Résumés
Résumé
Objectif La relation thérapeutique est un des piliers du traitement de la schizophrénie. Cependant, certains facteurs personnels du côté des psychiatres peuvent entraver celle-ci, notamment le fait de ne jamais avoir eu l’expérience d’hallucinations auditives. De tels facteurs peuvent conduire à une diminution de l’empathie et donc à une altération négative de la relation thérapeutique. Des études antérieures ont montré que les simulateurs d’hallucinations auditives avaient un impact positif sur les professionnel(-le)s de la santé mentale. Pourtant, à notre connaissance, aucun test de ce type n’a été conduit sur la population de résident(e)s en psychiatrie. Pour répondre à cette lacune, une équipe de recherche fut mis en place : comprenant des entendeur(-se)s de voix, des psychiatres, des chercheurs en génie acoustique, des chercheurs en recherche qualitative et des acteur(-trice)s - auteur(-trice)s. Cette équipe a cocréé le premier simulateur de voix en trois dimensions (simulateur 3DV) en utilisant la technologie sonore de reproduction binaurale. L’objectif de cette étude pilote est d’évaluer la réaction des résident(e)s en psychiatrie à ce simulateur 3DV.
Méthodes Dans cette étude exploratoire et descriptive, des résident(e)s en psychiatrie (n = 12) ont été inclu(e)s et ont été invité(e)s à écouter le simulateur 3DV pendant 15 minutes. L’empathie a été évaluée avant et après la simulation 3DV par le Jefferson Scale of Physician Empathy (JSPE ©), une échelle pour évaluer l’empathie chez les professionnel(le)s de santé. À la suite de la simulation, les participant(e)s furent invité(e)s à répondre un court entretien semi-dirigé qui se limitait à une question ouverte et générale sur leurs vécus et expériences, et à quelques questions additionnelles.
Résultats Les participant(e)s (83,3 %) ont trouvé que le simulateur 3DV était intéressant et utile. Ces dernier(e)s ont perçu la simulation comme une aide pour mieux comprendre l’expérience des patient(e)s et mieux s’identifier à leur vécu. Notre étude n’a pas trouvé de différence statistiquement significative dans le score total du JSPE© avant et après la simulation (p = 0,797).
Conclusion Cet article répond au besoin d’améliorer l’empathie des résident(e)s en psychiatrie envers les personnes qui souffrent d’hallucinations auditives. Une des originalités de ce projet pilote est la façon dont le simulateur a été conçu. À notre connaissance, il s’agit du premier simulateur de voix créé par une équipe multidisciplinaire et inclusive qui implique des entendeur(-euse)s de voix dans l’ensemble du processus de recherche. Les résultats de cette étude pilote présentés dans cet article soulignent la nécessité d’améliorer continuellement les interventions pédagogiques pour soutenir le développement de l’empathie des résident(e)s en psychiatrie. Ceux-ci suggèrent également que le simulateur 3DV a été bien accueilli par les résident(e)s, ce qui encourage la réalisation d’études à de plus grandes échelles.
Mots-clés :
- pédagogie médicale,
- hallucination auditive,
- empathie,
- résidence en psychiatrie,
- recherche participative
Abstract
Objective Therapeutic relationship is a cornerstone in the treatment of schizophrenia. However, certain personal factors on the part of psychiatrists can hinder it, notably the lack of experience with auditory hallucinations. Such factors can lead to a decrease in empathy and, consequently, a negative alteration in the therapeutic relationship. Previous studies have shown that auditory hallucination simulators have a positive impact on mental health professionals. Yet, to our knowledge, no such test has been conducted on the psychiatry resident population. To address this gap, a research team was formed, including voice hearers, psychiatrists, acoustical engineering researchers, qualitative research experts, and actor-authors. This team collaboratively created the first three-dimensional voice simulator (3DV simulator) using binaural sound reproduction technology. The objective of this pilot study is to evaluate the reaction of psychiatry residents to this 3DV simulator.
