Repetitive negative thinking and metacognitive beliefs in substance use disorders : contributions to the transdiagnostic processes literature

Contexte : Les pensées répétitives négatives, dont les formes les plus étudiées sont les ruminations dépressives et les inquiétudes anxieuses, sont aujourd'hui considérées comme un unique processus, responsable de l'apparition et du maintien de nombreux états psychopathologiques. Elles ont pour caractéristiques principales d'être répétitives, intrusives, difficile à contrôler et accaparant les capacités mentales. Elles seraient également sous-tendues par la présence de croyances dites « métacognitives » à propos de leur utilité, mais aussi de leurs conséquences négatives. Depuis une dizaine d'années, des études tendent à montrer qu'elles pourraient être impliquées dans le développement et le maintien des conduites addictives. Cependant, cette littérature reste hétérogène, essentiellement centrée sur les concepts spécifiques de ruminations dépressives ou d'inquiétudes anxieuses et pour sa majorité sur le trouble de l'usage d'alcool. De plus, à ce jour, peu de connaissances existent sur les facteurs pouvant influencer cette relation alors que différents arguments théoriques et empiriques laissent supposer que des variables comme le genre ou les croyances métacognitives puissent déterminer en partie leur rôle dans l'apparition de symptômes. Objectifs : Ce travail de thèse vise donc à évaluer et étudier l'influence des pensées répétitives négatives dans le mésusage d'alcool et de cannabis, à partir d'une mesure transdiagnostique, tout en considérant l'effet modérateur du genre, des croyances métacognitives et de l'évitement cognitif. Méthode : Deux études ont été menées afin de répondre à ces objectifs. Une première étude sur une population clinique de 81 patients consultants pour un trouble de l'usage d'alcool et une seconde étude sur 257 consommateurs de cannabis recrutés en population tout-venant via internet. Ces deux études transversales ont évalué les pensées répétitives, les croyances métacognitives et l'évitement cognitif à partir d'auto-questionnaires validés. Résultats : Les résultats révèlent que des difficultés attentionnelles provoquées par les pensées répétitives semblent être le mécanisme principal par lequel ce processus participe du déclenchement de consommations d'alcool ou de cannabis et que la façon dont une personne perçoit et régule ses pensées conditionne cet effet. En revanche, le profil métacognitif (croyances et stratégies métacognitives) des usagers concernés ne semble pas être le même entre les consommateurs de cannabis et d'alcool. D'autre part, les résultats montrent que les croyances à propos du besoin de contrôler les pensées, impliquées dans la plupart des conduites addictives, prédisent aussi le mésusage de cannabis. Conclusion : Ces résultats apportent de nouvelles preuves quant au caractère transdiagnostique des pensées répétitives et des croyances métacognitives. Ils apportent aussi des éléments théoriques en faveur de l'approche processuelle transdiagnostique. Enfin, ils soulignent la nécessité de prêter attention à ces processus lors des suivis en addictologie et laissent à nouveau supposer que des interventions centrées sur la rumination (et sur les croyances associées) pourraient présenter un intérêt dans la prise en charge d'un trouble de l'usage d'alcool ou de cannabis. Des études complémentaires sont maintenant nécessaires pour évaluer ce type d'intervention chez des consommateurs de substances.Context: Repetitive negative thinking, whose most studied forms are depressive ruminations and anxious worry, is today conceptualized as a unique process, responsible for the development and maintenance of many mental disorders. Their main characteristics are to be repetitive, relatively intrusive, negative in content and difficult to control. Repetitive negative thinking is also being activated and maintained by the presence of so-called "metacognitive beliefs" about their usefulness and negative consequences. Over the past decade, studies have tended to show that repetitive negative thinking could be involved in the development and maintenance of addictive behaviors. However, this literature remains heterogeneous, essentially centered on the specific concepts of depressive ruminations or anxious worry and for its majority on alcohol use disorder. In addition, to date, little is known about the factors that can influence this relationship, while different theoretical and empirical arguments suggest that variables such as gender or metacognitive beliefs may determine the role of repetitive thinking in the onset of symptoms. Objectives: This thesis aims to studying the influence of repetitive negative thinking in alcohol and cannabis misuse, from a process-based transdiagnostic approach, while considering the moderating effect of gender, metacognitive beliefs and cognitive avoidance. Method: Two studies were conducted to meet these objectives. A first study of a clinical population of 81 patients consulting for alcohol use disorders and a second study with a convenience sample of 257 cannabis users recruited online. These two cross-sectional studies assessed repetitive thinking, metacognitive beliefs, and cognitive avoidance from validated self-reported questionnaires. Results: The results reveal that attentional impairment caused by repetitive thinking seem to be the main mechanism by which this process contributes to alcohol or cannabis misuse and that the way in which a person perceives and regulates his thoughts conditions this effect. However, the metacognitive profile (metacognitive beliefs and strategies) of the concerned users does not seem to be the same between cannabis and alcohol users. Results also show that beliefs about the need to control thoughts, involved in most addictive behaviors, predict cannabis misuse. Conclusion: These findings provide new evidence for the transdiagnostic nature of negative repetitive thinking and metacognitive beliefs. They also provide theoretical elements in favor of the transdiagnostic process approach. Finally, they emphasize the need to pay attention to these processes during treatment and again suggest that rumination-focused interventions may be of interest in the treatment of alcohol and cannabis use disorder. Further studies are now needed to assess this type of intervention

