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Article Dans Une Revue Journal de Thérapie Comportementale et Cognitive Année : 2013

Thérapie comportementale et cognitive d’un trouble d’anxiété sociale chez une adolescente de culture arabo-musulmane migrante en France

Résumé

Interest in culturally specific factors in social anxiety disorder (SAD) arose from its integration into the nosology of psychopathology. We took up this question in the treatment of SAD with an immigrant patient. Taking into consideration that issues related to immigration can enhance vulnerability to SAD, we developed a cognitive-behavioral therapy that addressed the cultural elements involved in the emergence of SAD with this patient. In this case study, the therapeutic elements characteristic of the patient's situation are analyzed in light of current research conducted on SAD. Loubna, aged 16 and Algerian born, developed a SAD upon her arrival in France. The loss of her parental figures and her protective family environment precipitated the onset of symptoms. Bögels et al. (2001) [3] have specifically studied parenting behaviors that enhance the emergence of SAD. They have highlighted the need for a specific therapeutic action, which includes the whole family in the treatment of SAD in children and adolescents. We described these parental attitudes and the ways of therapeutic action. In this case, we also looked at the link between shyness and social anxiety. Chavira et al. (2002) [4] described shyness as a risk factor for the onset of SAD. Even though early signs of shyness can be identified in Loubna's childhood, she only developed this disorder in her adolescence. We tried to observe this transition in relation to literature analyzing this link. After a description of the therapeutic process established for Loubna, we focused our attention on the behavioral work carried out on the reduction of avoidances (avoidances of social experiences and gaze avoidance). Indeed, Horley et al. (2003) [15] identified that patients with social anxiety tend to avoid facial signals during their social interactions. The therapeutic process was designed to reduce this tendency in Loubna's case. On the other hand, Hoffman (2004) [16] showed that therapeutic intervention based on cognitive biases interpretation of patients with social phobia is more effective in maintaining long-term therapeutic benefits than therapy treatment based only on exposure. Therefore, we correlated the increase of social experiences with the cognitive work focusing on raising positive cognitions in social situations. The therapeutic process is described as well as the evolution of Loubna's cognitions. At the end of the cognitive and behavioral therapy, the benefits were evaluated. In addition to a significant reduction in phobic symptoms, measurements throughout therapy showed positive changes in social cognition. Loubna's attention was more focused on detection of emotion on other people's faces. The focus of this therapy was the inclusion of culturally specific factors. Shore and Rapport (1998) [26] found different levels of social anxiety across cultures, with a range of variable social fears. Throughout the cognitive-behavioral therapy, we analyzed these cultural elements, which facilitated and weakened Loubna's treatment. After 8 months of therapy, Loubna's SAD went from severe to moderate and the patient was able to join a training course. Her interpersonal skills improved and she succeeded in expanding her social network. This therapy has emphasized the complementary nature of cognitive and behavioral approaches to achieve a significant reduction in SAD symptoms. The behavioral work helped reduce fear of others through exposure, and the cognitive restructuring work led to the emergence of protective schemas in interactive situations. This case study also illustrates the need to take into account the combination of individual, family, social and cultural factors in the analysis and treatment of children and adolescents with SAD.
La question des spécificités culturelles du trouble d’anxiété sociale s’est posée dès son intégration à la nosographie des troubles psychopathologiques. Nous avons repris cette question dans le cadre du traitement d’un trouble d’anxiété sociale chez une patiente migrante. Nous avons mis en place une thérapie cognitivo-comportementale en nous attachant à relever les éléments culturels en jeu dans l’émergence du trouble d’anxiété sociale chez cette patiente, dans le cadre d’un contexte migratoire fragilisant pour elle. Les bénéfices de la TCC ont été évalués et ont notamment montré une évolution positive des cognitions en situation sociale ainsi qu’une attention mieux focalisée sur la détection des émotions du visage de l’autre. Les éléments culturels et familiaux facilitant et fragilisant le traitement ont été analysés au regard des recherches menées sur le trouble d’anxiété sociale et mis en parallèle du déroulement de la TCC.
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Dates et versions

hal-04082620 , version 1 (26-04-2023)

Identifiants

Citer

Vanessa Harscoet, Claire Hofer, Stephane Rusinek, Samiha Imrani. Thérapie comportementale et cognitive d’un trouble d’anxiété sociale chez une adolescente de culture arabo-musulmane migrante en France. Journal de Thérapie Comportementale et Cognitive, 2013, Journal de Thérapie Comportementale et Cognitive, 23 (3), p. 132-141. ⟨10.1016/j.jtcc.2013.06.005⟩. ⟨hal-04082620⟩

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