculo para alcanzar los fines que la educación persigue. El objetivo de este artículo es explicar cómo la vergüenza, la empatía, el estilo de enfrentamiento y la seguridad escolar discriminan entre observadores defensores y reforzadores ante una situación hipotética de acoso escolar. Participaron 505 estudiantes de secundarias públicas, técnicas y federales del Estado de Sonora con edades que van de los 12 a los 17 años. De esta muestra 131 fueron considerados defensores y 374 reforzadores. Los resultados demuestran que el reconocimiento de la vergüenza, la empatía afectiva, el enfrentamiento revalorativo y la seguridad escolar explican hasta el 71.4% las diferencias entre los observadores defensores y los reforzadores. Se concluye que las variables consideradas como predictoras sirven para diferenciar entre los tipos de observadores y significan un aporte valioso en el análisis del acoso como un proceso grupal.

Principais lesões psicológicas no esporte: conceito, modelos teóricos, formas de intervenção e reflexões sobre o medo e a vergonha / Main psychological injuries in sports: concept, theoretical models, forms of intervention and reflections on fear and shame / Principales lesiones psicológicas en el deporte: concepto, modelos teóricos, formas de intervención y reflexiones sobre el miedo y la vergüenza

O objetivo desta revisão narrativa foi abordar o conceito de lesões psicológicas no contexto do esporte, a partir de modelos teóricos e formas de intervenção; ainda, foi dado um enfoque ao medo e a vergonha. Para isso, focou-se na caracterização das lesões psicológicas no espor-te, traçando paralelos entre medo e vergonha e as demais ocorrências vivenciadas pelos atle-tas. Assim, pode-se concluir que o medo e a vergonha são causadores de muitas dores psíqui-cas, merecendo cuidados e atenção por parte dos dirigentes e profissionais do esporte.

The purpose of this narrative review was to approach the concept of psychological injuries in the context of sports, theoretical models and intervention forms; still has been given a focus on fear and shame. For this, it focused on the characterization of the psychological injuries in the sport, drawing parallels between fear and shame and the other occurrences experienced by the athletes. Thus, one can conclude that fear and shame cause many psychic pains, deserving care and attention on the part of the leaders and professionals of the sport.

El objetivo de esta revisión narrativa fue abordar el concepto de lesiones psicológicas en el contexto del deporte, modelos teóricos y formas de intervención; se ha dado un enfoque al miedo yla vergüenza. Para ello, se enfocó, en la caracterización de las lesiones psicológicas en el deporte, trazando paralelos entre miedo y vergüenza y las demás ocurrencias vivencia-das por los atletas. Así, se puede concluir que el miedo y la vergüenza son causantes de muchos dolores psíquicos, mereciendo atención y atención por parte de los dirigentes y profesio-nales del deporte.

A percepção da mulher sobre os espaços para amamentar: suporte na teoria interativa de amamentação / Women's perception about space for breastfeeding: support in interactive breastfeeding theory / Percepción de las mujeres sobre los espacios para lactancia materna: apoyo en la teoría interactiva de la lactancia materna

INTRODUÇÃO: a amamentação é fortemente influenciada por diversos fatores, e a falta de um lugar privado e o constrangimento em locais público desencorajam as mulheres. OBJETIVO: avaliar a percepção da mulher sobre o espaço para amamentar. MÉTODO: pesquisa descritiva, com abordagem qualitativa desenvolvida com 30 mulheres grávidas e puérperas internadas na maternidade de um hospital universitário do estado do Espírito Santo. A análise de conteúdo proposta por Bardin e a Teoria Interativa de Amamentação foram utilizadas para a sistematização dos dados. RESULTADOS: a maioria das mulheres relatou que iria amamentar em lugares públicos, no entanto, todas disseram que cobririam seus peitos com pano ou fralda e que se sentem mais confortáveis para amamentar em casa. As mulheres relataram sentir-se confortáveis quando estão próximas de mulheres, familiares ou amigas conhecidas, enquanto perto de homens, conhecidos ou não, sentem-se desconfortáveis e cobrem seus peitos para amamentar. E próximas de profissionais de saúde a maioria se sente confortável, já que orientam e apoiam a amamentação. CONCLUSÃO: amamentar em espaços públicos ainda causa desconforto, constrangimento e vergonha nas mulheres.(AU)

Introduction: breastfeeding is strongly influenced by many factors, and the lack of a private place and embarrassment in public places discourage women. Objective: to evaluate women's perceptions of space for breastfeeding. Method: a descriptive research with a qualitative approach developed with 30 pregnant and postpartum women admitted to the maternity ward of a university hospital in the Espírito Santo State. The content analysis proposed by Bardin and the Interactive Breastfeeding Theory were used to systematize the data. Results: most women reported that they would breastfeed in public places, but all said they would cover their breasts with cloth or diaper and feel more comfortable breastfeeding at home. Women reported feeling comfortable when they are close to known women, family or friends, while close to men, known or not, feel uncomfortable and cover their breasts for breastfeeding. And close to health professionals most feel comfortable as they guide and support breastfeeding. Conclusion: breastfeeding in public spaces still causes discomfort, embarrassment and shame in women.(AU)

