La méditation de Pleine Conscience pour la prise en charge de la souffrance émotionnelle associée à la douleur chronique : adaptation à des patients âgés douloureux chroniques

摘要

AbstractClinical and experimental studies using Meditation Mindfulness (MM) have demonstrated its effectiveness in improving many psychopathological symptoms (anxiety, depression), and emotional distress caused by chronic diseases (pain, psoriasis).These therapeutics primarily target the dysfunctional interactions initiated and/or perceived by the subject in relationship with internal and external events he encounters. They refer to the theory of complex systems, which focuses on adjustment and on emergence of mutual specification (Varela et al., 1993) between the subject and its environment, and think that playing changes the rules of the game (Gleick, 2008).The aim of this PhD research work is to adapt a MBCT (mindfulness based cognitive therapy) program for chronic pain older adults, and evaluate its feasibility and efficacy on pain intensity, function and emotional regulation.The proposed adjustment takes into account both the age related specificities on attentional resources, but also the program’s characteristics about training of attention and training to switch from linguistic-analytical to sensory-perceptual processing.One original feature of the study is the use of an integrated methodology, quantitative and qualitative, to test "if it works" and "how it works" as described by participants themselves (Masson & Hargreaves, 2001).The overall completion rate was 86.1 % at the end of the program (8 weeks) and the majority of participants continued to meditate at 3 months after the end of the program (3-month follow-up), suggesting that this intervention was feasible and acceptable in chronic pain older adults. Based on quantitative analyses results, the program appeared to have a beneficial effect on pain intensity, physical function and the internal and functional emotional regulation strategies. These specific strategies are those who require the greatest effort, need conscious voluntary process, facilitate the accomplishment of one’s goal and promote well-being. Based on qualitative analyses results, the main process involved in therapeutic change is the core theme “attention” always coupled with an “emotional appeasement”, and very often with “radical transformation” and “other vision”.This work demonstrates that an adapted MBCT program is feasible in CP older adults. The core theme “attention” seems to be the therapeutic lever of the adapted MBCT in CP older adults. The attentional training would enable to develop an attentional quality, allowing for ecological adaptation and reflected by emotional appeasement.