Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y compris la reproduction) est assujettie à sa politique d'utilisation que vous pouvez consulter en ligne.https://apropos.erudit.org/fr/usagers/politique-dutilisation/ Cet article est diffusé et préservé par Érudit.Érudit est un consortium interuniversitaire sans but lucratif composé de l'Université de Montréal, l'Université Laval et l'Université du Québec à Montréal. Il a pour mission la promotion et la valorisation de la recherche. A descriptive literature review was undertaken to explore the data on the efficacy of ACT for the treatment of mental health problems. Psycinfo and Medline, as well as the Association for Contextual Science website were analyzed for relevant articles. The key search terms were: "Acceptance and Commitment therapy" or "ACT" or "acceptance" or "mindfulness" or "defusion." The reference lists of the articles retrieved were also analyzed. The articles that were not in English or French were excluded. Results: Data suggest that ACT is particularly effective for stress, anxiety disorders, depression, substance abuse and various chronic medical conditions. The six processes of the model of psychological flexibility have been validated based on the results of correlational and meditational studies. More than seventy randomized clinical trials and a meta-analysis including 18 randomized control trials conclude that ACT is more effective than waiting list, placebo and treatment as usual control conditions. Conclusion: ACT is a promising and evidence-based approach in mental health for the treatment of anxiety and depression as well as for complex and chronic conditions. More research is needed to further validate its theoretical model and further refine our understanding of how ACT could be effective for the management of mental health illness and how it could enhance quality of life for people who suffer from these conditions. key words third wave, cognitive behavior therapy (CBT), Acceptance and Commitment Therapy (ACT), therapeutic efficacy, transdiagnostic treatment

Les interventions basées sur la pleine conscience deviennent de plus en plus populaires. Le présent article présente une recension de ses effets sur la santé mentale et physique, des mécanismes d’action et des recherches en neurobiologie.Interventions based on mindfulness have become increasingly popular. This article reviews the empirical literature on its effects on mental and physical health, discusses presumed mechanisms of action as well as its proposed neurobiological underpinning. Mindfulness is associated with increased well-being as well as reduced cognitive reactivity and behavioral avoidance. It seems to contribute to enhance immune functions, diminish inflammation, diminish the reactivity of the autonomic nervous system, increase telomerase activity, lead to higher levels of plasmatic melatonin and serotonin. It enhances the quality of life for patients suffering from chronic pain, fibromylagia and HIV infection. It facilitates adaptation to the diagnosis of cancer and diabetes. It seems to lead to symptomatic improvement in irritable bowel syndrome, chronic fatigue syndrome, hot flashes, insomnia, stress related hyperphagia. It diminishes craving in substance abuse. The proposed mechanism of action are enhanced metacognitive conscience, interoceptive exposure, experiential acceptance, self-management, attention control, memory, relaxation. Six mechanism of actions for which neurological underpinnings have been published are: attention regulation (anterior cingulate cortex), body awareness (insula, temporoparietal junction), emotion regulation (modulation of the amygdala by the lateral prefrontal cortex), cognitive re-evaluation (activation of the dorsal medial prefrontal cortex or diminished activity in prefrontal regions), exposure/extinction/reconsolidation (ventromedial prefrontal cortex, hippocampus, amygdala) and flexible self-concept (prefrontal median cortex, posterior cingulated cortex, insula, temporoparietal junction). The neurobiological effects of meditation are described. These are: (1) the deactivation of the default mode network that generates spontaneous thoughts, contributes to the maintenance of the autobiographical self and is associated with anxiety and depression; (2) the anterior cingulate cortex that underpins attention functions; (3) the anterior insula associated with the perception of visceral sensation, the detection of heartbeat and respiratory rate, and the affective response to pain; (4) the posterior cingulate cortex which helps to understand the context from which a stimulus emerges; (5) the temporoparietal junction which assumes a central role in empathy and compassion; (6) the amygdala implicated in fear responses. The article ends with a short review of the empirical basis supporting the efficacy for mindfulness based intervention and suggested directions for future research

