A spotlight on acceptance and commitment therapy

There is increasing scientific interest into third-wave cognitive behavioral therapies, which include a range of interventions advocating awareness of both oneself and the present moment. Acceptance and commitment therapy (ACT) is one such third-wave therapeutic modality, which employs a “self as context” framework. ACT aims at changing the relationship to one’s sensorial and automatic psychological events, leading to decreased experiential avoidance. However, there is a lack of awareness as to the range of health conditions for which empirical findings appear to support the therapeutic delivery of ACT. There also exists some confusion in terms of the key Eastern contemplative principles that underlie the conceptual and therapeutic framework of ACT. Consequently, the present paper briefly outlines the key conceptual and therapeutic principles that ACT embodies, provides a high-level map of current directions in ACT treatment research, and discusses challenges and future directions. ACT appears to be an effective treatment for a range of psychological and somatic disorders, such as depression, anxiety, and chronic pain. However, further studies using randomized controlled trial designs are required to better understand the other health conditions for which ACT is likely to be an effective treatment. Furthermore, there is a need for greater understanding as to the most appropriate means by which ancient contemplative principles should be integrated into ACT approaches, as well as other therapeutic modalities likely to be compatible with the ACT approach.N/

Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions

International audiencePURPOSE OF REVIEW: The definition of psychological pain is complex. It is a lasting unpleasant and unsustainable feeling characterized by a perception of inability or deficiency of the self, as well as frustrated psychological needs and social disconnection. The aim of our review was to summarize the most recent and updated findings supporting the role of psychological pain in the pathophysiology of depression and suicidal behavior. We also explored the relationship between psychological and physical pain in depression and suicide. RECENT FINDINGS: Psychological pain is a prominent dimension of depressive disorder and has been associated with higher risk of suicidal ideation and suicidal behavior. Sensitivity to psychological and physical pain is increased in depression. Conversely, higher tolerance to physical pain is associated with suicidal behavior. A better understanding of the pathophysiology of pain processing in depression and suicide offers new therapeutic options for the treatment of depression through the use of analgesic drugs

Borderline personality disorder: from understanding ontological addiction to psychotherapeutic revolution

Bypassing a reductionist view of existing diagnostic categories, ontological addiction theory (OAT) is a new psychological model of human functioning. Borderline Personality Disorder (BPD), defined as “a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity”, is not only common (up to 20% of psychiatric inpatients), but also strongly associated with suicide attempts and death by suicide. Therefore, BPD constitutes a major public health concern. As a consequence of an underlying condition of ontological addiction, self-harming behaviors can be conceptualized as addictions, suicidal acts reflecting an experiential avoidance strategy against unbearable psychological pain. The present paper aims at: (1) understanding BPD daily life experiences from the perspective of OAT; (2) offering psychotherapeutic perspectives for this mental disorder. The diagnostic category of BDP may be understood as a simple label reflecting several extreme types of manifestations resulting from the Self-grasping ignorance that underpins ontological addiction. Therefore, development of psychotherapeutic interventions targeting ontological addiction appears to be a promising future direction.N/

Personality Traits of Suicidality Are Associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder in a Suicidal Women Sample.

OBJECTIVE:Both Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) might increase the risk of suicidal behavior. The aim of this study was to assess the relationship between personality dimensions specifically involved in suicidal vulnerability and PMS/PMDD. METHOD:We collected data from 232 women consecutively hospitalized after a suicide attempt. We examined the relationship between impulsivity, aggressiveness/hostility, hopelessness, trait anger, affect intensity, emotional lability, and PMS/PMDD. Notably, we created an algorithm from the shortened Premenstrual Assessment form in order to assess PMDD status. RESULTS:The proportions of PMS and PMDD among female suicide attempters were 50% and 23% respectively. Women with PMS or PMDD were more likely to endorse most of these personality traits to than those without even after controlling for potential confounders. We found an impulsive-aggressive pattern of personality in women with PMS or PMDD, independently from the time of the menstrual cycle. Interestingly, trait anger remained associated with both PMS and PMDD independently of every other personality traits. The higher the anger level, the higher the risk was to suffer from both PMS and PMDD. CONCLUSIONS:This study demonstrates a strong, independent association between PMS/PMDD and trait anger among a representative sample of female suicide attempters. It is of major interest for clinicians in view of addressing a substantial public health problem among women of reproductive age

Activité physique, sommeil et consommation de substances chez les adultes déclarant un trouble de personnalité limite en France et au Canada : une étude en ligne

