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Theses

Les stimulations bilatérales alternées dans la prise en charge des troubles du comportement de la personne âgée en EHPAD : Usage d’une technique de la psychothérapie EMDR en gérontologie

Abstract : Many scientific studies validate the effectiveness of EMDR (Eye Movement Desensitization and Reprocessing) therapy for the treatment of PTSD (Post Traumatic Stress Disorder, DSM-5). The EMDR is developing an adaptive treatment of information that is established thanks to the specificity of its protocol in eight phases (Shapiro, 1989) and the action of Alternate Bilateral Stimulations (SBA). The therapeutic field of EMDR continues to expand towards mood disorders, phobias, addictions, chronic pain and health field (cancer announcement). Today, many EMDR protocols exist for children (Lovett, 1999), for people with intellectual deficits (Mevissen, Lievegoed, Seubert-Jongh, 2011), but little literature is interested in the elderly with major cognitive impairments. Hyer (1995) reports only clinical cases of EMDR sessions performed with patients with mild cognitive impairment. Amano et al., (2015) are the only researchers to have written a " nursing home field " protocol for severe cognitive impairment. Objective : The study of the University Hospital of Nice aims to establish a non-drug therapeutic method borrowed from EMDR with the aim of reducing behavioral disorders type verbal agitation in the elderly subject in nursing homes with major cognitive disorders. The management of emotions in the context of neurocognitive pathologies is in deficit in the same way as the medical processes. The symptoms of PTSD and those induced by dementia are similar: anxiety, hyper-vigilance, avoidance behaviour, etc. If ABSs produce an immediate appeasement of the parasympathetic system in PTSD, it is likely that we will find the same effect for BPSDs. Method : The protocol took place in nursing homes. The inclusion criteria are those of severe neurodegenerative pathologies (MMSE-10) as well as verbal agitation measured with health care teams (NPI-ES, Covi, CMAI scale). 15 residents were included in this feasibility study. Subjects were randomized and assigned in a control group and an ABS group after primary needs satisfaction verification. 10-minute SBA sessions were assigned to participants in the experimental group. For the control group: 10-minute sessions held the elderly person's hand (continuous tactile stimulation). The second phase of the study is training nursing's homes health care teams and long-term follow-up in a CPR to allow SBAs to integrate "usual care." Results : The descriptive statistitics showed a benefit of efficiency for the ABS group vs control concerning 5 on 6 items (Duration, Frequency, Intensity, Pittsburgh Scale and CMAI scale). The long-term follow-up of three residents confirmed the results of Cohen Mansfield's (2012) work on the correlation between cries, vocalizations and unmet primary needs. Discussion: The suitable ABS protocol for severe cognitive impairment could be recommended for non-drug communication approaches, although in nursing homes the lack of resources and the turn-over of health care teams is a hindrance to these approaches.
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Anne-Julie Vaillant-Ciszewicz. Les stimulations bilatérales alternées dans la prise en charge des troubles du comportement de la personne âgée en EHPAD : Usage d’une technique de la psychothérapie EMDR en gérontologie. Psychologie. Université Côte d'Azur, 2020. Français. ⟨NNT : 2020COAZ2003⟩. ⟨tel-02902678⟩

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