Depression är en funktionsnedsättande problematik som påverkar en stor del av den vuxna populationen varje år. Trots ett omfattande behov av hjälp så råder det brist på tillgång till effektiv behandling. Kognitiv Beteendeterapi (KBT) är en evidensbaserad metod som har stöd vid behandling av depression och förmedlad via internet skulle metoden kunna tillgängliggöras för fler. Dock är det i dagsläget oklart vilka format och vilket innehåll som kan användas när behandlingen förmedlas via internet, samt vilken betydelse den terapeutiska alliansen har för en behandling som till största del sker på distans. Syftet med denna avhandling var att undersöka effekterna för olika format av internetbehandling (epostterapi, guidad självhjälp och blended treatment) vid depression, samt alliansens roll i dessa format. Studiernas resultat visar på att epostterapi och internetförmedlade självhjälpsprogram med behandlarstöd var effektiva metoder för att behandla depression. Alliansskattningar var höga, vilket visar att en positiv terapeutisk allians kan uppnås i internetbehandling. Patientskattningar av allians kunde inte predicera utfallet i någon av behandlingarna, men behandlarskattad allians predicerade förbättring på depressionsskattningar i blended treatment. Den här avhandlingen innehåller den första randomiserade kontrollerade studien på KBT-baserad epostterapi vid depression, samt det första internet-förmedlade självhjälpsprogrammet baserat på beteendeaktivering och ACT. / Depression is a debilitating disorder that affects a large part of the adult population every year. Yet there is still a lack of access to effective care for people in need. Cognitive Behaviour therapy (CBT) is an evidence-based method for treating depression that together with the increased availability of Internet services provides an opportunity to increase access to effective treatment. Internet-based interventions can be effective in the treatment of depression, but there is a lack of knowledge concerning which formats of delivery that can be used and if therapeutic alliance is of equal importance when providing treatment over the Internet. The overall aim of this thesis was to examine the effects of different treatment formats (email therapy, guided self-help, and blended treatment) in internet-based CBT for depression and to further examine the role of alliance in these treatment modalities. Findings from this thesis show that email therapy and internetbased treatment programs were effective methods for treating depression. Alliance ratings were high, showing that a positive therapeutic alliance can be achieved in internet-based treatments. Patient-rated alliance could not predict outcome in any of the different treatment formats. However, therapist-rated alliance predicted change in depression during blended treatment. This thesis includes the first randomized controlled study on CBTbased email therapy, and the first internet-based behavioral activation program with ACT-components, for adult depression.

To evaluate psychological treatments for adolescent binge-eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic alliance and their associations in cognitive-behavioural therapy (CBT) for adolescents with BED. In a randomised-controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio-taped CBT sessions from a sample of N = 64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between-patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.

Introduction  Research about health has become a very important part of the world today. Theres a constant need for new treatment methods and evidence. Recruitment is one of the most challenging parts of conducting a trial, especially in trials regarding mental health. The result of this is often a waste of money and resources in research. Method  This study is a systematic review and meta-analysis investigating the recruitment in randomized controlled trials on internet-based CBT interventions for depression.  Results  The recruitment rates were calculated as number of participants screened divided by number of participants randomized into the trial. The overall recruitment rates of all the trials was 54.3%. The analysis of the recruitment moderators shown that a clinical recruitment setting together with referral as recruitment personnel.

