Étude qualitative de l’expérience de la formation en hypnose clinique pour les professionnels de santé

ObjectiveTraining in clinical hypnosis leads to important transformations in healthcare professionals, in their professional practices as well as in their personal lives. The objective of this study was to explore how health professionals experience the transformations that result from such a training.MethodSemi-structured interviews with health professionals from France and Europe were conducted. The qualitative method used was Interpretative Phenomenological Analysis. Purposive sampling required to include participants from different professions, experience and regions of origin. They had already completed training in clinical hypnosis at different teaching institutions.ResultsTen participants were included. The analysis showed four meta-themes of experience. First, it revealed participants’ motivations for training in clinical hypnosis as one's desire to improve one's practice, leading to extraordinary discoveries, at a particular timing in their life. Second, participants described that hypnosis sometimes set the ground for a relationship verging on the more “intimate”, therefore requiring greater caution so as not to disrupt the patient/healthcare professional relationship. Third, some participants experienced unforeseen personal fulfilment, better self-regulation of emotions and improved quality of life as well as greater comfort at the workplace. Finally, this study shed light on two limitations of training in clinical hypnosis as it can sometimes generate stress for the participants and/or result in bring about potential harmful effects: one of the risks being that the trainer might cross some ethical lines.DiscussionThe level of personal change experienced by the participants is similar to some changes induced by personal psychotherapy. For several participants, issues of power and vulnerability in the relationship using hypnosis were associated with a feeling of instability during the training. In hypnosis, the management of an asymmetrical relationship involves a two-way risk: vulnerability of the hypnotized person to the all-powerful relationship of their therapist as well as destabilization of therapists by the reduction of power asymmetry during hypnotic work with their patients.     

Étude des vécus de violences à l’encontre des femmes criminelles

BackgroundWomen constitute around 17% of criminal offenders. However, few studies have addressed criminality in females. The current study aims to determine the prevalence of violence inflicted upon a sample of 91 female criminals during their adult life and compare it to the general female population, in order to provide a better understanding of female crime.MaterialData was collected, between 2014 and 2019, from the criminal expertise files of an expert at the Rennes Court of Appeal for women aged over 15. History of violence experienced as defined by the WHO criteria, where included.ResultsNinety-one criminal expertise files were included. The prevalence of violence experienced during adulthood was 57.1%, a prevalence significantly higher than that of the general European and international female population. Furthermore, these women reported experiences of violence independently of their age in 76.1% of cases.ConclusionOur study highlights an important prevalence of experiences of violence in the life course of criminal women. This victimization appears to be closely related to criminality in women and seems to be a key point in understanding female criminality. In addition, psychiatric disorders are frequent in this population and are over-represented by substance use and personality disorders. The latter two disorders appear to be conditioned by a history of experienced violence, seem associated with crime and to increase the risk of committing a violent act. Therefore, experiences of violence seem to be a predisposing factor to the development of medico-legal issues.     

Les corrélats des traits de personnalité psychopathiques dans un échantillon d’étudiants universitaires en Tunisie

BackgroundAlthough psychopathy and its predictive factors are well documented in clinical samples, studies in non-clinical populations are relatively rare. We proposed to assess psychopathy traits in a population of Tunisian university students and to analyze their predictive factors.MethodThis was a cross-sectional study of 516 university students enrolled at three major Tunisian universities (Faculty of Humanities and Social Sciences of Tunis, National Engineering School of Tunis, Faculty of Medicine of Tunis). Participants responded to a survey sheet containing sociodemographic data and the Levenson Self-Report Psychopathy Scale.ResultsThe students were female in 63.2 % of the cases, with a mean age of 22.7 years. The socio-economic level was middle class in 62.4% of the cases. More than one-quarter of students (26.7%) consumed tobacco. The majority of students (81.4%) spent their free time on the Internet, while 11.8% participated in associative work. Psychopathy scores were relatively high (mean LSRPS scores = 64.8) with no noticeable gender differences. Psychopathic traits were significantly associated with university (P = 0.017), maternal occupational status (P = 0.038), and tobacco use (P = 0.029). In addition, the total psychopathy score was significantly lower among students sharing activities with their families (P = 0.044) and among students participating in associational work (P = 0.025). The multivariate multiple regression has retained as predictive factors of psychopathic traits the fact of being the eldest of his siblings and the associative work.ConclusionPrevention strategies should be put in place to prevent psychopathy and its individual and social impacts in young adults in general, and in university students in particular, especially promoting associative activity in the university environment which is currently lacking in our context.     

