Santé mentale au Québec

Published by NRC Research Press
Online ISSN: 1708-3923
Print ISSN: 0383-6320
Publications
Auto-development seeks to give back to the client the control of his development influenced by Rogers, Gendlin, Bugental and Gestalt. The author relates the events of his professional experience which lead him to set himself the following objective; insure that the participants are capable of transposing their experiences (apprenticeship) to their day-to-day life without outside help. With this intention, the author states the eight basic assumptions of his approach and the principal concepts which are : , process, recovering and responsability.
 
Transference focused psychotherapy is a version of psychodynamic psychotherapy that is modified and specialized for patients with borderline personality disorder. It is based on psychoanalytic principles with an emphasis on object relations theory. A fundamental concept in this model is that the organization of an individual's psyche is structured around internalized versions of interpersonal relations. The relationship experiences that are internalized involve a specific representation of the self, a specific representation of the other (the object of the libidinal or aggressive drive) and an intense affect that links them. However, this movement toward integration of the internal representational world does not take place in individuals with borderline personality, who continue to experience life in a way that is based on rigid and extreme views of self and others. The goal of transference focused psychotherapy is to help individuals advance to an integrated internal world through the analysis of the patient's ongoing experience of his or her relationship with the therapist. It is assumed that the analysis of this relationship will bring to light the internal representations of self and other, and the corresponding affects, that are related to unconscious desires and motivations, and that underlie the individual's extreme and discontinuous experience in life. The therapy begins with a specific diagnostic interview and the establishment of a treatment contract with the patient before the psychotherapeutic work begins. The first goal of the therapy is to engage the patient in the process of observing and gaining awareness of the representations of self and other that guide his or her perceptions of the world. The therapy then helps the patient to understand the internal forces that have kept theses representations segregated from each other and to integrate them into a more mature and coherent sense of self and others.
 
Violence between adolescents during teen pregnancy is relatively new in terms of scientific interest and clinical preoccupations. It is an alarming situation, given that 1) its prevalence ranges from 5 % to 29 % according to the literature; 2) consequences for both the mother's and baby's health are numerous at physical, psychological and sexual levels; 3) scientific and empirical knowledge regarding the phenomenon is limited and diminishes efficacy and relevance of current interventions. It therefore appears of major importance to acquire better knowledge of various ecological factors in order to implement preventative care and services that will allow them as well as their children to thrive in adverse conditions and have access to a safe and supportive environment.
 
In 1978 a radical psychiatric reform was passed in Italy, that revolutionized the mental health delivery system. The reform has attracted international attention for its resolute commitment to getting rid of the traditional state hospital and implementing a nationwide mental health system without this type of hospital. The paper begins by depicting its preparation, then after charting the main features of the reform and its implications, it moves on to providing data on the implementation. In the following years relevant legislation has supplemented the reform and is covered in the paper. Other concurrent elements of the implementation process are mentioned and existing empirical studies reviewed.
 
At the end of the 19th century, Henry Howard appeared as the first Quebec "aliéniste" to attempt to develop an inclusive theoretical treatise on the question of madness. Why this sudden upheaval ? There existed numerous european theories ; that might have sufficed. The author attempts to show the multiple connections of this theoretical pro-lect to the socio-political problems of québécois society. Howard tries, from the perspective of the theory which he elaborates, to intervene in the major discussions affecting Quebec: ultra montanism, the problem of universal compusory education, public morality. At a more professional level he attempts to intervene in the legal dispute opposing judicial and medical competence in the cases of insanity pleas, as well as in the question of the scientific and social status of the "aliéniste". The involvement in these struggles manifests itself in Howard's treatise as much at the level of the concepts themselves, and their architecture, as at the thematic level and in the applications which he naturally draws. It is not onty external and contingent but works on the text from the inside as well. The article attempts to suggest that at the very moment that the treatise on the alienated-which would become the "science" that we know today- seeks to structure itself into a theory, it cannot break its attachment to its determining social context and that, ignoring its ideological role it, in truth, succeeds only in creating illusion and the impression of a progressive process, all the while being circumstantial and having a verted interest.
 
