FR :

Les interventions basées sur la pleine conscience deviennent de plus en plus populaires. Le présent article présente une recension de ses effets sur la santé mentale et physique, des mécanismes d’action et des recherches en neurobiologie.

EN :

Interventions based on mindfulness have become increasingly popular. This article reviews the empirical literature on its effects on mental and physical health, discusses presumed mechanisms of action as well as its proposed neurobiological underpinning. Mindfulness is associated with increased well-being as well as reduced cognitive reactivity and behavioral avoidance. It seems to contribute to enhance immune functions, diminish inflammation, diminish the reactivity of the autonomic nervous system, increase telomerase activity, lead to higher levels of plasmatic melatonin and serotonin. It enhances the quality of life for patients suffering from chronic pain, fibromylagia and HIV infection. It facilitates adaptation to the diagnosis of cancer and diabetes. It seems to lead to symptomatic improvement in irritable bowel syndrome, chronic fatigue syndrome, hot flashes, insomnia, stress related hyperphagia. It diminishes craving in substance abuse. The proposed mechanism of action are enhanced metacognitive conscience, interoceptive exposure, experiential acceptance, self-management, attention control, memory, relaxation. Six mechanism of actions for which neurological underpinnings have been published are: attention regulation (anterior cingulate cortex), body awareness (insula, temporoparietal junction), emotion regulation (modulation of the amygdala by the lateral prefrontal cortex), cognitive re-evaluation (activation of the dorsal medial prefrontal cortex or diminished activity in prefrontal regions), exposure/extinction/reconsolidation (ventromedial prefrontal cortex, hippocampus, amygdala) and flexible self-concept (prefrontal median cortex, posterior cingulated cortex, insula, temporoparietal junction). The neurobiological effects of meditation are described. These are: (1) the deactivation of the default mode network that generates spontaneous thoughts, contributes to the maintenance of the autobiographical self and is associated with anxiety and depression; (2) the anterior cingulate cortex that underpins attention functions; (3) the anterior insula associated with the perception of visceral sensation, the detection of heartbeat and respiratory rate, and the affective response to pain; (4) the posterior cingulate cortex which helps to understand the context from which a stimulus emerges; (5) the temporoparietal junction which assumes a central role in empathy and compassion; (6) the amygdala implicated in fear responses. The article ends with a short review of the empirical basis supporting the efficacy for mindfulness based intervention and suggested directions for future research.

FR :

La thérapie cognitivo-comportementale (TCC) est une des approches principales en psychothérapie. Elle enseigne au patient à faire le lien entre les cognitions dysfonctionnelles et les comportements mésadaptés et à réévaluer les biais cognitifs qui maintiennent les symptômes en utilisant des stratégies telles que le questionnement socratique. La TCC évolue constamment afin d’en améliorer l’efficacité et l’accessibilité. Dans la dernière décennie, des approches de plus en plus populaires basées sur la pleine conscience et l’acceptation sont proposées. Elles ne visent pas la modification des pensées même si celles-ci peuvent paraître biaisées et dysfonctionnelles, mais cherchent plutôt à changer la relation de l’individu à ses symptômes. L’efficacité de ces approches commence à être documentée. Cet article vise à présenter le contexte historique qui a permis l’émergence de ce courant, les points de convergence et de divergence avec l’approche cognitivo-comportementale traditionnelle ainsi qu’une brève présentation des différentes thérapies basées sur l’acceptation et la pleine conscience.

EN :

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.

FR :

Objectifs : Cette revue vise à résumer les recherches antérieures et en cours portant sur la thérapie cognitive basée sur la pleine conscience (TCBPC) et à illustrer en pratique comment cette forme d’intervention peut aider les personnes à éviter la spirale qui les fera retomber dans la rumination, laquelle fait partie intégrante des épisodes dépressifs majeurs. Méthodologie : Des études comprenant des périodes de suivi à court et à long terme et reposant sur une revue de la documentation sur la TCBPC pour la prévention de rechutes chez les personnes qui présentent des antécédents de dépression majeure ont été incluses. De plus, des études récentes sur des adaptations novatrices de la TCBPC chez de nouvelles populations ont aussi été passées en revue et prises en compte dans le but de dégager les orientations à donner à la recherche future et aux nouvelles applications cliniques. Résultats : Dans la dernière décennie, la TCBPC s’est appuyée sur de solides données probantes en mettant en évidence son efficacité dans la prévention des taux de rechutes dépressives et dans le prolongement des périodes de bien-être. Des études récentes ont fait ressortir plusieurs mécanismes de changement possibles comme une diminution de la réactivité cognitive et une meilleure capacité de décentration, lesquelles déterminent et contribuent à une diminution des symptômes dépressifs. Discussion : Actuellement, de nouvelles applications de la TCBPC s’étendent au-delà de son objectif initial. Des travaux de recherche seront nécessaires pour éclairer l’efficacité et les mécanismes d’action à l’oeuvre une fois la TCBPC appliquée à ces nouvelles populations.

