Le trouble d’anxiété généralisée (TAG) demeure l'un des troubles anxieux les plus courants chez les personnes âgées. Bien qu'il existe des traitements pharmacologiques et psychologiques efficaces, des études suggèrent que le TAG soit sous-traité chez les personnes âgées puisque l’accès à la thérapie leur serait plus difficile. Afin d’augmenter l’accessibilité, des auto-traitements guidés permettant à la personne d’apprendre de manière autonome, à domicile, ont été développés. Toutefois, les recherches antérieures soulignent la nécessité d’examiner les variables prédictives pour déterminer qui bénéficie de ces traitements auto-guidés, considérant le peu d’informations disponibles sur les individus bénéficiant de telles interventions. De plus, l'efficacité à long terme des auto-traitements guidés n'a pas encore été démontrée de manière concluante. Ce problème est d'autant plus important chez les personnes âgées. Il est donc essentiel, pour une bonne application clinique, d'acquérir des connaissances sur les prédicteurs de résultats afin d’identifier les personnes susceptibles de répondre à ces types d'interventions. Par conséquent, cette thèse vise à développer une compréhension plus détaillée de la façon dont différentes variables sont associées à différentes mesures de résultats cliniques chez les personnes âgées, tant à court terme qu'à long terme, afin de faciliter les applications cliniques futures. Les données utilisées dans la présente thèse proviennent d'un essai contrôlé randomisé de plus grande envergure, conçu pour déterminer l'efficacité d'un auto-traitement guidé de 15 semaines pour traiter le TAG chez les personnes âgées, basé sur les principes de la thérapie cognitivo-comportementale (GSH-CBT) et guidé par des non-professionnels. La première étude a examiné les variables démographiques, motivationnelles et psychologiques qui ont prédit les résultats cliniques et l'abandon du traitement GSH-CBT en utilisant les données de 106 adultes âgés de 60 ans et plus. Les résultats cliniques comprenaient l'anxiété, l'inquiétude et l'intolérance à l'incertitude, mesurées respectivement par le GAD-7, le PSWQ et l'IUI. Une anxiété moins importante et une plus grande confiance vis-à-vis du traitement ont permis de prédire de meilleurs résultats post-traitement sur le GAD-7, tandis des inquiétudes moins intenses, une plus grande confiance dans le traitement et des attentes de résultats plus élevées ont permis de prédire de meilleurs résultats sur le PSWQ. Enfin, un niveau plus faible d'intolérance à l'incertitude et d'inquiétude, une plus grande motivation externe pour débuter le traitement, une meilleure perception de la crédibilité de la thérapie et des attentes de résultats plus élevées ont permis de prédire de meilleurs résultats sur l'IUI. Dans les analyses multivariées, seuls les niveaux initiaux d'anxiété, d'inquiétude et d'intolérance à l'incertitude permettaient de prédire l'issue du traitement. La seconde étude visait à déterminer quels facteurs prédisaient l'efficacité à long terme de ce traitement en examinant différentes variables qui prédisaient les mêmes résultats cliniques six mois et douze mois après le traitement, en utilisant les données de 26 adultes âgés de soixante ans et plus. Dans les analyses multivariées, des niveaux moins élevés d'anxiété, d'inquiétude et d'intolérance à l'incertitude, ainsi qu'une plus grande motivation externe, ont permis de prédire les résultats six mois après le traitement, tandis qu'un niveau moins élevé d'anxiété et une plus grande satisfaction à l'égard du soutien social ont permis de prédire les résultats douze mois après le traitement. L’ensemble de ces résultats révèle qu'une sévérité initiale des symptômes plus faible prédit un meilleur résultat du traitement, et que ce traitement peut être plus bénéfique à long terme pour les personnes âgées ayant des niveaux légers à modérés d'anxiété, d'inquiétude et d'intolérance à l'incertitude, motivées à suivre le traitement et ayant un plus grand niveau de satisfaction en matière de soutien social. / Generalized anxiety disorder (GAD) remains one of the most common anxiety disorders in older adults. Although effective pharmacological and psychological treatments are available, studies suggest that GAD is still undertreated in seniors because access to therapy is particularly difficult for older individuals. To increase accessibility, guided self-help treatments where the person learns autonomously from home have been developed. However, previous research highlights the need for more effective targeting through the determination of predictor variables to determine who benefits from these treatments, as little is known about which individuals benefit from guided self-help interventions. Furthermore, there is inconclusive evidence regarding the long-term effectiveness of guided self-help treatments. This issue is compounded with regards to older adults, thus gaining knowledge on outcome predictors to properly distinguish who is likely to respond from these types of interventions is vital to its proper clinical application. Therefore, this thesis focuses on developing a more detailed understanding of how different variables are associated with different measures of clinical outcomes in older adults both in the short-term and in the long-term to facilitate future clinical applications. The data used in the current thesis originates from a larger multisite randomized controlled trial designed to determine the efficacy of a 15-week guided self-help treatment of threshold and subthreshold GAD in older adults based on the principles of cognitive-behavioral therapy (GSH-CBT) and guided by lay providers. The first study examined the demographic, motivational, and psychological variables that predicted clinical outcomes and treatment dropout in this GSH-CBT using data from 106 older adults aged sixty years and over. Clinical outcomes included anxiety, worry, and intolerance of uncertainty measured by the GAD-7, PSWQ, and IUI respectively. Lower anxiety severity and higher confidence in the treatment predicted better post-treatment outcomes on the GAD-7, whereas lower worry severity, higher confidence in the treatment, and higher outcome expectations predicted better outcomes on the PSWQ. Lastly, lower intolerance of uncertainty and worry severity, greater external motivation for starting the treatment, greater perceived credibility of the therapy, and higher outcome expectations predicted better outcomes on the IUI. In multivariate analyses, only initial anxiety, worry, and intolerance of uncertainty severity predicted treatment outcome. The second study sought to determine which factors predicted the long-term efficacy of this treatment by examining different variables that predicted the same clinical outcomes at 6- and 12-months post-treatment using data from 26 older adults aged sixty years and over. In the multivariate analyses, lower initial anxiety, worry, and intolerance of uncertainty severity, as well as greater external motivation predicted treatment outcome at 6-months post-treatment, and lower initial anxiety and social support satisfaction predicted treatment outcome at 12-months post-treatment. Overall, the results of this thesis suggest that lower initial symptom severity predicts better treatment outcome, and that this treatment may be more beneficial in the long-term to older individuals with mild to moderate anxiety, worry, and intolerance of uncertainty, who are motivated to do the treatment and who have greater social support satisfaction.

L’implantation de programmes probants dans les milieux d’intervention peut comporter son lot de difficultés pour les gestionnaires ainsi que les intervenants en contexte de réadaptation pour adolescents. En effet, les contraintes auxquelles peuvent être confrontés les milieux de pratique mènent parfois à la modification des programmes, ceci en vue de faciliter leur implantation. Il devient alors important de documenter ainsi qu’identifier l’effet des éléments associés à la fidélité d’implantation lorsque les programmes d’intervention sont évalués. En plus d’évaluer l’effet du degré d’exposition au programme cognitif-comportemental implanté dans les unités d’hébergement du Centre jeunesse de Montréal – Institut universitaire (CJM-IU) sur l’ampleur des troubles de comportement des adolescentes, ce mémoire propose une nouvelle piste de recherche. Puisque la recherche empirique ne permet pas encore d’identifier les conditions selon lesquelles il serait possible de modifier les programmes d’intervention qui sont adoptés dans le contexte de la pratique, cette étude propose d’élaborer une logique d’exposition au programme qui s’inspire des principes d’intervention efficace élaborés par Andrews et ses collègues (1990). Cette approche permettrait d’adapter le niveau d’intervention aux caractéristiques de la clientèle, et ce, tout en s’assurant de l’efficacité du programme cognitif-comportemental. L’échantillon de cette étude est donc constitué de 74 adolescentes hébergées au CJM-IU pour une durée de six mois. Les résultats indiquent d’abord que les activités du programme cognitif-comportemental ont été appliquées de façon plutôt irrégulière et bien en deçà de la fréquence initialement prévue, ce qui rend bien compte des difficultés à implanter des programmes en contexte de pratique. Les résultats suggèrent aussi une diminution de l’ampleur des troubles de comportement six mois après l’admission au CJM-IU pour les adolescentes qui étaient caractérisées par une ampleur des troubles de comportement plus marquée au moment de leur admission et qui ont complété un plus grand nombre d’auto-observations durant leur placement. / The implementation of evidence-based programs into real world settings can be a difficult process for administrators and educators with adolescent clientele. Practice settings are faced with constraints that may lead to the modification of intervention programs in order to facilitate their implementation. It is therefore imperative to document and measure the effect of these modifications when programs are evaluated. However, because research hasn’t yet identified the conditions in which it is possible to modify programs for use in intervention settings, this study proposes a new approach based on the principles of effective treatment elaborated by Andrews and his colleagues (1990). This approach allows for the modification of intervention levels while ensuring the effectiveness of the cognitive-behavioral program. This study sampled 74 adolescent girls hosted at the Centre jeunesse de Montréal – Institut universitaire (CJM-IU) over 6 months in order to assess the effects of the cognitive-behavioral program dosage among behavioral disorders. The results indicate that cognitive-behavioral therapy was applied in an irregular fashion and much less frequently than originally planned, which speaks to the difficulties encountered in implementing evidence-based programs in real-world settings. The results also suggest that the adolescent girls with more characteristics of a behavioral disorder and who completed more auto-evaluations during their rehabilitation showed significantly fewer behavioral problems 6 months after the beginning of the treatment.