The article analyzes the medical discourse of the directors of the Toronto asylum during the period from 1841 to 1850. These administrators gave the asylum the double objective of returning human dignity to the insane and of curing their insanity. Thus, they elaborated policies congruent to this double objective, policies, whéch when subjected to an elaborate analysis are seen to be ambiguous. In addition, a study of the unofficial day practices, reveals the Utopian nature of the official objectives and the veritably unchanged situation of these unfortunate people.
 
This study examines in detail the dialectical process which has brought extensive changes in the governing and distribution structure of psychiatric services in Quebec's recent past. It is a study of shifting groups in positions of power, of conflicting ideas and plans for action, of tactics and strategies, of insurgence and invasion, of dynamism and conservatisn. However, in these debates over territories and management, the patient, in whose name beatuful structural blueprints are designed and defended, appears to be the one who least benefits.
 
The outcome of the drug approval process plays a major role in determining how drugs will be prescribed in Canada. The objective of this paper is to examine the nature of the regulatory approval process, its decisions, how these are expressed in pharmaceutical promotion and the ultimate impact of these factors on the prescribing of psychotropic drugs in general and particularly with regard to the benzodiazepines. There is strong circumstantial evidence that the benzodiazepines were approved on the basis of inadequate clinical trials resulting in these drugs being indicated for conditions for which they were not useful and significant safety issues being ignored. These deficiencies in the regulatory process were magnified in the advertising of these products to physicians, thus contributing to inappropriate prescribing in four areas: prescribing for psychosocial problems, overprescribing for somatic complaints, overprescribing to women and overprescribing for anxiety disorders. Problems in the approval process continue to exist and these will manifest themselves in ongoing inappropriate prescribing of psychotropic, and other, medications.
 
This article raises three questions : Has the family unit changed between the mid-70s and the mid-80s? Which characteristics of the family system are the most appropriate indicators of felonious activity? Does the explanation of felonious activity vary according to the sex of an adolescent? Two surveys conducted with Montreal adolescents in 1974 and in 1985 provide the answers. The authors show that the family structure has changed in view of single parenthood, its living conditions have deteriorated, control has been tightened, but emotional relationships have remained the same. The authors have found that the components of a family structure can be related to a precise model ; rebellion precedes delinquency ; didactic methods filter the influence of other family factors ; the psy-chosocial functionning of the family as well as conjugality follow as precipitative factors; finally, structural factors appear to have a remote influence. Also, the authors have noticed a great resemblance between boys and girls with respect to the primordial factors of delinquent behavior. In conclusion, the authors suggest practical involvement, particularly in terms of a diagnostic strategy for family problems, along with intervention strategies according to the type of problem.
 
A research program on the prevalence of reactions of posttraumatic stress is described in this article. The program is specifically centered on the psychological consequences of the April 1994 events in Rwanda and the genocide that followed. It includes three psycho-epidemiologic studies: 1) a study of non-accompanied Rwandan children; 2) a study of a small group of belgian cooperants; and 3) a study of an important sample of belgian civilians and militaries having been through the rwandan events. The psychological impact of the rwandan events is described in terms of prevalence of symptoms of posttraumatic stress.
 
This analytical review is intended to update the author's earlier writings on the position of the state mental hospital within the spectrum of services for long-term mental patients and to provide a perspective for the next generation of service planners. Findings and commentary are organized around four major questions. First, what is the prevailing view of state mental hospitals today, and how does it compare with the view that existed in the first half of this century? Second, what individuals tend to be served in state mental hospitals today? Third, what has been the fate of mentally ill persons who are no longer served in state mental hospitals? Fourth, what is an appropriate role for the state mental hospital in today's uncertain and rapidly changing systems of care? Individual state mental hospitals vary in the composition of their resident populations, the content of their services, and the overall quality of their care. Although they have been superseded by community-based service structures in some places, they continue in general, as the result of their multifunctionality, to occupy a critical place in systems of care. Renewed efforts to integrate them as full partners within those systems must be undertaken.
 
The July 1996 Saguenay floods affected an important part of the region's population. Disasters of this nature subject victims to particularly difficult psycho-emotional experiences. From a qualitative study of the clinical analysis of 30 case history, this exploratory research describes the impact of this disaster on the lives of the victims and evaluates the consequences on their psychological health. Results indicate that this disaster has greatly disrupted the lives of victims entailing several problems as well as a deterioration of their mental health translating into serious psychological problems and disorders.
 