Introduction Le trouble de personnalité limite (TPL) est associé à plusieurs comportements délétères pour la santé. L’usage de substances (alcool et drogues) est présent chez 78 % des adultes aux prises avec un TPL. De plus, une mauvaise qualité de sommeil semble intimement liée au portrait clinique des adultes avec un TPL. Finalement, plusieurs troubles médicaux comorbides au TPL sont associés à l’inactivité physique et la sédentarité comme l’obésité, les maladies cardiovasculaires et le diabète. Toutefois, à ce jour, aucune étude n’a documenté ni analysé ces comportements de santé dans la population francophone avec un TPL.Objectifs Cette étude a pour but de documenter les comportements de santé chez des adultes aux prises avec un TPL au Canada et en France.Méthode Cette étude transversale est réalisée à l’aide d’un sondage en ligne distribué en France et au Canada sur la plateforme LimeSurvey, incluant des questionnaires validés. Pour mesurer le niveau d’activité physique, nous utilisons le Global Physical Activity Questionnaire. L’insomnie est évaluée à l’aide de l’Index de Sévérité de l’Insomnie. Le trouble d’usage de substances (TUS) est évalué à l’aide du Alcohol, Smoking and Substance Involvement Test. Des statistiques descriptives (N, % et moyenne) sont utilisées pour décrire les comportements de santé préalablement cités. Cinq modèles de régression sont réalisés pour trouver les principales variables (âge, statut social perçu, niveau d’éducation, revenu du ménage, indice de masse corporelle, difficultés de régulation émotionnelle, symptômes de TPL, niveau de dépression, antécédent de tentatives de suicide et usage de médicaments psychotropes) associées aux comportements de santé.Résultats Au total, 167 participants (92 Canadiens, 75 Français ; 146 femmes, 21 hommes) ont répondu au sondage en ligne. Au sein de notre échantillon, 38 % des Canadiens et 28 % des Français ont rapporté faire moins de 150 minutes d’activité physique par semaine. L’insomnie affectait 42 % des Canadiens et 49 % des Français. Le TUS du tabac touchait 50 % des Canadiens et 60 % des Français. Le TUS d’alcool touchait 36 % des Canadiens et 53 % des Français. Le TUS du cannabis touchait 36 % des Canadiens et 38 % des Français. Toutes les variables testées sont liées à l’activité physique (R² = 0,09). L’insomnie est liée à la symptomatologie du TPL (R² = 0,24). Le TUS du tabac est lié au statut social et au TUS d’alcool (R² = 0,13). Le TUS d’alcool est lié au statut social, à l’indice de masse corporelle, au TUS du tabac et à la dépression (R² = 0,16). Finalement le TUS du cannabis est lié à l’âge, à l’indice de masse corporelle, au TUS du tabac, à la dépression et aux antécédents de tentatives de suicide (R² = 0,26).Conclusion Ces résultats sont essentiels pour l’élaboration d’interventions de prévention en santé chez les adultes francophones avec un TPL au Canada et en France. Ils aident à identifier les principaux facteurs associés aux différents comportements ciblés.Introduction Borderline personality disorder (BPD) is associated with many unhealthy behaviors. Psychoactive substance (alcohol and drugs) use is present in 78% of adults with BPD. Moreover, a poor sleep seems linked to the clinical profile of adults with BPD. Finally, some physical comorbid disorders like obesity, cardiovascular diseases, and diabetes are linked to physical inactivity and sedentary behaviors. However, to this day no study analyzed these behaviors in French-speaking individuals with BPD.Objectives This study’s goal is to document health behaviors in adults with BPD in Canada and in France.Method This cross-sectional study consists of an online survey on the LimeSurvey platform including validated questionnaires distributed in France and Canada. To measure physical activity, we used the “Global Physical Activity Questionnaire.” Insomnia was measured with the “Insomnia Severity Index.” Substance use was measured with the “Alcohol, Smoking and Substance Involvement Test.” Descriptive statistics (N,% and mean) are used to describe previously mentioned health behaviors. Five regression models have been realized to find the main associated variables (age, perceived social status, education level, household income, body mass index, emotional regulation difficulties, BPD symptoms, depression level, previous suicide attempts and psychotropic medication use) to health behaviors.Results A total of 167 participants (92 Canadians, 75 French; 146 women, 21 men) filled out the online survey. In this sample, 38% of Canadians and 28% of French reported doing less than 150 minutes of physical activity weekly. Insomnia affected 42% of Canadians and 49% of French. Tobacco use disorder affected 50% of Canadians and 60% of French. Alcohol use disorder affected 36% of Canadians and 53% of French. Cannabis use disorder affected 36% of Canadians and 38% of French. All tested variables were linked to physical activity (R² = 0.09). Insomnia was only linked with BPD symptoms (R² = 0.24). Tobacco use disorder was linked to social status and alcohol use disorder (R² = 0.13). Alcohol use disorder was linked to social status, body mass index, tobacco use disorder, and depression (R² = 0.16). Finally, cannabis use disorder was linked to age, body mass index, tobacco use disorder, depression, and past suicide attempts (R² = 0.26).Conclusion These results are essential to design health prevention interventions in French-speaking adults with BPD in Canada and in France. They help identify the main factors associated with these health behaviors

Effectiveness of the first French psychoeducational program on unipolar depression: study protocol for a randomized controlled trial

