INTRODUCTION: Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target. METHOD: A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated. RESULTS: Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another. DISCUSSION: The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.
Introduction: The transdiagnostic approach has been shown to offer promising prospects in psychopathology, based on the observation that common factors may be involved in different psychiatric disorders. The transdiagnostic skills scale (T2S) was developed recently to assess the skills that are disrupted in these disorders. However, studies have shown that the T2S has lower predictive power for externalizing than internalizing disorders. This may be due to the fact that the skills assessed do not include the control of urges and cravings. The aims of the current study are thus to develop a revised version of the T2S (T2S-R) integrating this dimension, and to assess its factor structure and invariance across employment status (workers vs. students) and the level of psychopathology. Method: We recruited 1,298 French participants online through social media. They completed the revised version of the T2S and the symptomatic transdiagnostic test (S2T), which evaluates 11 clusters of psychiatric symptoms. We assessed the factor structure, internal consistency, invariance, and predictive validity of the revised T2S. Results: We found a good fit for a bifactor exploratory structural equation modeling (B-ESEM) approach including a global skills factor and seven specific factors. The results also indicate that the new dimension (i.e., control of urges and cravings) has good predictive value, especially for externalizing problems. We also found total invariance of the scale across employment status and partial invariance across the level of psychopathology. Conclusion: The revised version of the T2S-R has good psychometric properties. It predicts better externalizing problems than the original version. However, the scale remains more correlated with internalizing than externalizing problems. We discuss the implications of the results on the transdiagnostic conceptualization and the interest of using a mixed approach combining transdiagnostic and diagnostic analyses.
Nowadays, two distinct conceptualizations are available to classify, label and guide the treatment of psychiatric disorders: the diagnostic approach and the transdiagnostic approach. There are pros and cons to both approaches. We propose here to link these two conceptualizations by creating a two-level clinical model that takes advantages of both approaches, named the bifocal model (BFM). This two-tier clinical model consists of a double level of analysis: the first step is to identify transdiagnostic mechanisms involved in multiple disorders and then to recognize specific mechanisms identified in a given disorder or cluster of symptoms. Such a process would bring the diagnostic and transdiagnostic approaches together and offer a more flexible way to understand mental disorders and ultimately to improve medical outcomes.
Mental Disorders , Humans , Mental Disorders/diagnosis , Mental Disorders/therapy
Previous studies set out profound cognitive impairments in subjects with treatment-resistant depression (TRD). However, little is known about the course of such alterations depending on levels of improvement in those patients followed longitudinally. The main objective of this study was to describe the course of cognitive impairments in responder versus non-responder TRD patients at one-year follow-up. The second aim was to evaluate the predictive aspect of cognitive impairments to treatment resistance in patients suffering from TRD. We included 131 patients from a longitudinal cohort (FACE-DR) of the French Network of Expert TRD Centers. They undertook comprehensive sociodemographic, clinical, global functioning, and neuropsychological testing (TMT, Baddeley task, verbal fluencies, WAIS-4 subtests, D2 and RLRI-16) at baseline (V0) and one-year follow-up (V1). Most patients (n = 83; 63.36%) did not respond (47 women, 49.47 ± 12.64 years old), while one-third of patients responded (n = 48, 30 women, 54.06 ± 12.03 years old). We compared the cognitive performances of participants to average theoretical performances in the general population. In addition, we compared the cognitive performances of patients between V1 and V0 and responder versus non-responder patients at V1. We observed cognitive impairments during the episode and after a therapeutic response. Overall, each of them tended to show an increase in their cognitive scores. Improvement was more prominent in responders at V1 compared to their non-responder counterparts. They experienced a more marked improvement in code, digit span, arithmetic, similarities, and D2 tasks. Patients suffering from TRD have significant cognitive impairments that persist but alleviate after therapeutic response. Cognitive remediation should be proposed after therapeutic response to improve efficiency and increase the daily functioning.