EN :

Against the backdrop of dauntingly high prevalence rates of clinical depression and subsequent relapse, Segal, Teasdale and Williams (2002) sought to develop an intervention that would address the long-term sequence of depression. In the past decade, Mindfulness-Based Cognitive Therapy has been supported with a robust evidence base, highlighting its efficacy in the short, and long-term follow-up studies. Currently, novel adaptations of this intervention are being developed and piloted with a wide range of clinical issues that share amplified ruminative processes as a core feature of pathology. This review aims to summarize current and past research on MBCT, and to practically illuminate how this intervention can aid individuals in stepping out of the ruminative spirals that are part-and-parcel with major depressive episode.

FR :

Les personnes souffrant d’un trouble de la personnalité borderline (TPL) représentent une proportion importante de la clientèle hospitalisée en psychiatrie et de la clientèle ambulatoire. Elles consomment jusqu’à 40 % des ressources en santé mentale. La thérapie comportementale dialectique (TCD) est l’une des thérapies les mieux validées dans les écrits scientifiques pour traiter cette clientèle. Malheureusement, son déploiement au Québec demeure assez limité, entre autres à cause d’un manque de ressources pour offrir la thérapie individuelle et les appels téléphoniques d’urgence. Même si l’approche globale, telle que préconisée initialement, est peu accessible, plusieurs départements de psychiatrie proposent des groupes d’entraînement aux compétences aux personnes souffrant de TPL. Cet article vise à dresser un bref portrait de ce qu’est la TCD, de rendre compte des études sur les groupes TCD et de quelques adaptations existantes. L’auteure présentera le modèle appliqué dans deux milieux psychiatriques québécois, le Centre de santé et de services sociaux du Sud de Lanaudière et le pavillon Albert-Prévost, ainsi que les adaptations prévues dans le cadre du plan d’action en santé mentale.

EN :

Patients suffering from borderline personality disorder (BPD) represent a substantial proportion of hospitalized and outpatient patients in psychiatry. They use up to 40% of mental health resources. Dialectical behavioral therapy (DBT) is one of the best studied treatment for this population. Unfortunately, its deployment in Quebec remains quite limited partly because resources are lacking to provide individual therapy and a response to emergency calls. Although the complete package, as originally studied, is not widely available, several psychiatric departments offer skills training groups for patients with BPD. This article aims to provide a brief overview of the DBT model, review studies on DBT groups and some existing adaptations to the original model. The author will also present the model used in two psychiatric settings, the Centre de Santé et Services Sociaux du Sud de Lanaudière and Pavilion Albert-Prévost, as well as the adaptations in the context of transfers to community health settings.

FR :

Cet article présente une vision de la santé mentale fondée sur le modèle de la flexibilité psychologique sur lequel repose la thérapie d’acceptation et d’engagement (ACT), une approche représentative de la troisième vague des thérapies cognitives-comportementales. Il vise à exposer la théorie et la pratique de l’ACT et à rendre compte de données empiriques qui soutiennent son utilisation clinique.Cet article présente une vision de la santé mentale fondée sur le modèle de la flexibilité psychologique sur lequel repose la thérapie d’acceptation et d’engagement (ACT), une approche représentative de la troisième vague des thérapies cognitives-comportementales. Il vise à exposer la théorie et la pratique de l’ACT et à rendre compte de données empiriques qui soutiennent son utilisation clinique.