This study tested the utility of three different models of personality, namely the social and personality model, the pathological personality traits model, and the psychological dysregulation model, in predicting overt aggression, relational aggression, and delinquency in a sample of detained boys (ages 12 to 18; M age = 15.31; SD = 1.16). Results indicated that the three personality approaches demonstrated different unique associations with aggression and delinquency. The psychological dysregulation approach, composed of behavioral dysregulation, emotional dysregulation, and cognitive dysregulation, emerged as the overall best predictor of overt aggression, relational aggression, and delinquency. After controlling for the Big Five personality traits, psychological dysregulation accounted for significant variance in overt aggression and delinquency, but not relational aggression. After controlling for callous-unemotional traits and narcissistic traits, psychological dysregulation also accounted for significant variance in overt aggression, relational aggression, and delinquency. Psychological dysregulation did not account for significant variance in aggression or delinquency after controlling for borderline traits. The pathological personality traits approach, comprised of callous-unemotional traits, narcissistic traits, and borderline traits performed second best. In particular, within this approach borderline traits accounted for the most unique variance, followed by narcissistic traits, then callous-unemotional traits. Borderline traits accounted for significant variance in overt aggression, relational aggression, and delinquency when controlling for the Big Five traits, but not after controlling for psychological dysregulation. Narcissistic traits only accounted for significant variance in overt aggression and relational aggression after controlling for the Big Five personality traits, but not after controlling for psychological dysregulation. CU traits only accounted for significant variance in overt aggression after controlling for the Big Five personality traits, but not after controlling for psychological dysregulation. The social and personality model, represented by the Big Five personality traits accounted for the least amount of variance in the prediction of aggression and delinquency, on its own, and when pitted against the other two personality approaches. The exception was that the Big Five personality traits accounted for significant variance in relational aggression beyond narcissistic traits, as well as psychological dysregulation. These findings have implications for assessment and intervention with aggressive and antisocial youth.

Research suggests that trauma has an impact on eating disorders. While prior research has demonstrated that the trauma from abuse has a significant impact on eating disorders, research has failed to explore other types of trauma. In addition, previous studies have stopped short of examining the impact trauma has on functioning among individuals with an eating disorder. This study aimed to address that gap in the literature. The purpose of this study is to examine whether traumatic life events impact psychosocial functioning among individuals living with an eating disorder. Furthermore, this study aimed to identify which traumas are shown to have the strongest impact on psychosocial functioning. A quantitative design was used for this investigation, using measurement scales that have been shown to be valid and reliable in measuring the constructs of trauma and psychosocial functioning among individuals with an eating disorder. Participants completed a single survey of the combined measurement scales. A non-random purposive sample was collected from online social media cites Tumblr, Facebook, eating disorder message boards, and an outpatient eating disorder treatment center. Using a study sample of N= 2,319 descriptive and inferential statistics were conducted using SPSS. Based on the results of correlation and multiple regression analyses, a statistically significant relationship was found between traumatic life events and psychosocial impairment among those with eating disorders. The findings of this study have the potential to impact the way social work policies address the relationship between trauma and eating disorders, and influence the way social work clinicians implement strategies to treat both trauma and eating psychopathology.

