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Background: The present study investigates the possibilities of using heart-rate variability (HRV) parameters as physiological markers that precede increase in observed behavioral excitation of intellectually disabled individuals. The ability to recognize or predict such patterns, especially in patients showing unpredictable reactions and language deficiencies, might be a major step forward in clinical research. Method: Thirteen volunteers with intellectual disabilities, who had suffered of at least one event of overt aggression in the preceding three months, participated to the study. The protocol consists in the acquisition of continuous electrocardiogram (ECG) throughout approximately two times of 8 hours in natural situation, using a t-shirt integrated with sensors . Simultaneously, an observer evaluates the patient’s level of overt excitation from calm (level 1) to extremely tense (level 5) and send online via Bluetooth these triggers into the ECG signals. The HRV indexes were then estimated offline on the basis of the inter-beat intervals recorded by the ECG, independently for the 30 minutes preceding each behavioral tension marking point, averaged, and compared through nonparametric Wilcoxon matched-pairs test. Of these, the RMSSD and LF/HF calculations were used to observe the fluctuations of inhibitory activity and cardiovagal balance through different tension states. Results: Seven individuals have sufficient reliable data for analysis. They have reached at least a level 3 of behavioral excitation (moderately tense) or more (very to extremely tense, level 4 and 5), and have been retained for further analysis. In sum, a total of 197 periods of tension were kept, made up of 46 periods of slight excitation (level 2), 18 of moderate excitation (level 3), 10 of high excitation (level 4) and 5 of extreme agitation (level 5). Variations in the HRV as a function of degree of excitation are observed for RMSSD index only (inhibitory parasympathetic activity). The changes from calm to increasing levels of excitation are characterized by a significant downfall in RMSSD index when patients were evaluated to be in a very high level of tension (level 4). Conclusion: The presence of precursors to agitation, reflected in the falling-off of parasympathetic activity, offers potentially interesting prospects for therapeutic development.

Toute psychotherapie (et, plus largement, toute therapie) necessite une alliance entre patient(s) et therapeute(s). Etablir, developper et maintenir cette alliance exige souvent du therapeute qu’il recoure a des techniques specifiques. Ne pas les connaitre peut ralentir le processus, diminuer l’efficacite de la psychotherapie, voire interrompre la therapie. Cet ouvrage, qui se veut surtout pratique, presente de maniere operatoire les methodes utiles dans les differents contextes d’intervention : - consultations individuelles ; - consultations de couple ; - consultations familiales ; - consultations avec un autre professionnel ou un benevole ; - animation des groupes. Il est illustre de nombreux exemples cliniques. Complete d’exercices pratiques permettant d’experimenter les techniques (la methode du « petit velo », la technique des Quatre R, etc.), il propose aussi des methodes d’autoevaluation du therapeute. Le plus : Sur un site internet associe, de nombreuses videos presentent les techniques developpees dans l’ouvrage : http://alliance-therapeutique.editions-retz.com Des sequences mettent en scene des entretiens mal conduits par le therapeute, en therapie individuelle et en therapie de couple ; d’autres proposent des entretiens bien conduits. Les commentaires du Dr Charly Cungi eclairent les points negatifs et les points positifs. Certaines videos permettent aussi de s’exercer a partir de cas concrets. Date de premiere edition : 2006.

La societe contemporaine favorise les addictions : tabac, alcool, drogue, jeux, Internet, sexe, sport... Ce qui, au depart, est un plaisir devient tres vite un esclavage dangereux pour l’equilibre psychique de l’individu. Comment se liberer de telles dependances ? Les therapies comportementales et cognitives (TCC) sont une reponse qui, par ses postulats pragmatiques, a su faire ses preuves. Apres une comprehension du probleme, les TCC mettent en œuvre des programmes adaptes aux differents types de dependances ou au comportement probleme. Chaque technique est illustree par des exemples tires de l’experience therapeutique et par des entretiens entre patients et therapeutes. Des exercices et des resumes favorisent l’acquisition de savoir-faire directement utiles et transferables a d’autres situations. Date de premiere edition : 2000.

