L’union des modèles de l’intolérance à l’incertitude et de la régulation émotionnelle renforce-t-elle le traitement cognitif-comportemental du trouble d’anxiété généralisée ?

Introduction

La combinaison des modèles de l’intolérance à l’incertitude (II) et de la régulation émotionnelle dysfonctionnelle (RÉD) pourrait améliorer l’efficacité du traitement cognitif-comportemental (TCC) du trouble d’anxiété généralisée (TAG). Cette étude préliminaire compare un TCC du TAG basé sur le modèle de l’II (TCC II) à un TCC du TAG basé sur la combinaison des modèles (TCC II + RÉD).

Méthode

Vingt participants ont complété le traitement. Des entretiens semi-structurés ont eu lieu deux semaines pré- et post-traitement. Des questionnaires ont été postés 3 et 6 mois post-traitement.

Résultats

Les analyses par modèles mixtes révèlent que les deux thérapies traitent efficacement le TAG (inquiétudes [F(3, 19,031) = 20,667, p < 0,001], sévérité du TAG [F(3, 29,567) = 20,567, p = < 0,001]). La régulation émotionnelle s’améliore dans les deux conditions (F[3,17,401] = 11,390, p < 0,001). Une différence intergroupe sur la régulation émotionnelle est identifiée par contraste entre le suivi 3 et 6 mois : les participants de la condition combinée s’améliorent davantage (t[15,678] = 2,133, p = 0,049, d de Cohen = 0,076).

Discussion

Un traitement du TAG intégrant la régulation émotionnelle pourrait entraîner une meilleure tolérance aux émotions.

Introduction

Generalized anxiety disorder (GAD) is characterised by excessive and incontrollable worry, and is associated with anxiety symptoms such as restlessness, insomnia, concentration difficulties and irritability. This condition has consequences in personal life, such as social withdrawal, and in societal life, such as absenteeism and an increased number of medical consultations. In addition, the evolution of GAD tends to be chronic without adequate treatment. Cognitive-behavioral therapy (CBT) successfully treats generalized anxiety disorder (GAD). More than 50% of individuals with GAD experience a complete remission or significant clinical change after CBT. However, a significant number of people still present GAD symptoms following CBT. Combining interventions from different theoretical GAD models could improve CBT efficacy. In this regard, theoretical links have been suggested between intolerance of uncertainty (IU ; Dugas et al., 1998) and emotion dysregulation (EDr ; Mennin et al., 2005) models (Ouellet, 2014; Riskind, 2005). The IU model posits that GAD development and maintenance is explained by a vulnerability to uncertainty. This vulnerability influences beliefs and attitudes towards worry as well as generates cognitive avoidance. The EDr model explains GAD by difficulties with emotion regulation. GAD individuals, in particular, have difficulties in understanding and react negatively to emotions. They also experience highly intense emotions and use inflexible emotion regulation strategies. Treatments based on these approaches are respectively considered efficient to treat this disorder in GAD literature. This preliminary study aims to compare CBT for GAD based on the IU model (CBT IU) to CBT for GAD based on the IU and EDr models (CBT IU + EDr).

Method

Twenty-one participants were randomly assigned to 12 sessions of CBT IU or CBT IU + EDr. The CBT IU included psychoeducation about GAD, exposition to situations of uncertainty, cognitive restructuring, problem-solving training and cognitive exposition. The CBT IU + EDr added psychoeducation, cognitive restructuring and exposure to emotions, as well as emotional awareness training. Twenty participants completed treatment. Evaluations, including the semi-structured Anxiety Disorders Interview Schedule (ADIS-IV) and self-administrated questionnaires, were carried out two weeks before and two weeks after GAD treatment. Follow-up questionnaires were sent by mail 3 and 6 months after therapy.

Results

Repeated measures mixed model analyses 2 (treatment conditions) × 4 (measurement time) were conducted and revealed that both treatments are efficacious for GAD symptoms (i.e., excessive worry [F(3, 19.031) = 20.667, P < 0.001], GAD severity [F(3, 29.567) = 20.567, P = < 0.001], anxiety [F(3, 19.375) = 9.176, P = 0.001], depression [F(3, 36.609) = 21.662, P < 0.001], intolerance of uncertainty [F(3, 35.053) = 28.837, P < 0.001]). Both conditions foster a change in emotion regulation (F[3,17.401] = 11.390, P < 0.001). Contrast analyses showed differences in emotion regulation among conditions between the 3-month follow-up and the 6-month follow-up. Participants in CBT IU + EDr seem to continue to improve emotion regulation capacity (t[15.678] = 2.133, P = 0.049, d de Cohen = 0.76), whereas participants in CBT IU seem to present a deterioration on this same variable (t[15.757] = −2.491, P = 0.024, d de Cohen = −0.56).

Discussion

Both treatments (i.e., CBT IU, CBT IU + EDr) are efficacious for GAD. The inclusion of an emotion regulation segment in GAD therapy seems, in a longer-term perspective, to be an advantage in improving emotion regulation in individuals presenting this disorder. The combined therapy (CBT IU + EDr) could cause greater tolerance to emotions or a generalisation effect on emotions. It seems relevant to continue studies on combining IU and EDr models in GAD treatment with a larger sample size and an in-depth therapy segment on emotion regulation.