Auxéméry Yann
Service médical de psychologie clinique appliquée à l'aéronautique, hôpital d'instruction des armées Percy, 1, rue du Lieutenant-Raoul-Batany, 92190 Clamart, France.
Encephale. 2018 Nov;44(5):403-408. doi: 10.1016/j.encep.2018.02.003. Epub 2018 Jun 8.
People who witness a horrific event are at risk of suffering from acute psychological disorders, potentially leading to chronic post-traumatic symptoms and severe medico-psycho-social complications. Traumatised individuals suffer from psychological damage that is initially indescribable: they are often unable to ask for care in the immediate aftermath of an event. Afterwards, traumatic events and their post-traumatic consequences are still often hidden or minimised by patients for reasons linked to the disorder itself (inexpressibility, shame, depressive thoughts, fear of stigmatisation, etc.). The provision of the initial stage of care has a major impact on the long-term prognosis. Although official French recommendations remain vague, and scientific studies lack power, there is a developing professional consensus on practices, and developments in neurobiology are opening up new opportunities to validate them.
Drawing upon our clinical experience and clinical principles provided by our mentors, our aim is to clarify the phases of psychotherapeutic treatment, and we describe three practices: immediate care ("defusing"), post-immediate care ("French debriefing" or "post-immediate psychotherapeutic intervention") and follow-up care ("deferred debriefing" and psychotherapy). Although the international literature considers these phases as separate, here we describe a continuity of talking therapies that support long-term remission.
The effectiveness of the combination of immediate, post-immediate and follow-up care has been confirmed by events surrounding the recent Paris and Nice attacks. Specific psychotherapeutic principles are unrelated to a particular school of psychotherapy (notably cognitive and behavioural therapies, analytical therapies, various forms of hypnosis, and eye-movement therapies, etc.). Instead, they refer to specific principles that are effective in the treatment of post-traumatic psychiatric disorders. By helping the individual to verbalise their experience, talking re-establishes dissociated psychological functions. A process of reconsolidation enables sensory memory to be integrated into verbal memory. Supported by psychotherapy, language can be used to discover, or construct, a new sense of meaning for the individual.
A single session of post-immediate or deferred debriefing has been found to have a miraculous effect on post-traumatic symptoms, confirmed by follow-up. When disorders are chronic and complex, however, treatment can last several months or years. In each case, although certain therapeutic principles are key, other psychotherapeutic and pharmacological treatments should be adapted to the individual's clinical situation, and the symptoms they present.
目睹恐怖事件的人有患急性心理障碍的风险，这可能会导致慢性创伤后症状以及严重的医学 - 心理 - 社会并发症。受创伤的个体遭受着最初难以言表的心理创伤：他们在事件刚发生后往往无法寻求帮助。之后，由于与该障碍本身相关的原因（难以表达、羞耻感、抑郁想法、害怕被污名化等），创伤事件及其创伤后后果仍常常被患者隐藏或淡化。初始阶段的护理提供对长期预后有重大影响。尽管法国官方建议仍不明确，且科学研究力度不足，但在实践方面正形成专业共识，神经生物学的发展也为验证这些实践提供了新机会。
借鉴我们的临床经验以及导师提供的临床原则，我们旨在阐明心理治疗的阶段，并描述三种实践方法：即时护理（“情绪缓和”）、即时后护理（“法国式心理汇报”或“即时后心理治疗干预”）以及后续护理（“延迟心理汇报”和心理治疗）。尽管国际文献将这些阶段视为相互独立的，但在此我们描述了一系列支持长期缓解的谈话疗法的连续性。
近期巴黎和尼斯袭击事件周边情况证实了即时、即时后和后续护理相结合的有效性。特定的心理治疗原则与某一特定心理治疗学派（尤其是认知行为疗法、分析疗法、各种形式的催眠疗法以及眼动疗法等）无关。相反，它们指的是在治疗创伤后精神障碍方面有效的特定原则。通过帮助个体用言语表达他们的经历，谈话重新建立起解离的心理功能。重新巩固的过程使感觉记忆能够整合到言语记忆中。在心理治疗的支持下，语言可用于为个体发现或构建新的意义感。
一次即时后或延迟心理汇报被发现对创伤后症状有神奇效果，随访证实了这一点。然而，当障碍是慢性且复杂时，治疗可能持续数月或数年。在每种情况下，尽管某些治疗原则是关键的，但其他心理治疗和药物治疗应根据个体的临床情况及其呈现的症状进行调整。
