Avaliação da relação entre esquemas iniciais desadaptativos e o coping em indivíduos com transtorno por uso de substâncias

Abstract

The substance use disorder (SUD) is considered complex, whose understanding involves biopsychosocial and environmental factors, and difficult to treat. Studies have demonstrated the efficacy of Cognitive and Behavioral Therapies (CBT) on SUD treatment, such as Dual Focus Schema Therapy (DFST), which combines Schema Therapy (TE) techniques, whose main concept is the early maladaptive schemas (EMS), and Relapse Prevention, focused on coping strategies. EIDs are self-defeating cognitive and emotional patterns that develop as a result of harmful experiences in childhood. In response to them and the associated emotional distress, individuals often develop multiple maladaptive coping mechanisms, such as substance abuse. In this sense, this study aimed to identify the occurrence and prevalence of EMS and coping strategies in outpatients of Oficina de Vida/PADEQ - Treatment Program for Substance Use of Uberlândia Federal University (UFU), and to identify possible correlations between the variables. The study was conducted in a sample of 20 individuals of both sexes (65% male), aged over 18 (55% up to 40 years) and with SUD diagnosis. The instruments used were ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), a sociodemographic questionnaire, the YSQ-S2 (Young Schema Questionnaire – Short Form) and the Folkman and Lazarus Coping Strategies Inventory. Almost the hole sample (95%) presented moderate to severe alcohol consumption levels and harmful consumption patterns to other substances were also observed. The results indicated scores above the overall mean scores in the sample for most of the EMS, with self-sacrifice being the EMS with the highest mean in the sample (M=3.89, SD=1.35), followed by insufficient self-control (M=3.35, SD=1.39) and unrelenting standards (M=3.35, SD=1.31). On the other hand, the coping strategy with the highest score was escape-avoidance (M=2.25, SD=0.94). In terms of the correlations between the two variables, the most significant coefficients were, respectively, between entitlement and confrontive coping (ρ=.513, p<.05), subjugation and confrontive coping (ρ=.473, p<.05), vulnerability and confrontive coping (ρ=.469; p<.05), self-sacrifice and confrontive coping (ρ=.461; p<.05), social isolation and self-control (ρ=.454, p<.05), subjugation and escape-avoidance (ρ=.449, p<.05), unrelenting standards and escape-avoidance (ρ=-.495; p<.05), dependence and planful problem-solving (ρ=-.474; p<.05) and emotional deprivation and seeking social support (ρ=-.447; p<.05). The results indicated correlations between different coping strategies and EMS in all domains, reflecting that individuals with complex disorders such as SUD and comorbid conditions have difficulties in meeting all the basic emotional needs, typical of each schema domain, and present different ways of coping, sometimes more or less adapted. The findings are consistent with the literature, suggesting that, in fact, EMS and maladaptive coping strategies to deal with the associated emotional distress may be important factors in the development and maintenance of SUD. In this sense, directing treatment models to EMS modification and more adaptive and effective coping strategies, as proposed by DFST, seems to be promising in the search for better therapeutic results, which highlights the relevance of the present study.