Étude des relations entre les schémas précoces inadaptés, les stratégies de coping et la flexibilité psychologique chez des sujets présentant des troubles anxieux

Anxiety is a major feature of all psychiatric diagnoses, and is, of course, the major feature of anxiety disorders. These disorders include: panic disorder, specific phobias, social anxiety, agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder (DSM-IV). Repercussions of anxiety can be significant and have serious impact on professional, family, and social functioning, notwithstanding the serious psychological suffering they can generate. Anxiety disorders are a serious and relatively common problem affecting the general French populated (aged 18 to 65 years) with an over prevalence of 15% over a 12-month period (Haute Autorité de santé). Treatment offered for anxiety usually involves psychotherapy, medication, or a combination of the two. Some patients may show resistance, however to one or both of these therapies. Young developed schema therapy within the cognitive behavioral therapy framework in order to surmount patient resistance to therapy. Schema therapy theory resides in the notion of 'early maladaptive schemas', which are defined as overwhelming emotional experience present from infance and having a serious impact on well-being and adaptive functioning. According to Young, activation of early maladaptive schemas has a direct impact on the development of anxiety disorders. In order to deal with the unpleasant associations evoked by these schemas, individuals develop coping mechanisms as early as childhood, some of which can be highly maladaptive. These coping strategies take a particularly rigid and dysfunctional form and appear to decrease psychological flexibility. According to Harris, psychological flexibility rests on two basic abilities: the ability to live in the 'here and now', along with the ability to engage in positive action that are in keeping with personal standards. Psychological flexibility involves the ability to accept and engage in true behavioral change. The current study seeks to better understand schemas in terms of potential positive impact. To put it differently, the authors postulate that it might be possible that the activation of some early maladaptive schemas could have a constructive effect on psychological flexibility as well as on the use of adaptive coping strategies. To investigate this hypothesis, the links between early maladaptive schemas, coping strategies and psychological flexibility were explored using, respectively, the Young Schema Questionnaire (YSQ-L3), the Ways of Coping Checklist, Revised (WCC-R) and the Acceptation-Action Questionnaire (AAQ-II). In addition, depressive affect was measured and controlled for using the Beck Depression Inventory (BDI-II). Participants (n = 28) were recruited in clinical practice and all had been diagnosed with one of the DSM-IV anxiety disorders presented above. Statistical analyses showed correlations between these concepts for the overall sample but were particularly strong for patients suffering from generalized anxiety disorder (GAD). Groups were identified according to scores on the BDI-II (mild/moderate severe depression) and comparisons showed interesting results for certain schemas and coping mechanisms. Similarly, results on some schemas were significantly different according to diagnosis. Although a direct link was not found between psychological flexibility and the other psychological notions, depression appeared to have a mediating effect on relationships between these variables. It would seem, for example, that the activation of the 'excessive demands' schema may reduce depressive symptoms. This study suggest many avenues for future research and provides some insight into therapeutic intervention taking into account psychological flexibility and maladaptive schemas.