In July 1996, the Saguenay-Lac-St-Jean region suffered one of the greatest natural disasters in Québec's history. This article presents results of a study aiming at comparing, two years after the flood, the physical and psychological health condition of victims (n=177) to that of non-victims (n=168). The results indicate that victims, - regardless of their gender - present a psychological well-being as well as a post-disaster physical health that is different from non-victims. Disaster victims are much more numerous than non-victims in considering that their health is bad or average and in witnessing new health problems or the exacerbation of existing problems. Victims also present more manifestations of prosttraumatic stress and somatic complaints, have higher levels of depression, anxiety and social dysfunction than non-victims. However, no significant difference between subjects was revealed concerning severe depression. Results obtained corroborated that of other studies. After a natural or technological disaster involving important material damages to individual belongings, victims are more affected than non-victims concerning their psychological and physical health.
 
Between January 5th and January 9th 1998, Quebec was struck by a natural disaster, an ice storm that disrupted the daily lives of millions of people. The ice accumulated on electric wires and installations caused the collapse of part of the system leaving millions of people without power for periods of up to a month. These events thus compelled many people to reorganize their daily lives in some of the most densely populated areas in Québec. Many elements make this disaster distinct from others. It is in this particular context that we must understand results of studies conducted for the Commission mandated by the Québec government to examine the consequences of the ice storm. These studies examined among other things, the psychosocial consequences of the disaster. By comparing the ice storm to other disasters, we see that the temporality of the phases of impact are somewhat different. The confusion between the phases of anticipation and the lengthy duration of the phase of impact are important characteristics which are also linked to some psychosocial impacts such as uncertainty and the more or less prolonged disorganization of daily life. The types of impact underlined in the studies lie in continuity with reactions generally expected in this area (stress, distress, vulnerability for example), and described in the literature but also reveal the specificity of a disaster occurring in a cold country. Here, there are no massive material destruction but help is diverse. However, as elsewhere, there is a context where some people are in a greater situation of vulnerability.
 
This team of five philosophers analyses the 18th and 19th century Quebec discourse on the subject of insanity. The 18th century saw the insane excluded from social contact with the state recognizing only their indigence. They were relegated either to the "Loges", designed to expiate their sins since insanity was linked to an abuse of mind and body, or to prison for appropriate punishment, since madness was considered to lead to crime. But economic pressures produced by the growing number in indigents, including the mentally ill, led to the creation of the Beauport asylum in 1845. The authors then describe how the urban insane, marginal to both the French Canadian and English Canadian communities* were placed in private institutions and subjected to a system of profit maximization controlled by bourgeois physicians. This situation increased the distance between proprietors and occupants, and accounts for the lack of original discourse on the subject of insanity. In addition, the reasoning of the alienist physicians was without scientific foundation, taking root rather in the dominant industrial capitalist ideology. As for the content of the discourse, the Beauport physicians borrowed from moral treatment and restraint system notions, giving them a certain Quebec character.
 
This article is the description of the personal journey of one of the pioneers of mindfulness teaching in health care in Quebec. It emphasizes the need to practice and to understand this concept experientially rather than conceptually. It describes the contribution of mindfulness to his medical practice and provides a brief overview of the workshops he has led a the Epic Centre (Centre for Preventive Medicine and Fitness of the Montreal Heart Institute) for the last 15 years.
 
Through an historical survey of law 24 and its evolution, the author clarifies its initial weaknesses and the abuses it could lead to. He then describes the adjustments applied to the law in its last revision and emphasizes its strong points. His conclusion is as follows : the law for the protection of the youth is good and generous but undeveloped. We have not yet learned how to let it evolve fully.
 
In this second article, the author analyses the impact of American deinstitutionalization on patients, their families, the communities and the health care system (medical clinics, general hospitals, community mental health centres and residential concerns). Following his analysis, the author develops the various hypotheses produced to solve the problems created by deinstitutionalization. These hypotheses follow the dominant political theme of the 80s in the area of health and social services : the integration of services.
 