Introduction: Family-focused cognitive behavioural therapy (FFCBT) is emphasized as an approach to optimize treatment outcomes for early-onset obsessive-compulsive disorder (OCD). Parental engagement is critical to successful treatment. However, few studies have examined how to promote parental engagement during FFCBT. Additionally, from a parental perspective, there is a limited understanding of factors that influence parental engagement throughout treatment, including the role of nurses. Aims: To determine (i) how parents experience and understand their engagement in FFCBT provided for their child with early-onset OCD in community or outpatient mental health programs, and (ii) how parents describe the role of nurses related to parental engagement during the treatment process. Methods: This study used an interpretive description approach. Semi-structured interviews were completed with parents (n = 17) recruited from community or outpatient children’s mental health programs in the Hamilton Region of Southwestern Ontario. Treatment provider interviews (n = 9) augmented the data collected from parents’ perceptions of their engagement and the role of nurses during FFCBT. Interviews were analyzed using Braun and Clark’s (2006) thematic analysis process. Results: A conceptualized model was constructed to display and communicate the individual, interpersonal, and contextual influences identified by parents and treatment providers. These influences facilitated or inhibited parental engagement during treatment across distinct phases, levels, and stages of engagement. Six distinct nursing roles were identified that promoted parental engagement throughout treatment. / Dissertation / Doctor of Philosophy (PhD) / Without effective treatment, pediatric obsessive-compulsive disorder (OCD) can interfere with childhood development. Early-onset OCD is a unique subtype of the disorder involving pediatric patients with symptoms that present before the age of 10 years. Family-focused cognitive behavioural therapy (FFCBT) emphasizing parental involvement is commonly used to treat pediatric OCD. However, parental engagement during FFCBT, including nurses’ roles, is poorly understood. This study aimed to increase knowledge about parental engagement during FFCBT for children with early-onset OCD receiving treatment in community programs. Data analysis of parent and treatment provider interviews identified various factors and how nurses influenced parental engagement during FFCBT. A model was made to display how these factors helped or hindered parental engagement during treatment and how nurses promoted engagement across three distinct phases. This new knowledge informed recommendations to promote parental engagement for treatment providers, improve service development and delivery, and strengthen nursing education.

Erythrophobie wird als klinische Bezeichnung für die Angst zu erröten verwendet, wenn das Einzelsymptom Erröten im Vordergrund einer Angstproblematik steht. Die vorliegende Übersicht beruht auf einer umfangreichen Literaturrecherche und wird ergänzt durch eigene klinische Beobachtungen aus einer Pilotstudie zur kognitiv-behavioralen Gruppentherapie der Errötungsangst. Wir referieren den aktuellen Kenntnisstand zu Erythrophobie in Bezug auf die differentialdiagnostische Einordnung, auf ätiologische und pathogenetische Konzepte sowie auf die Verhaltenstherapie der Störung. Insgesamt zeigt die Übersicht, dass Erythrophobie am sinnvollsten als Subsyndrom der Sozialen Phobie beschrieben werden kann. Patienten mit Errötungsangst als Hauptbeschwerde unterscheiden sich jedoch von anderen Patienten mit Sozialer Phobie im Hinblick auf Behandlungsanliegen, Inanspruchnahmeverhalten, Behandlungserwartung und Therapieziele sowie durch spezifische aufrechterhaltende Mechanismen der Störung, insbesondere durch eine übertriebene und inflexible Aufmerksamkeitsfokussierung auf körperliche Symptome. Der Einsatz eines Aufmerksamkeitstrainings als spezifisches Behandlungsmodul bei Errötungsangst ist vielversprechend und sollte in bekannte Ansätze zur Therapie der Sozialen Phobie integriert werden. Abschließend werden Impulse für weiterführende Forschungsaktivitäten skizziert. / Erythrophobia is the pathological form of fear of blushing. This review is based upon an extensive literature research and supplemented by clinical observations from a pilot study of a cognitive-behavioural group therapy for fear of blushing. Current knowledge about fear of blushing is reported regarding diagnostic considerations, aetiologic and pathogenetic mechanisms, and cognitive-behavioural therapy. In conclusion, this review indicates that fear of blushing should be classified as a sub-syndrome of social phobia. Patients suffering from fear of blushing as predominant complaint differ from other patients with social phobia in health-care utilisation, treatment expectation and treatment goals. However, the most prominent difference lies in the exaggerated and inflexible self-focused attention these patients direct to their arousal and bodily symptoms. Therefore, attention training as a specific treatment unit is promising and should be integrated in standard treatment approaches for social phobia. Finally, options for further research are outlined. