TCC pour premiers épisodes de psychose : pourquoi la thérapie de groupe obtient les meilleurs résultats ?

Abstract

Cet article fait un survol des études en TCC pour personnes en début de psychose, incluant une étude randomisée (RCT) de notre équipe et tente d’expliquer pourquoi les résultats des études de TCC auprès des premiers épisodes varient et pourquoi la thérapie en format de groupe obtient à ce jour les meilleurs résultats. Nous présentons les ingrédients actifs de la TCC pour la psychose débutante et soulignons les avantages de l’approche de groupe de manière plus spécifique pour cette clientèle-cible. Nous présentons en surcroît les résultats d’une étude où nous avons utilisé une approche combinée de TCC et de psychoéducation pour les proches des personnes en début de psychose. The present paper attempts to understand and offer a potential explanation regarding the mostly unimpressive results cognitive behaviour therapy for early psychosis has obtained in large randomized controlled trials. The Socrates study from the UK as well as the Cope study from Australia are good examples of high quality studies offering CBT for psychosis (or for recovery) by expert therapists with results not giving any strong advantage for CBT sessions over regular first episode treatment, supportive or befriending sessions. These results are surprising, given the strong empirical support for CBT for psychosis offered to individuals with many years struggling with the illness and considered treatment resistant. CBT for psychosis has also proven very useful for older individuals with schizophrenia, and even for individuals judged at risk for developing psychosis. We suggest that the answer lies in the format of the therapy: individual therapy might not be as effective as group therapy for individuals with early psychosis. We justify our hypothesis with theoretical concepts (such as developmental: the need to belong to a group of peers), stronger impact of specific CBT techniques in a group format (normalization) as well as with the results from our own large randomized controlled trial with early psychosis (previously published). Our trial has demonstrated that CBT for early psychosis in a group format is not only effective in reducing symptoms but offers advantages above and beyond those of more typical skills training for symptom management in terms of increased self-esteem, more active coping strategies when confronted with stress, and increased social support. Some of these results were maintained at 1-year follow-up (e.g. social support) whereas others were not (e.g. positive symptoms) although the beliefs underlying these symptoms had changed. This paper also presents a novel multi-family intervention that integrates psycho education and CBT for psychosis in order to help family members of those receiving group CBT for early psychosis. The module entitled WITH (for Wellness, Inform, Talk, Help) can be offered over the course of 16 hours up to 24 hours. A detailed description of the content of each session is offered. We also present the results of a pilot study with 40 family members, mostly parents, who participated in the 16 hour version of the WITH multi-family group. Although significant changes in perceived support were not detected, the results show a significant clinical and statistical decrease in psychological distress in the parents who took part in the group, compared to their baseline scores. The qualitative information obtained also suggests that the group was appreciated and that the parents had integrated some CBT skills as well as notions regarding recovery and how to maintain a healthier relationship with their relative receiving psychiatric care. Most agreed that the WITH group had been helpful. We conclude by further emphasizing the need to offer group CBT for early psychosis, and also group CBT with psycho education for family members of individuals with early psychosis.