Pour la thérapie des schémas, les premières expériences de la vie relationnelle sont primordiales. Elles mènent à la création de mémoires, en grande partie implicite. Par la suite, ces mémoires sont réactivées dans des contextes spécifiques, et très souvent gérées à travers des stratégies qualifiées de dysfonctionnelles. La thérapie des schémas cherche à modifier ces mémoires définies comme schémas. La thérapie d’acceptation et d’engagement (Acceptance and Commitment Therapy-ACT), de son côté, vise à modifier le rapport avec nos réactions découlant de nos histoires d’apprentissage et à développer une plus grande flexibilité par rapport aux expériences internes comme les pensées, les sensations et les émotions. Plusieurs de ses outils sont inspirés des méthodes de pleine conscience qui cherchent à favoriser la position de témoin de l’individu relativement à sa propre expérience. Malgré leurs paradigmes de départ différents, il est possible de faire jouer ensemble ces différentes approches. Le schéma se manifestant à travers des réactions somatiques, des pensées, des affects, des tendances à l’action, il devient possible de chercher à changer notre rapport à ceux-ci avec la philosophie et les méthodes de la thérapie ACT, notamment la pleine conscience. Cet article présente une réflexion théorique sur l’intégration des principes de la troisième vague à la thérapie des schémas.Objective: For schema therapy, significant weight is given to early experiences of social life. They lead to the creation of memories, largely implicit. These memories are reactivated in specific contexts and are often managed through dysfunctional strategies. Schema therapy seeks to modify these memories categorized as patterns. Acceptance and Commitment Therapy (ACT), meanwhile, aims to transform our reactions linked to our learning history and to develop a greater flexibility taking into account what occurs in the present moment. Several techniques originate from the mindfulness tradition and seek to transform the individual into a witness of his own experience, rather than someone acting out patterns based on his learning history. Despite their different paradigms, it is possible to combine these approaches. As schemas manifest through somatic reactions, thoughts, affects, action tendencies, it becomes possible to try to change the relationship between the individual and these private experiences through the use of mindfulness, philosophical concepts and techniques derived from ACT. This is the aim of this article. Method: Essay presenting the use of a schema mindfulness flash card to help patients tolerate intense affects generated by the activation of schemas and to attain greater adaptive flexibility (Healthy Adult mode). Conclusion: It is possible to integrate ACT techniques and concept to schema therapy in order to facilitate adaptive flexibility

La thérapie cognitivo-comportementale (TCC) est une des approches principales en psychothérapie. Elle enseigne au patient à faire le lien entre les cognitions dysfonctionnelles et les comportements mésadaptés et à réévaluer les biais cognitifs qui maintiennent les symptômes en utilisant des stratégies telles que le questionnement socratique. La TCC évolue constamment afin d’en améliorer l’efficacité et l’accessibilité. Dans la dernière décennie, des approches de plus en plus populaires basées sur la pleine conscience et l’acceptation sont proposées. Elles ne visent pas la modification des pensées même si celles-ci peuvent paraître biaisées et dysfonctionnelles, mais cherchent plutôt à changer la relation de l’individu à ses symptômes. L’efficacité de ces approches commence à être documentée. Cet article vise à présenter le contexte historique qui a permis l’émergence de ce courant, les points de convergence et de divergence avec l’approche cognitivo-comportementale traditionnelle ainsi qu’une brève présentation des différentes thérapies basées sur l’acceptation et la pleine conscience.Cognitive behavioral therapy (CBT) is one of the main approaches in psychotherapy. It teaches the patient to examine the link between dysfunctional thoughts and maladaptive behaviors and to re- evaluate the cognitive biases involved in the maintenance of symptoms by using strategies such as guided discovery. CBT is constantly evolving in part to improve its’ effectiveness and accessibility. Thus in the last decade, increasingly popular approaches based on mindfulness and acceptance have emerged. These therapies do not attempt to modify cognitions even when they are biased and dysfunctional but rather seek a change in the relationship between the individual and the symptoms. This article aims to present the historical context that has allowed the emergence of this trend, the points of convergence and divergence with traditional CBT as well as a brief presentation of the different therapies based on mindfulness meditation and acceptance. Hayes (2004) described three successive waves in behavior therapy, each characterized by “dominant assumptions, methods and goals”: traditional behavior therapy, cognitive therapy and therapies based on mindfulness meditation and acceptance. The latter consider that human suffering occurs when the individual lives a restricted life in order avoid pain and immediate discomfort to the detriment of his global wellbeing. These therapies combine mindfulness, experiential, acceptance strategies with traditional behavior principles in order to attain lasting results. There are significant points of convergence between traditional CBT and therapies based on mindfulness meditation and acceptance. They are both empirically validated, based upon a theoretical model postulating that avoidance is key in the maintenance of psychopathology and they recommend an approach strategy in order to overcome the identified problem. They both use behavioral techniques in the context of a collaborative relationship in order to...