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Approche psychologique des personnes atteintes d'hémopathies et inscrites dans un processus de greffe de cellules souches hématopoiétiques (CSH) : identification des facteurs socio-psychologiques impliqués dans l’état de santé mentale et physique aux différents stades du processus et développement d’un programme d’intervention adapté

Abstract : Hematopoietic stem cells allograft, or bone marrow transplantation, is one of the treatments proposed to stop the course of hematopoietic malignancies such as acute leukemia. This procedure consists of replacing the cells in the diseased blood with healthy cells from a compatible donor to maximize the chances of success. Although injecting the graft appears to be a relatively simple procedure, it is nonetheless part of a whole process that begins well before the procedure and has consequences in the months and even years following the allograft. Thus, the patient's care pathway can be divided into three stages: the pre-transplant, hospitalization in a protected sector, and the post-transplant period with the return home. At these different stages, an alteration in quality of life, the presence of symptoms of psychological distress and even a state of post-traumatic stress disorder (PTSD) can be observed. However, these psychological consequences may differ from one individual to another, suggesting that certain factors, other than medical ones, could influence both the physical and psychological consequences of the allograft. It is in this perspective and based on the Transactional Integrative and Multidimensional Model of Bruchon-Schweitzer and Boujut (2014) and the Complete State Health Approach of Keyes and Lopez (2002) that four studies were conducted in this thesis work in health psychology. The objective was to highlight the different protective and deleterious psychological factors at the different stages of allograft on the mental and physical health of patients, focusing on factors little explored to date and from the third wave of cognitive and behavioural therapies such as acceptance and commitment therapy. After validating a French version of the AFQ scale (article 1), the first study found that the level of happiness before the transplant contributes to a better quality of life before the procedure (article 2). The second highlighted the prospective effect of anxious preoccupations during hospitalization on the occurrence of post-traumatic stress disorder and the positive effect of fighting spirit on the level of resilience and happiness five months post-transplant (article 3). The third one revealed that the more people tended to be in experiential avoidance, the more likely they were to develop symptoms of PTSD, while patients with high non-judgmental scores (a facet of mindfulness) were less likely to develop such symptomatology (article 4). Finally, the fourth study shows that the experience of positive life changes in patients' lives after transplantation is far from systematic. Rather, patients show a decline in their psychological health that is related to a low level of acceptance (article 5). All of these results led us to reflect and propose an intervention adapted to the needs of patients (i.e. a digital platform) based on effective interventions in psycho-oncology and web-based therapies. In this perspective, a first device (i.e. DESP task) aimed at remedying the attentional biases involved in anxiety and depression has been developed and tested (article 6). The DESP has been the subject of a declaration of invention (declaration of invention n°0487-UCADESPTASK). Proposing a continuity of care and trying to overcome the obstacles inherent to the specificities of the allograft course is essential to improve the care of patients and accompany them during this pathway
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Maya Corman. Approche psychologique des personnes atteintes d'hémopathies et inscrites dans un processus de greffe de cellules souches hématopoiétiques (CSH) : identification des facteurs socio-psychologiques impliqués dans l’état de santé mentale et physique aux différents stades du processus et développement d’un programme d’intervention adapté. Psychologie. Université Clermont Auvergne, 2020. Français. ⟨NNT : 2020CLFAL015⟩. ⟨tel-03148987⟩

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