Thérapie cognitivo-comportementale des achats compulsifs

RésuméLe syndrome d’achats compulsifs est une forme de dépendance comportementale fréquente en population générale, surtout chez les femmes. Quelques études récentes suggèrent l’efficacité certaine des thérapies cognitivo-comportementales dans ce trouble. Les différentes étapes de cette thérapie sont ici présentées dans un ordre chronologique. La vérification de la présence d’un syndrome dépressif est un préalable nécessaire avant toute entreprise thérapeutique. La partie cognitive de la thérapie vise l’identification des pensées dysfonctionnelles, la remise en doute des fausses cognitions. La partie comportementale, elle, comprend une exposition graduée et progressive aux situations à risque, la mise en place d’un journal de bord, la gestion d’un budget. L’étape de la prévention de la rechute passe par l’identification des personnes étayantes et par la recherche de situations à risque. Cette thérapie courte, structurée en plusieurs étapes, permet aux dépendants de l’achat de revenir à des dépenses sans conséquences négatives.

Compulsive buying has been defined for many years as a repetition of excessive and impulsive buying behaviour entailing financial and familial problems. Subject to discussion about its nosographic category, the compulsive buying disorder is not represented in the Diagnostic Statistical Manual IV-R and the International Classification of Diseases 10. However, compulsive buying shares many common aspects with classical addictive disorders. In that way, compulsive buying can be considered as a behavioral dependance. Its prevalence seems to increase in the economically developed countries. American and European studies show a prevalence from 2 to 5.8% in the general population. These studies also prove that a cognitive behavioral therapy tends to reduce shopping time and episodes compared to a waiting list. In this article, we present the four steps of the therapy. First of all, the therapist should screen other comorbidities such as depression. Indeed, 60 % of patients presenting compulsive buying also suffer from depression. The cognitive behavioral therapy requires a lot of mental efforts. In case of depression, thymic disorder should be treated first. During the pretherapy, the therapist informs the patient on its compulsive buying disease. The patient assess himself his shopping behavior with questionnaires, such as “Questionnaire d’Évaluation des Achats”. The patient and the therapist can then agree on the number of sessions, the length of each of them. The cognitive part of the therapy consists in identifying, working on and changing dysfunctional thoughts related to buying. The patient becomes aware of his behavior: buying occurs in response to negative emotions such as anger, frustration. In this cognitive part, the therapist should also question the patient about his relation to money, since a lot of patients have dysfunctional beliefs such as “the more I buy, the richer I am” or “if I buy that shirt, I will worth something”. The behavioral part of the therapy tends to focus on teaching the patient alternative responses. The patient identifies the specific situations when the urge to buy appears. The therapist can also teach patient relaxation methods for stress management. Patients can then attempt to apply these methods when faced with a potential shopping situation. It also appears that these patients suffer from very low self-esteem, they tend to reduce their qualities and focus on their defects. Teaching them self-assertion methods help them to cope with it. It can also help them to face the sellers when they encourage them to buy. Each patient gets a diary where he writes everyday his emotions, his temptation to buy and so on. This very concrete tool is to be used at each session with the therapist. Last but not least, the therapist should help the patient to prevent relapses. The patient should set up a relapse plan in case of. This short, structured therapy gives a possibility for the patient to come back to normal buying without an addictive characteristic.