Utilisation de la thérapie EMDR dans le traitement d’un ESPT après cancer du sein

L’objectif de cet article est de tester l’utilisation de la thérapie EMDR – eye movement desensibilization and reprocessing – dans le traitement d’un ESPT – état de stress post-traumatique – après cancer du sein. Un cas clinique est présenté. Des évaluations quantitatives à intervalles espacés ont été réalisées avant la première séance, après la dernière séance et en suivi à trois puis six mois, avec l’échelle d’ESPT (PCLS), l’échelle modifiée des symptômes traumatiques, le questionnaire d’expériences dissociatives, mais également à l’aide de l’échelle HADS pour l’évaluation de l’anxiété et de la dépression et du questionnaire de qualité de vie FACT-B. Des retranscriptions des séances ainsi que des mesures à intervalles rapprochés (nombre d’évitement, nombre de reviviscences et intensité de l’anxiété par semaine) complètent ces évaluations. À travers la diminution de l’ensemble des mesures quantitatives effectuées, mais également par les changements cliniques perçus dans les propos de la patiente, la thérapie EMDR prétend à une efficacité dans le traitement d’un ESPT après cancer du sein.

The aim of this paper is to assess benefits of eye movement desensibilization and reprocessing (EMDR) therapy within treatment of post-traumatic stress disorder (PTSD) that may occur as a consequence of breast cancer. Indeed, scientific community attests to the powerful traumatic effect of cancer on human beings (APA, 2000; Brennsthul et al., 2015). Cancer gives rise to feelings of endangerment of one's life, of one life's quality and also that of psychological and physical integrity of the concerned, ill person. Cancer induces vulnerability, loss of control and feelings of helplessness. Moreover, the disease or the chirurgical intervention-related context may reactivate previously suffered psychological traumas and such trauma-related memories then may play a role in the perseverance of PTSD symptoms within the population of patients suffering from breast cancer. Several publications have pointed to the efficacy of EMDR within the domain of PTSD psychotherapy (Tarquinio, 2007), namely in the treatment of several psychopathologies (Shapiro, 1995; 2001; 2002; De Jongh et al., 1999). For instance, EMDR helped patients suffering from cancer to reduce their PTSD symptoms and more specifically the intrusive symptoms (Capezzani et al., 2013). Simply put, pains and other corporal perceptions may – due to their associations – recall the hard times related to the disease or its treatments. It is in this vein that EMDR is supposed to be efficient in PTSD treatment when applied to the phase that immediately follows after breast cancer. As to the underlying mechanisms, EMDR is based on the adaptive information processing model (Shapiro, 1995; 2001) and it would allow a reactivation of natural information processing while easing an adaptive reforming of previously deformed materials (Shapiro, 2002; Van der Kolk, 2002; Bergmann, 1998; 2000; Stickgold, 2002). The advantage of EMDR is that it is an integrative method. Patient takes confidence in self-healing ability and several objectives are proposed: (1) to stabilize the patient (psychoeducation, installation of a safe place, etc.); (2) to reprocess disturbing memories related to cancer; (3) to reduce anxiety and develop resources. In this paper, we present a case of a patient treated with EMDR therapy. Mrs. S., 35 years old, is in remission from breast cancer and shows clear signs of PTSD. According to DSM-IV, the patient has symptoms of dissociation (flashbacks), avoidance behaviors, and neurovegetative hyperactivity. Eight stages of the standard EMDR protocol were applied (Shapiro, 2001) in seven sessions. The first sessions allowed us to anchor therapeutic alliance, to perform the functional analysis, and to evaluate the patient on several criteria (anxiety, depression, quality of life, traumatic symptoms…). The following sessions constituted the core EMDR therapy (i.e. targeting plan, negative cognitions, positive cognitions, evaluation, desensitization, etc.) and two follow-up sessions served to verify transfer of positive results. Spaced quantitative assessments – including the PTSD PCL scale, the modified scale of trauma symptoms, the survey of dissociative experiences and also the HADS and FACT-B scales – were realized before the first meeting, just after the last meeting, three months and then again six months after the last meeting. Transcripts of interviews and other measures (e.g. number of avoidances, symptoms of revival, intensity of anxiety per week, etc.) complement these measures. By the end of therapy, symptoms of PTSD (repetition, avoidance, neurovegetative hypereactivity) significantly improved and the results also show a decrease in Mrs.’ S. anxiety and depression. An anxiety state persisted, presumably linked to fear of recurrence, but the patient has a good quality of life. We attest to EMDR efficiency not only through clinical evolution of the patient's verbatim but also due to decreases in all of the quantitative measures. We then argue that EMDR appears as a valuable therapeutic approach for breast cancer patients who are also diagnosed with PTSD and warrant future studies that would help us in ascertaining EMDR's efficiency beyond case studies.