Methods In this exploratory and descriptive study, psychiatry residents (n=12) were included and invited to listen to the 3DV simulator for 15 minutes. Empathy was assessed before and after the 3DV simulation using the Jefferson Scale of Physician Empathy (JSPE©), a scale to evaluate empathy in healthcare professionals. Following the simulation, participants were invited to participate in a brief semi-structured interview consisting of an open-ended and general question about their experiences, along with additional questions.
Results Participants (83.3%) found the 3DV simulator interesting and useful. They perceived the simulation as an aid to better understand the patients’ experience and to better identify with their lived realities. Our study did not find a statistically significant difference in the total JSPE© score before and after the simulation (p = 0.797).
Conclusion This article addresses the need to enhance the empathy of psychiatry residents towards individuals suffering from auditory hallucinations. One uniqueness of this pilot project is how the simulator was designed collaboratively by a multidisciplinary and inclusive team involving voice hearers throughout the research process. The results of this pilot study presented in this article underscore the necessity of continually improving educational interventions to support the development of empathy among psychiatry residents. They also suggest that the 3DV simulator was well-received by the residents, encouraging the conduct of larger-scale studies.
Keywords:
- medical education,
- auditory hallucination,
- participatory research,
- empathy,
- psychiatry residency
Parties annexes
Bibliographie
- Ait Bentaleb, L., Beauregard, M., Liddle, P. et Stip, E. (2002). Cerebral activity associated with auditory verbal hallucinations : A functional magnetic resonance imaging case study. Journal of Psychiatry and Neuroscience, 27(2), 110-115.
- Ait Bentaleb, L., Stip, E. et Beauregard, M. (2000). [Psychopathology and neurobiological bases of auditory hallucinations in schizophrenia.]. Santé mentale au Québec, 25(1), 241-257.
- Berger, P., Bitsch, F., Jakobi, B., Nagels, A., Straube, B. et Falkenberg, I. (2019). Cognitive and emotional empathy in patients with schizophrenia spectrum disorders : A replication and extension study. Psychiatry Research, 276, 56-59. https://doi.org/10.1016/j.psychres.2019.04.015
- Bitoun, A., Buffel du Vaure, C., lucet, cora, Jaury, P. et Malmartel, A. (2020). Assessment of medical student empathy : The French validation of the JSPE-MS©.
- Blauert, J. (1996). Spatial Hearing : The Psychophysics of Human Sound Localization. https://doi.org/10.7551/mitpress/6391.001.0001
- Bradshaw, T., Blakemore, A., Wilson, I., Fitzsimmons, M., Crawford, K. et Mairs, H. (2021). A systematic review of the outcomes of using voice hearing simulation in the education of health care professionals and those in training. Nurse Education Today, 96, 104626. https://doi.org/10.1016/j.nedt.2020.104626
- Browne, J., Bass, E., Mueser, K. T., Meyer-Kalos, P., Gottlieb, J. D., Estroff, S. E. et Penn, D. L. (2019). Client predictors of the therapeutic alliance in individual resiliency training for first episode psychosis. Schizophrenia Research, 204, 375-380. https://doi.org/10.1016/j.schres.2018.07.035
- Bunn, W. et Terpstra, J. (2009). Cultivating empathy for the mentally ill using simulated auditory hallucinations. Academic Psychiatry : The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 33(6), 457-460. https://doi.org/10.1176/appi.ap.33.6.457