The history of the last thirty years of North-American psychiatry points up the difficulties encountered in the treatment of psychotic patients in a hospital setting but also in the maintaining of their social integration. In a search for solutions, and taking into account the needs observed at the Robert-Giffard Hospital in Quebec, a group of professionals of GIFRIC decided to open, in the center of town, a Psychoanalytical Center for psychotics. Operating since 1982, the "388" is arming at a social réintégration of the psychotic patients in order to read a more satisfying life according to their possibilities of co-existence with others. It is an outside of the hospital structure which permits the treatment of the crisis as well as providing longterm care. The care and services given are based on a psychoanalytical frame. This paper describes the clientele, the services offered, the treatment, the patients' evolution and the problems that arise from the evaluation of such a new structure.
 
The recent emergence of a critical phase in life called maturescence, situated between the ages of 40 and 65, is a by-product of social life in industrialized societies. Because it is considered as a crossroads, this phase in life is not connected with any particular chronological age, such as reaching forty or fifty. Rather, it involves the difficulties of aging in society and the oncoming of identity conflicts, all of which must be seen in relation with the specific health-related problems that result from aging.
 
In this article, the author presents a reflection on the phenomenon of suicide of men in Québec under the paradigm of the ecology of mental health and from the perspective of the Abitibi region. This region, according to the author, constitutes in a way an amplifying barometer of the phenomenon of suicide in Québec.
 
This article suggests that the notion of madness varies with the social context, the dominating values of each cultural community and the position given to agents and social workers in the field and in the hierarchy of knowledge. As an interplay of representations and cognitive strategies, madness can be considered as a "symptom" of the "normative" and "reductive" biases of each era, but also as a revealing trait of the sensibility of each culture toward certain dimensions of unusual experiences. Following a review of the magical, prophetic, theological, moral, pathological and analytical versions of madness, the author concludes by emphasizing the necessity of always taking into consideration the cultural standpoint that characterizes the experience of madness as much as it does its study.
 
This article examines how the issue of clinical intervention with the Aboriginals presents itself within Montreal's transcultural psychiatric services. The cultural consultation service at Montreal Jewish Hospital created by Dr. Kirmayer as well as the transcultural psychiatric clinic at Montreal Children's Hospital founded by Dr. Rousseau are relatively recent settings of care. Their mandate being to provide care and services to Montreal's cultural diversity, the author questions the place and response given to the demands of a minority unlike the others, the Aboriginals.
 
The author traces the evolution of psychiatrie services in Montréal and the province of Québec up until 1977. Following this summary, the author describes what has been undertaken in the area of mental health since that year. He also recounts his observations in the course of visits made in the fall of 1986 to certain hospital centers catering to short term patients (centres hospitaliers de courte durée), at the request of the Harnois Committee. Among his findings, he points out that the projects started at the onset of the Bédard and Castonguay reforms have been implemented, if not in spirit by the book, and that the integration of the entire psychiatric services of the C.H.C.D. is about to be completed.
 
The issues surrounding sexual abuse and negligence are rarely examined in parallel by researchers and social workers. Based on a review of relevant literature and on a preliminary analysis of data collected during two surveys, the authors present in this article a comparison of these two subjects. In short, sexual abuse and negligence do not seem to differ fundamentally when it is a matter of establishing the state of health of victims once under the care of authorities and of choosing a type of psychosocial intervention. However, the researchers do look closely at very different risk factors when analyzing the family environment and the characteristics of the actors involved.
 
In an on-going review of the literature dealing with the assessment of drug abuse treatment and prevention programs, the authors indicate that changes are occurring in basic concepts : the concept of addiction has been expanded and a more systemic approach to drug use and abuse is more prevalent. An examination of the relationship between adolescent drug use and the related psychosocial images leads to an outline of two main evaluative approaches : the moralistic a priori approach and the empirical social approach. To efficiently prevent youthful drug abuse, they propose that primary preventive actions should focus on demand factors and be complemented with secondary preventive actions focused on supply factors.
 
In order to better understand women who suffer from severe psychiatric disorders, this literature review of 18 studies examines their experiences of sexual and physical abuse. It is apparent that people with severe mental disorder and more specifically women, are vulnerable to physical and sexual abuse. Homeless women with severe mental disorders are particularly vulnerable. The authors focus on links between reality and practice in the treatment of this clientele in both institutional and community settings.
 
