PSİKODRAMA YÖNELİMLİ GRUP TERAPİSİNİN, OBEZİTESİ OLAN ERGENLERİN STANDARDİZE BEDEN KİTLE İNDEKSİ VE YEME-EGZERSİZ DAVRANIŞLARI ÜZERİNE ETKİSİNİN DEĞERLENDİRİLMESİ

Abstract

Amaç: Çalışmanın amacı, psikodrama grup terapisinin, obezitesi olan ergenlerin standardize beden kitle indekslerine (BKİ), yeme davranışlarına ve egzersiz-beslenme tutumlarına etkisinin araştırılmasıdır. Gereç ve yöntemler: Yarı deneysel olarak gerçekleştirilen bu araştırmada, 12-19 yaş aralığındaki obezitesi olan 16 ergene [10 kız (%62.5)] 8 haftalık online psikodrama grup terapisi uygulanmıştır. Katılımcıların terapi öncesi ve sonrası standardize BKİ değerleri, bel ve kalça çevresi ölçülmüş, haftalık fiziksel aktivite ve bilgisayar/internet kullanım süreleri kaydedilmiş, Üç Faktörlü Yeme Anketi (ÜFYA) ve Beslenme/Egzersiz Davranışı Ölçeklerini (BEDA) doldurmaları sağlanmıştır. Bulgular: Terapi öncesine göre, terapi sonrasında katılımcıların standardize BKİ [t(15)=3.446, p=0.04] değerinin, bel [t(13)=2.806, p=0.01] ve kalça çevrelerinin [t(11)=4.690, p=0.001], BEDA-psikolojik/bağımlı yeme [t(15)=3.301, p=0.005] ve BEDA-sağlıksız beslenme-egzersiz davranış [t(15)=3.408, p=0.004] puanlarının azaldığı; haftalık fiziksel aktivite sürelerinin [t(12)=-2.586, p=0.02] ve ÜFYA-bilişsel yeme kısıtlaması skorlarının arttığı [t(15)=-3.093, p=0.007]; internet/bilgisayarda geçirilen sürenin, emosyonel yeme, kontrolsüz yeme, BEDA-öğün düzeni ve BEDA-sağlıklı beslenme-egzersiz tutum puanlarının değişmediği bulunmuştur. Standardize BKİ değişimi ile anlamlı korelasyon gösteren tek faktörün bilişsel yeme kısıtlamasındaki artış olduğu gösterilmiştir [r=-0.681, p=0.002, CI ([-0.88]-[0.26])]. Sonuç: Bu araştırmada, psikodrama yönelimli grup terapisinin obezitesi olan ergenlerin standardize BKİ değerlerinin, yeme bağımlılığı ve sağlıksız beslenme-egzersiz tutumlarının azalmasına, fiziksel aktivite düzeylerinin ve bilişsel yeme kısıtlama becerilerinin artmasına katkı sağladığı gösterilmiştir. Bulgularımızın randomize kontrollü araştırmalar ile doğrulanması durumunda, obezitesi olan ergenlerin tedavisinde psikodrama grup terapisinin, yaşam tarzı değişikliklerini sağlamak için kullanılabilecek bir terapötik yöntem olabileceği söylenebilir.

Keywords

• psikodrama
• obezite
• ergenlik dönemi
• yeme davranışı

Evaluating the efficacy of psychdrama group therapy on BMI-SDS and eating-exercise behaviors among adolescents with obesity