EN :

Objective: This paper presents a vision of mental health using the model of psychological flexibility of Acceptance and Commitment Therapy (ACT). ACT is a representative approach of the third wave of cognitive-behavioural therapy (CBT). This article first describes the theoretical and practical aspects of ACT and, in a second part, reviews some of the empirical data supporting its clinical use. Due to the high rate of comorbidity in mental health settings, transdiagnostic approaches in CBT, such as ACT, have recently become popular and particularly appealing to various clinical settings. Method: The theoretical aspects underlying ACT, as well as its clinical components in the treatment of psychopathology were described based on major books in this area, such as Hayes, Strosahl and Wilson (2012). A descriptive literature review was undertaken to explore the data on the efficacy of ACT for the treatment of mental health problems. 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.” The reference lists of the articles retrieved were also analyzed. The articles that were not in English or French were excluded. Results: Data suggest that ACT is particularly effective for stress, anxiety disorders, depression, substance abuse and various chronic medical conditions. The six processes of the model of psychological flexibility have been validated based on the results of correlational and meditational studies. More than seventy randomized clinical trials and a meta-analysis including 18 randomized control trials conclude that ACT is more effective than waiting list, placebo and treatment as usual control conditions. Conclusion: ACT is a promising and evidence-based approach in mental health for the treatment of anxiety and depression as well as for complex and chronic conditions. 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 mental health illness and how it could enhance quality of life for people who suffer from these conditions.

FR :

Cet article vise à présenter les particularités de la thérapie d’acceptation et d’engagement (Acceptance and Commitment Therapy ou « ACT ») dans l’intervention auprès de patients souffrant de douleur chronique. Il décrit le contexte historique du développement des thérapies comportementales et cognitives dans ce domaine et présente les fondements théoriques de l’ACT. Il introduit les composantes d’une intervention basée sur l’acceptation et la pleine conscience en visitant plusieurs concepts du modèle de la flexibilité psychologique. Enfin, il synthétise un certain nombre de données probantes provenant des études expérimentales, corrélationnelles et cliniques qui appuient l’utilisation de l’ACT dans le domaine de la douleur chronique.

EN :

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.

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En termes de prévalence, le trouble obsessionnel-compulsif (TOC) se classe au quatrième rang des troubles de santé mentale. Les traitements actuellement dispensés sont issus de la première et de la deuxième vague des thérapies comportementales et cognitives et utilisent l’exposition et la restructuration cognitive. Cependant, les thérapies de la troisième vague, soit la thérapie par la pleine conscience et la thérapie d’acceptation et d’engagement (ACT), sont de plus en plus reconnues comme traitements de choix. Le présent article décrit les bases théoriques de l’ACT, incluant la théorie des cadres relationnels et ses cibles cliniques : l’évitement expérientiel, ses principaux processus et un outil utilisé lors du traitement, la matrice. Plutôt que de restructurer les pensées problématiques et de l’exposer à son anxiété, l’ACT vise à entraîner la flexibilité psychologique, c’est-à-dire la capacité à se distancer de ses pensées problématiques et à accepter les ressentis inconfortables afin de pouvoir poser des actions en lien avec ses valeurs personnelles. Ceci peut permettre au comportement du client qui était largement sous le contrôle aversif de ses obsessions et de son anxiété de passer graduellement sous le contrôle appétitif de ses valeurs personnelles. L’application de l’ACT au TOC est illustrée par une étude de cas.

EN :

In terms of prevalence, Obsessive compulsive disorder is the 4^th ranked psychiatric disorder. Current treatments include 1^st and 2^nd wave cognitive behavioural therapies involving exposure and cognitive restructuring. However, 3^rd 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.

FR :

La dépression comptant parmi les troubles psychologiques ayant les plus hauts taux de prévalence dans le monde, il importe de trouver des interventions efficaces et peu coûteuses afin de faciliter l’accès aux services. On observe, depuis une dizaine d’années, un regain d’intérêt pour les interventions comportementales dans le traitement de la dépression. L’activation comportementale, une composante de la thérapie cognitivo-comportementale, a été développée de manière à constituer un traitement à part entière et depuis, les données probantes qui appuient l’efficacité de ce traitement s’accumulent. Cet article résume d’abord les origines du modèle comportemental de la dépression. Il est suivi d’une explication détaillée des différentes étapes impliquées lors d’une intervention d’activation comportementale. Ses appuis empiriques sont par la suite présentés. L’activation comportementale est ensuite discutée dans le cadre de thérapies de troisième vague, abordant le rôle potentiel de la pleine conscience à travers les objectifs d’activation comportementale. Des suggestions sont faites quant à la façon dont les thérapeutes peuvent inclure des activités basées sur la pleine conscience dans la hiérarchie d’activation comportementale. L’article se conclut par une discussion sur les questions qui devraient être abordées dans les recherches futures.