Acute myocardial infarction (AMI), caused by ischaemic heart disease (IHD), is a leading cause of death in both men and women in the western society. Hypertension, diabetes, and smoking are examples of well-known risk factors of IHD, but also there are psychosocial factors, such as stress, vital exhaustion (unusual fatigue, irritability, and demoralization) and depression that have been associated with an increased risk in both genders. After an AMI, however, women are more likely than men to be psychosocially impaired resulting in suffering and a presumed increase in the risk of recurrent cardiac events. Psychosocial factors may be targeted in secondary prevention, complementary to drug treatment and conventional lifestyle advice. There is some evidence of beneficial effects on both psychosocial well-being and cardiac outcomes by psychosocial interventions in men. Far fewer women have been studied and the results have been inconsistent. It is not clear how psychosocial factors convey the increased risk of cardiac events, but many possible psychopathological mechanisms, including biochemical and physiological links, have been suggested. In the Women’s Hearts study we have, in a randomised controlled trial, evaluated a one-year cognitive-behavioural stress management programme designed specifically for women with IHD. We included 198 women with IHD, with a mean age of 61 years and from the county of Västerbotten in Northern Sweden, who were randomised to either conventional treatment and follow-up, or to stress management in addition to conventional care. Extensive questionnaires, blood samplings, and biomedical and physiologic data were obtained before randomisation, as well as at follow-ups approximately one and two years after randomisation. Two groups of healthy controls were included for comparisons with women with IHD. Compared to women without IHD, women with IHD reported more stress behaviour and vital exhaustion. Women with IHD also had a lower heart rate variability (HRV) than the healthy controls, possibly reflecting a dysfunctional autonomic nervous regulation of the heart. Reduced HRV has been shown to increase the risk of cardiac arrhythmias and sudden death. At the first follow-up, performed at the end of the one-year stress management programme, women who had participated in the programme had reduced the stress behaviour and vital exhaustion, compared to the women in the conventional care group. We could not find any evidence of a direct cause-effect relationship between stress management and biological cardiovascular risk indicators, or HRV; the intervention and control groups did not differ in insulin resistance, inflammatory, haemostatic and fibrinolytic factors, or HRV. At second follow-up one year later, several additional psychosocial domains were studied. The stress management programme had accelerated psychosocial recovery at the first follow-up over and above that observed in the control group. At the second follow-up, there was further marked improvement in the control group, so the differences in psychosocial variables between the intervention and control groups were no longer significant. In conclusion, a cognitive-behavioural stress management programme could accelerate psychosocial improvement in women with IHD, and thus reduce the amount of psychological and psychosocial suffering. We could not find any evidence that the stress management programme was associated with a concomitant improvement in biological cardiovascular risk indicators, or HRV. Our results suggest that the women with the greatest psychosocial burden should be identified and targeted in new clinical trials of cognitive-behavioural interventions in women with IHD. Future studies within the Women’s Hearts project will evaluate the psychosocial effects at a five-year follow-up, as well as investigations of other possible pathways by which psychosocial interventions might mediate beneficial effects on cardiac events.

No description available.

The thesis highlights the importance of the cross-cutting theme of ``Personal and social education.{\crqq} Various cross-cutting issues such as those included in the general curriculum of basic education are defined in the theoretical part of the work. However, closer attention is dedicated to the cross-cutting theme of "Personal and social education". Presented in the practical part of the thesis is the information from the survey conducted on the sample of schools. These schools have had a yearly experience in application of their School education programs, including Personal and social education, into their own education systems.