In clinical practice, anhedonia and apathy are challenging symptoms of schizophrenia. Anhedonia in schizophrenia appears to be associated with impairment in anticipatory pleasure. However, the problem is complicated since comorbid depression occurs in 50 % of patients and the symptoms of the different disorders may overlap. This chapter presents an intervention to train anticipatory pleasure in patients with schizophrenia. This intervention has been evaluated in an exploratory pilot study. Results show that the patients improved on the anticipatory scale of the Temporal Experience of Pleasure Scale. Patients also increased their daily activities. The program is still being improved and should be tested in a controlled study.

La vie nous confronte a des obstacles difficiles a franchir (deuil, separation, perte d’emploi, stress soutenu, conflits au travail ou a la maison, echecs…) avec leur lot d’emotions penibles. Parfois, la souffrance persiste et augmente au point qu’elle empeche la personne de reflechir posement aux problemes qui l’assaillent. La vie perd son attrait. La douleur morale, constante et pesante, apporte la « preuve » qu’il sera impossible de s’en sortir. La pente de la depression est engagee. Cet ouvrage est un guide du savoir-faire depressif. Il s’attaque au versant psychologique de la lutte contre la depression et decrit, de facon pratique et precise, des techniques de restructuration cognitive tres efficaces pour sortir du cycle depressif. En confrontant l’univers interieur de la personne a la realite, ces techniques permettent : - de changer la perception de l’environnement, et donc l’humeur ; - de modifier les croyances sur soi-meme, et donc la confiance en soi ; - de restaurer la vision positive de l’avenir, et donc la capacite a agir. Chaque technique est illustree par des exemples tires de l’experience therapeutique des auteurs, par des entretiens entre patient et therapeute qui montrent les techniques en action sur des cas reels. Des exercices et des resumes favorisent egalement l’acquisition des connaissances et des savoir-faire directement utiles. Date de premiere edition : 1999.

Background: The goal of the present study was to validate the French version of the Agoraphobic Cognitions Questionnaire (ACQ). Methods: Subjects consisted of 115 patients with panic disorder and agoraphobia, 54 obsessive-compulsive patients and 72 normal controls. Patients were referred for outpatient treatment. They filled in the questionnaire before and after entering treatment. The control group consisted of people taken from the general population. It was matched with the clinical groups on age, sex and education. Results: The ACQ appears to have a constant factor structure across US, Dutch and French samples. Results support the validity of the total score of the ACQ. Patients with panic disorder and agoraphobia scored significantly higher than obsessive-compulsive patients and control subjects. On the ACQ physical concerns subscale agoraphobic patients were significantly different from obsessive-compulsive patients and control subjects. On the social/behavioural subscale agoraphobic patients and obsessive-compulsive patients were significantly different from control subjects. The French translation of the ACQ was found to be stable over an interval of 15 days in the control group. The Cronbach coefficients of both subscales were also satisfactory. These results support the stability and the internal consistency of the questionnaire. In addition, the French translation of the ACQ was sensitive to changes with cognitive-behavioural therapy. Conclusions: These results support the findings of Chambless and Gracely [Cogn Ther Res 1989;13:9–20]. The ACQ physical concerns subscale is a specific feature for the anxiety status experienced by patients with panic disorder and agoraphobia. The ACQ social/behavioural subscale seems to be a more general feature of anxious patients.

BackgroundThis multicentre study compared a 16-week buspirone treatment with placebo in patients presenting with panic disorder with agoraphobia and also receiving cognitive behaviour therapy (CBT).MethodDouble-blind testing was maintained until week 68, but not tested; 91 patients were included; 14 placebo-responders excluded; 77 patients randomised; 48 reached week 16 and 41 reached week 68.ResultsAt week 16, within-group analysis showed significant improvements in agoraphobia, panic attacks, and depression in both groups. Generalised anxiety improved only in CBT + buspirone. Between-group comparisons showed buspirone to have an effect on generalised anxiety and agoraphobia. Changes in degree of agoraphobia and depression were correlated in subjects on CBT + buspirone only. A significantly higher proportion of women, and of subjects showing high avoidance dropped out. Positive expectations regarding medication predicted success in both groups. At week 68, improvement was retained without significant buspirone effect.ConclusionBuspirone enhanced the effects of cognitive behaviour therapy on generalised anxiety and agoraphobia in the short term.