Problématique : Les troubles mentaux ont une forte prévalence dans tous les pays et constituent environ un tiers des résultats de consultation en médecine générale de ville. En France, les médecins généralistes (MG) assurent la prise en charge de la plupart des psychopathologies. Selon la définition du Collège National des Généralistes Enseignants, le MG est particulièrement apte à assurer le suivi de ces patients. Différents facteurs viennent compliquer ces prises en charge- l'organisation de la formation médicale, le système de soins français, la faible fréquence des prises en charge en réseaux de soins, des difficultés de communication entre généralistes et professionnels de santé mentale - et contribuent à privilégier les traitements pharmacologiques au détriment des psychothérapies ou des traitements combinés. Objectifs : Nous souhaitions connaître les pratiques, attitudes et attentes des MG français dans le domaine de la prise en charge des troubles mentaux et dans celui des thérapies cognitivo-comportementales (T.C.C.), modalité de soins psychiques scientifiquement validée, efficace dans de nombreux troubles mentaux mais encore peu répandue en France. Méthode : Nous avons mené une étude– action auprès de MG français. Résultats : Les résultats sont indicatifs de besoins de formation. Nous présentons les concepts théoriques et thérapeutiques cognitivo-comportementaux des principaux troubles mentaux qui pourraient avoir leur place dans la formation initiale et continue ( FMI/FMC) des spécialistes en médecine générale. Discussion : celle-ci présente les limites du présent travail, et des éléments d'une FMC en T.C.C. par internet centrée sur le cadre des soins primaires. / Background: Mental health problems are prevalent in all countries and make up approximately one-third of consultations for general practitioners (GP) in large cities. In France, GPs provide service delivery to the majority of common psychopathological disorders. According to the National College of GP Educators, GPs are well suited to provide follow-up to these patients. Yet, many factors make this type of service delivery difficult: initial medical school training, the particularities of the French health system including a lack of networked service delivery, and poor communication between GPs and other health service providers, to name a few. These difficulties result in an over-usage of prescription psychotropic medications and this to the detriment of other types of therapies. Objectives: The objective of the current work is to better understand practices, attitudes and expectations of French GPs with regards to mental health treatment and the usage of CBT, an empirically validated approach to mental health problems that is still largely underutilized in France. Method: A study was implemented with the participation of French GPs. Results: The results show an overall need for better training of GPs. These results underline theoretical concepts in CBT and how they could provide a better foundation in both initial and continuing education of GPs, as well as how they could be integrated into the GP’s daily practice. Discussion: Limits of the work are presented along with a detailed inventory of CBT concepts that could be provided through an internet-based continuing education program for primary care doctors.

Many people use smoking as a weight control mechanism and do not want to quit because they fear weight gain. These weight-concerned smokers tend to be female, are significantly less likely to stop smoking, are less likely to join smoking cessation programs, and will relapse more often than smokers who are not weight-concerned. Research suggests that a woman’s confidence in her ability to control her weight after quitting relates positively with her intention to quit smoking. Likewise, success in smoking cessation has been associated with increased self-efficacy for weight control. It has been shown that success in changing one negative health behavior may trigger success in changing another, causing a synergistic effect. Recently research has focused on interventions for weight-concerned smokers who are ready to quit smoking. The present study investigated the effect of a cognitive based weight control program on self-efficacy for weight control and the effect on smoking behavior for a group of female weight concerned smokers. Two hundred and sixteen subjects who wanted to lose weight but who were not ready to quit smoking were recruited to participate in a 12-week, cognitive-behavioral weight control program consisting of twelve one-hour sessions. Subjects were randomly assigned to either 1) the weight-control program (intervention group), or 2) the control group. Results of this study demonstrated that subjects in the intervention group increased self-efficacy for weight control, which was associated with improved healthy eating index scores, weight loss, increased self-efficacy for quitting smoking, a decrease in number of cigarettes smoked and triggered positive movement in stage of change towards smoking cessation compared to the control subjects. For these subjects, positive changes in self-efficacy for one behavior (weight control) appeared to have a positive effect on their readiness to change another health behavior (smoking cessation). Further study of the psychological variables that influence weight-concerned female smokers’ decisions to initiate changes in these behaviors and their ability to maintain those changes are warranted.