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Paper one: The attitudes and reasoning of abusive behaviour in adolescents who have been exposed to domestic abuse Exposure to domestic abuse in childhood can go on to negatively affect every aspect of that individual’s life. During adolescence, the impact of exposure to domestic abuse may go beyond the borders of the family and the individual, and affect the development of intimate relationships. This study explores the attitudes and reasoning of eleven young people who have been exposed to domestic abuse and are displaying perpetrator behaviours. Results reveal a complex interaction between experiences and skill deficits at a crucial time of identity formation, resulting in the formation and maintenance of destructive attitudes and contradictory reasoning about abusive behaviour. The direct implications of this study, suggestions for further research, and for Educational Psychology Services are discussed. Paper two: An evaluation of an intervention for adolescents who have been exposed to domestic abuse and are displaying perpetrator behaviours Where domestic violence occurs, children and young people are likely to have been exposed to such abuse. Evidence suggests that this is likely to have a detrimental impact on them. There is an acute gap in provision for such individuals, despite evidence suggesting a link between exposure to domestic abuse in childhood, and involvement in abusive dating relationships in late adolescence and adulthood. There has been little research testing the effectiveness of intervention programmes which aim to reduce this risk. In this study a before and after design was used to evaluate a cognitive-behavioural intervention programme for young people who have been exposed to domestic abuse and are displaying abusive behaviours. This evaluation was based on the views of the young people on this programme. Results indicate that certain elements of the programme were more successful in achieving the programme aims. Considerations for the development of further programmes which target this client group are discussed.

Cette thèse avait pour but premier d’évaluer la douleur chronique endométriosique et ses concomitants (dépression, anxiété et stress), les conséquences de la douleur sur le physique, les activités et le travail, sur la relation maritale et les séquelles sur la qualité de vie chez des participantes souffrant de douleurs pelviennes chroniques diagnostiquées endométriose (laparoscopie). En deuxième lieu, il s’agissait d’évaluer et de comparer l’efficacité des techniques psychologiques de contrôle de la douleur (Hypnose, Cognitif-behavioral) en ajout aux traitements médicaux à un groupe contrôle (Attention thérapeute). L’échantillon était composé de 60 femmes réparties aléatoirement soit à l’un des deux groupes de traitement ou au groupe contrôle. Les instruments de mesure étaient tous des questionnaires déjà traduits en français et validés pour la population francophone québécoise. Des tests du khi-carré ont été effectués pour les variables nominales et des analyses de variances (ANOVA) ont été faites pour les variables continues. Dans des modèles ANOVA estimant l’effet du traitement, du temps et de leur interaction, une différence significative (effet de Groupe ou traitement) a été trouvée pour les variables suivantes : Douleur (McGill :composante évaluative p = 0.02), au moment « présent » de l’Échelle visuelle analogique (EVA, p = 0.05) et dans l’Échelle de Qualité de vie (douleur, p = 0,03) ainsi qu’à la dimension Fonctionnement social de cette dernière échelle (SF-36; p = 0,04). En comparant les données en pré et post-traitement, des résultats significatifs au niveau du Temps ont aussi été mis en évidence pour les variables suivantes : Douleur McGill: Score total, (p = 0,03), Affective (p = 0,04), Évaluative (p = 0,01); Douleur (ÉVA) moment Fort (p < 0,0005), Dépression (p = 0,005), Anxiété (situationnelle/état (p = 0,002), Anxiété/trait (p < 0,001), Stress (p = 0, 003) ainsi que pour quatre composantes de la Qualité de vie (Fonctionnement social, (p = 0,05), Vitalité (p = 0,002), Douleur, (p = 0,003) et Changement de la santé (p < 0,001) et ceci pour les trois groupes à l’exception du groupe Hypnose sur cette dernière variable. Des effets d’Interaction (Groupe X Temps) sont ressortis sur les variables « Conséquences physiques » de la douleur mais sur la dimension « Activités » seulement (p = 0,02), sur l’anxiété situationnelle (État : p = 0,007). Un effet d’interaction se rapprochant de la signification (p = 0,08) a aussi été analysé pour la variable Fonctionnement social (SF-36). L’étude montre une légère supériorité quant au traitement Cognitif-behavioral pour l’anxiété situationnelle, pour le Fonctionnement social et pour la douleur mesurée par le SF-36. L’étude présente des forces (groupe homogène, essai clinique prospectif, répartition aléatoire des participantes et groupe contrôle) mais aussi des lacunes (faible échantillon et biais potentiels reliés à l’expérimentateur et à l’effet placebo). Toute future étude devrait tenir compte de biais potentiels quant au nombre d’expérimentateur et inclure un groupe placebo spécifique aux études à caractère psychologique. Une future étude devrait évaluer le schème cognitif « catastrophisation » impliqué dans la douleur, les traits de personnalité des participantes ainsi que le rôle du conjoint. De plus, des techniques psychologiques (entrevues motivationnelles) récentes utilisées dans plusieurs études devraient aussi être prises en considérations. Tout de même des résultats significatifs offrent des pistes intéressantes pour un essai clinique comportant un échantillon plus élevé et pour un suivi à long terme. / The goal of the study was twofold. The first objective was to assess chronic endometriotic pain and its psychological dimensions (depression, anxiety, stress), and the consequences on the marital adjustment, and quality of life on women diagnosed with endometriosis by laparoscopy. The second objective was to compare two psychological treatments with a control group (no active treatment). Sixty women were randomly assigned to one of the treatment groups (Hypnosis, Cognitive-behavioural) or to the control group (Therapist Attention). All measures were valid and the French translation had been adapted for the Quebec population. The statistical analysis were the Chi-square for nominal measures and ANOVAS for the continuous variables. ANOVAS’s model estimate Treatment effect, Time effect and Interaction Group X Time. Both interventions (Group effect) were significantly positive for the pain dimension on the McGill questionnaire but on the Evaluative dimension only (p = 0,02), pain on “present” time on the Visual Analogue Scale (VAS, p = 0,05), pain in the Quality of life scale (SF-36, p = 0,03), and on Social functioning dimension measured by SF-36 (p = 0,04). When comparing data following treatment (post-treatment) with the baseline measures (pre-testing), Time effect occurred for the three groups on following variables: pain (McGill): Total score (p = 0, 03), Affective (p = 0, 04), Evaluative (p = 0,01), pain measured by a Visual analogue scale (VAS) at the Highest level (p < 0,0005), on Depression (p = 0,005), for State anxiety (p = 0,002), and Trait Anxiety (p < 0,001), on Stress (p = 0,003), and on four dimensions on the Quality of Life’s scale (SF-36): Social functioning (p = 0, 05), Vitality (p = 0,002), Pain (p = 0,003), and Health change (p < 0,001) where the group Hypnosis seems to do better for the last variable. Interaction effect (Group X Time) were statistically significant for dimension Activities in the Physical pain (SF-36, p = 0,02), and on State Anxiety (p = 0,007). Interaction effect close to statistically significant results (p = 0,08) on Social functioning (SF-36) has also been analyze. In this study, all group showed a comparable reduction of pain at the end of treatment, and an increase level of activities in the Cognitive-behavioural group. For the secondary variables the statistical results went in the same direction as the primary variable (pain). The level of depression, anxiety, and stress decreased with time for all groups. The study also showed a mild superiority of the Cognitive-behavioural treatment on State anxiety, Social functioning, and on Pain measured by the SF-36. Statistical analysis didn’t show any change for the marital situation. Quality of life showed positive results on four scales only (social functioning, vitality, pain and perception change in health). The study presents strengths (homogenous group, prospective study, control group and randomisation) and some weaknesses (small number of participants, potential bias with one interviewer, and absence of placebo group). Even so, statistically significant results emerge and are promising for new studies with a higher number of subjects. We also recommend a long time follow-up. Future studies should take into account a distorted cognitive schema (catastrophization), personality traits well documented in chronic pain syndrome, and spouse’s role. We also recommend the use of “Motivational Interview” recently described in the literature.

