Clinical processes and interventions

Job support for people with personality disorders

Accessing or returning to employment is a difficult challenge for people with mental health problems, even though it can be an important factor in recovery. Studies have shown that it is probably more useful for the vocational reintegration of individuals with severe psychological disorders to support efforts to return to work quickly (Working First or Place then Train models), rather than waiting for symptomatic and functional recovery (classic Train then Place models, e.g., sheltered workshops). For people with personality disorders, re-entering the competitive job market may be comparatively easy. However, maintaining one's job over a long period of time often proves to be very problematic, as the severe relational dysfunctions that accompany this type of pathology negatively affect relationships with colleagues and employers who are often unprepared to deal with this type of difficulty. This is followed by layoffs or resignations that span the entire career.

Programs such as IPS (Individual Placement and Support) offer job support with no admission requirements other than the desire to work. Evaluative research has documented the value of this type of program with populations suffering from severe mental disorders. However, their effectiveness appears to be more limited for individuals with pathological personalities, probably because their interpersonal difficulties also impair the alliance and collaboration with their stakeholders. Therefore, employment support methods within the Working First approach, such as IPS, often prove to be insufficient to help the professionals in the field to better deal with these difficult individuals.

Carried out in collaboration with the Community Psychiatry Service of the Department of Psychiatry CHUV (PCO) and the Research centre in vocational psychology and career counselling (Cepco, UNIL), our research projects aim to better understand the occupational trajectories of people with problematic personalities, and to develop and then validate evaluation instruments and intervention methods that complement the offer of job support programs such as IPS.

Assessment of difficulties, needs and resources

Most current etiopathogenic models of mental disorders refer to the generic diathesis-stress model. This model assumes that the development of disorders, their chronicization or the recovery of mental health, respond to complex interactions combining psychobiological vulnerability, internal or external stressors, and individual or social resources.

While the objective evaluation of these parameters remains essential for the understanding of psychological difficulties and the implementation of effective treatments, subjective self-evaluation also proves to be very useful and should not be neglected. On the one hand, models of recovery show that the notions of well-being and personal growth are no longer necessarily synonymous with symptom reduction; on the other hand, it seems difficult to plan therapeutic care that does not take into account the subjective perception of the difficulties, needs and resources of the person in suffering.

We have developed two self-assessment tools based on a Q-Sort method with semi-structured interviews: ELADEB (Lausanne scales for self-assessment of difficulties and needs), and AERES (Resources self-assessment scale). In the field of psychosocial rehabilitation of psychiatric patients, these two tools, which can be used independently, draw up a general profile of difficulties, needs and resources that can be taken into consideration in the setting of a therapeutic care more in line with patients' expectations.

Already widespread in many psychiatric and psychosocial institutions in Switzerland and France, these tools are also beginning to arouse interest outside the field of psychiatry or clinical psychology, such as sports psychology (ELADEB sport version), vocational psychology and career counselling (AERES, professional transition version), or health psychology. Online versions of these tools are also being studied, as well as the development of additional modules for AERES aimed at complementing the self-assessment with intervention proposals based on positive psychology.

Links :

Internet Interventions

Ample evidence suggests that Internet interventions are just as efficient as face-to-face therapy (Andersson, 2018; Andersson et al., 2019). However, research dealing both with the potential of this modern service delivery and with the availability of empirically validated internet interventions is still very scarce in French-speaking countries.

One area of research CARLA is developing is internet interventions in the field of grief and loss. It is a known fact that losing a loved one, either through death, divorce or separation, is both commonly experienced and particularly stressful. Some people indeed show major difficulties in coping with such an event that can lead to increased mental health problems. The team is collaborating with the Universities of Bern and Zürich to develop different innovative internet interventions, with the support of the Swiss National Science Foundation and LIVES (the Swiss centre of expertise in life course research).

More information is available here: and here.

Self-training modules in behavioural and cognitive intervention techniques
Behavioural and cognitive therapy brings together an increasingly broad and varied set of intervention techniques. Beyond their use in psychotherapy, these techniques are also employed by clinical psychologists, counsellors and other mental health professionals. Even if direct and supervised experience of these techniques during intervention sessions remains the preferred means of developing and establishing competence, learning these techniques can be facilitated by means of specific exercises, particularly for university students who have little access to clinical settings. We are progressively setting up and evaluating online self-training modules complementary to an introductory master's course in behavioural and cognitive intervention techniques.
Behavioural addictions

We are conducting extensive research regarding the conceptualization and diagnosis of behavioural addictions (aka non-substance-related addictive behaviours, such as Gaming and Gambling addictions), as well as on the study of the psychological mechanisms involved in the onset, maintenance, and relapse of these disorders (e.g., personality traits, neuropsychological impairments). We are also interested in epidemiological research on online addictive behaviours (or cyber-addictions) and research that aimed to develop and validate (a) screening tools to identify behavioural addictions (e.g., pornography consumption) or (b) questionnaires measuring important aspects of behavioural addictions (e.g., gambling craving, online gaming motives).

Representative research outcomes and related publications:

Our group was the first to elaborate on what is now described as the “confirmatory approach to behavioural addictions”. In a nutshell, this confirmatory approach refers to situations where potentially excessive behaviours (e.g., working, eating, gaming) are a priori conceptualized as genuine addictions and assessed by criteria transposed from knowledge of substance use disorders (SUDs). We criticized such dominant approach by showing that it potentially neglects alternative sound conceptualizations (e.g., maladaptive coping phenomena) and participate in over-diagnosis and inappropriate pathologization. Our seminal paper on this issue was published in 2015 in the Journal of Behavioral Addictions.