International audienceAbstractBackgroundMajor Depressive Disorder (MDD) is highly prevalent and was associated with greater morbidity, mortality (including suicide), and healthcare costs. By 2030, MDD will become the leading cause of disability in high-income countries. Notably, among patients with a previous experience of a major depressive episode, it was indeed estimated that up to 85 % of those patients will suffer from relapse. Two main factors were associated with a significantly higher risk of relapse: poor medication adherence and low self-efficacy in disease management. Interestingly, these issues could become the targets of psychoeducational programs for chronic diseases. Indded psychoeducational program for depression are recommended in international guidelines, but have not yet been proposed in France.Methods/DesignWe propose to evaluate the first French psychoeducational program for depression “ENVIE” in a multicenter randomized controlled trial. The group intervention will include 9 weekly sessions. Its aim is to educate patients on the latest knowledge on depression and effective treatments through didactic and interactive sessions. Patients will experiment the latest innovating psychological skills (from acceptance and commitment therapy) to cope with depressive symptoms and maintain motivation in behavioral activation. In total, 332 unipolar non-chronic (<2 years) outpatients with moderate to severe depression, without psychotic features, will be randomly allocated to the add-on ENVIE program (N = 166) or to a waiting list (N = 166). The follow-up will last 15 months and include 5 assessment visits.The primary endpoint will be the remission rate of the index episode at 15 months post-inclusion, defined by a Montgomery and Asberg Depression Rating Scale (MADRS) score ≤ 12 over an 8-week period, and without relapse during follow-up. We will also assess the response rate and relapse at 15 months post-inclusion, hospitalization rate and adherence to treatment during the follow-up period, quality of life and global functioning upon inclusion and at 9 and 15 months post inclusion.DiscussionIf the proposed trial shows the effectiveness of the intervention, but also an increased remission rate in depressed outpatients at 15-months post-inclusion, in addition to improved treatment adherence in patients, it will further promotes arguments in favor of a wide dissemination of psychoeducational programs for depression.Trial registrationThis trial is registered under number 2015-A00249-40 (PURE clinical trial: NCT02501226) (June 30th, 2015)

Anhedonia is associated with suicidal ideation independently of depression: A meta-analysis

International audienceBACKGROUND:Anhedonia is considered a suicide risk factor in patients with major affective disorders. Here, we wanted to quantify the association between anhedonia and current suicidal ideation according to the absence/presence of between-group differences for depressive scores and psychiatric disorders.METHODS:We performed a meta-analysis of data on studies retrieved from Medline, Web of Science, and PsycINFO from 1965 to 2016 using, among others, the terms (suicid* or depression) and anhedonia.RESULTS:We identified 15 observational case-control studies that investigated the anhedonia differences in individuals with and without current (i.e., within the past week, independently of the lifetime suicidality status) suicidal ideation (defined as thoughts of killing oneself). Overall, 657 subjects with and 6,690 subjects without current suicidal ideation could be compared. Anhedonia level was higher in the group with current suicidal ideation than in the group without, with a medium effect size (standardized mean difference = 0.57, z = 5.43, P < 0.001, 95% confidence interval, CI = 0.37-0.79). The association between anhedonia and current suicidal ideation remained significant when controlling for depression and psychiatric disorders. The anhedonia scales used in the selected studies did not allow investigating consummatory and motivational anhedonia separately.CONCLUSION:Our major finding is the robust association between anhedonia and current suicidal ideation, independently of depression. This is highly relevant for the clinicians' daily practice and might help improving suicidal risk detection and the development of new therapeutic strategies for suicide prevention

Association between anhedonia and suicidal events in patients with mood disorders: A 3‐year prospective study

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Factors associated with lamotrigine concentration/dose ratio in individuals with bipolar disorders

International audienceMonitoring of lamotrigine levels is recommended in epilepsy. However, in bipolar disorders (BD), no study has described the therapeutic range in daily practice and factors being associated to it. We used retrospective data of individuals with BD, treated with lamotrigine, and included in the FondaMental Advanced Centers of Expertise for Bipolar Disorders cohort. We extracted clinical and biological data and explored associations between these variables and lamotrigine concentration/dose (C/D) ratio. The database included 675 individuals who received lamotrigine at inclusion, whose main characteristics were female sex (68.3%) and BD type 2 (52.1%). Data about lamotrigine C/D ratio were available for 205 individuals. Lamotrigine C/D ratio was significantly associated with: Body Mass Index (BMI) (r=-0.159), estimated GFR (glomerular filtration rate) (r=-0.228), total bilirubin (r = 0.241) and at a trend level, antidepressant co-prescription (U = 3169). The model obtained was: lamotrigine C/D ratio = 1.736 - 0.013*BMI + 0.095*total bilirubin (UI/L) - 0.007*eGFR (ml/min) + 0.210*AST/ALT – 0.004*GGT (UI/L) + 0.014*age (year) + 0.303*currently smoking (yes or no) – 0.588*antidepressant co-prescription (yes or no) – 0.357*gender (F = 1.899, p = 0.057, adjusted R2 = 0.11) Information about plasma lamotrigine C/D ratio were available for only 205 out of the 675 individuals in the database and has been obtained from different laboratories. The representativeness of the included sample may be questionable. This is the first study providing information on a large sample of individuals with BD regarding factors associated with lamotrigine C/D ratio. This study allows to propose a model of lamotrigine C/D ratio that would deserve further replication