Carpentier D, Romo L, Bouthillon-Heitzmann P, Limosin F
EA 4430 CLIPSYD, université Paris Ouest Nanterre la Défénse, 200, avenue de la République, 92001 Nanterre cedex, France.
EA 4430 CLIPSYD, université Paris Ouest Nanterre la Défénse, 200, avenue de la République, 92001 Nanterre cedex, France; Inserm, U894, centre de psychiatrie et neurosciences, 75014 Paris, France.
Encephale. 2015 Dec;41(6):521-6. doi: 10.1016/j.encep.2015.05.003. Epub 2015 Jul 6.
For several years, the learning of mindfulness has developed in a psychological intervention perspective, particularly in the field of addiction. Presently, the management of addictions with substances is centered on two questions: the motivation in the change of behaviour and in a significant change in alcohol consumption. Concerning alcohol dependence, the evolution of behaviour is variable and characterized by forgiveness episodes and relapses. Over many years, a treatment for the abuse of substance associated with techniques based on full consciousness (Kabat-Zinn, 1990; Segal et al., 2002) Mindfulness-based relapse prevention (MBRP) was developed by Marlatt et al. (2011). The prevention of the relapse therapy, based on full consciousness, is a program of eight sessions integrating techniques of "mindfulness" into the techniques of prevention of the relapse. However, not much research has focused on the MBRP, the publication of the manual regarding this intervention is too recent (Bowen S et al., 2011).
We are interested in the active mechanisms, which are at stake in the MBRP. Indeed, the meditation acts presents many mechanisms in the addicting disorders. Our non-controlled research was based on a protocol in order to evaluate the alcohol consummation, mindfulness, impulsiveness, automatic thoughts, anxiety and abilities to cope. The first results are interesting: reduction of alcohol consummation, increase of mindfulness, reduction of trigger relapse, increasing cognitive flexibility and high degree of satisfaction among participants.
An intervention MBRP was proposed to 26 patients who were assigned to three groups. They were questioned about their alcohol consumption and assessed by a protocol of seven evaluations before and after the group MBRP: Five Facets Mindfulness (FFMQ), Impulsive Behavior Scale (UPPS), Acceptance and Action Questionnaire (AAQ II), State Trait Anxiety Inventory (STAI-A, STAI-B), Questionnaire of the automatic thoughts (QPA), and The Drug-Taking Confidence Questionnaire (DTCQ-8). This study exposes the preliminary results of an intervention for substance use disorders called mindfulness-based relapse prevention (mbrp) administered to five groups of alcohol dependent patients in a psychiatric department and a department of alcohol science in France.
The results show maintained abstinence and a moderation leading to abstinence for the still consuming patients. According to our evaluations, we obtained several significant results after the therapy, despite our small cohort: patients accepted their thoughts and feelings better (FFMQ-judgment); the tendency to give in to the impulses decreased (urgency-UPPS), and their tolerance to anxiety increased (STAI-YA-YB). Moreover, this study appears to confirm that the MBRP program allows an improvement of self-efficiency. The study continues in order to confirm these results on a larger sample and to explore the long-term results, so as to propose a new work-tool for patients and caregivers.
多年来,正念学习是从心理干预的角度发展起来的,尤其是在成瘾领域。目前,物质成瘾的管理集中在两个问题上:行为改变的动机以及酒精消费的显著变化。关于酒精依赖,行为的演变是可变的,其特征是有宽恕期和复发。多年来,一种基于完全意识的技术(卡巴金,1990;西格尔等人,2002)的物质滥用治疗方法——基于正念的复发预防(MBRP)由马尔拉特等人(2011年)开发。基于完全意识的复发预防疗法是一个八节课程的项目,将“正念”技术融入复发预防技术中。然而,针对MBRP的研究并不多,关于这种干预的手册出版时间还很近(鲍文等人,2011年)。
我们对MBRP中涉及的积极机制感兴趣。事实上,冥想行为在成瘾障碍中呈现出许多机制。我们的非对照研究基于一个方案,以评估酒精消费、正念、冲动性、自动思维模式、焦虑和应对能力。初步结果很有意思:酒精消费减少、正念增强、触发复发的情况减少、认知灵活性提高以及参与者的满意度很高。
对26名患者实施了MBRP干预,并将他们分为三组。在MBRP组前后,通过一个包含七项评估的方案对他们的酒精消费情况进行询问和评估:五因素正念问卷(FFMQ)、冲动行为量表(UPPS)、接纳与行动问卷(AAQ II)、状态特质焦虑量表(STAI - A、STAI - B)、自动思维问卷(QPA)以及药物服用信心问卷(DTCQ - 8)。本研究展示了在法国一个精神科和一个酒精科学科室对五组成瘾性物质使用障碍患者实施的名为基于正念的复发预防(MBRP)干预的初步结果。
结果显示,对于仍在饮酒的患者,实现了持续戒酒以及节制饮酒直至戒酒。根据我们的评估,尽管我们的样本量较小,但治疗后我们获得了几个显著结果:患者更好地接受了自己的思维模式和感受(FFMQ - 判断);屈服于冲动的倾向降低(冲动性 - UPPS),并且他们对焦虑的耐受性增强(STAI - YA - YB)。此外,本研究似乎证实了MBRP项目能提高自我效能感。该研究将继续进行,以便在更大样本上证实这些结果并探索长期结果,从而为患者和护理人员提出一种新的工作工具。