Individually delivered Mindfulness-Based Cognitive Therapy in concomitant problematic substance use and emotional symptoms: A process-based case study.

The process-based approach assumes that transdiagnostic psychological processes are involved in the onset and maintenance of mental disorders. Case conceptualization is used to identify such psychological processes and to individualize the intervention accordingly. This approach is fundamentally different from syndrome-based approaches in which standardized treatments are administered for psychiatric diagnoses or symptoms. In the current case, we proposed a process-based conceptualization and treatment for a woman with concomitant problematic substance use and emotional symptoms. Our idiosyncratic process-based conceptualization showed that for this person, substance abuse consisted in a maladaptive coping strategy to deal with repetitive negative thinking and poor emotion regulation skills, for which we decided to use a mindfulness-based intervention. Treatment comprised 8 weeks of individually delivered Mindfulness-Based Cognitive Therapy sessions. A comprehensive assessment of psychiatric symptoms and psychological processes was conducted at baseline, post-intervention, and 3-month follow-up. The post-treatment assessment revealed that psychological processes targeted by the intervention were improved, together with the mindfulness trait. At the symptom-based level, we observed a significant reduction in substance abuse and emotional symptoms. Treatment gains were maintained at follow-up. From a process-based perspective, this result implies that the intervention successfully targeted the psychological processes underlying the presenting symptoms. Adopting a process-based approach rather than symptom- or syndrome-based approaches is a valuable alternative in the conceptualization and treatment of complex cases presenting with multiple comorbidities

Groupe TCC et trouble de l’usage de substances : exemple d’une pratique en hôpital dejour d’addictologie

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Alcohol Use, Anxiety and Depression among French <i>Grandes Écoles</i> Engineering Students during the COVID-19 Pandemic

In French Grandes Écoles, heavy alcohol consumption seems to be generalized and largely tolerated, leading to particular concerns about Alcohol Use Disorder and harmful alcohol practices among students. The COVID-19 pandemic led to increased psychological difficulties, and two coexisting scenarios seemed to emerge regarding alcohol consumption: A decrease in alcohol consumption linked to the absence of festive events, and an increase in solitary alcohol consumption to cope with lockdowns. The aim of this exploratory study is to investigate the evolution of alcohol consumption, consumption motives and the relationship of these factors to the anxiety and the depression of French Grandes Écoles students during the COVID-19 pandemic, depending on their residential status. After the last lockdown, 353 students completed a questionnaire measuring alcohol consumption, motivation to drink, anxiety and depression during and after the COVID-19 period. Although students confined to campus were more likely to increase their alcohol use, they also presented higher well-being scores than those who lived off campus. A significant proportion of students were aware of their increased alcohol use due to the COVID-19 pandemic, and the motives attributed to their increased consumption highlight the need for vigilance and specialized support facilities