Les thérapies cognitivo-comportementales (TCC) sont des psychothérapies ayant démontré leur efficacité dans le traitement de nombreux troubles psychiques. Nous avons souhaité établir l’état des lieux actuel en ce qui concerne leur recours, leur intérêt, et leur implication dans le cadre d’une sous-spécialité particulière, la psychiatrie de consultation–liaison (PCL).

La sélection des travaux de recherche sur le thème de l’utilisation actuelle de la TCC en PCL a été effectuée par le biais des bases de données PubMed (Medline), ScienceDirect et PsycINFO.

Par cette recherche, seulement cinq études ont pu être retenues. L’intérêt d’une prise en charge grâce à des outils de TCC en PCL est retrouvé dans le cas de plusieurs types de troubles : les symptômes médicalement inexpliqués, le syndrome de fatigue chronique, et chez les patients infectés par le virus de l’immunodéficience humaine (VIH). Il ressort des études sélectionnées que l’utilisation des TCC dans ces cadres cliniques permet en effet une amélioration objective de certains symptômes psychiques.

Bien que l’utilisation des TCC en PCL ne soit qu’assez peu étudiée dans la littérature, les résultats déjà disponibles se montrent encourageants et semblent mettre en avant certains avantages de cette association. Un essor ultérieur de cette pratique est ainsi envisageable, notamment auprès des patients souffrant de pathologies avec une intrication somato-psychique particulière.

Cognitive-behavioral therapy (CBT) is a psychotherapy proven to be effective in the treatment of numerous psychological disorders. A specific psychiatric subspecialty, consultation–liaison (C-L) psychiatry, is used to detect and treat psychological comorbidities in general hospitalized patients. The practice of psychotherapy by the psychiatric C-L team offers certain advantages, but may also be faced with limitations. In this context, our research was focused on the current use of CBT by C-L psychiatry, and its effectiveness.

Articles were found through English databases, such as PubMed (Medline), ScienceDirect, and PsychINFO. Moreover, they were selected based on precise criteria: recent date of publication, journal impact factor, written in English or French, good quality methodological criteria and original subject matter.

Five articles were retained. The first one was a review of somatic symptoms in C-L psychiatry setting (Grover and Kate, 2013). It emphasized the role of C-L psychiatry in the diagnosis and management of medically unexplained symptoms (MUS), as well as teaching with an internist. The use of CBT reduced the severity of complaints, chronic pain, chronic fatigue syndrome (CFS), and number of hospital visits. The second article assessed the treatment of MUS with CBT (Ehlert et al., 1999), and observed a decrease in somatic complaints, depressive symptoms (NS), and increased motivation for psychotherapy. Three research reports were also retained on the treatment of CFS, or human immunodeficiency virus (HIV)-infected patients. The use of CBT in CFS tended to lead to a reduction in the frequency of symptoms, a decrease of functional and social damage, and a reduction in hospital visits (Akagi et al., 2001). Two other studies revealed that the treatment of HIV-infected patients with CBT by C-L psychiatry improved depressive and anxious symptoms (Blanch et al., 2002), and enhanced psychosocial adjustment to HIV infection (Rousaud et al., 2007).

There are few studies in scientific literature on the use of CBT with patients with somatic disorders, but not specifically by the psychiatric C-L team. Due to the very low number of publications on this topic, interpretability of results must be considered as the main limitation of this review. Nevertheless, the exposed results are encouraging, in particular in the treatment of some disorders. Indeed, use of CBT by C-L psychiatry in the cases of MUS, CFS, and with HIV-infected patients leads to a significant clinical improvement. Through these studies, particular advantages in CBT use by the psychiatric C-L team were observed. This management involves multidisciplinarity, which may lead to a more global comprehension of patients. The importance of therapeutic alliance is also emphasized and is particularly efficient when elaborated as early as possible. Fundamental tools seem to be psychoeducation, self-observation, and preparation of a therapeutic contract. Other authors explain the advantages of CBT use in hospitals (Rangaraj and Pelissolo, 2007). Crisis situations can facilitate the request for assistance; regular exchanges in CBT make therapeutic alliance easier, and facilitate quick results. The hospital setting enables better observation of the patient, and frequent and varied tasks of exposure. On the other hand, limitations must be considered, such as follow-up when the patient leaves the hospital, or acute mental or somatic disorders which are contraindications in CBT use. Finally, it is necessary to emphasize the particular interest of third wave techniques, which are currently being developed. For example, an original study observed the benefits of a treatment of HIV-infected patients with mindfulness, against CD4+ T lymphocytes decrease (Creswell et al., 2009).

Despite their low impact, the results of our review are positive and encouraging. Indeed, if CBT use by the psychiatric C-L team reveals positive effects in cases of MUS, CFS and with HIV-infected patients, development of this practice in patients suffering from other disorders with psychosomatic components can be envisaged.