M'Bailara K, Minois I, Zanouy L, Josse F, Rouan E, Maîtrot A, Sportich J, Roux S, Jutant A, Deloge A, Desage A, Gard S
EA4139, laboratoire de psychologie, université de Bordeaux, 33076 Bordeaux cedex, France; Pôle 3-4-7, centre hospitalier Charles-Perrens, 33076 Bordeaux, France; Centre expert trouble bipolaire, fondation FondaMental, fondation de Coopération scientifique, 94000 Créteil, France.
Pôle 3-4-7, centre hospitalier Charles-Perrens, 33076 Bordeaux, France; Centre expert trouble bipolaire, fondation FondaMental, fondation de Coopération scientifique, 94000 Créteil, France.
Encephale. 2019 Jun;45(3):239-244. doi: 10.1016/j.encep.2018.11.004. Epub 2019 Feb 2.
The patient with bipolar disorder and his family are caught in a reciprocal interaction: on one hand, the pathology leads to family sufferings and on the other hand, family behavior affects the disease of the patient and its development. Therefore, it seems of core importance that the psychologist should work with the family on their perception of bipolar disorder, that is to say, on their knowledge and psychological representations of the pathology. The aim of our study is to assess whether the initial perception of bipolar disorder evolves after a therapeutic education program.
Our research was conducted at the Bipolar Expertise Centre in Bordeaux/Centre Expert Bipolaire in Bordeaux on a sample of 145 participants (78patients and 67 family caregivers). They were all interviewed before and after the therapeutic education program (12 sessions in 6months). The Brief Illness Perception Questionnaire Revised (Moss-Morris, 2002) measures the perception of bipolar disorder and the BP Quizz (Fondation Fondamental) assesses the degree of knowledge of the disorder.
Results show that therapeutic education helps families to level up their knowledge about bipolar disorder. Furthermore, representations on bipolar disorder have globally changed so that on average, bipolar disorder is viewed as less threatening by families after 12 sessions of therapeutic education. More precisely, after the program, families have a better understanding and a better insight of the disorder, which is then perceived as being less severe. On the emotional level, anxiety and stress have decreased. So there are an increase of knowledge and a change in perception.
Our study shows that the therapeutic education program enables families to change their perception of the disease, that is to say, their knowledge but also their representations of the disease, which is a fundamental element according to the models of therapeutic education. Our results point out one of the active processes of therapeutic education at work in the sessions: in the perception of the disease, which is composed of both knowledge and representations of the disease, just a change in representations constitutes a lever for therapeutic education. Therefore, working on representations should be a therapeutic target. As a conclusion, we can say that therapeutic education of families cannot be reduced to an educational dimension which would only consist of gaining knowledge. Then, the right posture of the psychologist is to hold each participant's own development and changing process of representations.
双相情感障碍患者及其家人陷入了一种相互作用之中：一方面，病理状况导致家庭痛苦；另一方面，家庭行为会影响患者的疾病及其发展。因此，心理学家与家庭共同探讨他们对双相情感障碍的认知，也就是说，探讨他们对该病理状况的了解和心理表征，这似乎至关重要。我们研究的目的是评估在接受治疗性教育项目后，对双相情感障碍的初始认知是否会发生变化。
我们的研究在波尔多双相情感障碍专家中心进行，样本包括145名参与者（78名患者和67名家庭照顾者）。他们在治疗性教育项目前后（6个月内进行12次课程）均接受了访谈。修订后的简短疾病认知问卷（莫斯 - 莫里斯，2002年）用于测量对双相情感障碍的认知，而双相情感障碍测验（基础基金会）则评估对该疾病的了解程度。
结果表明，治疗性教育有助于家庭提升对双相情感障碍的认知。此外，对双相情感障碍的表征总体上发生了变化，以至于在接受12次治疗性教育课程后，家庭平均认为双相情感障碍的威胁性降低了。更确切地说，在项目结束后，家庭对该疾病有了更好的理解和洞察，进而认为其严重程度降低。在情感层面，焦虑和压力有所减轻。因此，出现了知识的增加和认知的改变。
我们的研究表明，治疗性教育项目使家庭能够改变他们对疾病的认知，也就是说，改变他们对疾病的了解以及对疾病的表征，这是治疗性教育模式中的一个基本要素。我们的研究结果指出了治疗性教育在课程中发挥作用的一个积极过程：在由对疾病的了解和表征构成的疾病认知方面，仅仅表征的改变就构成了治疗性教育的一个杠杆。因此，致力于改变表征应该是一个治疗目标。总之，我们可以说家庭的治疗性教育不能仅仅局限于仅包括获取知识的教育层面。那么，心理学家的正确姿态是把握每个参与者自身表征的发展和变化过程。