INTRODUCTION: Psychotherapy has proved its efficacy for treating a wide range of psychological disorders. Most types of psychotherapy have been developed to treat specific disorders and validated through controlled-randomized trials. In recent years, researchers have developed a new way to conceptualize patients' difficulties, focusing on processes instead of diagnoses. However, there is no simple scale that evaluates transdiagnostic processes, and the development of such a tool is thus the aim of this study. METHOD: We identified 12 processes that can be targeted in cognitive behavior therapy and created the Transdiagnostic Skills Scale (T2S) to evaluate them. We measured its internal consistency, factor structure and convergent validity in clinical and non-clinical samples. RESULTS: We found a 6-factor structure composed of emotion regulation, behavioral activation/planning, emotional identification, assertiveness, problem solving and emotional confrontation. The T2S has high internal consistency (Cronbach's alpha = 0.95). We found negative associations between skills and symptoms of anxiety, depression and eating disorders. We found no association between these processes and symptoms of either alcohol or cannabis use disorder. CONCLUSIONS: The T2S is a useful and valid tool to identify the skills that clinicians should work on with their patients. It offers a complementary way to understand patients' difficulties when categorical assessment is complicated.
Cognitive Behavioral Therapy , Emotions , Humans , Treatment Outcome , Anxiety/therapy , Anxiety Disorders/psychology
Objectives: COVID-19 pandemic and its consequences have put into great difficulty health professionals, and the general population, fostering the emergence of various psychological and psychiatric disorders. Medical and psychological emergency units' mission is the medical and psychological emergency care of people impacted during a traumatic event. Given their expertise in crisis management, they set up an important medical and psychological support system adapted to the health crisis' characteristics. The unusual modalities of intervention, the specific clinic that these professionals faced in this context of great tension may have unsettled workers and generate a psychological impact. This study aims to assess the existence of such repercussions among medical and psychological emergency unit professionals involved in this new system. Method: In all, 313 medical and psychological emergency unit professionals agreed to participate at the online survey. They filled surveys and visual analog scales assessing the difficulties encountered in the system, as well as their level of satisfaction, post-traumatic stress, burnout, level of anxiety and depression and coping strategies put in place. Results: Results show few significant emotional difficulties. However higher scores are found among women, among professionals who felt a negative impact on their personal lives, as well as for those who thought they had been infected with COVID-19. The establishment of coping strategies such as active coping, planning, expressing feelings, positive reinterpretation and acceptance helped to decrease the level of emotional complexities and brought more compassionate satisfaction. We note that participants with more medical and psychological emergency unit experience tend to show less emotional hardship and more compassionate satisfaction. It appears that older as well as younger professionals have lower burnout scores, as do workers who conducted more interviews for the same person. Likewise, participants who were satisfied of the system organization and of the support - a majority in this study - report less emotional challenges and more compassionate satisfaction. Conclusion: Psychological impact in this new system among medical and psychological emergency unit professionals is overall low. It appears that some coping strategies, perceived usefulness, satisfaction with the organization and the received support are associated with a lower level of emotional difficulties. A supportive framework and an operative organization of the medical and psychological emergency unit system in times of crisis has a protective effect on the participants.
BACKGROUND: Innovative therapeutic interventions for post-traumatic stress disorder (PTSD) are required. We opted to facilitate fear extinction by combining trauma script exposure with repetitive transcranial magnetic stimulation (rTMS) to reduce symptoms of PTSD. OBJECTIVE: The efficacy and safety of 10 Hz rTMS of the right dorsolateral prefrontal cortex simultaneously with exposure to personal traumatic narrative were studied in patients with PTSD. MATERIALS AND METHODS: This trial was a single-center randomized controlled trial (NCT02584894). Patients were randomly assigned 1:1 to receive eight daily sessions of 110% of motor threshold high frequency (HF) 10 Hz rTMS (110% HF rTMS) or 70% low frequency (LF) 1 Hz rTMS (70% LF rTMS) with trauma script exposure in both groups. Severity of PTSD, depression, and anxiety were assessed before and after study treatment (one month, three months) by an assessor masked to the trial group assignment. The primary outcome was the severity of PTSD assessed by the Clinician Administered PTSD Scale (CAPS). We used mixed linear regression models for statistical comparisons. RESULTS: Thirty-eight patients (65.8% females) were randomly assigned to 110% HF rTMS (n = 18, 31.3 ± 10.0 years, 13 females) or 70% LF rTMS (n = 20, 33.5 ± 11.1 years, 12 females). From baseline to three months, mean CAPS scores decreased by 51% in the 110% HF rTMS group (from 83.7 ± 14.4 to 41.8 ± 31.9) and by 36.9% in the 70% LF rTMS group (from 81.8 ± 15.6 to 51.6 ± 23.7), but with no significant difference in improvement (time by treatment interaction -3.61 [95% confidence interval (CI), -9.70 to 2.47]; p = 0.24; effect size 0.53). One serious adverse event occurred during the study (psychogenic nonepileptic seizure). CONCLUSION: We found no evidence of difference in clinical improvement or remission rates between the 110% HF and 70% LF stimulation. These findings may reflect the importance of exposure procedure and that larger number of participants is needed.