L’insomnie, commune auprès de la population gériatrique, est typiquement traitée avec des benzodiazépines qui peuvent augmenter le risque des chutes. La thérapie cognitive-comportementale (TCC) est une intervention non-pharmacologique ayant une efficacité équivalente et aucun effet secondaire. Dans la présente thèse, le coût des benzodiazépines (BZD) sera comparé à celui de la TCC dans le traitement de l’insomnie auprès d’une population âgée, avec et sans considération du coût additionnel engendré par les chutes reliées à la prise des BZD. Un modèle d’arbre décisionnel a été conçu et appliqué selon la perspective du système de santé sur une période d’un an. Les probabilités de chutes, de visites à l’urgence, d’hospitalisation avec et sans fracture de la hanche, les données sur les coûts et sur les utilités ont été recueillies à partir d’une revue de la littérature. Des analyses sur le coût des conséquences, sur le coût-utilité et sur les économies potentielles ont été faites. Des analyses de sensibilité probabilistes et déterministes ont permis de prendre en considération les estimations des données. Le traitement par BZD coûte 30% fois moins cher que TCC si les coûts reliés aux chutes ne sont pas considérés (231$ CAN vs 335$ CAN/personne/année). Lorsque le coût relié aux chutes est pris en compte, la TCC s’avère être l’option la moins chère (177$ CAN d’économie absolue/ personne/année, 1,357$ CAN avec les BZD vs 1,180$ pour la TCC). La TCC a dominé l’utilisation des BZD avec une économie moyenne de 25, 743$ CAN par QALY à cause des chutes moins nombreuses observées avec la TCC. Les résultats des analyses d’économies d’argent suggèrent que si la TCC remplaçait le traitement par BZD, l’économie annuelle directe pour le traitement de l’insomnie serait de 441 millions de dollars CAN avec une économie cumulative de 112 billions de dollars canadiens sur une période de cinq ans. D’après le rapport sensibilité, le traitement par BZD coûte en moyenne 1,305$ CAN, écart type 598$ (étendue : 245-2,625)/personne/année alors qu’il en coûte moyenne 1,129$ CAN, écart type 514$ (étendue : 342-2,526)/personne/année avec la TCC. Les options actuelles de remboursement de traitements pharmacologiques au lieu des traitements non-pharmacologiques pour l’insomnie chez les personnes âgées ne permettent pas d’économie de coûts et ne sont pas recommandables éthiquement dans une perspective du système de santé. / Insomnia is common in the geriatric population, typically treated with benzodiazepine drugs which can increase the risk of falls. Cognitive behavioral therapy (CBT) is a non-pharmacological intervention with equivalent efficacy and no adverse events. This thesis compares the cost of benzodiazepines versus CBT for the treatment of insomnia in older adults, with and without consideration of the additional cost of falls incurred by benzodiazepine use. A decision tree model was constructed and run from the health payer’s perspective over 1 year. The probability of falls, ER visits, hospitalisation with and without hip fracture, cost data and utilities were derived from a comprehensive literature review. Cost consequence, cost utility and potential cost saving analyses were performed. Both probabilistic and deterministic sensitivity analyses were conducted to account for uncertainty around the data estimates. Benzodiazepine treatment costs 30% less than the price of CBT when the costs of falls are not considered (CAN $231 vs. CAN $335 per individual per year). When the cost of falls is considered, CBT emerges as the least expensive option (absolute cost-saving CAN$ 177 per person per year, CAN $1,357 with benzodiazepines vs. $1,180 for CBT). CBT dominated benzodiazepines, with a mean cost saving of CAN $ 25,743 per QALY gained with CBT due to fewer falls. The cost savings analysis shows that if the CBT were to completely replace benzodiazepine therapy, the expected annual direct cost savings for the treatment of insomnia would be $ 441 million CAD dollars, with a cumulative cost savings of $112 billion CAD dollars over 5-years. The PSA report shows that even at different varying parameters, benzodiazepines cost CAD$ 1,305, S.D $ 598 (range 245-2,625) on average / person / year vs. CAD$ 1,129, S.D $ 514 (range 342-2,526) on average / person / year for CBT. Current treatment reimbursement options that fund pharmacologic therapy instead of non-pharmacologic therapy for geriatric insomnia are neither cost-saving nor ethically recommendable from the health system’s perspective.

