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De nos jours, la dépression et l'anxiété sont des réalités malheureusement très prégnantes en Europe. Pour soigner de tels troubles, les traitements se focalisaient jusqu'alors sur l'étiquette diagnostique. L'approche processuelle préconisée actuellement tient compte davantage des processus psychologiques sous-jacents aux difficultés.Dans ce contexte, l'activation comportementale est une approche psychothérapeutique qui vise à améliorer la santé mentale du sujet en termes d'humeur, de pensées et de qualité de vie. Elle est ici présentée comme un outil permettant le traitement des évitements, non seulement comportementaux, mais aussi cognitifs, dont la rumination mentale. Ces évitements se manifestent dans une multitude de troubles psychologiques accompagnés de dépression et d'anxiété.Après un état des lieux des connaissances actuelles sur les protocoles de traitement centrés sur l'activation comportementale et les évitements, ce livre présente aux psychothérapeutes, et pour la première fois en langue française, les stratégies d'intervention de l'activation comportementale ainsi que des outils permettant les mesures de la rumination mentale, des évitements comportementaux et d'autres phénomènes psychologiques.

Anxiety --- Psychotherapy. --- Treatment.

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Cognitive models of social phobia underline the importance of maladaptive beliefs and thought processes in the development and maintenance of the disorder (e.g. Clark & Wells, 1995; Rapee & Heimberg, 1997). A wealth of studies have evidenced that socially anxious individuals report more frequent negative thoughts and negative self-images, not only during social situations, but also before and after social situations. Recent evidence further suggests that these cognitions can be qualified as intrusive and recurrent, and that they are a target of control for socially anxious individuals (Rachman, Grüter-Andrew, & Shafran, 2000; Vassilopoulos, 2004). Based on the seminal study of Wegner (Wegner, Schneider, Carter, & White, 1987), some authors have proposed that attempts to control social threatening thoughts and images could lead to paradoxical consequences such as an increase in cognitions frequency after suppression, i.e., a rebound effect (e.g., Huppert & Foa, 2004). However, studies on emotional thought suppression have produced equivocal results not only in relation to social anxiety (Becker, Rinck, Roth, & Margraf, 1998; Cougle, Smits, Lee, Powers, & Telch, 2005; Fhem & Margraf, 2002) but also in relation to other psychological disorders (for reviews, see Purdon, 1999; Rassin, Merckelbach, & Muris, 2001). This state of affairs has led some researchers to explore the specific conditions under which the rebound effect might be observed (e.g., Abramowitz, Tolin, & Street, 2001) whereas others have suggested that suppression might lead to undesirable emotional consequences rather than cognitive ones (e.g., Roemer & Borkovec, 1994; Wegner & Gold, 1995). In this perspective, the first three studies presented in this dissertation have explored whether suppressing thoughts related to social anxiety results in paradoxical consequences, either cognitive or emotional, and whether ironic consequences depend on the discreteness of the thought to-be-suppressed (Study 1), on the strategies used during suppression (Study 2) or on the clinical status of people who suppress thoughts (Study 3). The results obtained in these three studies failed to reveal any ironic consequences, either cognitive or emotional. The absence of significant results in the first three studies might lead to the conclusion that suppressing thoughts related to social anxiety does not lead to ironic consequences, either cognitive or emotional, and whatever the moderators considered. In order to explore whether the suppression does not lead to irony when it is specifically applied to social anxiety-related thoughts, in comparison to other emotional thoughts, a meta-analysis on the effect of thought suppression was conducted (Study 4). The major contributions of this meta-analysis were threefold. First, it explored the effects of suppression with emotional thoughts potentially having a clinical relevance. Second, suppression effects were explored on four dependent variables, i.e., on thought frequency, thought duration, negative emotions and on the discomfort associated with the thought occurrence. Finally, it contrasted two definitions of paradoxical effects, one related to between-groups comparisons, the other related to within-group comparisons. Taken together, the results of the meta-analysis suggested that emotional thought suppression does not lead to clear ironic effects, whatever the dependent variables considered or the definitions adopted. The results of the four first studies lead to conclude that it seemed unlikely that the thought suppression paradigm could represent a fruitful procedure to understand the difficulty that patients encounter in controlling their negative thoughts. However, the fact remains that people suffering from emotional disorders, including those suffering from social anxiety, have difficulties to control their thoughts. In a final part of this dissertation, a set of three studies aimed at exploring the specificity of negative cognitions and cognitive process in relation to social anxiety. The results of these studies suggested that the difficulties to control thoughts in social anxiety are not linked to their ability to suppress a particular thought but rather linked to their inability in inhibiting a catastrophisation process.

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