- Cavelti, M., Homan, P. et Vauth, R. (2016). The impact of thought disorder on therapeutic alliance and personal recovery in schizophrenia and schizoaffective disorder : An exploratory study. Psychiatry Research, 239, 92-98. https://doi.org/10.1016/j.psychres.2016.02.070
- Charpentier, A., Goudemand, M. et Thomas, P. (2009). [Therapeutic alliance, a stake in schizophrenia]. L’Encéphale, 35(1), 80-89. https://doi.org/10.1016/j.encep.2007.12.009
- Decety, J. et Fotopoulou, A. (2015). Why empathy has a beneficial impact on others in medicine : Unifying theories. Frontiers in Behavioral Neuroscience, 8, 457. https://doi.org/10.3389/fnbeh.2014.00457
- Deegan, P. (2006). The Hearing Distressing Voices Toolkit. https://www.commongroundprogram.com/hearing-voices
- Dos Santos, B. et Beavan, V. (2015). Qualitatively exploring hearing voices network support groups. The Journal of Mental Health Training, Education and Practice, 10(1), 26-38. https://doi.org/10.1108/JMHTEP-07-2014-0017
- Farrelly, S., Brown, G., Szmukler, G., Rose, D., Birchwood, M., Marshall, M., Waheed, W. et Thornicroft, G. (2014). Can the therapeutic relationship predict 18 month outcomes for individuals with psychosis ? Psychiatry Research, 220(1-2), 585-591. https://doi.org/10.1016/j.psychres.2014.07.032
- Frank, A. F. et Gunderson, J. G. (1990). The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Archives of General Psychiatry, 47(3), 228-236. https://doi.org/10.1001/archpsyc.1990.01810150028006
- Galletly, C. et Burton, C. (2011). Improving medical student attitudes towards people with schizophrenia. The Australian and New Zealand Journal of Psychiatry, 45(6), 473-476. https://doi.org/10.3109/00048674.2011.541419
- Gleichgerrcht, E. et Decety, J. (2013). Empathy in clinical practice : How individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PloS One, 8(4), e61526. https://doi.org/10.1371/journal.pone.0061526
- Goeree, R., Farahati, F., Burke, N., Blackhouse, G., O’Reilly, D., Pyne, J. et Tarride, J.-E. (2005). The economic burden of schizophrenia in Canada in 2004. Current Medical Research and Opinion, 21(12), 2017-2028. https://doi.org/10.1185/030079905X75087
- Goldsmith, L. P., Lewis, S. W., Dunn, G. et Bentall, R. P. (2015). Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance : An instrumental variable analysis. Psychological Medicine, 45(11), 2365-2373. https://doi.org/10.1017/S003329171500032X
- Halcomb, E. J. et Davidson, P. M. (2006). Is verbatim transcription of interview data always necessary ? Applied Nursing Research : ANR, 19(1), 38-42. https://doi.org/10.1016/j.apnr.2005.06.001
- Hojat, M. et Gonnella, J. S. (2015). Eleven Years of Data on the Jefferson Scale of Empathy-Medical Student Version (JSE-S) : Proxy Norm Data and Tentative Cutoff Scores. Medical Principles and Practice : International Journal of the Kuwait University, Health Science Centre, 24(4), 344-350. https://doi.org/10.1159/000381954
- Hojat, M., Mangione, S., Nasca, T. J., Cohen, M. J. M., Gonnella, J. S., Erdmann, J. B., Veloski, J. et Magee, M. (2001). The Jefferson Scale of Physician Empathy : Development and Preliminary Psychometric Data. Educational and Psychological Measurement, 61(2), 349-365. https://doi.org/10.1177/00131640121971158
- Hojat, M., Vergare, M. J., Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., Veloski, J. et Gonnella, J. S. (2009). The devil is in the third year : A longitudinal study of erosion of empathy in medical school. Academic Medicine : Journal of the Association of American Medical Colleges, 84(9), 1182-1191. https://doi.org/10.1097/ACM.0b013e3181b17e55
- Hong, H. et Han, A. (2020). A systematic review on empathy measurement tools for care professionals. Educational Gerontology, 46(2), 72-83. https://doi.org/10.1080/03601277.2020.1712058