EN :

Depression is a widespread psychological disorder that affects approximately one in five North American. Typical reactions to depression include inactivity, isolation, and rumination. Several treatments and psychological interventions have emerged to address this problematic. Cognitive behavioural therapies have received increasingly large amounts of empirical support. A sub-component of cognitive behavioural therapy, behavioural activation, has been shown to in itself effectively treat symptoms of depression. This intervention involves efforts to re-activate the depressed client by having them engage in pleasant, gratifying, leisure, social, or physical activities, thereby counteracting the tendency to be inactive and to isolate oneself. Clients are guided through the process of establishing a list of potentially rewarding social, leisure, mastery-oriented or physical activities, to then establish a gradual hierarchy of objectives to be accomplished over the span of several weeks. Concrete action plans are devised, and solutions to potential obstacles are elaborated. The client is the asked to execute the targeted objective and to record their mood prior to and following the activity. Behavioural activation effectively reverses the downward spiral to depression. Interestingly, studies show that behavioural activation has a positive effect on cognitive activities. It has been shown to reduce rumination and favour cognitive restructuring, without requiring cognitively-based interventions. The advantage of this treatment is therefore that it is simpler to administer in comparison to full-packaged cognitive behavioural therapies, it requires a lesser number of sessions and can be disseminated in a low-intensity format. This article begins by summarizing the origins of the behavioural model of depression, which serves as a basis to the understanding of behavioural activation. This is followed by a detailed explanation of the different phases involved in a behavioural activation intervention. Empirical support for behavioural activation is then presented in regards to depression as well as comorbid physical and psychological health problems. The results of meta-analyses and randomized controlled trials are presented. Behavioural activation is then discussed within the framework of third-wave therapies, discussing the potential role of mindfulness in behavioural activation objectives. Specifically, it is suggested that mindfulness, although not necessarily directly addressed in behavioural activation interventions, is an integral part of this intervention as clients are asked to record their mood and activities and to become cognizant of the relationship between their symptoms of depression and the participation in activities that provide positive reinforcement. This favours self-awareness and allows clients to realize the impact of their actions on their physical and psychological states. In engaging in self-observation and self-recording, and in participating in a variety of tasks and activities, clients are indirectly encouraged to focus on the here and now rather that to succumb to the depressive tendency that is to ruminate. Suggestions are made as to how therapists can include mindfulness-based activities in the behavioural activation hierarchy. It is hypothesized that, due to the calming effect of mindfulness practices on the nervous system, incorporating mindfulness-based activities–such as yoga, tai chi, Qi Gong, or meditation–could for some people enhance the efficacy of behavioural activation interventions and foster a greater sense of well-being. The article concludes by discussing issues that should be addressed in future research. It is suggested that future studies on behavioural activation explore the impacts of incorporating mindfulness-based activities in the behavioural activation hierarchy in comparison to a traditional hierarchy limited to the accomplishment of gratifying or mastery-oriented tasks, social outings, leisure activities and physical activity.

FR :

Pour la thérapie des schémas, les premières expériences de la vie relationnelle sont primordiales. Elles mènent à la création de mémoires, en grande partie implicite. Par la suite, ces mémoires sont réactivées dans des contextes spécifiques, et très souvent gérées à travers des stratégies qualifiées de dysfonctionnelles. La thérapie des schémas cherche à modifier ces mémoires définies comme schémas. La thérapie d’acceptation et d’engagement (Acceptance and Commitment Therapy-ACT), de son côté, vise à modifier le rapport avec nos réactions découlant de nos histoires d’apprentissage et à développer une plus grande flexibilité par rapport aux expériences internes comme les pensées, les sensations et les émotions. Plusieurs de ses outils sont inspirés des méthodes de pleine conscience qui cherchent à favoriser la position de témoin de l’individu relativement à sa propre expérience. Malgré leurs paradigmes de départ différents, il est possible de faire jouer ensemble ces différentes approches. Le schéma se manifestant à travers des réactions somatiques, des pensées, des affects, des tendances à l’action, il devient possible de chercher à changer notre rapport à ceux-ci avec la philosophie et les méthodes de la thérapie ACT, notamment la pleine conscience. Cet article présente une réflexion théorique sur l’intégration des principes de la troisième vague à la thérapie des schémas.

