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Les recherches sur le traitement des cauchemars chroniques par le biais de la modification du contenu onirique et la répétition cognitive de l'imagerie modifiée (Imagery Rehearsal Therapy) ont demontré leur efficacité auprès des adultes souffrant de cauchemars liés au stress post-traumatique (Krakow et al., 2001) ou seulement de cauchemars (Krakow, Kellner, Neidhart, Pathak & Lambert, 1993). À partir de leur expérience clinique avec les enfants, Siegel et Bulkeley (I998) ont proposé une approche similaire à la répétition de l'imagerie chez l'adulte et qu'ils ont nommée les quatre "R", soit: réassurance, réécriture, répétition et résolution. Cependant, aucune recherche n'a ete publiée sur l'éfficacité de cette technique d'imagerie pour le traitement des cauchemars chez les enfants. Vingt enfants, onze garçons et neuf filles, de 9 à 11 ans, ayant des cauchemars fréquents ont été recrutés par le biais de publicité dans les écoles et les médias. Ils ont été assignés aléatoirement à deux groupes: neuf enfants formant un groupe de traitement par imagerie répétée et onze enfants formant un groupe en attente de traitement. À la première rencontre, ils complétaient des questionnaires sur la détresse reliée aux cauchemars (DAC), le style causal (SC), l'anxiété manifesté (RCMAS) et les expériencés de vie (JHLES). Ensuite, durant quatre semaines, ils devaient tous prendre note chaque matin à la maison du nombre de rêves et de cauchemars qu'ils avaient eus. Suite aux quatre semaines, soit à la deuxième rencontre, les deux groupes recevaient des instructions différentes. Le groupe traité devait mettre en application le traitement d'imagerie répétée. Ils devaient aussi enregistrer leurs cauchemars et leurs cauchemars modifiés pendant huit semaines. Le groupe en attente de traitement devait prendre en note le nombre de rêves et de cauchemars à chaque matin. Après ces huit semaines, les questionnaires étaient complétés de nouveau et le groupe en attente de traitement recevait alors le traitement. Un sous-groupe d'enfants (n = 6) ont dormi au laboratoire afin d'étudier leurs patrons de sommeil et les comparer à des enfants sans cauchemar (n = 6). Pendant neuf mois, un suivi téléphonique a été éffectué auprès des vingt enfants ayant reçu le traitement. Une ANCOVA à mesures répetées sur la fréquence hebdomadaire de cauchemars a démontré que le traitement a été efficace pour réduire la fréquence des cauchemars pour le groupe traité, alors que le groupe en attente de traitement n'a pas demontré de changement significatif. De plus, une ANOVA a mesurés répétées sur la fréquence mensuelle de cauchemars pendant le suivi a démontré que le groupe traité a maintenu les gains acquis lors du traitement, alors que le groupe auparavant en attente de traitement a démontré une diminution de la fréquence sous le seuil d'inclusion. Les résultats sur les mesures de détresse, d'anxiété et de style causal, en plus des mesures de sommeil sont aussi rapportés et discutés. Il est donc possible de conclure que la technique d'imagerie répétée que nous avons adapté est efficace avec les enfants de ce groupe d'âge. Le fait qu'il n'a suffi que d'une session d'instruction de 30 minutes et de l'utilisation de la technique pendant deux mois à la maison pour obtenir la rémission des cauchemars témoigne de sa pértinence comme moyen d'intérvention pratique.

This longitudinal study was designed to refine the search for reliable predictors of premature termination from adult psychotherapy by examining therapy-specific and contextual factors that may predict clients' decisions to leave treatment early. These variables included client's stage of change prior to treatment, client's level of self-determination or motivation for therapy, client and therapist expectations and any discrepancies between them, the therapeutic alliance, and practical barriers to treatment participation. To facilitate comparison with previous research, premature termination was operationalized in two manners, duration of treatment and type of termination decision (unilateral versus mutual agreement with the therapist), although type of termination decision was considered a better measure of premature termination. These variables were examined with self-report data from 107 client/therapist dyads at a community mental health clinic. Data were collected prospectively and retrospectively from both client and therapist perspectives before therapy began, after the third treatment session, and after therapy ended. Logistic regression analyses showed that barriers to treatment participation, measured at the end of therapy, and working alliance, measured after the third treatment session, predicted type of termination from the client perspective, and barriers predicted type of termination from the therapist's perspective. The therapist's perception of barriers to treatment added incremental predictive value to that of the client's. The client's perspective on barriers to treatment also enhanced the predictive value of the therapist's perception of barriers. The discrepancy between client and therapist expectations for therapy duration did not predict the nature of the termination decision. When a client had a low self-determination index score, or was non self-determined, but had expectations of longer therapy, he or she tended to make a unilateral decision to end therapy. If a client, who perceived a poor working alliance, was not far along in the stage of change process (e.g., more contemplative than active), s/he was more likely to make a unilateral decision to end therapy. The strengths and limitations of the study and implication of these results for future research and clinical application are discussed. The findings support the overall contention of this study that it is therapy-specific and contextual factors, and not client or therapist factors alone, that predict the likelihood of premature termination.

The aim of this study was to investigate the personal stressors and patterns of coping in adolescents living with a chronic illness. Primary objectives were to: (1) identify salient stressors and to determine the relation between cognitive appraisals and the degree to which a stressor is perceived as illness-related or typical of adolescence; (2) assess differences in coping strategies used for illness-related and other types of stressors; (3) investigate if gender or age influences the frequency, cognitive appraisals or types of stressors reported, or the nature and the overall number of coping strategies reported. A secondary objective was to assess the extent to which health-related quality of life is related to stressors, coping strategies and coping in general. In the current study, 193 chronically ill adolescents listed up to 20 personal stressors and rated the frequency, control over the cause, perceived impact, control over the outcome, and the extent to which each stressor was related to the chronic illness, and typical of adolescence. Adolescents reported coping strategies (Kidcope) for one self-identified illness related and one non-illness related stressor and for two stressors standardized for the entire sample. Participants also completed a global measure of adolescent coping (A-COPE) and a health-related quality of life measure (Rand 36-item Health Survey). Results showed that the most frequently identified stressors were similar to those reported for healthy adolescents. Moreover, stressors were rated as more typical of adolescence than they were illness-related. Although perceived control over the cause was negatively related to stressor impact for self-identified stressors, neither controllability ratings nor impact were significantly correlated with illness or typical ratings. Considerable consistency in coping was found across self-identified stressors only. Females employed more social support and emotional regulation than did males. Although the number of stressors and the perceived impact of stressors increased with age, consistent age differences in coping were not obtained. Poorer general health perception was associated with greater impact for illness stressors. Perceived controllability over the outcome was associated with increased approach coping for both self-generated and standard stressors. Study limitations, suggestions for future research, and clinical implications are discussed.