| Resumo: |
This dissertation deals with lifestyle changes in patients with metabolic syndrome (MS), using the Transtheoretical Model (TTM) as the framework of intervention. Initially, we present a contextualization of the current research from both a theoretical and a practical point of view. From a theoretical point of view we discuss (1) the metabolic syndrome and its prevalence in Brazil; (2) constructs from TTM; (3) some studies that used this model for health problems; and (4) factors that may interfere with the motivation of subjects to change their behavior. We approach the practical side from the four dimensions that this dissertation examines: stages of change, processes of change, markers of change and context of change. To answer the four questions in a more detailed way, this dissertation is composed of four articles: a thematic essay about the importance of techniques and therapeutic alliance in the treatment; an empirical study comparing the efficacy of two treatments based on TTM with a control treatment; an empirical study of predictor factors to weight loss; and one article about the development of an intervention based on TTM for patients with MS, with a focus on the adherence to diet and exercise. The thematic essay discusses the treatments with manual versus treatments without a manual to be followed, debating what the more important factor in the treatment is: the techniques or the working alliance. The discussion is based on different authors with diverse opinions, and do not seek a single truth, but provides a platform for discussion about how psychotherapists are formed as well as about their work. The first empirical study tackles the efficacy of two treatments - individual (IT) and group (GT) - both based on TTM for patients with MS. The article presents how each intervention was applied, and shows which variables had significant effect on each group. The results show that participants from IT had significantly improved upon their weight, body mass index (BMI), abdominal circumference, amount of exercise per week, readiness to exercise 3-5 times per week, and their readiness to increase fibers and to decrease salt. Group treatment has no better results than control treatment for any outcome. The second empirical study evaluates the predictor factors of weight loss in these patients, submitted to the treatments tested in the first article. For the total sample, the predictors of weight loss were self-efficacy to keep diet after treatment and self-efficacy to keep exercising after treatment. Perceived problem severity shows to contribute to a very small weight loss or increase in weight. For individual intervention readiness to exercise 3 to 5 times per week was a predictor of weight loss. For group treatment, the predictor factors were: self-efficacy to keep diet after and self-efficacy to keep exercise after the treatment. Pressure to change, familly support, anxiety/depression and intrusive behavior did not significantly contribute to the prediction of changes. Examining the three treatments as independent variables, Individual Treatment increases in 3 times the chance of losing more than 5% of the initial weight |
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