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Spécificités de la prise en charge cognitivo-comportementale des formes pathologiques de l’anxiété envers la santé - 11/06/13

Doi : 10.1016/j.jtcc.2013.02.001 
Morgiane Bridou , Colette Aguerre
 Département de psychologie, université François-Rabelais, UFR arts et sciences humaines, EA 2114 « Psychologie des âges de la vie », 3, rue des Tanneurs, 37041 Tours cedex 1, France 

*Auteur correspondant.

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Résumé

L’anxiété envers la santé est une forme d’anxiété très particulière, faisant actuellement l’objet d’un nombre considérable de travaux scientifiques et d’essais cliniques en découlant. Elle se caractérise par une hypervigilance envers les sensations physiques, couplée à une propension à les interpréter systématiquement comme les signes avant-coureurs d’une maladie somatique grave. Ce processus tend à générer des peurs et des inquiétudes très spécifiques et envahissantes, contre lesquelles le sujet lutte en mobilisant des stratégies de coping dysfonctionnelles. Le concept d’anxiété envers la santé rend compte de toute une diversité clinique, allant de simples inquiétudes relatives à l’état de santé jusqu’à l’hypocondrie, en passant par des formes plus modérées susceptibles d’avoir des répercussions plus ou moins négatives, tant sur la santé que sur le bien-être des individus. Ainsi, il paraît primordial de prendre en charge le plus efficacement possible les formes modérées et sévères d’anxiété envers la santé. L’objectif principal des prises en charge cognitivo-comportementales est principalement d’agir sur les facteurs de maintien des formes sévères d’anxiété envers la santé. Il s’agit de lutter contre des comportements excessifs d’évitement et de recherche de réassurance, d’une part, et de modifier ou d’assouplir les croyances dysfonctionnelles concernant les sensations et les modifications corporelles, ainsi que la vulnérabilité personnelle face à la maladie, d’autre part. Cet article vise à présenter les connaissances les plus récentes portant sur la prise en charge cognitivo-comportementale des formes modérées à sévères d’anxiété envers la santé.

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Summary

The concept of health anxiety is a very specific type of anxiety related to the fear of suffering from a serious physical illness without knowing it, or inadvertently succumbing to such an illness (Asmundson et al., 2001 [1]). It is characterized by hypervigilance to bodily sensations, together with a tendency to systematically misinterpret them as forerunners to a serious somatic illness (Barsky, 1992 [14]). This process tends to generate very specific invasive fears and concerns which the subject struggles against by mobilizing dysfunctional coping strategies (Salkovskis and Warwick, 2001 [22]). The concept of health anxiety takes into account clinical diversity, varying from simple concerns about health to hypochondria, including more moderate forms likely to have more or less negative repercussions on both the health and well-being of the individuals. This concept is currently the subject of a considerable number of scientific studies. Several comparative studies on behavioral and cognitive therapies applied to the treatment of health anxiety and hypochondria offer particularly encouraging results (Walker and Furer, 2007; Barsky and Ahern, 2004; Lovas and Barsky, 2010; Seivewright et al., 2008; Taylor et al., 2005 [26, 34, 35, 38, 39]). Therefore, it seems important to treat moderate and severe forms of health anxiety in the most efficient way possible. The main objectives in the cognitive-behavioral treatment of moderate to severe forms of health anxiety are: a) to help the patient pacify their relationship with their body so that they are more serene about physical signs and changes; b) to soften rigid beliefs relating to their general state of health and their perceived vulnerability to illness; and c) to fight against inappropriate coping strategies (avoidance, recurrent palpitations, systematic seeking of reassurance). The first therapeutic meetings are essential in building real trust and a good therapeutic alliance, as well as defusing the phenomena of resistance and reactivity partly caused by the fear of being labeled a hypochondriac after a long medical history. The functional analysis must highlight the vulnerability factors, such as genetic predisposition and/or negative past experiences, precipitating factors such as stressful life events (Taylor, 2004 [21]), catastrophic explanatory interpretations of perceived physical sensations, and aggravating and maintenance mechanisms such as the systematic recourse to poorly adapted behavioral strategies which are used as the first resort in fighting against invasive concerns about illness (Salkovskis and Warwick, 2001; Langlois et al., 2006 [22, 23]). The behavioral treatment of moderate to severe forms of health anxiety call for: a) interoceptive exposure techniques relating to feared and avoided physical sensations (Visser and Bouman, 2001; Walker and Furer, 2007 [26, 27]); b) behavioral exercises aimed at evaluating the probability of catastrophic scenarios evoked by the patient (Warwick, 2004; Salkovskis and Warwick, 1986 [19, 29]); c) cognitive restructuring (Socratic questioning, empirical confrontation or distancing strategies) with the objective of causing the patient to question the pertinence and reality of their beliefs and worries so that they can see them as simple hypotheses and not as actual facts (Taylor, 2004; Barsky and Ahern, 2004 [21, 34]); d) fully conscious meditation exercises (body scan, fully conscious movements, exercises to refocus attention, etc.) in particular targeting the perceptive cognitive dimension of the mechanism involved in the appearance and maintenance of the symptoms of health anxiety (Lovas and Barsky, 2010; Papageorgiou and Wells, 1998 [35, 36]). In order to maximize the efficiency of the treatment of moderate and severe forms of health anxiety and ensure its long-term benefits, consolidation of progress made should be offered during the final sessions (Taylor, 2004 [21]). At this time, it is important to emphasize the positive aspects of daily life often neglected by anxious individuals who tend to focus on their fears and worries. Finally a complete progress report is written detailing any residual difficulties as well as the future expectations of the patient. This should highlight the importance of regular practice of the cognitive-behavioral exercises learnt during the initial treatment (Abramowitz et al., 2010 [37]).

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Mots clés : Anxiété envers la santé, Thérapie cognitivo-comportementale

Keywords : Health anxiety, Cognitive behavior therapy


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Vol 23 - N° 2

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