Traditional approaches to treating clients with co-occurring disorders based sequential or parallel mental health and substance abuse treatments have failed, leading to the development of integrated treatment programs. In this article we define integrated treatment for clients with co-occurring disorders, and identify the core components of effective integrated programs, including: assertive outreach, comprehensiveness, shared decision-making, harm-reduction, long-term commitment, and stage-wise (motivation-based) treatment. The concept of stages of treatment is described to illustrate the different motivational states through which clients progress as they recover from substance abuse: engagement, persuasion, active treatment, and relapse prevention. The stages of treatment have clinical utility for guiding clinicians in identifying appropriate treatment goals matched to clients' motivational states, and selecting interventions based on these goals. By recognizing each client's current stage of treatment, clinicians can optimize outcomes by selecting interventions that are appropriate to the client's current motivational state or stage of treatment, and minimize clients dropping out from treatment. Effective integrated treatment programs for clients with co-occurring disorders differ in the specific services they provide, but share common elements in their philosophy and values. Research documents the beneficial effects of these programs, which bodes well for the long-term prognosis of clients with co-occurring disorders.
 
This study examines the symptoms of 30 adolescent girls who are under child protection care following sexual assault. In addition to describing the psychological profile of these adolescents, the study describes the sexual abuse, services received, and identifies factors that are likely to be linked to symptoms. Results show that adolescents present many psychological problems and that the majority experience distress necessitating clinical attention. Sexual abuses are at the extreme end of the large continuum reported in the literature and services are infrequent and irregular. Symptoms are associated with the time elapsed since the last sexual abuse and with services received. The discussion highlights the importance of adequacy between services and psychological profile of each adolescent while suggesting a model of recovery.
 
On April 27th 2004, Dr Jean-Yves Roy passed away, leaving unachieved research projects on the schizophrenia - substance abuse comorbidity, which we were able to complete over the last few years at the Fernand-Seguin Research Center. It is these developments that we summarize in the current review of literature. First, we present a series of studies evaluating the self-medication hypothesis, using diverse scientific techniques (meta-analysis, brain imaging and neuropsychology). The results of these studies strongly suggest that patients with schizophrenia and substance abuse have less negative deficits and less cognitive deficits, compared to non-abusing patients. However, these dual diagnosis patients suffer from more extrapyramidal symptoms. In particular, our results demonstrate that dual diagnosis patients show less anhedonia, which emphasizes the key role of pleasure in comorbid patients, as anticipated by Dr Roy. We also present preliminary results form an open-label study suggesting a potential beneficial effect of quetiapine among patients with schizophrenia and substance abuse. This study also allowed to highlight intriguing relationships between endogenous cannabinoids, cytokines, schizophrenia and substance abuse. Being promising, these results have paved the way to a broader study evaluating, in the same conditions and using the same parameters, non-abusing patients with schizophrenia and non-psychosis substance abusers.
 
This article examines coocurrence of three types of problems of adaptation during adolescence : abuse of psychotropic drugs, behavioral disorder (oppositional and behavioral disorders) and feelings of depression (depression and dysthymia). The study also examines behavioral, social as well as family characteristics which, during childhood, distinguish youths with many adaptation problems from those with only one or no problem. More than 1600 youths from all regions of Quebec participated in the study. These youths were around 15,7 years old when they completed an interview aiming at determining the possible presence of abusive use of psychotropic drugs, behavioral problems and feelings of depression. Their behavioral and sociofamilial characteristics had been previously evaluated (between the ages of 6 and 12) with questionnaires answered by parents and teachers. Results reveal that almost 10 % of youths experience two or three adaptation problems. These youths distinguish themselves from those with only one problem on various personal and sociofamilial dimensions in the course of childhood. Those with one problem represent a little more than 25 % of the sample. They also distinguish themselves from the group of youth with no problem on several variables. However, the group of youths with a problem of substance abuse only, is an exception. The discussion underlines the importance of knowing if there is simultaneous presence of several problems and proposes to intervene in a preventive fashion with youths who risk experiencing many problems.
 
