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Accueil In practice Psychiatry

Psychiatry

lundi 7 mai 2018, par David GRIMA, Vincent BIDAULT

Pole D - House of Psychosocial Rehabilitation
Feelings MDR First Team Game

Social cognition is defined as the ability to understand oneself and others and to interact with them.
The social cognition components of mind theory, emotion recognition and attributional style are disrupted in schizophrenia, with direct repercussions on the social and professional integration of those who suffer from it (N. Franck et al., 2013).
The House of Rehabilitation is a home for post-cure and psychosocial rehabilitation that offers care and support for young users from 18 to 35 years old with a beginner psychotic disorder. The earliest possible intervention aims to reduce the severity of the disease, promote recovery and improve the quality of life of these young people by helping their social and professional integration.
The care offered in our structure aims at the creation of a strong therapeutic alliance, the acceptance of a medicinal treatment, the psychoeducation, the reinforcement of the autonomy in everyday life, the training with the social skills, the cognitive remediation, the stress management and relapse prevention, and thus support self-reliance through housing, work and participation in social life.
In this perspective, it was essential to propose a therapeutic approach to reduce disorders related to the alterations of social cognition, while relying on group dynamics that are particularly promising in young subjects.
It was for us to choose and adapt a tool aimed at the following objectives :
- Enable commitment and motivation to participate in a cognitive remediation workshop based on the notion of pleasure and sharing
- Recognize and express emotions (of oneself and others)
- Take into account the other in a work of differentiation
- Develop your empathy
- Improve assertiveness and self-esteem
- Use hypothetical reasoning to question one’s beliefs and those of others, while relying on a better analysis of the context of the proposed situations
- Addressing the issue of discrimination, a major obstacle to the recovery process, especially for a young population, playing from personal situations
We therefore chose the Feelings tool, which met all these objectives, and suggested that the caregiver-users group create their own game (emotion cards and situation cards).
The closed group thus welcomed 3 users and 2 caregivers (nurse pair and carer, the carer can change according to the team’s schedule), with equal participation of all, at each stage of the game, in ’Supporting the principle of a symmetrical relationship between each, the caregiver in the same way as the user is thus subject to the same framework and rules as the latter. These rules are : respect for everyone’s word, non-judgment, the active participation of each member and the collegial decision. Each session is organized according to the same model : round table beginning of session inviting each member to express his mood of the day, reminder of the objectives of the session, solicitation at the end of the session of the members of the group to express their feelings on the session then definition objectives and planning for the upcoming session.
Each session lasts between 1 and 2 hours. On a rhythm of once a week to once every 15 days, in the same place. Throughout the sessions, each member will be asked to make regular situations (note in the Feelings workshop notebook).
Pre- and post-program evaluations were conducted, and included the assessment of emotional expressiveness (ESR), emotional intensity measurement (AIM), and facial expression recognition (Faces Test).

The course of the Feelings activity was divided into 8 steps detailed below :
 • Step 1 : Game Phase (4 sessions) :
- "Feelings" board game with an emphasis on exchanging and sharing points of view around situations maps. (situations chosen freely by each member).
 • Step 2 : Listing emotions (3 sessions) :
- Brainstorming emotions on paperboard then definition, classification and establishment of the list of emotions chosen by the group (use of the wheel of emotions of Plutchik).
 • Step 3 : Mime and take pictures "emotions" :
Instructions :
- Choice of 1 to 3 undisclosed emotions to the rest of the group that will have to be mime in front of the objective.
- Black and white photo of trunk and face.
- Right to look at the pictures taken.
- Ability to delete the photo (s) taken if the result does not correspond to expectations. No limit in the number of tests.
- Fill in the "descriptive" grid (see appendix) as an individual (description of each emotion mimed) and put it in an envelope. This stage takes place in 2 big times :
- Between the members of the group : realization of the photos "emotions" and complete the grid "descriptive" (2 sessions).
- Then the members of the group put themselves in the position of "co-therapist" where each person is commissioned to photograph the members of the team of the House of the Rehabilitation of its list and invite them to fill the grid "descriptive "(3 weeks to accomplish this individual achievement that requires organization and planning meetings).
Establishment of 2 group sessions in this period, to take stock of the progress of each to avoid the situation of failure.
 • Step 4 : Definition of the emotion of each photo (3 sessions) :
- Guess the mimed emotion for each photo. Exchange on the representations of each one, with descriptive contribution of mimicry and postures defining the emotion.
 • Step 5 : Realization, making emotion cards. (2 sessions) :
- Choice of "emotions" photos for future cards.
- Making "emotions" cards (using the computer and the laminator).
 • Step 6 : Realization and preparation of situation maps. (2 sessions) :
- Gathering of the different situations brought throughout the sessions of the workshop. (use of the "Feelings" notebook).
- Reformulation of situations if necessary.
- Making situation cards (computer and laminator).
 • Step 7 : Play with your own Feelings MDR First Experience game tools (4 sessions)
 • Step 8 : Results (1 session)
- Review of the workshop : each member of the group is invited to express their criticism (positive points / negative points) vis-à-vis the workshop and express what the tool has brought him.
- Individual evaluation.
The effects observed throughout the participation in the therapeutic workshop were :
- Symmetrical relationship and sharing allowed everyone to gain spontaneity in speaking and emotional expression
- Improvement of emotional skills both in their recognition and expressions (observed by caregivers, post-participation evaluations have not yet been carried out, the group has just closed)
- Recognition of the emotional state of others, their beliefs and intentions, differentiated from their own emotional state or their beliefs in relation to a situation, allowing a questioning of the erroneous beliefs of each
- Reinforcement of social skills and help with destigmatization (especially for the autostigmatization component) through decentration (work around photography) and self-deprecation (laughter)
- Strengthening of self-esteem through the realization of new game materials and the overcoming of certain difficulties (empowerment)
- Remediation of cold cognitions (executive functions, planning) in connection with the organization for taking pictures of other team caregivers

Pole-d-maison-rehabilitation@ch-poitiers.fr

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