Vers un protocole de traitement processuel et modulaire des troubles anxio-dépressifs - 24/08/15
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Résumé |
L’approche processuelle transdiagnostique a été conçue pour pallier les limites des protocoles de traitement empiriquement validés pour un diagnostic et régulièrement utilisés en thérapie comportementale et cognitive. Dans cet article, nous avons présenté une nouvelle manière de concevoir les thérapies : une approche modulaire et processuelle. Son idée centrale est que l’évaluation et l’intervention en psychopathologie doivent cibler les processus étiopathologiques, responsables de l’apparition et du maintien du trouble. Le rationnel général est de proposer un modèle de conceptualisation de cas individuel centré sur les processus responsables du maintien du trouble chez la personne. Plus précisément, nous avons identifié et présenté sept classes de processus (évitement expérientiel et désactivation comportementale, stratégies de régulation des émotions, croyances métacognitives dysfonctionnelles, sentiment d’inopérance et faible sentiment d’efficacité personnelle, écarts entre les sois, ruminations mentales, intolérance à l’incertitude), ainsi que les questionnaires permettant de les évaluer. Des modules d’intervention ciblant chacun un processus dysfonctionnel chez un patient donné seront ensuite proposés.
Le texte complet de cet article est disponible en PDF.Summary |
Recently, the approach of applying a validated treatment protocol as a function of the psychiatric disorder diagnosed has been questioned. Among the limitations highlighted, is the fact that, in most cases, people presenting a mental disorder also suffer from co-morbid mental disorders. In these conditions, it is uncertain how to determine a treatment approach based on protocols that have been validated for uni-morbid cases. Others have also pointed to the great diversity of individual profiles within the same diagnostic category, questioning the relevance of a single treatment for different cases presenting the same diagnosis. Finally, from a logical standpoint, some claim that any treatment should address the cause of the disorder (i.e. etiopathological processes) and not its effect (symptoms determining the diagnosis). To overcome these limitations, a transdiagnostic, processual approach has been proposed. This approach supposes that there are psychological processes common to different diagnoses, and that treatment should target the cause of the disorder (i.e. the underlying psychological processes) and not its consequences (i.e. the symptoms and the diagnoses). In this article, building on the transdiagnostic, processual perspective, we present a new way to conceive psychological treatment of mental disorders: the processual, modular approach. In this approach, case conceptualization is central. It aims at identifying the psychological processes that are responsible for the onset and maintenance of the disorder. Based on this processual case conceptualisation, the intervention targets the specific processes that have been found active in a given individual. More precisely, the intervention consists of the concatenation of modules, each module targeting a specific etiopathological process. Hence, the end-treatment, the concatenation of modules, is individualized according to the specific processes that have been identified as determining the condition of a specific individual. The proximal validation of this approach relies on demonstrating that the processual case conceptualization accurately identifies the psychological processes that maintain the problem and that each module is indeed effective in altering the psychological process it targets. The distal validation would be to demonstrate that this new approach is more effective in reducing symptoms than the traditional “diagnosis-based treatment approach”. We expose a case conceptualization module that aims at identifying the main processes that are active in anxio-depressive disorders in adults. Based on a literature review, we have identified seven classes of processes: experiential avoidance and behavioral deactivation, dysfunctional emotion regulation strategies, meta-cognitive beliefs, helplessness and poor self-efficacy, gaps between actual self and ideal or socially prescribed selves, mental rumination, and intolerance to uncertainty. From the literature, we have selected self-reported questionnaires measuring each of these processes. Special care has been given to choosing questionnaires easy to use in everyday regular clinical practice, and that allow for constructive feedback with the clients. The structure and underlying dimensions, psychometric characteristics, validation in English and in French are presented for each questionnaire. The selected questionnaires are the Multidimensional Emotion Avoidance Questionnaire (MEAQ), the Emotion Regulation Questionnaire (ERQ), the Meta-cognition Questionnaire (MCQ), a specially designed questionnaire assessing self-efficacy in a variety of life situations, a specially designed questionnaire defining the ideal and the socially prescribed selves of the client, as well as the gaps between these selves and the actual self, and the distress it triggers, the Cambridge-Exeter Repetitive Thinking Scale (CERTS), and the Intolerance to Uncertainty Scale (IUS). The resulting clinical instrument for case conceptualization is presented and its limitations are discussed. This article is complemented by a sister article in this volume that presents a clinical case, conceptualized with the present protocol.
Le texte complet de cet article est disponible en PDF.Mots clés : Conceptualisation de cas, Diagnostic, Processus transdiagnostiques, Protocole modulaire, Anxiété, Dépression
Keywords : Case conceptualisation, Diagnosis, Transdiagnostic processes, Modular protocol, Anxiety, Depression
Plan
☆ | Un site internet présente le projet décrit dans cet article, ainsi que les instruments cliniques qui en font l’objet : processus. |
Vol 25 - N° 3
P. 106-116 - septembre 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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