Billieux, J., Schimmenti, A., Khazaal, Y., Maurage, P., & Heeren, A. (2015). Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Journal of Behavioral Addictions, 4(3), 119-123.

Kardefelt-Winther, D., Heeren, A., Schimmenti, A., van Rooij, A., Maurage, P., Carras, M., Edman, J., Blaszczynski, A., Khazaal, Y., & Billieux, J. (2017). How can we conceptualize behavioral addiction without pathologizing common behaviors? Addiction, 112, 1709-1715.

Perales, J.C., King, D.L., Navas, J.C., Schimmenti, A., Sescousse, G., Starcevic, V., van Holst, R., & Billieux, J. (2020). Learning to lose control: A process-based account of behavioral addiction. Neuroscience and Biobehavioral Reviews, 108, 771-780.

We have formulated the first attempt to propose a comprehensive model of addictive mobile phone use. This model, which describes different pathways leading to addictive mobile phone use, has become dominant and paved the way for many problematic mobile phone use studies internationally. This model was updated in 2015.

Billieux, J. (2012). Problematic Mobile Phone Use: A literature review and a pathways model. Current Psychiatry Reviews, 8, 299-307.

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J., & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2; 156-162.


Problematic use of ICTs

The advent of on-demand viewing technology (e.g., Netflix, Amazon prime, or Hulu) has been associated in recent years with a dramatic increase in binge-watching (i.e., watching multiple episodes of TV series in one session). Nevertheless, along with its massive rise has come academic and clinical concerns about the potential harmfulness and addictiveness of such excessive-like behaviour. Our research focuses on understanding the psychology of healthy and problematic binge-watching. We are also particularly interested in the elucidation of TV series’ structural characteristics that may facilitate initiation, development and maintenance of binge-watching behaviours.

Representative research outcomes and related publications:

We conducted pioneering work in this emerging research field which is likely to pave the way for future theoretically and psychometrically sound research on binge-watching. Specifically, we provided (1) valid and sound measurement instruments to investigate this new behavioural phenomenon across a wide range of cultures; (2) initial clarifications about the psychological processes underlying elevated - but healthy - and problematic engagement in binge-watching; and (3) an alternative conceptualization involving maladaptive coping or emotional regulation strategies in the etiology and maintenance of problematic binge-watching.

Flayelle, M., Canale, N., Maurage, P., Vögele, C., Karila, L., & Billieux, J. (2019). Assessing binge-watching behaviors: Development of the « Watching TV Series Motives » and the « Binge-Watching Engagement » questionnaires. Computers in Human Behavior, 90, 26-36.

Flayelle, M., Maurage, P., Karila, L., Vögele, C., & Billieux, J. (2019). Overcoming the unitary exploration of binge-watching: A cluster analytical approach. Journal of Behavioral Addictions, 8, 586-602.

Flayelle, M., Maurage, P., Vögele, C., Karila, L., Billieux, J. (2019). Time for a plot twist: Beyond confirmatory approaches to binge-watching research. Psychology of Popular Media Culture, 8, 308-318.

Flayelle, M., Castro-Calvo, J., Vögele, C., Astur, R., Ballester-Arnal, R., Challet-Bouju, G., Brand, M., Cárdenas, G., Devos, G., Elkholy, H., Grall-Bronnec, M., James, R., Jiménez Martínez, M., Khazaal, Y., King, D., Liu, Y., Lochner, C., Steins-Loeber, S., Long, J., Potenza, M., Rahmatizadeh, S., Schimmenti, A., Stein, D., Tóth-Király, I., Tunney, R., Valizadeh-Haghi, S., Wang, Y., Wei Zhai, Z., Maurage, P., & Billieux, J. (2020). Towards a cross-cultural assessment of binge-watching: psychometric evaluation of the « Watching TV Series Motives » and « Binge-Watching Engagement and Symptoms » questionnaires across nine languages. Computers in Human Behavior, 111, 106410.


The representation of psychological disorders and their treatment in movies

Films or television series help the public to develop a representation of a reality that is rather unknown to them, such as a particular profession or any scientific field. Fiction films, unlike documentaries, are not perceived by the public as mirrors of reality, since they must also comply with a certain number of script codes that are generally well known and expected. One can thus always wonder what is more important in the way reality is shown in films, i.e. the documentary truth, the broader social representation conveyed by other mass media, or the rules inherent to the art of filmmaking in terms of dramatization, directing or other aesthetic aspects.

The representation of mental disorders, of psychotherapy or of mental health professionals in the movies has long imposed the caricatural figures of a diabolical, eccentric or romantic therapist, often a psychiatrist, with a predilection for psychoanalytic therapies or hypnosis (or for somatic treatments such as electroshock, neurosurgery or pharmacotherapy).

We seek to highlight key elements of the representation of mental disorders and their therapies in cinema and television series. We rely in particular on the detailed analysis of scenes illustrating, for example, segments of psychotherapy or people who express signs and symptoms of certain mental disorders. These sequences are decoded using observation grids from clinical psychology and adapted to film material. They help us identify stereotypes and explore their frequency and nature. The provided data help us to explore and better understand the nature of these stereotypes. Among other things, we are trying to find out whether they reflect the authors' adhesion to certain widespread social representations, or whether may be the result of specific rules and codes linked to a particular genre or to the directors' own aesthetics.