Abstract

Objective: The aim of the study is to investigate the effect of psychodrama group therapy on body mass index standard deviation (BMI-SDS), eating and nutrition-exercise behaviors among adolescents with obesity. Material and Methods: In this quasi-experimental study, 16 adolescents aged 12-19 years [10 girls (62.5%)] attended 8-week psychodrama group therapy. The following variables were collected at baseline and at the end of the intervention: BMI-SDS, BMI percentile, waist and hip circumferences, weekly physical exercise and computer/internet usage time, the Three Factors Eating Questionnaire (TFE-Q), and Nutrition-Exercise Behavior Scale (NEBS). Results: We found a significant decrease in BMI-SDS value [t(15)=3.446, p=0.04], waist [t(13)=2.806, p=0.01] and hip circumferences [t(11)=4.690, p=0.001], NEBS-psychological/addicted eating [t(15)=3.301, p=0.005] and NEBS-unhealthy nutrition-exercise behavior scores [t(15)=3.408, p=0.004]; a significant increase in weekly physical activity time [t(12)=-2.586, p=0.02] and TFE-Q-cognitive eating restrain score [t(15)=-3.093, p=0.007]; and no significant change in computer/internet usage time, TFE-Q-emotional and uncontrolled eating, NEBS-meal plan and NEBS-health nutrition-exercise behavior scores in post-intervention compared to pre-intervention. The increase in the TFE-Q-cognitive eating restrain score was the only variable associated with a decrease in the SDS-BMI score. Conclusion: The findings showed that psychodrama group therapy could be effective not only in decreasing BMI-SDS, psychological eating, and unhealthy nutrition-exercise behaviors but also in increasing cognitive eating restrain and physical activity time among obese adolescents. If our results can be verified with randomized controlled studies, psychodrama group therapy can be used as an intervention to provide lifestyle changes among adolescents with obesity.

Keywords

• psychodrama
• obesity
• adolescence
• eating behavior

References

1. World Health Organization. Consideration of the evidence on childhood obesity for the Commission on Ending Childhood Obesity: report of the ad hoc working group on science and evidence for ending childhood obesity. Access date: 17 August 2022 / Erişim tarihi: 17 Ağustos 2022: http://apps.who.int/iris/bitstream/handle/10665/206549/9789241565332_eng.pdf?sequence=1
2. Kansra AR, Lakkunarajah S, Jay MS. Childhood and adolescent obesity: A review. Front. Pediatr. 2021;8:581461.
3. Sondike SB, Copperman N, Jacobson MS. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. The Journal of Pediatrics. 2003;142(3):253-8.
4. Robinson TN. Television viewing and childhood obesity. Pediatric Clinics of North America. 2001;48(4):1017-25.
5. Avenell A, Sattar N, Lean M. Management: Part I—Behaviour change, diet, and activity. BMJ. 2006;333(7571):740-3.
6. De Miguel-Etayo P, Bueno G, Garagorri JM et al. Interventions for Treating Obesity in Children. In: Szajewska H, Shamir R, eds. World Review of Nutrition and Dietetics. 1st ed. Basel. S. KARGER AG, 2013:108:98-106.
7. Bejarano CM, Marker AM, Cushing CC. Cognitive-behavioral therapy for pediatric obesity. In: Friedberg RD, Paternostro JK, eds. Handbook of Cognitive Behavioral Therapy for Pediatric Medical Conditions. 1st ed. Cham. Springer International Publishing; 2019:369-83.
8. Epstein LH, Roemmich JN, Raynor HA. Behavioral therapy in the treatment of pediatric obesity. Pediatric Clinics of North America. 2001;48(4):981-93.