Critical Review of the LiteratureCan Borderline Personality Disorder be treated effectively in forensic settings? A systematic reviewBorderline Personality Disorder (BPD) is a common diagnosis in forensic settings. Certain features of BPD, such as impulsivity and emotional dysregulation, can create a vulnerability to impulsive acts. The condition is also associated with poor mental and physical health, making the treatment of BPD and its clinical features an important goal in forensic settings. This paper reviews evidence for the effectiveness of treating BPD and its symptoms using psychological approaches in forensic settings. A systematic search found 2913 papers, of which 13 met the inclusion criteria. The papers reported nine separate studies (six controlled) that implemented four distinct interventions, often adapted for particular forensic settings. Improvements in overall BPD symptomatology and specific BPD symptoms were reported for all types of intervention, although few differences in outcome between intervention and control groups were found. There were also reported improvements in BPD-related behaviours, but data on offending behaviour were absent. Heterogeneity in study quality and design makes it challenging to draw any firm conclusions about the effectiveness of any one form of treatment over another, nor about which treatment may best suit a particular setting. Further randomised controlled trials are needed to answer these questions. Service Improvement ProjectEvaluation of a brief educational intervention for clinical staff aimed at promoting trauma-informed approaches to careThere is growing evidence that trauma plays an important role in the aetiology of severe and enduring mental health problems. Yet staff can be reluctant to ask patients about trauma for reasons such as anxiety about harming patients and limited access to training. Where services have adopted trauma-informed approaches (TIAs) to mental health care (i.e., considering the ways in which trauma affects individuals when planning and delivering services), improved clinical outcomes have been observed. With this in mind, a new educational video was developed for mental health staff at an NHS trust. The video was intended to be (a) brief (10 minutes); (b) contemporary and engaging; and (c) accessible using computers, smartphones and tablets. Forty-one multidisciplinary staff viewed the video. Quantitative and qualitative evaluation indicated improvements in self-reported knowledge and confidence with regard to trauma, and a decrease in worries with regard to asking patients about such experiences. Participants found the video to be enjoyable, understandable and informative. Importantly, many indicated that it spurred them to further action, such as further training and asking patients about possible trauma. These findings indicate that a video of this type can offer an important ‘taster’ of trauma-related learning, constituting an important step towards embedding trauma-informed ways of working at a service. Main Research ProjectThe Role of Intrusive Imagery in Hoarding DisorderThe cardinal feature of Hoarding Disorder (HD) is persistent difficulty discarding possessions, with the resulting clutter compromising the intended use of living areas. Within the dominant cognitive-behavioural model of hoarding (Frost & Hartl, 1996), hoarding behaviours are positively and negatively reinforced in the context of certain object-related beliefs. Available treatments for HD have so far yielded modest outcomes, indicating a need for new approaches. Intrusive imagery has so far been neglected in HD research, despite the frequency of trauma in the histories of people with the condition. To address this, 27 individuals who met the DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about their everyday experiences of mental imagery. Participants were also asked about the images they experienced during two recent real-life examples of actual or attempted discard of (1) an object of low subjective value; and (2) an object of high subjective value. Everyday imagery in the HD group commonly reflected themes of illness, death and reminiscence. Imagery in HD participants tended to carry negative emotional valence in comparison with CCs, and was associated with greater interference in everyday life and attempts to avoid the imagery. HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD participants experienced positive imagery when discarding, or trying to discard, high value objects. These findings indicate that although people with HD frequently report traumatic histories, this is not reflected in the everyday imagery that they experience. There is some evidence to suggest that the negative and positive memories experienced in relation to low and high value objects may aid our understanding of discarding and saving behaviour in HD. The theoretical and clinical implications of these findings are further discussed.

