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Dimensions diachronique et synchronique des cardiopathies

Abstract : This thesis by publication registers in the field of psycho-traumatology and psycho-cardiology. The purpose of this work is to improve our understanding of the experience of people who have survived a potentially traumatic cardiac event, namely a myocardial infarction (MI) (synchronic dimension), in the light of their life history, a history sometimes marked by difficult, even traumatic events (diachronic dimension). This thesis is organized in two parts. The objective of the first part is to provide an overview of the state of knowledge on the links between psychological trauma and MI. In this perspective, we conducted an initial review of the literature on posttraumatic stress disorder (PTSD) (American Psychiatric Association, [APA], 2013) induced by MI. Second, we questioned, through an epistemological reflection, the interest as well as the limitations of the concept of PTSD, as defined by the DSM-5, applied to acute forms of coronary heart disease. Two literature reviews were then conducted: one focused on the links between PTSD and the subsequent onset of MI, the other on the links between adverse childhood experiences and the occurrence of MI in adulthood. The second part of this thesis aims to deepen our understanding of the experiences of people who have suffered from MI (synchronic dimension) by considering their life experiences (diachronic dimension), through three studies. A first study, including 73 participants in a cardiovascular rehabilitation program, was conducted to examine the relationships between attachment, post-traumatic stress symptomatology, somatoform dissociative symptomatology and health-related quality of life (HRQoL). These variables were respectively assessed through the following self-administered questionnaires: Experiences in Close Relationship (ECR-12), Post-Traumatic Stress Disorder Checklist Scale, DSM-5 version, (PCL-5) and Somatoform Dissociation Questionnaire (SDQ-20), MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew). Mediation analyses were performed. The results show that the more intense the level of abandonment anxiety that characterizes the subjects' attachment, the more the HRQoL is reduced, after MI. The severity of posttraumatic stress symptoms fully explains why people with an attachment marked by a high level of abandonment anxiety have a reduced HRQoL, whereas the importance of somatoform dissociative symptomatology partially explains this relationship. A second study was conducted with two individuals participating in a cardiovascular rehabilitation program. A semi-directive interview was conducted with each of them to provide the most detailed understanding possible of their cardiac disease experience, considering their life history. The participants also completed the following self-administered questionnaires: ECR-12, MacNew, PCL-5 and SDQ-20. The analysis of the interviews and the results of the questionnaires show that the relational context in which the subject grew up, the difficult situations with which he or she was sometimes confronted in early life, and his or her past or more recent attachment experiences play a crucial role in the HRQoL, the experience of heart disease, and related emotional distress. To close the second part of this thesis, we will present a clinical situation illustrating the implementation of EMDR therapy (Eye Movement Desentitization and Reprocessing) in a person who has suffered from MI.
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Submitted on : Monday, February 7, 2022 - 4:17:36 PM
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Murielle Jacquet-Smailovic. Dimensions diachronique et synchronique des cardiopathies. Psychologie. Université de Lorraine, 2021. Français. ⟨NNT : 2021LORR0174⟩. ⟨tel-03560614⟩



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