EN :

Objective: For schema therapy, significant weight is given to early experiences of social life. They lead to the creation of memories, largely implicit. These memories are reactivated in specific contexts and are often managed through dysfunctional strategies. Schema therapy seeks to modify these memories categorized as patterns. Acceptance and Commitment Therapy (ACT), meanwhile, aims to transform our reactions linked to our learning history and to develop a greater flexibility taking into account what occurs in the present moment. Several techniques originate from the mindfulness tradition and seek to transform the individual into a witness of his own experience, rather than someone acting out patterns based on his learning history. Despite their different paradigms, it is possible to combine these approaches. As schemas manifest through somatic reactions, thoughts, affects, action tendencies, it becomes possible to try to change the relationship between the individual and these private experiences through the use of mindfulness, philosophical concepts and techniques derived from ACT. This is the aim of this article. Method: Essay presenting the use of a schema mindfulness flash card to help patients tolerate intense affects generated by the activation of schemas and to attain greater adaptive flexibility (Healthy Adult mode). Conclusion: It is possible to integrate ACT techniques and concept to schema therapy in order to facilitate adaptive flexibility.

FR :

L’objectif du présent texte est de démontrer les effets de l’inégalité de revenus sur la santé mentale et le bonheur dans les pays riches. La première section fait état du niveau élevé d’inégalité de revenus aux États-Unis et, à un degré moindre, dans les autres pays riches. Les résultats présentés dans la seconde partie font voir des corrélations positives de l’inégalité de revenus avec la maladie mentale, avec un indice de consommation de drogues et avec un indice composite de 10 problèmes psychosociaux. De plus, il existe une corrélation négative entre l’inégalité de revenus et un indice de bien-être des enfants mis au point par l’UNICEF. La troisième partie aborde l’association négative élevée entre l’inégalité de revenus et le bonheur, concrétisée ici par la satisfaction de vivre, dans les pays riches. De nombreux arguments appuient l’idée de la causalité selon laquelle l’inégalité de revenus est une source importante des problèmes psychosociaux, comme un « virus » qui affecte le bien-être de toute la population. Enfin, les praticiens des sciences humaines sont invités à s’impliquer dans l’élaboration des politiques sociales, dans les efforts d’éducation pour contrer les coûts de l’inégalité et dans des programmes susceptibles de favoriser une santé mentale « florissante ».

EN :

Aim. The purpose of this paper is to demonstrate the impact of income inequality on various indexes of mental health and on happiness in wealthy nations. Initially, the unequal distribution of income is documented in wealthy nations, especially in the United States of America. After the World War II, income equality was at a level never reached before, but since the eighties, income inequality has raised dramatically in many industrialized countries. The 2008 crisis has worsened the situation in many of them, particularly in the United States. Furthermore, prejudices have increased against women, Blacks, Spanish-speakers and those who receive social welfare. Method. A selective review of the literature is made in order to document the impact of income inequality on a few indicators of mental health (from WHO, UN, UNICEF, OCDE and World Bank) and on happiness, defined here as life satisfaction. Results. Income inequality is positively related to the following indexes: Index of Mental Illness from the WHO (0.73), Index of the United Nations’ Office on Drug Consumption (0.63) and a composite Index of ten psychosocial problems, constituted by Wilkinson and Pickett, 2013 (0.87). On the other hand, income inequality is negatively associated to the UNICEF Index of Child Well-Being (-0.71). Furthermore, the level of anxiety and of depression is higher in countries where income inequality is greater. The correlation between happiness and income inequality in the 23 wealthy nations is -0.48; this correlation becomes -0.41 after control of the effect of the GNP (Gross National Product). These results support the idea that it is relative income – not absolute income – which matters in the evaluation of our life and of our happiness. In underdeveloped nations, any increase in GNP promotes the well-being of the citizens; whereas in wealthy nations, it is the equality of the distribution that is more important. Many arguments supporting the causal relation from income inequality to psychosocial problems and unhappiness are presented. In reality, this income inequality is like a “virus” which affects the well-being of the entire population. Conclusion. Even if the increase of mental problems may be explained by many factors – historical, cultural, ethnic, social, and societal – these factors do not eliminate the effect of income inequality. In order to counter the effects of income inequality and to promote a “flourishing” mental health, the professionals of human sciences are invited to take into account this reality in the implementation of their interventions and to participate to the elaboration of social politics as well as in the education process of the general population.