Advances in breast cancer detection and oncology treatment modalities have prolonged the survival time for the cancer population, which is officially the largest group of cancer survivors among women in the western world, including South Africa (Brem & Kumar, 2011; Fisher, Dolbeault, Sultan & Bredart, 2014; Herbst, 2011; Reyes-Gibby, et al., 2012). In the light of shocking statistics and ever rising numbers of cancer, especially breast cancer, the time is ripe for further research in the domain of psycho-oncology and has motivated the researcher, due to her interest and involvement in breast cancer, to make this her field of research. Despite the need for a bio-psycho-social approach when treating cancer patients there is little literature available on the psychological interventions in South Africa where the majority of research studies previously conducted in South Africa have generally focused on the bio-medical aspects of cancer (Albrecht, 2009; Venter, 2014). To comprehend the paradigm of psycho-oncology, which is the backbone of this study, a theoretical framework was attained from Engel’s humanistic or psychological model (caring) and Pasteur’s biomedical model (curing) (Borrel-Carrio, Suchman, & Epstein, 2004). The primary aim of this study was to explore the lived experiences of breast cancer patients concerning their diagnosis, treatment and survivorship and unique needs for psycho-oncological interventions through their own “voices”. The research was conducted within a qualitative framework with a case study method of inquiry employing open-ended style interviews and psychotherapeutic sessions with five purposely sampled breast cancer patients. Two qualitative questionnaires were also used for triangulation purposes. Transcripts of all the therapeutic sessions were analysed using interpretive analysis where categories and themes were developed and described in full. Findings indicated that in spite the extensive proof that breast cancer causes numerous sexual and psychological complications during active treatment and afterwards, patients still feel that they have no “platform” to express their emotions and sexual issues within the oncology framework, or that there is enough and sufficient assistance to attend to their needs. e The researcher hopes that this study will make a valuable contribution to research in the field of psycho-oncology in South Africa and to indicate new realities of the chronicity of breast cancer and treatment complications that demand psychotherapeutic interventions in cancer care and that the study will initiate new ways of understanding the role of psychology and the psychologist in the medical world of cancer. The researcher hopes that by offering an understanding of participants’ unique experiences of this process, practitioners will have insight when working therapeutically with this population and empower them to have a quality of life, even within the boundaries of their illness. / Psychology / D. Litt. et Phil. (Psychology)

Antalet sjukskrivningar till följd av stressrelaterade sjukdomar har ökat kraftigt för vårdpersonal. Därtill saknas det evidens för internetbaserade interventioner mot stressrelaterad ohälsa för vårdpersonal. Syftet var att undersöka och utvärdera en internetbaserad kognitiv beteendeterapi-intervention (iKBT) avseende graden av samvetsstress, arbetsrelaterad stress samt självmedkänsla hos vårdpersonal. Enkäter bestående av Stress of Conscience Questionnaire (SCQ), Copenhagen Psychosocial Questionnaire version II (COPSOQ II) och Self-Compassion Scale (SCS) besvarades av deltagarna (N = 8), samtliga var kvinnor mellan 27 – 53 år. Resultaten analyserades med PEM och RCI på individnivå och T-test på gruppnivå. RCI-analysen visade begränsade resultat för SCQ, blandade resultat för COPSOQ II och övervägande positiva resultat för SCS. Analysen på gruppnivå visade en signifikant minskning i Sömnbesvär (p = .032) och Self-Judgment (p = .021) samt signifikant ökning i Self-Kindness (p = .016). Studien behöver replikeras i framtida studier med ett större antal deltagare och en studiedesign som är metodologiskt robust. / The amount of sick leave due to stress-related illnesses has increased significantly for healthcare staff. In addition, there is a lack of evidence for internet-based interventions for stress-related illness for healthcare staff. The aim was to examine and evaluate an internet-based Cognitive Behavioral Therapy (iCBT) intervention regarding the degree of stress of conscience, work-related stress and self-compassion among healthcare staff. Questionnaires consisting of Stress of Conscience Questionnaire (SCQ), Copenhagen Psychosocial Questionnaire version II (COPSOQ II) and Self-Compassion Scale (SCS) were answered by the participants (N = 8), all were women between 27 - 53 years. The results were analyzed with PEM and RCI at the individual level and T-tests at group level. The RCI analysis showed limited results for SCQ, mixed results for COPSOQ II and predominantly positive results for SCS. The analysis at group level showed a significant decrease in Sleep Disorders (p = .032) and Self-Judgment (p = .021) as well as a significant increase in Self-Kindness (p = .016). The study needs to be replicated in future studies with a larger number of participants and a study design that is more methodologically robust.

