Revue des différents programmes de thérapies cognitivo-comportementales sur Internet dans le traitement de la dépression - 20/11/14
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Résumé |
Les traitements psychologiques sur Internet se sont beaucoup développés durant cette dernière décennie. Parmi les traitements proposés, les thérapies cognitivo-comportementales tiennent une place majeure et notamment dans la prise en charge de syndromes dépressifs. Ces interventions se sont montrées efficaces au moins à court terme. L’objectif de cet article est une brève présentation de sept programmes ayant montré une efficacité dans le traitement de la dépression : MoodGym, E-couch, MomMoodBooster, Mom-Net, Depressionshjälpen, Sadness Program et Deprexis. La découverte des différentes possibilités techniques proposées par ces sept programmes permettent d’isoler des paramètres de qualités pour la mise en place ou l’optimisation de ce type de sites dans le futur. Ces critères sont : 1) l’accessibilité, 2) l’adaptation à la langue maternelle du patient et à sa culture, 3) l’adaptation à la pathologie du patient et de ses comorbidités, 4) l’anonymisation, 5) la qualité du contenu thérapeutique (thérapies cognitivo-comportementales, psychoéducation, relaxation…), 6) l’ergonomie des documents numériques, 7) la présence d’un forum de discussion, 8) la possibilité d’être dirigé vers une aide urgente, 9) le suivi personnalisé par un thérapeute, 10) l’engagement du patient vers un suivi et enfin 11) le lien avec le médecin généraliste et/ou le psychothérapeute du patient.
Le texte complet de cet article est disponible en PDF.Summary |
Depression is a major public health problem. In 2010, the number of people suffering from major depression was estimated at around 298 million (Ferrari et al., 2013) [1 ]. Depression is the fourth most debilitating illness in the world and risks becoming the leading cause of disability in the developed world by 2030 (Mathers et Loncar, 2006) [2 ]. Lifetime prevalence of this disorder is 16.2% and annual prevalence is 6.6% (Kessler et al., 2003) [3 ]. The potential benefits of early intervention are clear and it is necessary to facilitate access to treatment for sufferers (Cuijpers et al., 2008; Garber et l., 2009) [4 , 5 ]. Among the range of psychological therapies, cognitive behavioral therapy (CBT) is known for its efficiency in dealing with depression, either alone or alongside medication (Parikh et al., 2009) [8 ]. Unfortunately, as with many mental disorders, sufferers have difficulty initiating treatment. The Internet could therefore be a useful tool in the prevention and treatment of certain mental disorders such as depression. Over the last few years, CBT on the web, known as iCBT (Internet Cognitive Behavioral Therapy), has become more widely available. Literature reviews and meta-analyses have already been published on this subject (Andersson et Cuijpers, 2009; Griffiths et al., 2010; Richards et Richardson, 2012; So et al., 2013) [9 , 10 , 11 , 12 ]. The efficiency of iCBT treatment for depression has been proven but with a variation in efficiency between different meta-analyses. The effect sizes in favor of iCBT are small to medium. The long-term efficiency has been widely debated given the large number of patients who disappear (So et al., 2013) [13 ]. The aim of this article was to identify and describe different iCBT programs mentioned in scientific literature, which treat depression. As the websites were not always accessible, this review was compiled either from descriptions contained in scientific articles or by associating data from the literature and visiting sites online wherever possible. We found seven programs with proven efficiency in the treatment of depression: MoodGym, E-couch, MomMoodBooster (Danaher et al., 2012) [33 ], Mom-Net (Sheeber et al., 2012) [36 ], Depressionshjälpen (Carlbring et al., 2013) [14 ], Sadness Program and Deprexis. Despite the fact that all these programs offer cognitive behavioral therapy for depression, they are all very different. However, according to the authors, due to the diversity in form and content, it was possible to isolate quality criteria that could be used in setting up future iCBT programs or in improving existing ones. The criteria were based on ethical, democratic and treatment effectiveness aspects as well as the technical capacity currently offered by the Internet. The programs should: 1) be freely accessible, free of charge and compatible with different operating systems (Windows, IOS, Unbutu), tablets and smart phones, 2) be available in the mother tongue of the patient and culturally adapted, 3) be adapted to the pathology of the patient and their co-morbidities, which implies a reliable diagnosis with the help of hetero-questionnaires, 4) respect patient anonymity, 5) offer efficient therapeutical techniques (cognitive behavioral therapy, psychoeducation, relaxation…) adapted to the pathology, its intensity, its evolution and its co-morbidities, 6) provide easy-to-use high-quality documents with playful and attractive interfaces (drawings, photos, dialogues, flash animation) and be flexible, 7) contain a discussion forum, 8) provide the possibility of direction towards emergency help if needed, 9) provide personalized care by a therapist (by email, by telephone or face to face) if necessary, 10) direct the patient towards a follow-up to prevent a relapse and/or recurrence (psychoeducation, appointments with a local therapist or physician) and finally 11) with the agreement of the patient, involve their physician and/or their psychotherapist to ensure coherent treatment and follow-up. None of the programs mentioned above completely fulfilled these criteria. However, the sites Moodgym, Sadness Program and MomMoodBooster provided the closest match.
Le texte complet de cet article est disponible en PDF.Mots clés : Dépression, Internet, Thérapies comportementales et cognitives
Keywords : Depression, Internet, Cognitive behavioral therapy
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Vol 24 - N° 4
P. 138-143 - décembre 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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