Le traitement de l'état de stress post-traumatique

Istanbul Center for Behavior Research and Therapy, Turkey


L'état de stress post-traumatique (ÉSPT) est un trouble mental commun chez les personnes qui ont été exposées à des évènements traumatiques. Depuis son introduction au sein des systèmes de classification en psychiatrie dans les années 1980, diverses approches psychothérapeutiques ont été mises à l'essai dans le traitement de l'ÉSPT. L'efficacité de ces thérapies dans la réduction des symptômes de stress post-traumatique varie considérablement de l'une à l'autre. Des méta-analyses d'essais cliniques contrôlés à répartition aléatoire ont permis de conclure que les psychothérapies se concentrant sur le traumatisme sont les plus efficaces dans le traitement de l'ÉSPT (Bisson et coll. 2007; Bradley et coll. 2005; Van Etten et Taylor 1998). Les thérapies axées sur les traumatismes comprennent des approches de thérapie cognitivo-comportementale (TCC), particulièrement la thérapie par l'exposition et la thérapie cognitive, ainsi que l' intégration neuro-émotionnelle par les mouvements oculaires (Eye Movement Desensitization and Reprocessing ou EMDR). Une analyse de ces thérapies, de leur fondement théorique, de leurs applications, de leur efficacité et des enjeux entourant leur possibilité d'exécution dans différents contextes est exposée dans le présent article.

Download full-text


Available from: Metin Başoğlu, May 07, 2014
91 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The disturbances observed in animals subjected to unpredictable and uncontrollable aversive events resemble post-traumatic stress disorder (PTSD) symptoms and thus may constitute an animal model of this disorder. It is argued that the similarity between animals' symptoms and those of trauma victims may reflect common etiological factors. Relevant experiments in which animals exhibit generalized fear and arousal, discrete fear of a conditioned stimulus (CS), analgesia, and avoidance are reviewed with the view that these manifestations may be analogous to the PTSD symptom clusters of persistent arousal, reexperiencing, numbing, and avoidance, respectively. Finally, animal paradigms are suggested to test the validity of the model and specific hypotheses are derived from the animal literature regarding trauma variables that are predictive of particular PTSD symptom clusters.
    Psychological Bulletin 10/1992; 112(2):218-38. DOI:10.1037//0033-2909.112.2.218 · 14.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We tested whether the effectiveness of imaginal exposure (IE) treatment for posttraumatic stress disorder (PTSD) was enhanced by combining IE with imagery rescripting (IE+IR). It was hypothesized that IE+IR would be more effective than IE by (1) providing more corrective information so that more trauma-related problems can be addressed, and (2) allowing patients to express emotions that they had been inhibiting, such as anger. In a controlled study 71 chronic PTSD patients were randomly assigned to IE or IE+IR. Data of 67 patients were available. Treatment consisted of 10 weekly individual therapy sessions and treatment evaluation was conducted post-treatment and at 1-month follow-up. Results show that when compared with wait-list, treatment reduced severity of PTSD symptoms. More patients dropped out of IE than out of IE+IR before the 8th sessions, 51% vs. 25%, p=.03. Completers and intention-to-treat analyses indicated that both conditions did not differ significantly in reduction of PTSD severity. IE+IR was more effective for anger control, externalization of anger, hostility and guilt, especially at follow-up. Less strong effects were found on shame and internalized anger. Therapists tended to favor IE+IR as it decreased their feelings of helplessness compared to IE. Results suggest that the addition of rescripting to IE makes the treatment more acceptable for both patients and therapists, and leads to better effects on non-fear problems like anger and guilt.
    Journal of Behavior Therapy and Experimental Psychiatry 01/2008; 38(4):345-70. DOI:10.1016/j.jbtep.2007.10.006 · 2.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Prevailing models of exposure therapy for phobias and anxiety disorders construe level of fear throughout exposure trials as an index of corrective learning. However, the evidence, reviewed herein, indicates that neither the degree by which fear reduces nor the ending fear level predict therapeutic outcome. Developments in the theory and science of fear extinction, and learning and memory, indicate that 'performance during training' is not commensurate with learning at the process level. Inhibitory learning is recognized as being central to extinction and access to secondary inhibitory associations is subject to influences such as context and time, rather than fear during extinction training. Strategies for enhancing inhibitory learning, and its retrieval over time and context, are reviewed along with their clinical implications for exposure therapy and directions for future research.
    Behaviour Research and Therapy 02/2008; 46(1):5-27. DOI:10.1016/j.brat.2007.10.003 · 3.85 Impact Factor
Show more