FR :

Au Québec, les centres de crise ont été développés dans le contexte de la désinstitutionnalisation, ce qui a mené à une offre de services devant répondre aux besoins d’une clientèle hétérogène. À ce jour, encore peu d’études ont décrit et comparé les profils cliniques des personnes qui effectuent une demande d’aide à un centre de crise en considérant la présence ou non d’un trouble de santé mentale et la nature de celui-ci. Les dossiers de 1170 nouveaux demandeurs de services au Centre d’aide 24/7 ont été examinés rétrospectivement. Parmi ces demandeurs, 48 % souffraient d’un trouble de santé mentale et, de ceux-ci, 9 % rapportaient un trouble mental grave, soit un trouble psychotique ou bipolaire. Les résultats indiquent que le fait d’avoir un trouble de santé mentale est associé à une probabilité plus élevée de rapporter des événements stressants à caractère interpersonnel, une crise plus intense ainsi que des comportements auto-agressifs. Les personnes ayant un trouble psychotique ou bipolaire sont quant à elles plus fréquemment hébergées et plus susceptibles de recevoir des services intensifs et encadrants. Il semble donc que la présence et le type de troubles de santé mentale des demandeurs d’aide en centre de crise permettent non seulement de mieux anticiper la nature et l’intensité de la crise mais aussi le type de services requis.

EN :

The mandate of crisis centres varies substantially from one country to the next according to the government policies in effect. In the United States, crisis centres were developed based on Caplan’s theory, which defines crisis as a psychosocial disorganization following a life event that is resolved with a return to balance. This approach aims at preventing the onset of mental health disorders through short-term intervention. It is different in Quebec, where crisis centres were developed in a deinstitutionalization context and ought to constitute an alternative to hospitalisation. Such mandate of Quebec crisis centres is not necessarily of the preventive nature associated with Caplan’s theory and it has led to services having to be adapted to a heterogeneous clientele that may or may not suffer from mental health problems. It has implications related to the crisis characteristics such as its nature, intensity, and dangerosity, as well as implications regarding the organization of crisis centre services, which have been the object of few studies so far. Objective: The present study aims at distinguishing clinical profiles of crisis centre callers according to the presence or absence of a mental health disorder and its nature, that is severe and persistent (psychotic or bipolar disorder) or not (mood, anxiety or personality disorder). In order to do so, participants are compared on the characteristics of the crisis and the services they received. Method: In this descriptive study, the files of 1170 new assistance applicants are retrospectively analyzed based on a predetermined grid that was used to collect data according to the main clinical characteristics of persons in distress, as recognized in the literature. The subgroup of persons presenting a psychotic or bipolar disorder was examined separately from the one comprising persons with an anxiety, mood or personality disorder because of its clinical complexity, which generally requires intensive, multidisciplinary follow-up. Results: Among the new applicants, 48% had a mental health disorder and, of these, 9% reported a serious mental health disorder, that is, a psychotic or bipolar disorder. The results indicate that having an anxiety-, mood- or personality-type disorder is associated with a higher probability of reporting stressful interpersonal-type events, a more intense crisis, as well as a greater risk of auto-aggressive behaviours. Meanwhile, persons with a psychotic or bipolar disorder are more frequently provided with accommodations and more likely to receive intensive and support services, such as emergency interventions or the use of the Act respecting the protection of persons whose mental state presents a danger to themselves or others (P-38). Conclusions: This descriptive portrait of the crisis centre clientele contributes to the reflection on differential intervention with persons in a crisis situation. It appears important to take an interest in the presence and type of mental health disorders of crisis centre callers, since these characteristics help to better foresee not only the nature and intensity of the crisis but also the type of services required. However, Quebec crisis centres have to respond to the needs of a heterogeneous clientele without having access to a typology and a theoretical model that consider this clinical diversity. Other studies should be conducted to validate, on the one hand, a crisis typology that would make it easier for caseworkers to collect data for evaluation purposes and, on the other hand, a differential intervention model.

