Les interventions basées sur la pleine conscience (MBI: Mindfulness Based Interventions) ont récemment fait leur apparition en médecine occidentale. L’efficacité de ces programmes a été démontrée en ce qui concerne la régulation émotionnelle et le déploiement des ressources cognitives, notamment de l’attention. Malgré l’intérêt potentiel des MBI sur la stabilisation attentionnelle, le recours à ces thérapeutiques est encore rare dans la réhabilitation neuropsychologique. Nous avons réalisé une revue de la littérature dont l’objectif est de discuter les possibles articulations entre les MBI et la prise en charge neuropsychologique.

Dans la première partie, nous rappelons les concepts clés de la neuropsychologie de l’attention. Ensuite, nous examinons l’efficacité des approches MBI sur les processus cognitifs, affectifs et somatiques. La complexité des manifestations psychiatriques provient entre autres des liens étroits entre ces trois types des processus. Les MBI, qui tiennent compte de ces interdépendances peuvent ainsi avoir une pertinence clinique dans la prévention et la prise en charge des altérations cognitives. Dans la dernière partie, nous suggérons d’intégrer les principes des MBI dans les programmes de remédiation cognitive et d’éducation thérapeutique. Dans cette perspective nous proposons plusieurs recommandations pour la mise en place des outils de réhabilitation inspirés de la pleine conscience.

L’approche intégrative préconisée ici s’inspirerait ainsi d’une part de la neuropsychologie actuelle et des MBI qui restructurent le rapport à soi, à ses affects, à ses cognitions et à son environnement via un travail métacognitif.

Mindfulness based interventions (MBI) have recently gained much interest in western medicine. MBSR paradigm is based on teaching participants to pay complete attention to the present experience and act nonjudgmentally towards stressful events. During this mental practice the meditator focuses his or her attention on the sensations of the body. While the distractions (mental images, thoughts, emotional or somatic states) arise the participant is taught to acknowledge discursive thoughts and cultivate the state of awareness without immediate reaction. The effectiveness of these programs is well documented in the field of emotional response regulation in depression (relapse prevention), anxiety disorders, obsessive-compulsive disorder or eating disorders. Furthermore, converging lines of evidence support the hypothesis that mindfulness practice improves cognition, especially the ability to sustain attention and think in a more flexible manner. Nevertheless, formal rehabilitation programs targeting cognitive disturbances resulting from psychiatric (depression, disorder bipolar, schizophrenia) or neurologic conditions (brain injury, dementia) seldom rely on MBI principles. This review of literature aims at discussing possible links between MBI and clinical neuropsychology.

We conducted a review of literature using electronic databases up to December 2016, screening studies with variants of the keywords (“Mindfulness”, “MBI”, “MBSR”, “Meditation”) OR/AND (“Cognition”, “Attention”, “Executive function”, “Memory”, “Learning”)

In the first part, we describe key concepts of the neuropsychology of attention in the light of Posner's model of attention control. We also underline the potential scope of different therapeutic contexts where disturbances of attention may be clinically relevant. Second, we review the efficacy of MBI in the field of cognition (thinking disturbances, attention biases, memory and executive processes impairment or low metacognitive abilities), mood (emotional dysregulation, anxiety, depression, mood shifts) and somatic preoccupations (stress induced immune dysregulation, chronic pain, body representation, eating disorders, sleep quality, fatigue). In psychiatry, these three components closely coexist and interact which explains the complexity of patient assessment and care. Numerous studies show that meditation inspired interventions offer a promising solution in the prevention and rehabilitation of cognitive impairment. In the last part, we discuss the benefits and risks of integrating meditation practice into broader programs of cognitive remediation and therapeutic education in patients suffering from cognitive disorders. We propose a number of possible guidelines for developing mindfulness inspired cognitive remediation tools. Along with Jon Kabatt Zinn (Kabatt-Zinn & Maskens, 2012), we suggest that the construction of neuropsychological tools relies on seven attitudinal foundations of mindfulness practice.

This paper highlights the importance of referring to holistic approaches such as MBI when dealing with patients with neuropsychological impairment, especially in the field of psychiatry. We advocate introducing mindfulness principles in order to help patients stabilize their attention and improve cognitive flexibility. We believe this transition in neuropsychological care may offer an interesting paradigm shift promoting a more efficient approach towards cognition and its links to emotion, body, and environment.