- Kahn, R. S., Sommer, I. E., Murray, R. M., Meyer-Lindenberg, A., Weinberger, D. R., Cannon, T. D., O’Donovan, M., Correll, C. U., Kane, J. M., van Os, J. et Insel, T. R. (2015). Schizophrenia. Nature Reviews. Disease Primers, 1, 15067. https://doi.org/10.1038/nrdp.2015.67
- Kennedy, J. L., Altar, C. A., Taylor, D. L., Degtiar, I. et Hornberger, J. C. (2014). The social and economic burden of treatment-resistant schizophrenia : A systematic literature review. International Clinical Psychopharmacology, 29(2), 63-76. https://doi.org/10.1097/YIC.0b013e32836508e6
- Kim, H. J. et Wojnar, D. M. (2019). Hearing Distressing Voices Simulation : Students’ Perspectives. Issues in Mental Health Nursing, 40(3), 240-246. https://doi.org/10.1080/01612840.2018.1490835
- Kolb, D. (2015). Experiential Learning : Experience as the Source of Learning and Development. /content/one-dot-com/one-dot-com/us/en/higher-education/program.html
- Kvrgic, S., Cavelti, M., Beck, E.-M., Rüsch, N. et Vauth, R. (2013). Therapeutic alliance in schizophrenia : The role of recovery orientation, self-stigma, and insight. Psychiatry Research, 209(1), 15-20. https://doi.org/10.1016/j.psychres.2012.10.009
- Martin, B. et Franck, N. (2013). Facteurs subjectifs et rétablissement dans la schizophrénie. /data/revues/00143855/v78i1/S0014385512001247/. https://www.em-consulte.com/en/article/794215
- McCabe, R., Bullenkamp, J., Hansson, L., Lauber, C., Martinez-Leal, R., Rössler, W., Salize, H. J., Svensson, B., Torres-Gonzalez, F., van den Brink, R., Wiersma, D. et Priebe, S. (2012). The therapeutic relationship and adherence to antipsychotic medication in schizophrenia. PloS One, 7(4), e36080. https://doi.org/10.1371/journal.pone.0036080
- Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., Haramati, A. et Scheffer, C. (2011). Empathy decline and its reasons : A systematic review of studies with medical students and residents. Academic Medicine : Journal of the Association of American Medical Colleges, 86(8), 996-1009. https://doi.org/10.1097/ACM.0b013e318221e615
- O’Brien, A., Fahmy, R. et Singh, S. P. (2009). Disengagement from mental health services. A literature review. Social Psychiatry and Psychiatric Epidemiology, 44(7), 558-568. https://doi.org/10.1007/s00127-008-0476-0
- Orr, F., Kellehear, K., Armari, E., Pearson, A. et Holmes, D. (2013). The distress of voice-hearing : The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education. Nurse Education in Practice, 13(6), 529-535. https://doi.org/10.1016/j.nepr.2013.03.023
- Patterson, S., Goulter, N. et Weaver, T. (2014). Hearing voices simulation : Process and outcomes of training. The Journal of Mental Health Training, Education and Practice, 9(1), 46-58. https://doi.org/10.1108/JMHTEP-01-2013-0003
- Pelletier, L., Grignon, S. et Zemmour, K. (2021). Outils pédagogiques pour améliorer la relation thérapeutique des psychiatres et résidents en psychiatrie envers les patients souffrant de psychose : Revue systématique. Santé mentale au Québec, 46(2), 417-438. https://doi.org/10.7202/1088191ar
- Perälä, J., Suvisaari, J., Saarni, S. I., Kuoppasalmi, K., Isometsä, E., Pirkola, S., Partonen, T., Tuulio-Henriksson, A., Hintikka, J., Kieseppä, T., Härkänen, T., Koskinen, S. et Lönnqvist, J. (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry, 64(1), 19-28. https://doi.org/10.1001/archpsyc.64.1.19
- Reardon, G., Zalles, G., Genovese, A., Flanagan, P. et Roginska, A. (2018, May 14). Evaluation of Binaural Renderers : Externalization. Audio Engineering Society Convention 144. https://www.aes.org/e-lib/browse.cfm?elib=19506