Les troubles des tics, comme le syndrome de Gilles de la Tourette et le trouble de tics chroniques, sont des conditions neuropsychiatriques impliquant des tics moteurs et/ou phoniques. En plus de nombreuses comorbidités, les patients qui en sont atteints ont aussi des difficultés neuropsychologiques, notamment au niveau de l’inhibition et des fonctions motrices. La thérapie cognitivo-comportementale permet d’améliorer les tics et la condition générale de ces patients. Nous avons donc enregistré, durant une tâche de compatibilité stimulus-réponse, les potentiels évoqués cognitifs et les potentiels de latéralisation motrice (lateralized readiness potential; LRP) chez 20 patients atteints de trouble des tic avant et après une thérapie cognitivo-comportementale, et chez 20 participants contrôles. Chez les patients atteints de trouble des tics, nos résultats ont révélé une apparition plus tardive de l’amorce du LRP moyenné par rapport au stimulus, une amplitude plus élevée du LRP moyenné par rapport à la réponse, et une suractivation frontale liée aux processus d’inhibition. Suite à la thérapie, le retard au niveau de la latence de l’amorce du LRP moyenné par rapport à la réponse est comblé et l’amplitude du LRP moyenné par rapport à la réponse est normalisée, mais pas la suractivation frontale liée à l’inhibition. Cela suggère donc que la thérapie induit une modification des processus prémoteurs de sélection et de préparation de la réponse, ainsi que des processus d’exécution motrice, mais n’altère pas la suractivation frontale reliée aux fonctions inhibitrices. Étant donnés ces résultats, nous suggérons que la thérapie cognitivo-comportementale induit une modification du fonctionnement des aires motrices du cerveau. / Gilles de la Tourette syndrome and chronic tic disorder are two neuropsychiatric condition involving motor and/or phonic tics. In the DSM, these two conditions are characterized as “tic disorders”. Patients with such diagnoses face numerous comorbidities, and also show multiple neuropsychological impairments, especially concerning inhibition and motor processing. Tic symptoms, as well as general condition, can be improved with a cognitive-behavioural therapy (CBT). To this end, we recorded, during a stimulus-response compatibility task, event-related potentials and lateralized readiness potentials in 20 patients with tic disorder and 20 healthy controls. Patients and controls were paired on age, sex and hand dominance. Our result revealed a delay in stimulus-locked lateralized readiness potential (LRP) onset latency, higher response-locked LRP peak amplitude and a frontal overactivation related to stimulus inhibition in GTS and CTD patients. Following CBT, stimulus-locked LRP onset latency and response-locked LRP peak amplitude were normalized, but the frontal overactivation related to inhibition processing remained unchanged. These results suggest that CBT induces a modification of pre-motor processes such as response selection and preparation, as well as motor processes like response execution, but does not affect cortical activation related to stimulus inhibition. Since we found a reduction in tic symptoms, as well as a normalization of stimulus-locked LRP onset latency and response-locked LRP peak amplitude, and because LRPs are partly generated by the supplementary motor area, we suggest that CBT leads to a modification of this structure’s functioning.