Sortir des addictions : à l’alcool,par l’alcool ou vers l’alcool

Pathways from alcoholism to recovery are documented; less often are those from drug addiction to alcoholism. Biographical approaches allow analyzing how people change their uses and talk about their trajectories of recovery.

Étude pilote de l’inclusion professionnelle en milieu ordinaire de personnes atteintes d’autisme

Objective

Study concerned of job types of tasks analysis performed in firm by six adults with autism and in autonomy's degree with which they were these ones, while they were accompanied during all their professional activities by expert in autism coaches in the context of an Intervention-Development-Home-School-Firm-Supervision’ Program (IDHSFS). The objective is to research types of tasks in which adults were more or less autonomous in order to identify these ones needing specific interventions and guidance actions.

Évaluation des troubles thymiques par l’étude des données passives : le concept de phénotype digital à l’épreuve de la culture de métier de psychiatre

Objectives

The search for objective clinical signs is a constant practitioners’ and researchers’ concern in psychiatry. New technologies (embedded sensors, artificial intelligence) give an easier access to untapped information such as passive data (i.e. that do not require patient intervention). The concept of “digital phenotype” is emerging in psychiatry: a psychomotor alteration translated by accelerometer's modifications contrasting with the usual functioning of the subject, or the graphorrhea of patients presenting a manic episode which is replaced by an increase of SMS sent. Our main objective is to highlight the digital phenotype of mood disorders by means of a selective review of the literature.

Étude de faisabilité d’une exposition thérapeutique en réalité virtuelle pour joueurs pathologiques

The experiment presented is the result of a partnership between the Paris-Nanterre University (CLIPSYD laboratory, EA 4430) and the CSAPA Imagine (Simone Veil Hospital, GH Eaubonne-Montmorency). Virtual reality immersion exposure for pathological gamblers is beneficial in the context of cognitive and behavioral interventions. It can be used to evoke the desire to play and to have access to automatic thoughts and mistaken beliefs of the players when they find themselves in a gambling context. Exposure is used until the urge to play diminishes and disappears which is the process of desensitization or extinction.ObjectiveThe objective of the study was to investigate the possibilities implemented by virtual reality in the case of an exhibition for pathological gamers to create a desire to play and work with the patient in an environment identical to the ecological one. Two hypotheses were proposed. On the one hand, the virtual reality exhibition will help to change the desire to play in relation to the game. On the other hand, virtual exhibition sessions associated with cognitive restructuring will have a greater impact on the perception of reality.MethodAfter a diagnosis was made, participation in the study was offered to patients (n = 10) in routine care and able to participate (exclusion criteria). It consisted of four virtual reality exposure sessions integrated with traditional care. Exposure did not exceed 20 minutes. To carry out this study we used the virtual reality headset “Oculus Rift CV1” and the headphones measuring EEG waves, “Emotiv Epoc”. A battery of questionnaires were proposed to evaluate gambling-related behaviors (ICJP, GRCS, UPPS), to analyze the interest of the virtual reality exhibition (SIS, CGI, TEI, EVA), and to glimpse the immersion abilities (QEP and QPI).ResultsTen participants aged 25 to 60 agreed to participate in the study. The results of this study demonstrated the viability of RV gamers’ exposure as a tool that can help reduce pathological gambling symptoms and the severity perceived by therapists (CPI: t = 1.6, P = 0.001; CGI: t = 4.87, P = 0.001) between the beginning of the care and the end of the care and at D+1. We were also able to observe significant results (P < 0.05) concerning a decrease in cognitive distortions (GRCS tot, Illusion of control, Power of prediction, Favorable interpretation).ConclusionThe feasibility study shows that the desire to play is very present during the virtual reality exhibition in accordance with literature studies. The results also demonstrate the utility of virtual reality to allow the patient to elaborate on the cognitive distortions associated with the practice of pathological gambling. From a therapeutic point of view, the results suggest that virtual reality can increase the effectiveness of cognitive restructuring and increase understanding of the urge to play related to stimuli in the environment of play.     