During the course of 2001, a team of researchers and clinicians supported by Health Canada developed guidelines for best practices related to concurrent mental health and substance abuse disorders. This article first describes the importance of best practices for Health Canada followed by a description of the processes of research as well as consultation of the editorial team. We hope that these methodological elements will serve as reference for the development of best practices for other mental health problems. This article will not summarize the content of the guidelines for best practices found in the monograph, if only to illustrate examples of what we wish to transmit to the reader.
 
The phenomenon of child abuse and neglect has always existed in Western society. Yet, it is only recently that clinicians and researchers have taken a serious look at these problems. This ever growing interest has come about from not only the stunning number of cases identified each year, but also by the extent and gravity of consequences observed among children. Several professionals interested by the issue have put forward a great number of etiological factors to try to explain abuse and neglect within the family unit. However, when assessing the proposed theoretical models (psychiatric/psychological, sociological, systemic), it appears that certain simple factors can play a large role, for instance the history behind parental development, the quality of marital relations, the child-parent relation, the stress and the extent of the social network, but none of these can clearly differentiate abusive families from non abusive families. It seems however that these different explicative factors would be even more valuable if they were considered in interaction rather than taken individually. Inspired by the ecological framework proposed by Bronfenbrenner (1977, 1979), Belsky (1980, 1984) as well as Cicchetti and Rizley (1981) have also developed a model that simultaneously takes into account all of these factors and their interaction.
 
This study examines the emotional reactions of 118 mothers after the disclosure of the sexual assault of their child. After tracing a portrait of these mothers, the study attempts to determine the importance of the psychological symptoms and identify psychosocial factors likely to influence them. Results show that mothers present various configurations of psychological symptoms and that many experience distress exceeding the clinical treshold. The presence of these symptoms is specifically associated to a limited number of psychosocial factors. The discussion highlights the importance of distress experienced by mothers of sexually abused children and the support they need from professional health workers to deal with the situation.
 
With the advent of feminist ideology, women believed they could fashion made-to-measure tools to end their oppression and emancipate themselves. However, passing from ideology to practice has led to a certain number of difficulties. On the other hand, the feminist viewpoint has made a major and undeniable contribution to society. This article discusses the trials and tribulations as well as the successes of feminist practice.
 
In this article, some hopeful outlooks on the evolution of the law are identified and ways of assessing the state and progress of legislation are advanced, drawing from international organizations and some inspiring efforts in other countries. Potential contributors to the evolution of Canadian mental health law are surveyed. The author concludes that there are coherent ways of changing tack, although in this fraught legislative field, no one can make confident predictions about the future.
 
L'hexaflex et les six processus de flexibilité psychologique  
In terms of prevalence, Obsessive compulsive disorder is the 4th ranked psychiatric disorder. Current treatments include 1st and 2nd wave cognitive behavioural therapies involving exposure and cognitive restructuring. However, 3rd wave therapies such as mindfulness and acceptance and commitment therapy (ACT) are also increasingly recognized as treatments of choice. The current article describes the underlying theory of ACT including relational frame theory, its clinical target: experiential avoidance, its main processes and a tool for the delivery of ACT to patients, the matrix. Rather than aiming to restructure problematic thoughts and evaluations, ACT seeks to train psychological flexibility, the ability to distance from problematic thoughts and accept uncomfortable emotion in the service of engaging personally valued actions. This can help move patient behaviour away from the aversive control of anxiety and obsessions and toward the appetitive control of personal values. The application of ACT to OCD is illustrated by a successful case study.
 