La schizophrénie est considérée comme l'un des troubles psychiatriques les plus invalidants. L'une des principales raisons de ce fardeau élevé est qu'une grande partie des patients atteints de schizophrénie ne répondent pas adéquatement aux traitements pharmacologiques de première ligne et continueront de souffrir d’hallucinations auditives. La présence de celles-ci peut avoir un effet dévastateur sur le bien-être émotionnel des patients ainsi que sur leur qualité de vie. Les alternatives non-pharmacologiques (ex., Thérapie cognitivo-comportementale (TCC)) demeurent aussi limitées. Ainsi, pour plusieurs patients, les traitements actuellement recommandés ne sont pas suffisants. À cet égard, le traitement de la schizophrénie peut être perfectionné si, en plus du traitement des symptômes, l'accent thérapeutique est mis sur d’autres sphères importantes pour les patients (ex., améliorer l’estime de soi, réguler les émotions). Les efforts visant à accroître l'efficacité et les bénéfices des psychothérapies fondées sur des preuves ont mené à l'émergence d'interventions basées sur la réalité virtuelle (RV). Avec ces progrès technologiques, AVATAR Therapy et l’adaptation faite par notre équipe, la Thérapie assistée par la Réalité Virtuelle (TRV) (ou communément nommé la Thérapie Avatar (TA)), permettent aux patients d’entrer en dialogue en temps réel avec un avatar, animé entièrement par le thérapeute, qui représente leur voix la plus persécutrice. Cette approche, à la fois relationnelle et expérientielle, offre une occasion unique d’aider les patients à prendre le contrôle de leur voix. Cette thèse a pour objectif principal d’évaluer l’efficacité de cette psychothérapie basée sur la RV ainsi que les thèmes abordés durant et après la thérapie. Pour arriver à cette fin, divers objectifs ont été mis à l’avant : (i) résumer l'état des preuves sur l'efficacité des interventions basées sur la RV pour les troubles psychiatriques, (ii) évaluer l'efficacité de la TA/TRV par rapport à la TCC, (iii) illustrer l’efficacité de la thérapie à travers la perspective de patients ayant montré des effets bénéfiques, et (iv) explorer les thèmes émergeants ainsi que les processus thérapeutiques de la TA/TRV. Dans la première section, deux recensions des écritsdans diverses bases de données ont été effectuées pour examiner l’efficacité des psychothérapies basées sur la RV. Notre méta-revue (c’est-à-dire revue de méta-analyse) incluant 11 méta-analyses et 41 tailles d'effet a montré des résultats positifs de la RV dans le traitement des troubles psychiatriques, principalement des troubles anxieux. Les interventions basées sur la RV sont meilleures que le traitement usuel et montrent généralement des effets similaires par rapport aux approches fondées sur des preuves. Les résultats préliminaires suggèrent également que les effets de la RV se maintiennent dans le temps. Par contre, de nombreux symptômes et troubles psychiatriques qui peuvent être traités par des interventions utilisant RV n'ont pu être examinés par une analyse méta-analytique, en particulier les symptômes psychotiques (ex., hallucinations auditives) et les comportements liés à l'agressivité (ex., régulation émotionnelle). Ainsi, notre seconde revue a montré qu’il existe un nombre limité de paradigmes basés sur la RV pour traiter les individus atteints de troubles psychotiques et autres troubles mentaux à risque de comportements agressifs. Les études préliminaires dans des populations autres que la schizophrénie ont montré des réductions de la colère et de l'impulsivité, des améliorations des capacités de résolution des conflits ainsi que des niveaux d'empathie et des diminutions de l'agressivité. En ce qui a trait aux interventions basées sur la RV pour la schizophrénie, des réductions par rapport aux délires et aux hallucinations auditives ont été trouvées. Dans la seconde section, deux essais cliniques ont été menés pour évaluer l’efficacité de la TA/TRV seule en comparaison avec la TCC et en combinaison avec la TCC (TCC+TA/TRV). Notre essai randomisé comparant la TA/TRV à la TCC a compris 37 participants de plus de 18 ans entendant des voix persécutives et souffrant de schizophrénie résistante aux traitements dans chacun des groupes. Les résultats principaux ont montré que les deux interventions ont produit des améliorations significatives sur la sévérité des symptômes hallucinatoires avec des effets plus prononcés pour la TA/TRV. De plus, les résultats suggèrent une supériorité de la TA/TRV par rapport à la TCC sur les symptômes affectifs. La TA/TRV a également montré des effets positifs sur la qualité de vie. Les effets ont été maintenus à long terme, soit jusqu'à un an de suivi. Notre preuve de concept sur 10 patients ayant suivi la TCC de notre essai clinique comparatif qui souhaitaient continuer à obtenir des améliorations avec la TA/TRV a montré que les effets de la TCC+TA/TRV sur les symptômes dépressifs