3. Thérapies envisagées
4.3. Perspectives futures
Il serait important de prolonger cette analyse détaillée des processus de récompenses et de punitions chez les personnes dépressives et d’envisager des perspectives futures.
178 Discussion: Conclusion Dans un premier temps, il serait intéressant de prendre en compte les liens du modèle théorique qui n’ont pas été considérés dans les différentes études de ce travail de thèse. Nous pourrions par exemple évaluer non seulement le mécanisme de biais de mémoire négatif dans l’anticipation des récompenses et des punitions, mais également le mécanisme de locus de contrôle dans l’anticipation des récompenses et le mécanisme de rumination dans la consommation des punitions. Au niveau de la manipulation du biais de mémoire, il serait envisageable de proposer à la moitié des participants d’effectuer une tâche de rappel autobiographique, dans laquelle ils doivent décrire des événements positifs qui sont arrivés alors qu’ils étaient au collège et qui les ont rendu joyeux au moment où ils sont arrivés. L’autre moitié des participants devraient alors effectuer une tâche de distraction dans laquelle les participants sont face à une liste de 40 mots et reçoivent la consigne selon laquelle ils doivent utiliser les lettres de chacun des mots de la liste pour reconstruire deux autres mots plus courts (Joormann, Siemer, & Gotlib, 2007). Au niveau de la manipulation de la rumination, nous pourrions utiliser une tâche d’induction de la rumination que la moitié des participants devraient effectuer et durant laquelle les participants doivent focaliser leur attention durant 8 minutes sur des pensées liées aux symptômes, aux émotions ou à soi (ex : ce que vos sentiments peuvent signifier, les sensations physiques que vous ressentez dans votre corps, les conséquences possibles de la manière dont vous ressentez les choses, à quelle vitesse vont vos pensées en ce moment). L’autre moitié des participants pourrait être conviée à effectuer une tâche de distraction, durant laquelle ils doivent focaliser leur attention durant 8 minutes sur des pensées externes et non pas liées aux symptômes ou aux émotions (ex : la disposition du centre commercial proche de chez vous, la taille du Golden Gate Bridge, deux oiseaux assis sur une branche, la forme du continent africain) (Lyubomirsky & Nolen-Hoeksema, 1993).
En outre, nous avons vu que le symptôme d'anhédonie était très important dans le trouble dépressif, mais il est également présent dans d'autres troubles psychopathologiques, comme le trouble psychotique (Barch, Treadway, & Schoen, 2014; Huxley & Fonseca, 2014;
Strauss & Gold, 2012), les abus de substances (Diekhof, Falkai, & Gruber, 2008), le trouble borderline (Marissen, Arnold, & Franken, 2012) et les troubles alimentaires (Davis &
Woodside, 2002). De plus, il a été montré que la sensibilité à la récompense était également inadaptée au niveau du trouble bipolaire (Alloy et al., 2012). Il serait alors intéressant d’investiguer ce symptôme de manière transdiagnostique dans des troubles autres que la dépression.
Finalement, nous avons vu de manière théorique qu’un certain nombre de thérapies pouvaient avoir un impact sur les déficits liés à la sensibilité à la récompense et à la punition dans la dépression. Il serait alors intéressant de continuer sur cette voie et d’investiguer de manière empirique l’impact de ces différentes thérapies sur les déficits spécifiques. Prenons l’exemple du traitement d’activation comportementale. Nous pourrions alors suggérer qu’avant
Discussion : Conclusion 179 le traitement, les personnes dépressives mobiliseraient moins d’effort que les personnes non dépressives durant la phase d’anticipation des récompenses et des punitions. Puis, nous pourrions supposer que les participants dépressifs ayant suivi ce traitement auraient appris à développer des comportements d’évitement actif face aux punitions ainsi qu’un comportement d’approche face aux récompenses et que de ce fait, ils mobiliseraient autant d’effort que les participants non dépressifs durant la phase d’anticipation. Si nous investiguons l’impact de la MBCT sur la sensibilité aux récompenses des personnes dépressives durant la phase de consommation, nous pourrions poser l’hypothèse selon laquelle avant le traitement, ces personnes auraient des expressions faciales réduites lors de la réception de la récompense.
Puis, nous pourrions supposer que les personnes dépressives ayant suivi le traitement auraient appris à ressentir de l’affect positif et auraient ainsi des expressions faciales similaires aux personnes non dépressives durant la consommation des récompenses.
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