Anxiety disorders; such as separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia, are widespread in children and adolescents. Cognitive behavioral therapy (CBT) has been shown to be effective in reducing excessive fears and anxieties in children and adolescents. Research has produced equivocal findings that involving parents in treatment of child anxiety enhances effects over individual CBT (ICBT). The present dissertation study examined whether parental involvement can enhance individual treatment effect if the parent conditions are streamlined by targeting specific parental variables. The first parent condition, Parent Reinforcement Skills Training (RFST), involved increasing mothers’ use of positive reinforcement and decreasing use of negative reinforcement. The second parent condition, Parent Relationship Skill Training (RLST), involved increasing maternal child acceptance and decreasing maternal control (or increasing autonomy granting). Results of the present dissertation findings support the use of all three treatment conditions (ICBT, RLST, RFST) for child anxiety; that is, significant reductions in anxiety were found in each of the three treatment conditions. No significant differences were found between treatment conditions with respect to diagnostic recovery rate, clinician rating, and parent rating of child anxiety. Significant differences between conditions were found on child self rating of anxiety, with some evidence to support the superiority of RLST and RFST to ICBT. These findings support the efficacy of individual, as well as parent involved CBT, and provide mixed evidence with respect to the superiority of parent involved CBT over ICBT. The conceptual, empirical, and clinical implications of the findings are discussed.