FR :

Cette étude longitudinale s’intéresse à la relation temporelle entre l’anxiété et la dépression en contexte de la transition primaire-secondaire, en examinant si la présence d’un trouble anxieux en sixième année (temps 1), soit à l’âge de 11-12 ans, augmente le risque que se développe un trouble dépressif deux ans plus tard, soit en deuxième secondaire (temps 2). Un échantillon de 146 élèves, soit 62 filles et 84 garçons (moyenne d’âge 11,22 ans) qui ont participé à cette étude. Les résultats révèlent une tendance entre la présence d’anxiété en sixième année et le développement d’un trouble dépressif en deuxième secondaire, et ce, chez les filles seulement. La présence de distorsions cognitives distingue les groupes sur le plan transversal seulement. L’analyse longitudinale s’avère non significative entre la présence de distorsions cognitives chez les élèves anxieux du temps 1 et le développement d’un trouble dépressif au temps 2. En sixième année, les élèves anxieux présentent déjà des distorsions cognitives associées à la dépression, alors que les élèves concomitants de deuxième secondaire se distinguent des élèves anxieux par la présence de distorsions cognitives de dépendance. Ces résultats démontrent l’importance d’intervenir tôt chez les élèves qui présentent un trouble anxieux et plus spécifiquement chez les filles, qui se révèlent être plus vulnérables pour ce qui est du développement de la dépression au début de l’adolescence.

EN :

Depression and anxiety are among the most prevalent disorders in the adolescent population. An increase of the prevalence of these disorders is taking place during adolescence, this developmental period being experienced in synchronicity with the high school transition. Also, some studies suggested the existence of a developmental trend between the onset of anxiety and depression. This longitudinal study explored the temporal relationship between anxiety and depression during the transition from primary to high school. Goals: first, this study examined whether the presence of anxiety in grade 6 (Time 1) increases the risk of depression in grade 8 (Time 2). Then a subgroup of comorbid students, who presented anxiety and depression, was compared with a subgroup of anxious ones on the presence of cognitive distortions. It was assessed whether cognitive distortions in the anxious group in Time 1 influenced the development of comorbidity between anxiety and depression in Time 2. Method: 146 students from 12 public schools, 62 girls and 84 boys (mean = 11.22 years) participated in this study. This sub sample was drowned from a larger sample of 499 students, in a 9 years longitudinal study (2003-2012). Participants completed the questionnaire and were met for an interview at the beginning of each school year. Parents consent was obtained. In Time 1, students were divided into two subgroups, anxious and non-anxious students. At time 2, two subgroups of students were constituted, either anxious or comorbid anxious and depressed students. Depression was controlled at time 1.The Dominic Interactive for Adolescents (Valla, 2000) was used to measure the presence of anxiety and depression. The correlation (.34 to .62) between the three anxiety scales (separation anxiety, generalized anxiety and phobia) allowed to create an unique anxiety score. Cognitive distortions (related to dependence, achievement and self control) were measured by the Dysfunctional Attitudes Scale (Weisseman & Beck, 1978). Results: The hierarchical log linear analyse revealed a tendency between the presence of anxiety in Time 1 and the development of depression in Time 2, only for girls (p=.08), so that 25% of anxious girls at Time 1 became depressive at Time 2, compare to 0% of non anxious girls. For boys, whether anxiety is present or not, the two subgroups presented the same risk to develop depression. Then, results of a Manova analysis revealed that anxious students at time 1 already adopted cognitive distortions related to dependency and to achievement, usually associated with depression. At time 2, the result of the Manova revealed that comorbid students presented more cognitive distortions related to dependency then the anxious students. However, non significant results were found for the longitudinal analyse, which did not supported the existence of a predicting link between the presence of depressogenous cognitive distortions at Time 1 in the anxious subgroup of students and the emergence of comorbidity at Time 2. Conclusion: The results of the present study testified the importance to prevent depression, especially for anxious school girls. Anxiety seems to have a different role for girls and boys. A trend was observed between the presence of an anxiety disorder in Grade 6 and the development of a depressive disorder 2 years later, among girls only. This result raises the importance to understand the role of anxiety in girls to reduce their risk to develop a depressive disorder. Our results also showed that anxious students in grade 6, already presented cognitive distortions related to dependency and achievement which are associated with depression while comorbid students in the second year of high school presented more cognitive distortions related to dependency only, when they were compared with the anxious group.