et les symptômes de la schizophrénie étaient plus larges que ceux trouvés pour l'une ou l'autre des interventions uniques. La troisième section a pour but de détailler les cas de 2 patients ayant suivi la TA/TRV. D’abord, nous avons décrit un partenariat entre un utilisateur de services en santé mentale et des chercheurs cliniciens en mettant en vedette M. X, le premier patient à suivre la thérapie. Nous avons ainsi montré l’apport de monsieur X quant à ses suggestions d’amélioration de la thérapie et ensuite en tant que notre pair aidant pour les futurs patients, dans son cheminement vers le rétablissement. Ensuite, nous avions rapporté le cas d'un patient atteint d’une schizophrénie ultra-résistante, soit M. Smith, qui n'a pas répondu à plusieurs traitements antipsychotiques, à la stimulation magnétique transcrânienne répétitive et à la thérapie par électrochocs avant de participer à notre essai. De plus, le patient a terminé notre TCC avant de se voir proposer notre TA/TRV. Cette dernière intervention a montré les effets les plus positifs. Or, ces deux cas ont montré que la thérapie a aidé non seulement à diminuer leurs symptômes, mais aussi à améliorer leur qualité de vie. La quatrième section a pour objectif d’explorer les thèmes émergents de la TA/TRV suite à des analyses de contenu. Ainsi, suite à une analyse qualitative découlant du discours spontané de 10 patients ayant bien répondu à la TA/TRV, quatre thèmes généraux ont émergé : impact de la thérapie sur les voix, relations interpersonnelles, bien-être psychologique et mode de vie. Cette analyse de contenu a permis d’identifier plusieurs sphères de vie qui sont davantage améliorées chez les patients ayant une schizophrénie résistante aux traitements à l’aide de la TA/TRV. Deux autres analyses qualitatives ont été conduites pour approfondir nos connaissances sur les processus thérapeutiques de la TA/TRV. Celles-ci ont permis de montrer que les patients répondent au propos de l’avatar en utilisant des mécanismes d'adaptation ou en exprimant des émotions, des croyances, des perceptions de soi ou des aspirations. Le discours de l'avatar a pu être catégorisé en techniques de confrontation (ex., provocation) et en techniques positives (ex., renforcement). Grâce à l'identification de changements mutuels dans l'interaction entre le patient et son avatar, un changement a été observé au fil des séances de la confrontation vers un dialogue constructif. L'affirmation de soi, les réponses émotionnelles et les stratégies de prévention semblaient être au cœur du processus thérapeutique, et celles-ci se produisent généralement en réponse à des techniques positives. Cette thèse contribue à la validation d’une nouvelle approche thérapeutique répondant à un besoin clinique fondamental. Ainsi, la TA/TRV met en lumière l'avenir des approches adaptées aux patients qui peuvent présenter des avantages par rapport aux traitements conventionnels. Ces types d’interventions holistiques utilisant la RV pourraient aussi présenter des avenues prometteuses dans plusieurs autres troubles psychiatriques. / Schizophrenia is considered one of the most debilitating psychiatric disorders. One of the main reasons for this high burden is that a large proportion of patients with schizophrenia do not respond adequately to first-line pharmacological treatments and will continue to suffer from auditory hallucinations. The presence of these symptoms can have a devastating effect on the emotional well-being of patients as well as their quality of life. Non-pharmacological alternatives (e.g., Cognitive Behavioral Therapy (CBT)) also remain limited. Thus, for many patients, the treatments currently recommended are not sufficient. In this regard, the treatment of schizophrenia may be improved if, in addition to the treatment of symptoms, therapeutic emphasis is placed on other areas of importance to patients (e.g., improving self-esteem, emotion regulation). Efforts to increase the effectiveness and benefits of evidence-based psychotherapies have led to the emergence of virtual reality (VR)-based interventions. With these technological advances, AVATAR Therapy and its related innovative form from our team, Virtual Reality Assisted Therapy (VRT) (or commonly Avatar Therapy (AT)), allow patients to enter a real-time dialogue with an avatar, animated entirely by the therapist, who represents their most persecutory voice. This approach, both relational and experiential, offers a unique opportunity to help patients take control of their voice. The main objective of this thesis is to evaluate the effectiveness of this psychotherapy based on VR as well as the themes addressed during and after the therapy. To achieve this end, various objectives have been put forward: (i) summarize the state of the evidence on the effectiveness of VR-based interventions for psychiatric disorders, (ii) assess the effectiveness of AT/VRT versus