- Riches, S., Khan, F., Kwieder, S. et Fisher, H. L. (2019). Impact of an auditory hallucinations simulation on trainee and newly qualified clinical psychologists : A mixed-methods cross-sectional study. Clinical Psychology & Psychotherapy, 26(3), 277-290. https://doi.org/10.1002/cpp.2349
- Riess, H., Kelley, J. M., Bailey, R. W., Dunn, E. J. et Phillips, M. (2012). Empathy training for resident physicians : A randomized controlled trial of a neuroscience-informed curriculum. Journal of General Internal Medicine, 27(10), 1280-1286. https://doi.org/10.1007/s11606-012-2063-z
- Schneider, M. (2021, May 24). The Development of Dummy Head Microphones since 1970. Audio Engineering Society Convention 150. https://www.aes.org/e-lib/browse.cfm?elib=21093
- Shapiro, J. (2011). The Paradox of Teaching Empathy in Medical Education. https://doi.org/10.7551/mitpress/8884.003.0023
- Shattock, L., Berry, K., Degnan, A. et Edge, D. (2018). Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses : A systematic review. Clinical Psychology & Psychotherapy, 25(1), e60–e85. https://doi.org/10.1002/cpp.2135
- Skoy, E. T., Eukel, H. N., Frenzel, J. E., Werremeyer, A. et McDaniel, B. (2016). Use of an Auditory Hallucination Simulation to Increase Student Pharmacist Empathy for Patients with Mental Illness. American Journal of Pharmaceutical Education, 80(8), 142. https://doi.org/10.5688/ajpe808142
- Smidt, A., Balandin, S., Sigafoos, J. et Reed, V. A. (2009). The Kirkpatrick model : A useful tool for evaluating training outcomes. Journal of Intellectual & Developmental Disability, 34(3), 266-274. https://doi.org/10.1080/13668250903093125
- Stip, E., Sepehry, A. A., Tempier, A. et Brochu-Blain, A. (2006). [Differences and similarities in perception of schizophrenia between physicians and the general population in Quebec]. Santé mentale au Québec, 31(1), 189-200. https://doi.org/10.7202/013692ar
- Svensson, B. et Hansson, L. (1999). Relationships among patient and therapist ratings of therapeutic alliance and patient assessments of therapeutic process : A study of cognitive therapy with long-term mentally ill patients. The Journal of Nervous and Mental Disease, 187(9), 579-585. https://doi.org/10.1097/00005053-199909000-00008
- Tessier, A., Boyer, L., Husky, M., Baylé, F., Llorca, P.-M. et Misdrahi, D. (2017). Medication adherence in schizophrenia : The role of insight, therapeutic alliance and perceived trauma associated with psychiatric care. Psychiatry Research, 257, 315-321. https://doi.org/10.1016/j.psychres.2017.07.063
- The Royal College of Physicians and Surgeons of Canada (2015). Objectives of Training in the Speciality of Psychiatry. https://www.royalcollege.ca/rcsite/documents/ibd/psychiatry_otr_e.pdf
- Thirioux, B., Birault, F. et Jaafari, N. (2016). Empathy Is a Protective Factor of Burnout in Physicians : New Neuro-Phenomenological Hypotheses Regarding Empathy and Sympathy in Care Relationship. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.00763
- Thompson, N. M., Uusberg, A., Gross, J. J. et Charkrabarti, B. (2019). Empathy and Emotion Regulation : An Integrative Account. https://pubmed.ncbi.nlm.nih.gov/31196438/?from_term=empathy+and+emotion+regulation%3A+an+integrative
- Weisz, E. et Zaki, J. (2018). Motivated empathy : A social neuroscience perspective. Current Opinion in Psychology, 24, 67-71. https://doi.org/10.1016/j.copsyc.2018.05.005
- Yardley, S., Teunissen, P. W. et Dornan, T. (2012). Experiential learning : Transforming theory into practice. Medical Teacher, 34(2), 161-164. https://doi.org/10.3109/0142159X.2012.643264