FR :

Le présent article s’intéresse aux femmes aînées des communautés ethnoculturelles de l’Afrique noire. Il a pour but de présenter le sens qu’elles donnent au « vieillissement réussi » dans leur pays d’accueil, et de mettre en évidence les facteurs qu’elles considèrent comme essentiels pour expérimenter « un maximum de satisfaction et de bonheur » au cours de cette étape de leur vie. Il s’appuie sur une étude qualitative exploratoire menée auprès de sept femmes âgées de 65 à 77 ans qui ont immigré au Québec alors qu’elles avaient plus de 50 ans. L’étude met en relief des femmes aux identités multiples et aux vieillissements différentiels, pour qui le « vieillissement réussi » est tributaire de leur implication dans la famille et dans la société, de la foi et de l’autonomie financière. L’analyse des résultats sous un angle intersectionnel permet aussi de noter que les femmes aînées immigrantes de l’Afrique noire connaissent des difficultés en raison de l’entrecroisement des effets dus à leur âge, leur appartenance ethnique et leur genre, avec d’autres aspects liés à leur identité tels que la culture, la langue, le sexe, le parcours migratoire. Une multitude d’obstacles jonchent alors leur processus de vieillissement et influent sur leur conception du « vieillissement réussi ».

EN :

Objectives: This article focuses on older immigrant women from Black Africa living in Montreal. Its purpose is to present the meaning that they give to “successful aging” in their hosting country and to highlight the factors they consider essential to experience “a maximum of satisfaction and happiness” during this stage of their life. It is based on the fact that Quebec society is facing an ever increasing aging of its population which is accompanied with a more and more significant ethnocultural diversification due to immigration. Statistically the number of black women over 65 years increases over the years. In Canada, older women in general are victims of various social inequalities. These vulnerabilities are even more flagrant when one comes from a visible ethnocultural community and can have a biopsychosocial impact on the lives of these older women. These situations justify our concern for the quality of life and well-being of these aged women.

Method: Our methodology leans on an exploratory qualitative approach conducted with seven women aged from 65 to 77 years who immigrated to Canada when they were more than 50 years old. Five of them had less than 10 years of stay in Quebec while the other two were 18 and 20 years. To gather their views, semi-structured interviews were recorded, transcribed and coded. The content was analyzed with an approach inspired by analysis techniques of data from the grounded theory. Then, an intersectional analytical framework has been favored, firstly to understand the complex nature of various forms of identities and social inequalities experienced by the participants, and secondly to examine the connections between discriminatory phenomena such as ageism, racism or sexism, ethnicity and even the migratory journey.

Results: As results, this research allows noting that older immigrant women of Black Africa are facing many difficulties due to the interrelation of their age, their ethnic background, their gender, with other aspects of their identity such as culture, language, and migratory course. Anyway, it is important to emphasize that the majority looked at aging and this time of their life as normal and even as a privilege. Their comments reflected no denial, no bitterness, and no regret. These women who presented themselves as resourceful people, hardworking, determined and combative have enumerated four key elements that they find essential for successful aging: social engagement, intergenerational relationships, financial autonomy and faith. Even though a multitude of obstacles affects their perception of “successful ageing,” their stories have demonstrated their ability to cope with difficulties and have shown their inner strengths. Black African older women are working hard to integrate or adjust to an environment in which changes and novelty are not always favorable to their development.

Conclusion: If old age is undoubtedly a woman’s world, it is also more and more diverse and multi-ethnic. In an ever-changing immigration environment, the results of this study cannot be generalized because of the limited number of participants. However, this research clearly shows that significant efforts are still required to tackle the problems and obstacles faced by older and aging ethnic minorities. Beside limitations identified in this study, several avenues of research could be considered, particularly with regard to their relationship to health services, in conjunction with language and cultural barriers. It is therefore appropriate to interpellate government officials to take into account in their new social policies: gender, ethnicity, economic conditions, social isolation, and poor access to health services of aged immigrant women.

FR :

Le présent article est la description du parcours d’un des pionniers de l’enseignement de la méditation pleine conscience en milieu médical au Québec. Il met l’accent sur la nécessité de pratiquer et d’appréhender ce concept par l’expérience plutôt que par une recherche intellectuelle. Il décrit l’apport de la pleine conscience sur sa pratique médicale et présente un bref survol des ateliers qu’il anime au Centre Épic (Centre de médecine préventive et de conditionnement physique de l’Institut de Cardiologie de Montréal) depuis 15 ans.

EN :

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.