Adaptação e validação do questionário de esquemas de Young - versão breve (ysq-s3) para uso no Brasil

Abstract

Schema Therapy (ST) is an integrative therapeutic approach based on Cognitive-Behavioral Therapy and elements of attachment and object relations theory, psychodynamic approaches, Cognitive Analytic Therapy, personal schemas, Emotion Focused and Gestalt Therapy. ST allows an extended understanding about pathological aspects of the personality and provides explanatory models for different psychopathologies, as well as intervention strategies. This understanding is based on Early Maladaptive Schemas (EMSs), which are dysfunctional structures formed by cognitions, emotions, memories and sensations. EMSs are developed throughout childhood and adolescence from basic emotional needs that are not met, a process that occurs in the interaction between the individual's temperament and the environment in which the individual was inserted. To aid in the identification of EMSs, the Young Schema Questionnaire - short version (YSQ-S3) was developed. This instrument has been widely used in research and allows for important advances in studies on the theoretical model and evaluation of interventions in ST. The YSQ-S3 is a self-report instrument with 90 items and a 6-point Likert scale. The present dissertation aims to present the processes of adaptation and study of the validity evidences of YSQ-S3 for use in Brazil. Initially, a theoretical section is presented, with theoretical foundation on ST, the EMSs and a review on studies that evaluated the evidence of validity of the YSQ-S3 in other countries. The empirical section of the dissertation is divided into three empirical articles. The first article, titled "Brazilian Adaptation of the Young Schema Questionnaire - Short Version (YSQ-S3)", aims to present the semantic adaptation of the YSQ-S3 to Brazil and its preliminary evidence of internal consistency. In the adaptation, the procedures required by the International Society of Schema Therapy (ISST) for translation, revision and back-translation were followed. Moreover, additional evaluation steps were considered with three experts, focus group evaluation and a pilot study with 10 participants. Subsequently, the YSQ-S3 was applied with 200 individuals to analyze the internal consistency of the instrument. With regard to the adaptation process, the article describes the items that have undergone linguistic modifications to maintain the contents of the items and the suggestions of the experts. In the evaluation stages with the target audience, all participants reported a complete understanding of the items and ease of completion, except for some items related to the Social Isolation EMSs, which are described in the article. The overall internal consistency of the instrument was classified as excellent (α = 0.965) and satisfactory for all EMSs (α between 0.76 and 0.92), except for the Entitlement EMS (α = 0.67). These data allow us to verify that the instrument presents good semantic adequacy for use in Brazil and satisfactory preliminary evidences of internal consistency. The second study, entitled "Evidence of validity of the Brazilian version of the Young Schema Questionnaire - short version (YSQ-S3)", aims to present evidence of internal and external validity of the instrument. The collection was done for convenience and 1,050 individuals from the population who completed the YSQ-S3 and the Symptom Checklist (SCL-90) participated. The factorial structure was investigated with Factorial Confirmatory Analysis (FCA) in the R environment with the lavaan package, and the convergent validity based on the correlation between the EMSs and clinical psychological symptoms. The adjustments of the factorial model were satisfactory, ² (3.762) = 15.481.55, CFI = 0.98, TLI = 0.98, RMSEA = 0.054, SRMR = 0.055. In general, adjustments of the factorial models of each subscale were also satisfactory and the measures of composite reliability and ordinal alpha were all higher than 0.7. In the convergent validity, bivariate correlation analyzes showed positive correlations between all EMSs and SCL-90 subscales, indicating that the greater the activation of EMSs, the greater the presence of psychological symptoms. The main correlations are discussed in the article. This study allowed for identification of satisfactory evidences of structural and convergent validity. The third empirical article, entitled "Early Maladaptive Schemas: A Study with Network Analysis", aims to present a model for the distribution of EMSs in Schema Domains, as well as to identify aspects of centrality and connectivity between EMSs. From the analysis of communities, a model of four Domains was identified, entitled: "Disconnection and Rejection"; "Negative future prediction and vulnerability," "Impaired Autonomy and performance," and "Excessive standards and status search." In the article, the descriptions of the Domains are explained and possible explanations about the basic necessities are supplied in each of them. From the "expected influence" centrality measure, it was possible to identify the EMSs with the greatest network activation potential: Subjugation; Negativity; Defectiveness/Shame; and Abandonment. As far as connectivity "betwenness", the EMSs were highlighted with important mediators: Defectiveness/Shame; Unrelenting Standards; Failure and Abandonment. In both measures of centrality and connectivity, the EMSs of Defectiveness/Shame and Abandonment stand out as especially damaging. The results allow advances in the empirical understanding of the model.