L’addiction aux jeux vidéo n’est pas, pour l’instant, un diagnostic pleinement reconnu. Pour aborder ce phénomène, nous questionnons le concept d’addiction sans substance. Reconnu comme une addiction comportementale dans le DSM-V, le jeu pathologique, concernant les jeux de hasard et d’argent, est le prototype des addictions sans substance. L’utilisation excessive des jeux vidéo a fait l’objet de multiples comparaisons avec le jeu pathologique. À l’avènement d’Internet, la recherche et la clinique se sont fortement focalisées sur l’utilisation excessive des jeux vidéo en ligne. Au regard de la littérature actuelle, nous avons choisi d’aborder l’addiction aux jeux vidéo selon la pluralité des jeux vidéo existants et des modes d’utilisation des jeux vidéo. Nos recherches se situent dans le champ de la psychologie cognitive et prennent leur source dans la clinique en lien avec les Thérapies Comportementales et Cognitives. La première étude permet de préciser les fonctionnements émotionnels, cognitifs et comportementaux des joueurs assidus de jeux vidéo. Nous décrivons un ensemble de phénomènes psychologiques qui sont en résonance avec la littérature actuelle sur l’addiction aux jeux vidéo. De plus, nous avons rapproché certaines cognitions des joueurs avec les croyances Anticipatoires, Soulageantes et Permissives décrites par Beck et al. (1993). Pour nous, des cognitions et des comportements spécifiques sous-tendent une attention soit orientée vers le jeu pour certains, soit orientée vers l’extérieur du jeu pour d’autres. Nous explorons différents moments de jeu : avant, pendant et après le jeu mais aussi au moment de gagner et au moment de perdre. Des comparaisons entre les moments de jeu révèlent une dynamique des émotions, cognitions et comportements en lien avec le jeu. La deuxième étude passe par l’opérationnalisation des variables psychologiques relevées dans la première étude et par la construction d’un nouvel outil de mesure de l’addiction aux jeux vidéo. Ce questionnaire nous a permis d’établir des groupes distincts de joueurs considérés comme excessifs et de joueurs non excessifs de jeux vidéo. Ainsi, nous avons comparé ces joueurs sur la base des émotions, cognitions et comportements propres à nos études. Des pistes thérapeutiques, en lien avec les TCC, sont discutées à partir de nos résultats. Une adaptation du modèle des addictions de Beck et al. (1993) est proposée. Deux études de cas permettent d’illustrer nos propos et d’aborder la clinique spécifique concernant l’addiction aux jeux vidéo. En plus des conclusions en lien avec nos travaux, nous abordons des pistes de recherche qui nous semblent présager de l’avenir des études sur cette thématique. Même s’il faut rester prudent, certaines données actuelles convergent vers le rapprochement entre l’addiction et l’utilisation excessive des jeux vidéo. Nos résultats s’ajoutent à cette argumentation. Avec la proposition du « trouble du jeu (vidéo) sur Internet » dans la section III du DMS-V, il est, d’autant plus, nécessaire de poursuivre les études. / Video game addiction is not yet a fully recognized diagnosis. To address this phenomenon, we question the concept of addiction without substance. Known as a behavioral addiction in DSM-V, pathological gambling is the prototype of addictions without substance. The excessive use of video games has been the subject of multiple comparisons with pathological gambling. With the advent of Internet, research and the clinical approach have highly focused on the excessive use of online games. In light of the current literature, we have chosen to address video game addiction according to the plurality of existing games and the different games modes. Our research lies in the scope of cognitive psychology and is rooted in the Cognitive Behavioral Therapy approach. The first study allows to specify the emotional, cognitive and behavioral functionings of assiduous video game players. We describe a set of psychological phenomena that are resonant with the current literature on video game addiction. In addition, some cognitions of players draw near to anticipatory, relief-oriented and permissive beliefs described by Beck et al. (1993). For us, specific cognitions and behaviors underlie an attention process which is directed towards the game for some and outwards of the game for others. We explore different game moments: before, during and after the game but also, at the moment of winning and losing. Comparisons between the game moments reveal a dynamic of emotions, cognitions and behaviors related to the game. The second study involves the operationalization of psychological variables identified in the first study and the construction of a new measure of video game addiction. This questionnaire allowed us to establish separate groups of players considered excessive and non-excessive video game players. Between these players, we performed statistical comparisons based on the emotions, cognitions and behaviors that are specific to our studies. From our results, therapeutic proposals related to CBT are discussed. An adaptation of addiction model of Beck et al. (1993) is proposed. Two case studies allow to illustrate these results and to address the specific clinical approach of the video game addiction. In addition to the conclusions related to our work, we discuss on new research avenues that seem to predict future studies on video game addiction. Even if we remain cautious, some current data converge towards the link between addiction and excessive use of video games. Our findings are added to this argumentation. With the proposal of "Internet gaming disorder" in Section III of the DMS-V, it is all the more necessary to continue studies.

The Secondary Prevention in Uppsala Primary Health Care Project (SUPRIM) is a randomized controlled trial evaluating the effects of cognitive behavioral therapy on coronary heart disease patients. Various outcomes of psychological and physical health are recorded every six months approximately, over the course of two years after entry to the trial. In this thesis, relationships between the psychological outcome variables, Stress, Anxiety, Depression and Exhaustion, and five physical health biomarkers, are assessed using bivariate linear mixed models. Significant associations are found between one of the biomarkers and both Depression and Exhaustion, and also between one of the other biomarkers and Exhaustion.

Nearly 10% of college students experience chronic insomnia. Cognitive-behavioral therapy for insomnia (CBTi) is an empirically validated multi-component treatment that has been demonstrated to produce reliable and durable benefits in the general adult population. However, there have been no studies examining the effectiveness of multi-component CBTi in a college student population, even though many studies have examined the efficacy of single treatment modalities. These young adults are different from the general adult population because they are in a unique transitional developmental phase as they are maturing from adolescence into adulthood, they are sleepier than adults, they tend to have irregular sleep schedules, and their living situations are often different from the general adult population. In this study college students with chronic insomnia were randomly assigned to either six sessions of CBTi or a wait list control (WLC) group. All participants completed sleep diaries, sleep measures, and psychosocial measures. The results indicated students who received CBTi showed improvements in sleep efficiency (SE), sleep onset latency (SOL), number of awakenings (NWAK), time awake after sleep onset (WASO), and sleep quality (SQ). They also had decreased insomnia severity (ISI), dysfunctional beliefs about sleep (DBAS), and general fatigue (MFI), as well as increases in global sleep quality (PSQI).