Cognitive behavioral therapy (CBT) is one of the main approaches in psychotherapy. It teaches the patient to examine the link between dysfunctional thoughts and maladaptive behaviors and to re- evaluate the cognitive biases involved in the maintenance of symptoms by using strategies such as guided discovery. CBT is constantly evolving in part to improve its' effectiveness and accessibility. Thus in the last decade, increasingly popular approaches based on mindfulness and acceptance have emerged. These therapies do not attempt to modify cognitions even when they are biased and dysfunctional but rather seek a change in the relationship between the individual and the symptoms. This article aims to present the historical context that has allowed the emergence of this trend, the points of convergence and divergence with traditional CBT as well as a brief presentation of the different therapies based on mindfulness meditation and acceptance. Hayes (2004) described three successive waves in behavior therapy, each characterized by "dominant assumptions, methods and goals": traditional behavior therapy, cognitive therapy and therapies based on mindfulness meditation and acceptance. The latter consider that human suffering occurs when the individual lives a restricted life in order avoid pain and immediate discomfort to the detriment of his global wellbeing. These therapies combine mindfulness, experiential, acceptance strategies with traditional behavior principles in order to attain lasting results. There are significant points of convergence between traditional CBT and therapies based on mindfulness meditation and acceptance. They are both empirically validated, based upon a theoretical model postulating that avoidance is key in the maintenance of psychopathology and they recommend an approach strategy in order to overcome the identified problem. They both use behavioral techniques in the context of a collaborative relationship in order to identify precise problems and to achieve specific goals. They focus on the present moment rather than on historical causes. However, they also present significant differences: control vs acceptance of thoughts, focus on cognition vs behavior, focus on the relationship between the individual and his thoughts vs cognitive content, goal of modifying dysfunctional beliefs vs metacognitive processes, use of experiential vs didactic methods, focus on symptoms vs quality of life, strategies used before vs after the unfolding of full emotional response. The main interventions based on mindfulness meditation and acceptance are: Acceptance and Commitment Therapy, Functional Analytic Therapy, the expanded model of Behavioral Activation, Metacognitive Therapy, Mindfulness based Cognitive Therapy, Dialectic Behavior Therapy, Integrative Behavioral Couples Therapy and Compassionate Mind Training. These are described in this article. They offer concepts and techniques which might enhance therapeutic efficacy. They teach a new way to deploy attention and to enter into a relationship with current experience (for example, defusion) in order to diminish cognitive reactivity, a maintenance factor for psychopathology, and to enhance psychological flexibility. The focus on cognitive process, metacognition as well as cognitive content might yield additional benefits in therapy. It is possible to combine traditional CBT with third wave approaches by using psychoeducation and cognitive restructuring in the beginning phases of therapy in order to establish thought bias and to then encourage acceptance of internal experiences as well as exposure to feared stimuli rather than to continue to use cognitive restructuring techniques. Traditional CBT and third wave approaches seem to impact different processes: the former enhance the capacity to observe and describe experiences and the latter diminish experiential avoidance and increase conscious action as well as acceptance. The identification of personal values helps to motivate the individual to undertake actions required in order to enhance quality of life. In the case of chronic illness, it diminishes suffering by increasing acceptance. Although the evidence base supporting the efficacy of third wave approaches is less robust than in the case of traditional cognitive or behavior therapy, therapies based on mindfulness meditation and acceptance are promising interventions that might help to elucidate change process and offer complementary strategies in order to help patients.
 
Objectives: The purpose of this article is to present the characteristics of the Acceptance and Commitment Therapy (ACT) for the treatment of chronic pain. The historical context of the development of cognitive and behavioural therapy (CBT) for chronic pain will be described and the theoretical aspects of ACT will be introduced. The components of an acceptance and mindfulness based treatment will also be presented by exploring various processes of the psychological flexibility model. Finally, the article will summarize the scientific evidence supporting ACT based on experimental, correlational and clinical studies in the field of chronic pain. Method: The theoretical aspects underlying ACT, as well as its clinical components in the specific domain of chronic pain were described based on major books in this area, such as McCracken (2005) and Dahl et al. (2005). A descriptive literature review was undertaken to explore the data on the efficacy of ACT for the treatment of chronic pain. Psycinfo and Medline, as well as the Association for Contextual Science website were analyzed for relevant articles. The key search terms were: "Acceptance and Commitment Therapy" or "ACT" or "acceptance" or "mindfulness" or "defusion" and "chronic pain" or "pain." The reference lists of the articles retrieved were also analyzed. The articles that were not in English or French were excluded as well as those that were not specific to ACT and chronic pain. Results: Results show that ACT is a relevant and empirically supported approach that may be used as a complement to CBT strategies in the treatment of chronic pain. There is growing evidence stemming from experimental and correlational studies that support the majority of the ACT processes. Clinical studies undertaken in the field of chronic pain from different backgrounds support the efficacy of ACT for the management of this condition. Conclusion: ACT is a promising and evidence-based approach for the treatment of chronic pain. More research is needed to further validate its theoretical model and further refine our understanding of how ACT could be effective for the management of chronic pain and enhance quality of life for people who suffer from this health condition. For now, ACT is considered to be as effective as traditional cognitive and behavioral therapy for chronic pain.
 