CBT, (iii) obtain the perspective of patients who have undergone AT/TRV, (iv) explore the therapeutic processes of AT/VRT. In the first section, two literature reviews in various databases were performed to examine the effectiveness of VR-based psychotherapies. Our meta-review including 11 meta-analyzes and 41 effect sizes showed positive results of VR in the treatment of psychiatric disorders, mainly anxiety disorders. VR-based interventions appear better than inactive controls and generally show similar effects compared to evidence-based approaches. Preliminary results also suggest that the effects of VR are sustained over time. On the other hand, many psychiatric symptoms and disorders that can be treated with interventions using VR have not been examined by a meta-analytical analysis, including psychotic symptoms (e.g., auditory hallucinations) and related behaviors. aggression (e.g., emotional regulation). Thus, our second review showed that there are a limited number of VR-based paradigms for treating individuals with psychotic disorders and other mental disorders at risk for aggressive behavior. Preliminary studies in populations other than schizophrenia have shown reductions in anger and impulsivity, improvements in conflict resolution skills as well as levels of empathy and decreases in aggression. Particularly related to VR interventions for schizophrenia, reductions in delusions and auditory hallucinations were found. In the second section, two clinical trials were conducted to evaluate the efficacy of AT/VRT alone in comparison with CBT and in combination with CBT (CBT+TA/VRT). Our randomized trial comparing AT/VRT to CBT included 37 participants over 18 years of age hearing persecutory voices and suffering from treatment-resistant schizophrenia in each group. The main results showed that the two interventions produced significant improvements in the severity of hallucinatory symptoms with more pronounced effects for AT/VRT. In addition, the results suggest that AT/VRT is superior to CBT on affective symptoms. AT/VRT has also shown positive effects on quality of life. The effects were maintained for up to one year of follow-up. Our proof of concept on 10 patients having followed CBT from our comparative clinical trial who wanted to continue to achieve improvements with AT/VRT showed that the effects of CBT+AT/VRT on depressive symptoms and symptoms of schizophrenia were broader than those found for either intervention alone. The third section details the cases of 2 patients who had followed AT/VRT. First, we described a partnership between a mental health service user and clinical researchers by featuring Mr. X, the first to follow therapy for his suggestions and our peer helper for future patients, on his journey to the recovery. Next, we reported the case of a patient with ultra-resistant schizophrenia, Mr. Smith, who failed to respond to multiple antipsychotic treatments, repetitive transcranial magnetic stimulation, and electroconvulsive therapy before participating in our trial. In addition, this patient completed our CBT before being offered AT/VRT. The latter intervention showed the most positive effects. These two cases showed that AT/VRT not only helped to decrease their symptoms, but also to improve their quality of life. The fourth section aimed to explore emerging themes of AT/VRT following content analyses. Thus, following a qualitative analysis resulting from the spontaneous speech of 10 patients who responded well to AT/VRT, four general themes emerged: impact of therapy on voices, interpersonal relationships, psychological well-being and lifestyle. This content analysis identified several areas of life that are further improved in patients with treatment resistant schizophrenia after having followed AT/VRT. Two other qualitative analyses were carried out to deepen our knowledge of the therapeutic processes of AT/VRT. These have shown that patients respond to the avatar's words by using a coping mechanism or by expressing emotions, beliefs, self-perceptions or aspirations. The avatar's discourse could be categorized into confrontational techniques (e.g., provocation) and positive techniques (e.g., reinforcement). With the identification of mutual changes in the interaction between the patient and their avatar, a shift was observed over therapy sessions from confrontation towards a constructive dialogue. Assertiveness, emotional responses, and prevention strategies seemed to be central to the therapeutic process, and these usually occurred in response to positive techniques. This thesis contributes to the validation of a new therapeutic approach responding to a fundamental clinical need. Thus, AT/VRT shines a light on the future of patient-oriented approaches that may have advantages over conventional treatments. These types of holistic interventions using VR may have notable applications in several other psychiatric disorders.