Évaluation du sentiment d’efficacité des cliniciens lors d’une formation TCC pour la gestion des hallucinations auditives en groupe : étude Accept Voices©

Dans le cadre d’un projet de recherche sur l’efficacité d’une approche groupale pour la gestion des hallucinations acoustico-verbales (HAVs), nous avons mesuré le sentiment d’efficacité des cliniciens pour aider leurs patients à faire face aux phénomènes hallucinatoires, avant et après avoir reçu une formation. Vingt-trois cliniciens ont reçu une formation de trois jours pour acquérir les bases nécessaires à la mise en place et la gestion des séances de l’intervention groupale pour la gestion des HAVs. Le sentiment d’efficacité des cliniciens pour aider leurs patients à gérer leurs HAVs a été mesuré avant et après la formation. Le sentiment d’efficacité initial des cliniciens pour aider leurs patients à gérer leurs HAVs était relativement faible. Après la formation, tous les cliniciens ont vu leur sentiment d’efficacité s’améliorer, que ce soit pour la gestion des HAVs en groupe ou en individuel. La formation de trois jours, dispensée dans le cadre de notre recherche, semble avoir été suffisante et efficace pour amener les cliniciens à mettre en œuvre et à gérer l’intervention groupale sur les HAVs. Aider les patients à faire face aux HAVs peut être difficile pour les cliniciens exerçant en psychiatrie. La nécessité d’évoluer dans sa pratique et d’acquérir de nouvelles compétences issues d’approche telles que les TCC peut permettre de combler cette lacune. La pertinence de l’évaluation du sentiment d’efficacité des thérapeutes pour aider leur patient à gérer les hallucinations pour l’amélioration de la pratique clinique y est discutée. The objective of this study was to measure clinicians’ self-efficacy (psychologists and psychiatrists) in helping their patients cope with auditory hallucinations, before and after receiving a specific training in this regard. This research work was part of a larger clinical research project to assess the feasibility and effects of a CBT/third wave group approach for the management of auditory hallucinations in patients with schizophrenia. Currently, in France few CBT/third wave approaches to treating patients with schizophrenic disorders who hear voices are being offered. Given our study, we were also interested in determining how efficacious clinicians working with this clientele feel when helping their patients better understand and manage their voices. Our main objective was to train clinicians to become efficacious in working with patients with auditory hallucinations, particularly in using the CBT/third wave group intervention under study. After responding to a call for projects launched with nine mental health institutions in the Occitanie region of France, 23 clinicians (psychologists and psychiatrists) accepted to participate and received a three-day training. The purpose of this training was to: 1) develop the basic skills necessary in CBT/third wave to deal with psychotic disorders (non-confrontational approaches, coping development, CBT/third wave principles and basic exercises; 2) acquire competence in managing group sessions for the intervention called Accept Voices; 3) ensure the protocol is respected for the implementation of the study in the region (regulatory and research ethics aspect). A 15-items questionnaire with a response system based on a percentage score was developed specifically for this research. The items addressed different clinical situations, in order to assess clinicians’ sense of self-efficacy in helping their patients manage their auditory hallucinations, both in a group and individually. This measurement was done with clinicians before and after receiving the training. Regardless of the clinicians’ therapeutic orientation (CBT or psychoanalysis) and the number of years in working with psychotic disorders, the initial level of clinicians’ sense of efficacy in helping their patients manage their auditory hallucinations was relatively low, for both individual and group interventions. Following the training, the 23 clinicians saw their self-efficacy significantly improve, in both conditions (group and individual), regarding their ability to help their patients better manage their voices. Subsequently, after the training, 12 of the 23 clinicians were able to implement the group intervention method for voice management acquired during the training. The three-day training, provided as part of our study, appears to have been sufficient and effective to engage clinicians in implementing and managing the group intervention. It has also helped improve their skills and feelings of efficacy in their daily practice with individuals with schizophrenia. The outcomes from our study, which were part of a larger research project evaluating the effectiveness of a group intervention for auditory hallucinations, allowed us to observe an initial low self-efficacy among clinicians in helping their patients manage their auditory hallucinations. Fortunately, the training appeared successful in improving their self-efficacy. For many, helping patients cope with auditory hallucinations with psychotherapeutic tools, rather than solely with medication, was deemed difficult prior to the training. Despite the small size of our sample, these results encourage further initiatives to train clinicians who accompany patients with psychotic disorders in CBT/Third wave therapeutic approaches.

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