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Traitement de l’information à contenu émotionnel et représentation de soi chez des patients bipolaires de type I après traitement combiné médicamenteux et comportemental-cognitif - 25/11/09

Doi : 10.1016/j.amp.2009.03.014 
A. Docteur a, , b , C. Mirabel-Sarron a, I. Urdapilleta b, J.-D. Guelfi a, F. Rouillon a
a CMME , université Paris-V René-Descartes, centre hospitalier Sainte-Anne, 100, rue de la Santé, 75014 Paris, France 
b UFR de psychologie, laboratoire de psychologie sociale EA 351, université Paris-VIII, 2, rue de la Liberté, 93526 Saint-Denis, France 

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Résumé

Notre étude porte sur la vulnérabilité cognitive de patients bipolaires I ayant suivi ou non une thérapie comportementale et cognitive (TCC). Douze patients dans le groupe contrôle (traitement prophylactique) et 12 patients dans le groupe d’étude (TCC conjointement à un traitement prophylactique) ont participé à l’étude. L’évaluation a été effectuée à l’aide d’autoquestionnaires, d’une tâche de rappel libre de mots à connotation émotionnelle et d’un entretien sur la représentation de soi. Les résultats n’indiquent aucune souffrance émotionnelle pathologique chez ces patients. Ils montrent en revanche que ces deux groupes diffèrent pour certaines variables de vulnérabilité, avec pour le groupe d’étude un biais de rappel spécifique aux mots à tonalité positive ainsi qu’un schéma de soi moins centré sur les symptômes thymiques et cognitifs du trouble. La relation entre schéma de soi et biais mnésique est discutée.

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Abstract

Objectives

Bipolar disorder currently affects around 1 % of the general population. Despite mood stabilizers, 37 % of patients continue to present mood fluctuations. Moreover, psychotherapeutic approaches, together with prophylactic treatment, have been developed over the past 10 years, including the behavioural and cognitive approach. Lam’s behavioural model has thus become a major reference. Bipolar patients who have undergone cognitive behavioural therapy (CBT) based on this program experience fewer manic and depressive recurrences as well as fewer hospitalizations, thus improving the quality of their relations with others, reducing their dysfunctional beliefs and attitudes, and enhancing their self-esteem. However, no study has evaluated the effects of CBT on cognitive functions in this disorder, such as memory, nor on its connection with cognitive patterns, among bipolar patients. Previous research has suggested the existence of many disturbances of cognitive functions. Several studies have demonstrated memory disturbances in a free recall task among type I bipolar patients, even during periods of remission. However, none of these studies focused on explicit-memory recall bias for words with affective valence during remission, nor did they investigate the connection between self schemata and bias in memory processes. The goal of this study was to explore the cognitive vulnerability of bipolar I patients in remission by linking self schemata with recall bias for words with affective valence, and to compare these variables among patients who underwent CBT, and patients who did not.

Materials and methods

The study included 24 bipolar I patients, 12 were in the control group (mood regulating treatment) and 12 were in the experimental group (CBT in conjunction with a mood stabilizer), according to the DSM-IV criteria. The free recall tasks for words with distinct affective valences (positive, neutral, negative) allowed us to assess the performance and recall bias for affective information. In addition, the lexical assessment enabled us to study the cognitive schemata with reference to self-representation.

Results

The results do not indicate any signs of depression, mania or anxiety among the two groups at the time of their inclusion in the study. The cognitive results show that not only is the experimental group significantly more likely to recall words with positive affective valence (F1, 22=5.770; P=0.025) and significantly less likely to recall those with negative affective valence (F1, 22=6.629; P=0.017) than the control group, but that it also presents a specific recall bias for words with a positive connotation as compared to neutral words (t11=4.722; P=0.001) and negative words (t11=5.777; P<0.0001). Furthermore, the experimental group uses a vocabulary which is less focused on the disorder mood and cognitive symptoms.

Conclusion

The results demonstrate the various recall biases between the two groups, with a specific bias for the positive words and a self-representation which is less focused on bipolar illness in the experimental group. Learning the cognitive and behavioural coping strategies based on the Lam et al. model may lead to a modification of bipolar patients’ cognitive schemata. This modification may itself contribute to a better recall of positive stimuli. Just as, according to Bower, the activation of a negative emotion may facilitate the recall of negative information, a better management of emotions seems to result in a better recall of positive information.

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Mots clés : Analyse lexicale, Mémoire explicite, Thérapie comportementale et cognitive, Trouble bipolaire, Valence émotionnelle

Keywords : Bipolar disorder, Cognitive behavioural therapy, Explicit memory, Lexical analysis


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© 2009  Elsevier Masson SAS. Reservados todos los derechos.
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Vol 167 - N° 10

P. 779-786 - décembre 2009 Regresar al número
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