The present study examined the efficacy of a cognitive-behavioral therapy package and a highly credible attention-placebo in the treatment of male heterosocial anxiety. Previous research provided evidence that cognitive factors are important in the etiology and maintenance of heterosocial anxiety, and suggested that a cognitive-behavioral approach should be effective in the treatment of this problem. Despite such evidence, relatively few therapy outcome studies have been conducted using cognitive-behavioral procedures.

Change-talk (CT), or self-arguments for change, has been associated with favorable patient outcomes, while counter change-talk (CCT), or self-arguments against change, has been associated with poorer outcomes. Most studies on change language have focused on the prediction of distal posttreatment outcomes, while the prediction of more proximal outcomes has remained largely untested. Addressing this gap, we examined early treatment CT and CCT as predictors of worry change trajectories, “hazard” of clinically significant response, and time to response (i.e., outcome efficiency) in CBT and CBT integrated with MI (MI-CBT) for generalized anxiety disorder (GAD). We also explored whether treatment type moderated these associations. Data derived from a randomized controlled trial comparing CBT (n = 43) and MI-CBT (n = 42) for GAD. Independent observers reliably coded CT/CCT during session 1. Patients rated their worry after every session. Multilevel modeling revealed that, across both treatments, more CT associated with lower midtreatment worry level (p = .03), whereas more CCT associated with a slower rate of worry reduction at midtreatment (p = .04). However, treatment moderated the associations between CT and both midtreatment worry level (p = .004) and rate of change (p = .03). In CBT, patients with higher vs. lower CT had less worry and a faster rate of worry reduction; in MI-CBT, CT was unrelated to midtreatment worry level and the rate of worry change. Treatment did not moderate the CCT-worry relations. Survival analyses revealed that, across both treatments, more CT associated with a greater hazard of response (p = .004) and approached a faster time to response (p = .05), and more CCT associated with a lower hazard of response (p = .002) and approached a slower time to response (p = .06). Patient motivational language predicts proximal outcomes, and may be useful in differential treatment selection.

Aim: A randomized clinical trial demonstrated that responsively adding motivational interviewing (MI) to cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) outperformed CBT alone on long-term worry reduction (Westra et al., 2016). Consistent with MI’s additive aim, this effect was mediated by less patient midtreatment resistance in the integrative treatment (Constantino et al., 2019). Insofar as GAD is marked by interpersonal styles of excessive nonassertiveness and over accommodation, I tested here whether MI-CBT also outperformed CBT, across acute treatment and long-term follow up, on reducing these characteristic interpersonal problems. Moreover, as patient resistance is an interpersonal event for which person-centered MI should, according to theory, be more helpful than directive CBT, I tested if resistance also mediated the expected effect of treatment on the long-term interpersonal outcomes. Method: Eighty-five patients with severe GAD were randomly assigned to 15 sessions of MI-CBT or CBT. Patients completed a measure of interpersonal problems repeatedly through treatment and 12 months of follow up. Independent observers rated patient resistance at a midtreatment session. Results: As expected, structural equation models revealed comparable reductions in nonassertiveness and over accommodation across acute MI-CBT and CBT. Also as predicted, MI-CBT vs. CBT promoted significantly greater reduction in over accommodation problems over long-term follow up; however, this differential effect was only marginally significant for nonassertiveness problems. Finally, as predicted, the treatment effect on the level of both interpersonal problems at 12-month follow up was mediated by less midtreatment resistance in MI-CBT vs. CBT. Discussion: Results support that the benefit of adding MI to CBT for GAD extends to long-term interpersonal change, and they implicate resistance management as a candidate mechanism of this additive effect.

Background: Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT. Aims: This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression. Methods: A parallel randomized controlled trial design (n = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken. Results: Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes d = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group d = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group. Conclusion: Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.