9. Vallabhan MK, Jimenez EY, Nash JL, Gonzales-Pacheco D, Coakley KE, Noe SR et al. Motivational interviewing to treat adolescents with obesity: A meta-analysis. Pediatrics. 2018;142(5):e20180733.
10. Bagherniya M, Taghipour A, Sharma M, Sahebkar A, Contento IR, Keshavarz SA et al. Obesity intervention programs among adolescents using social cognitive theory: a systematic literature review. Health Education Research. 2018;33(1):26-39.
11. Kitzmann KM, Beech BM. Family-based interventions for pediatric obesity: Methodological and conceptual challenges from family psychology. Couple and Family Psychology: Research and Practice. 2011;1(S):45-62.
12. Sbruzzi G, Eibel B, Barbiero SM, Petkowicz RO, Ribeiro RA, Cesa CC et al. Educational interventions in childhood obesity: A systematic review with meta-analysis of randomized clinical trials. Preventive Medicine. 2013;56(5):254-64.
13. Shokraneh A, Neshat-Doost H, Abedi M, Talebi H. The Effect of Psychodrama on Body Mass Index, Self-Esteem and Cognitive Regulation of Emotion in Obese Female Children. Journal of Research in Behavioural Sciences. 2016;14(3):331-8.
14. Demir Acar M, Bayat M. The Effect of Diet-Exercise Trainings Provided to Overweight and Obese Teenagers through Creative Drama on Their Knowledge, Attitude, and Behaviors. Child Obes. 2019;15(2):93-104.
15. Gade H, Hjelmesæth J, Rosenvinge JH, Friborg O. Effectiveness of a cognitive behavioral therapy for dysfunctional eating among patients admitted for bariatric surgery: A randomized controlled trial. Journal of Obesity. 2014;2014:1-6.
16. van Strien T, Beijers R, Smeekens S, Winkens LHH, Konttinen H. Parenting quality in infancy and emotional eating in adolescence: Mediation through emotion suppression and alexithymia. Appetite. 2019;141:104339.
17. Leehr EJ, Krohmer K, Schag K, Dresler T, Zipfel S, Giel KE. Emotion regulation model in binge eating disorder and obesity - a systematic review. Neuroscience & Biobehavioral Reviews. 2015;49:125-34.
18. Verzijl CL, Ahlich E, Schlauch RC, Rancourt D. The role of craving in emotional and uncontrolled eating. Appetite. 2018;123:146-51.
19. Yilmaz Kafali H, Uçaktürk SA, Mengen E, Akpinar S, Erguven Demirtas M, Uneri OS. Emotion dysregulation and pediatric obesity: investigating the role of Internet addiction and eating behaviors on this relationship in an adolescent sample. Eat Weight Disord. 2021;26(6):1767-79.
20. Merlo LJ, Klingman C, Malasanos TH, Silverstein JH. Exploration of food addiction in pediatric patients: A preliminary investigation. Journal of addiction medicine. 2009;3(1):26.
21. Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F et al. Reference values for weight, height, head circumference, and body mass index in Turkish children. Journal of clinical research in pediatric endocrinology. 2015;7(4):280.
22. Gökler B, Ünal F, Pehlivantürk B, Kültür EÇ, Akdemir D, Taner Y. Reliability and Validity of Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL-T). Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health. 2004;11(3):109-16.
23. Karlsson J, Persson LO, Sjöström L, Sullivan M. Psychometric properties and factor structure of the Three-Factor Eating Questionnaire (TFEQ) in obese men and women. Results from the Swedish Obese Subjects (SOS) study. Int. J. Obes. Relat. Metab. Disord. 2000;24(12):1715-25.
24. Kirac D, Kaspar E, Avcilar T, Cakir O, Ulucan K, Kurtel H et al. A New Method For Investigating Eating Behaviours Related With Obesity: Three-Factor Eating Questionnaire. Journal of Marmara University Institute of Health Sciences. 2015;5(3):162-9.
25. Bahia L, Schaan CW, Sparrenberger K, Abreu GA, Barufaldi LA, Coutinho W et al. Overview of meta-analysis on prevention and treatment of childhood obesity. Jornal de Pediatria. 2019;95(4):385-400.
26. Öztürk Y, Özyurt G, Akay AP. Çocukluk çaği obezite tedavisinde davranişçi ve bilişsel yaklaşimlar. Turk J Child Adolesc Ment Health. 2017;24(1):59-69
27. Leon AD, Roemmich J, Casperson S. Responses on the Three Factor Eating Questionnaire restraint and disinhibition scales change after a controlled energy-restricted diet (P21-002-19). Current Developments in Nutrition. 2019;3(Supplement_1):nzz041.P21-002-19.
28. Nurkkala M, Kaikkonen K, Vanhala ML, Karhunen L, Keränen AM, Korpelainen R. Lifestyle intervention has a beneficial effect on eating behavior and long-term weight loss in obese adults. Eating Behaviors. 2015;18:179-85.
29. Sweerts SJ, Apfeldorfer G, Romo L, Kureta-Vanoli K. Treat or enhance cognitive restraint in individuals suffering from overweight or obesity? Systematic revue of the literature. SOJ Psychology. 2016;3(1):1-8.
30. Sheppes G, Suri G, Gross JJ. Emotion Regulation and Psychopathology. Annual Review of Clinical Psychology. 2015;11(1):379-405.
31. Leary M, Pursey KM, Verdejo-Garcia A, Burrows TL. Current intervention treatments for food addiction: A systematic review. Behavioral Sciences. 2021;11(6):80.