Thérapie cognitive et comportementale et thérapie positive par le jeu : une étude pilote comparative - 06/09/17
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Résumé |
Cette étude évalue l’effet immédiat et à six mois d’une psychothérapie positive médiatisée par un jeu (TPJ=14) basé sur les ressources personnelles comparativement à une approche de thérapie cognitive et comportementale (TCC=9) classique centrée sur la résolution de problème. Si les effets semblent comparables sur la dépression, la sévérité perçue de la problématique principale et la confiance en soi, seule l’approche TPJ augmente l’estime de soi à court terme (t(13)=7,623 ; p.adj<0,001) et, à long terme, la satisfaction de vie (t(13)=2,337 ; p=0,036) et les dimensions d’autonomie (t(13)=3,543 ; p=0,004) et de relations positives (t(13)=3,417 ; p=0,005) du bien-être psychologique. Le jeu n’a cependant pas d’effet sur le bien-être subjectif (F(2,26)=1,915 ; p=0,167) à la différence de la condition TCC. Au niveau intergroupe, les participants au jeu rapportent après l’intervention davantage de relations positives que ceux du groupe TCC (F(1,42)=5,15 ; η2part.=0,197 ; p=0,034). D’un point de vue qualitatif, l’intervention par le jeu apparaît comme une approche bien acceptée par les participants et augmente leur satisfaction. L’étude pilote démontre que l’intervention par le jeu a une place légitime dans la palette d’intervention du thérapeute. Des préconisations pour adapter la procédure au contexte thérapeutique sont discutées à la suite des résultats et des limites de l’étude.
Le texte complet de cet article est disponible en PDF.Summary |
Recent work in the field of positive psychology interventions has shown that attrition rates appear to be lower compared to classic cognitive and behavioral therapies (CBT). Positive psychology interventions are distinct from first and second generation CBT in that work is mainly focused on functional dimensions in the patient and on the acceptance of problematic aspects rather than on problem-solving strategies. This leads to higher levels of vitality, meaning in life and motivation in patients. On the other hand, serious play allows focus on the patient's resources and values by fostering a state of complete immersion in the activity that generates feelings of control and satisfaction (i.e., flow experience; Csikszentmihalyi, 1988). From these perspectives, a new tool for practitioners has been proposed and assessed in our study. More precisely, this new serious play is consistent with the principles of positive psychology (Seligman, 2014) that point to a more pleasant (i.e., positive emotions), shared (i.e., relationship) and meaningful life, oriented towards engagement and leading to feelings of achievement.
Aim |
This study evaluates the effects of positive serious play (PSP) and its effectiveness compared with a classical CBT approach. One of the particularities of this research is that it does not oppose two therapeutic strategies but questions psychotherapists’ practices and tries to broaden their panel of interventions in order to provide ever more personalized patient support.
Method |
Twenty-three subjects (average age 43; sd=10.8) took part in the survey. The sample was made up of predominantly women. Problems which motivated the consultation were either personal (12 subjects; 52.2 %), or related to family (5 subjects; 21.7 %), or to work (4 subjects; 17.4 %), or to social relations (2 subjects; 8.7 %). Subjects were divided into small groups of 4–5 participants according to therapeutic approaches which were compared; on the one hand, a positive serious play procedure (PSP) gathered participants (n=14) around a new board game inspired by the Peterson and Seligman's 2004 character strengths (for more details, see motivesens.fr/), and, on the other hand, a classical CBT intervention focused on problem solving (n=9). Assessments were carried out before (T0) and after (T1) the consultation and 6 months later (T2). Measures of depression, but also, positive dimensions (e.g., optimism, subjective well-being, self-confidence, self-esteem) were considered. Although the question concerns a “problem”, the assessment of positive functioning here allows a more nuanced understanding of how the patient copes in every procedure.
Results |
Both CBT and PSP increase. Intragroup analyses highlight that, unlike the CBT group, the PSP approach increased self-esteem in the short term (t(13)=7.623; p.adj<0,001) and, in the long term, life-satisfaction (t(13)=2.337; P=0,036) and two dimensions of psychological well-being, i.e., autonomy (t(13)=3.543; P=0,004) and positive relationships (t(13)=3.417; P=0.005). However, subjective well-being was not impacted (F(2,26)=1.915; P=0.167). The only significant intergroup difference was that the participants of the positive serious play reported more positive relationships than the CBT group in the long term (F(1,42)=5.15; η2part.=0.197; P=0.034).
Conclusion |
This pilot study underlines the fact that the new positive serious play interventions appear to have similar effects to a classical CBT intervention. The major difference between the two strategies is that PSP seems to target primarily psychological (authentic) well-being while CBT impacts subjective (conditional) well-being. According to Prochaska and Di Clemente (1982), it appears that the personal newfound resources in the PSP group contribute to fostering the client's “feeling of autonomy”. At the same time, group interactivity encourages patients to open themselves up to others. In practice, the positive serious play offers a new therapeutic strategy to help patients solve problems (e.g., symbolism, playfulness; Behr, 2009). Recommendations to adapt this new practice tool to different therapeutic settings as well as the limitations of the study (e.g., sample size of the study, subjective assessment of the problem severity) are discussed.
Le texte complet de cet article est disponible en PDF.Mots clés : Psychologie positive, Thérapie par le jeu, Forces personnelles, Thérapies cognitives et comportementales, Bien-être
Keywords : Positive psychology, Serious play, Character strengths, Cognitive behavior therapy, Well-being
Plan
☆ | Communication : Broc, G., Carré, C., Valantin, S., Blanc, V., Shankland, R. (2015, septembre). Résolution de problème et thérapie positive par le jeu : étude pilote comparative entre une prise en charge cognitivo-comportementale et une prise en charge axée sur le développement de ressources personnelles. Symposium de psychologie positive, 56e congrès de la SFP, Strasbourg. |
Vol 27 - N° 2
P. 60-69 - juin 2017 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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