In this article, the author describes the help program provided for the employees at the Royal Bank. Named "Access", this program is available to all employees of the bank, their immediate family and also retired personnel. In the first part of the article the author gives a detailed description of the program. In the second part, using a question and answer format, he reviews the main questions the employee asks himself before joining the program. Finally, the author quotes statistics showing that the program "Access" answers a real need.
 
Everyone has a certain knowledge of what psychologically constitutes him/her. Part of the therapist's ethical approach is to help this knowledge come to conscience. Apart from the analytical process, within one or a few therapeutic sessions, is the person consulting able to have access to a minimal knowledge about him-herself? Using this knowledge to guide certain aspects of his-her life, calls upon an ethics of responsibility on the part of the person consulting. To have this knowledge emerge demands on the therapists' part, a concept of the human being that takes into account subjective dimensions of the person.
 
APIC (Citizen Accompaniment Project for Community Integration) offers support for the social integration of people living with traumatic brain injury. The accompanying citizen meets the person three hours a week for a period of a year in order to offer assistance in the accomplishment of his/her projects and activities. This role confronts the accompanying citizen with many challenges that may put their mental health at risk. This article offers a reflection on this practice from the accompanying citizen's perspective. Five principles that can help better delimit and define citizen accompaniment are drawn from the results: 1) finding a "good distance" in the relationship to the accompanied person, 2) considering all of the actors in the process, 3) putting the accompanied person and their desires at the heart of the practice, 4) accepting not knowing everything, 5) being committed to the project and accepting it may transform you.
 
This cross-sectional study examined the effect of immigration and acculturative stress on the mental health of a sample of 197 Lebanese immigrants in Montreal. An Orthogonal Model of Cultural Identification was used to determine whether the acculturation style adopted by immigrants had any effect on mental health or on acculturative stress. Results revealed no significant differences in psychological distress between the Lebanese sample and a comparative group of Quebec native-born. Among the indices of acculturative stress, adaptation problems alone predicted psychological distress. Finally, acculturation styles did not have any effect on psychological distress or on acculturative stress indices, with discrimination excepted. Individuals who adopted the Assimilation style reported less discrimination than those in the Ethnocentric and Integration groups. Results are discussed with reference to findings reported in the literature on Canadian studies.
 
This study examines the links between acculturation and psychological adjustment of 94 Somalian refugee women. On a group level, the preferred mode of acculturation is integration. Somalian women who have lived the longest in Canada identify more as Canadians and perceive more discrimination against themselves and against Somalians in general. Moreover, the endorsement of the mode of acculturation by integration implies a refusal of other modes such as assimilation, rejection and marginalization. Important links are also established between age, the desire to take part in Canadian society and mental health. Young women especially distinguish themselves from the group as they have a tendency to have a higher level of depression. Moreover, those refugees who have emigrated for political reasons wish to return to their homeland and are less satisfied with their life in Canada.
 
The feeling of not being acknowledged at work, though frequently reported, is rarely addressed in itself. As the reflection of a subjective position that is as much existential as it is institutional or professional, it emerges through the monitoring of a hospital-based closed discussion group for a period of six years as a screen masking more personal dimensions that are anything but clear to the subjects and rarely thought about in themselves. This leads us to question the system of representations adopted by caregivers and their ability to be satisfied. It imbues the speech of people with burnout syndrome with a tone of profound disappointment and translates a feeling of uselessness, of professional expectations that were probably too high to be satisfied. In effect, it disrupts subjects' relationship to their work, to their professional environment and even to their patients. It consequently deserves to be listened to more attentively.
 
Top-cited authors
Alain Lesage
  • L'Institut universitaire en santé mentale de Québec
Louis Rochette
  • Institut National de Santé Publique du Québec (INSPQ)
Éric Pelletier
  • Institut National de Santé Publique du Québec (INSPQ)
Baudouin Forgeot d'Arc
  • Université de Montréal
Isabelle Courcy
  • Université de Montréal