Stress Disorders, Post-Traumatic , Transcranial Magnetic Stimulation , Extinction, Psychological , Fear , Female , Humans , Male , Prefrontal Cortex , Stress Disorders, Post-Traumatic/therapy , Transcranial Magnetic Stimulation/adverse effects , Transcranial Magnetic Stimulation/methods , Treatment Outcome
Background: COVID-19 sanitary crisis is associated with emotional difficulties such as depression, anxiety and reactional post-traumatic symptoms among healthcare workers. Indeed, healthcare workers were particularly exposed to COVID-19 sanitary crisis. This study aimed to investigate the effects of exposure to COVID-19 sanitary crisis on affective symptoms (anxiety, post-traumatic stress, burnout) among French healthcare workers and the mediating role of cognitive emotion regulation strategies (positive re-evaluation and set in perspective) and coping strategies (active coping, planning, instrumental support, emotional support, emotional expression, positive reappraisal, acceptance, denial, blame, humor, religion, distraction, substance use, behavioral disengagement). Method: This cross-sectional survey-based study collected demographic data and mental health measurements from 1,010 volunteers (838 women) who consented online to participate, from March 24 to June 28, 2020, in France. Participants filled out online questionnaires and visual analogic scales that evaluate affective symptoms related to the COVID-19 sanitary crisis, namely symptoms of post-traumatic stress, burnout, emotion regulation abilities, and coping abilities. Results: The majority (57.8%) of the participants presented post-traumatic symptoms. Depending on the sub-dimensions evaluated, a proportion of participants reported moderate (25.9-31.2%) to severe (17.2-40.7%) burnout symptoms. We found a significant effect of the level of exposure to COVID-19 on affective symptoms. Being a woman, having a lower job position and having less experience were associated with higher level of affective symptoms. Moreover, coping strategies had a mediating effect on the relation between stress and burnout, supporting the coping reserve model. Conclusion: Post-traumatic and burnout symptoms were highly prevalent among French healthcare workers at the beginning of the COVID-19 crisis. Exposure to COVID-19 is a determining factor. We can thus promote both coping training and a good environment to limit the emotional consequences of exposure to COVID-19.
BACKGROUND: The purpose of this study is to assess the psychometric properties of the French version of the Positivity scale (P scale), a self-report measure of positivity, which is the tendency to view and address life and experience with a positive outlook. Positivity is seen as a latent factor underlying multiple cognitive concepts such as self-esteem, life satisfaction, and optimism. METHODS: We recruited 666 volunteers (540 women and 126 men). They completed the P scale online, as well as self-report measures of psychological well-being, self-esteem, satisfaction with life, general health, and personality dimensions. The study sample was randomly split into two sub-groups, one used for exploratory factor analysis and the other for confirmatory factor analysis. RESULTS: We found conflictual results related to the uni-dimensionality of the French version of the P scale. We found good internal consistency and high concurrent validity. CONCLUSION: The French version of the P scale demonstrated good psychometric qualities and is a reliable tool that can now be used by French researchers and clinicians to assess positivity.