Introducción: la lactancia materna está muy influenciada por varios factores. La falta de un lugar privado y la vergüenza de exponerse en lugares públicos desalientan a las mujeres. Objetivo: evaluar las percepciones de las mujeres sobre los espacios para lactancia materna. Método: investigación descriptiva de enfoque cualitativo desarrollado con 30 mujeres embarazadas y en el posparto ingresadas en la maternidad de un hospital universitario del estado de Espírito Santo. Se utilizaron el análisis de contenido propuesto por Bardin y la Teoría Interactiva de la Lactancia materna para sistematizar los datos. Resultados: la mayoría de las mujeres declararon que amamantarían a sus niños en lugares públicos; todas ellas dijeron que cubrirían los senos con una tela o un pañal y que se sentirían más cómodas para amamantar en casa. Las mujeres manifestaron sentirse cómodas cuando están cerca de mujeres conocidas, familiares o amigos y que se sienten incómodas cuando están cerca de hombres, conocidos o no, y que se cubren los senos. La mayoría se siente cómoda cerca de los profesionales de la salud ya que guían y apoyan la lactancia materna. Conclusión: la lactancia materna en espacios públicos todavía causa molestias, bochorno y vergüenza a las mujeres.(AU)

Compassion-focused imagery reduces shame and is moderated by shame, self-reassurance and multisensory imagery vividness.

Compassion-focused imagery (CFI) is an emotion-regulation technique involving visualization of a person, animal or object offering one compassion, to generate feelings of safeness. It is proven to increase self-compassion and reduce negative affect. This study explores two hypotheses not previously investigated: i) which sensory modalities can stimulate compassionate affect; and ii) whether presentation of pictorial stimuli can enhance CFI. Additionally, we examine iii) whether CFI can reduce shame and iv) whether self-criticism inhibits CFI, since previous studies have involved small samples or methodological limitations. After completing measures of self-criticism, selfreassurance and imagery abilities in five sensory modalities, participants (n=160) were randomly assigned to look at compassionate images during CFI (visual input), compassionate images before CFI (priming), or abstract images (control). Participants trialled CFI then rated compassionate affect and completed open-response questions. Before and after CFI, participants recalled a shame-based memory and rated state shame. Correlational analyses explored whether self-criticism, self-reassurance, and multisensory imagery abilities moderated outcomes. CFI significantly reduced shame regarding a recalled memory, particularly for those high in shame. Compassionate affect was predicted by imagery vividness in visual and bodily-sensation modalities. Self-criticism predicted poorer CFI In multiple regressions, self-reassurance predicted poorer CFI outcomes but self-criticism did not. Between-group effects did not emerge. Qualitative data suggested that pictures helped some participants but hindered others. CFI is a promising technique for shame-prone clients, but may be challenging for those with low imagery abilities or unfamiliar with self-reassurance. Multiple senses should be engaged.

Estigma familiar percibido por los cuidadores primarios de personas con enfermedad mental / Family stigma perceived by primary caregivers of people with mental illness

Se planteó como objetivo describir el estigma familiar percibido por los cuidadores primarios de personas con enfermedad mental, para lo que empleamos como metodología un estudio de tipo exploratorio descriptivo, basado en la fenomenología eidética, en donde se describió de forma detallada la experiencia de vida frente al estigma de la enfermedad mental percibida por el cuidador primario, buscamos revelar, describir e interpretar el fenómeno. Fueron entrevistados en profundidad 14 cuidadores primarios de pacientes con la técnica de punto donde se presentó la saturación de datos cualitativos, fueron analizados estableciendo categorías y subcategorías que permitieron identificar claros patrones de estigma el estigma experimentado y el estigma por asociación, el estudio se desarrolló en una Institución Prestadora de Servicios de Salud mental. Podemos concluir que se logran identificar claros patrones de estigma asociados a una condición mental, estos patrones son percibidos por el cuidador principal del paciente con dicha alteración; esto abre la puerta a nuevas preguntas relacionadas con los alcances que tiene el rechazo social que sufren las familias y pacientes que adolecen alteraciones mentales; por lo tanto esta problemática deberá ser objeto para continuar con investigaciones de este fenómeno.

The objective was to describe the family stigma perceived by the primary caregivers of people with mental illness, for which we used as a methodology a descriptive exploratory study, based on the eidetic phenomenology, where the life experience was described in detail. To the stigma of mental illness perceived by the primary caregiver, we seek to reveal, describe and interpret the phenomenon. Fourteen primary caregivers of patients were interviewed in depth with the point technique where the saturation of qualitative data was presented, they were analyzed establishing categories and subcategories that allowed to identify clear patterns of stigma, stigma experienced and stigma by association, the study was developed in a Institution that provides mental health services. We can conclude that it is possible to identify clear stigma patterns associated with a mental condition, these patterns are perceived by the main caregiver of the patient with said alteration; this opens the door to new questions related to the scope of the social rejection suffered by families and patients who suffer from mental disorders; therefore, this problem should be the object to continue with investigations of this phenomenon.