Étude rétrospective des bénéfices développementaux et comportementaux d’une intervention psycho-éducative pour des enfants porteurs d’un Trouble du Spectre de l’Autisme

The purpose of the study is to measure the impact of a 4-year-psycho-educative intervention on the skills and behaviors of 26 children with autism located a Day Center Hospital of High Normandy. Communication, autonomy and social abilities are the main area stimulated in order to develop the skills of the children. Autistic behaviors are referring to the behavioral patterns associated to autism which could limit social integration as well as the availability of the child for the proposed acquisitions. To estimate the children's progress during the period of intervention, tests and scales adapted for autism, recommended and validated are used (PEP, Vineland and ECA). The evolution rates are calculated from the scores obtained every year in these evaluations. They allow to quantify in percentage the evolution between two dates. These analysis show evidence of 89% of increasing in psycho-educative abilities (PEP), 79% in socio-adaptive competencies (Vineland) and 73% of decreasing in autistic behavior (ECA). The children's acquisitions testify of progress in favor of new skills development from one year to the next: faster progress are observed at the beginning of the program, a threshold effect is noticed after several years of intervention. The regulation of the autistic behavior is globally more and more effective during the intervention, although punctual periods of outbreaks of this behavior are observed. The length of the intervention also has a favourable impact on the progress in all the domains.     

Contribution à l’étude clinique des institutions de soins. Le fantasme de l’institution malfaisante

In France, the lens with which clinical psychology gazes through institutional matters seems limited to what happens between patients and professionals. It pays little interest to the interactions between the administration of the institution, i.e. organizational matters, and the daily clinical setting of mental health care. Unconscious institutional dynamics seem to receive much more attention from management sciences, which sometimes use psychoanalytical concepts to shed light on managerial and organizational problems. This article, based on an action-research study in a French university hospital, aims to shed light on one of the unconscious mental constructs which could be at the root of what several authors in psychiatry have identified as “institutional paranoia”: the fantasy of a malicious institution. We hypothesize that this fantasy, which attributes harmful intentions towards its agents to the institution, is a recurrent avatar of the typical problem institutional psychology deals with. It is therefore even more specific to hospitals, due to the abundantly documented tensions which they have been faced during the last two decades. We were initially appointed to conduct a “cooperative action research” project in a French University Hospital Centre between October 2018 and September 2019, in order to write a preliminary research report on the quality of working life as experienced by its personnel. Four ethnographic qualitative research techniques were used to assess the needs of healthcare professionals: individual and group interviews with teams from all departments (health care, administrative, logistical and technical), on formal or informal times, participant observations in services which were later recorded in a written logbook, interprofessional working groups called “thematic commissions” that met for five sessions of 3 hours each and the creation of a digital “suggestion box” accessible on the hospital's intranet. Our results show the fantasy of the malicious institution deserves to be isolated due to its three constitutive elements: 1) a blurry institutional governance and incarnation of the hospital's leadership; 2) the recognition of the symbolic power of the institution, including its coercive power; and 3) the attribution of negative intentions to the institution by aggressive projections, which in turn transform it into a persecuting object. We discuss the link between the feeling of belonging to the institution and the feeling of abandonment as experienced by staff in regards to the religious past of French hospitals, and indicate the necessity but also the caution with which research can and must investigate the weight of the personal history and vulnerability of each individual in his or her sensitivity to the representation of the malicious institution.