Clinical research - Strasbourg

Anne Giersch

Patients describe strange perceptual experiences, such as a fragmentation of thought, reputedly linked to disorders of the sense of self. Trying to understand these experiences leads us to explore abstract questions such as the continuity of time. We intuitively think that we perceive the information around us as continuous, in the same way that physical time seems continuous. Yet a growing body of evidence suggests that we perceive time rhythmically. What is it that allows us, but not patients, to perceive time as continuous? We have demonstrated the existence of prediction mechanisms on the millisecond scale, which would compensate for the constraints of our conscious perception and enable us to follow what is happening around us in a fluid manner. These mechanisms appear to be disrupted in schizophrenia, but not in patients with bipolar disorder, who instead have difficulty controlling their mental activities on the scale of the second. We are seeking to ascertain whether these disorders pre-exist the development of psychosis, how they contribute to disorders of the sense of self, why these disorders are often transient, what causes them, and what the neurobiological bases of these disorders are. Our expertise lies in the field of experimental psychology and psychophysics, but we are broadening our methods to answer our questions: eye movement recording, electroencephalography, fMRI, virtual reality, motion capture and motor trajectory recording are used in current practice in our ongoing projects.

Anne Bonnefond

My research is organised around two main themes: 1. the neurophysiological study of sustained attention, an impaired cognitive function in many clinical populations, and 2. the study of multidimensional apathy, a very common transnosographic clinical symptom. Our studies of healthy subjects and clinical populations - schizophrenia, attention deficit disorder with or without hyperactivity (ADHD) and depression - are based mainly on tools developed in experimental cognitive psychology and the electroencephalography (EEG) technique.

1. Sustained attention is a basic form of attention which refers to our ability to maintain our cognitive activity effectively on a task for a relatively long period of time. Although it plays a decisive role in the proper functioning of a large number of perceptual and cognitive functions and, by extension, in all goal-directed behaviour, the cognitive and neuronal mechanisms underlying it are still poorly understood. To make progress in this area, AS deficits are explored along a continuum with, at one end, the state of inattention (a transient state of reduced attention), at the other end, inattentive symptomatology (a diagnostic criterion for ADHD) and, in between, the inattentive trait, i.e. a characteristic that is more stable than the state of inattention but without the disabling consequences associated with the symptom.
2. Apathy is a clinical symptom defined as a quantitative reduction in goal-directed behaviour compared with the person's previous level of functioning. Despite the frequency of this symptom and its negative repercussions in all spheres of daily life, there is currently no effective treatment for it. To improve our understanding of the cognitive and neural mechanisms underlying apathy, our studies, conducted in healthy subjects with an apathetic trait as well as in patients suffering from schizophrenia or depressive disorders, are based on a multidimensional model of apathy that considers three distinct clinical sub-forms (i.e. emotional, executive, initiation).

Fabrice Berna

My main area of research concerns the study of autobiographical memory in schizophrenia, with the aim of gaining a better understanding of how disorders of this form of memory have an impact on certain symptoms such as personal identity (or self), delusions, hallucinations, etc. Our work also aims to develop innovative approaches to cognitive remediation of autobiographical memory, using portable cameras in particular. Our more recent work aims to gain a better understanding of the mechanisms common to alterations in episodic memory and autobiographical memory in schizophrenia by exploring different experimental materials, ranging from the most controlled (similar to episodic memory) to the most ecological (similar to autobiographical memory).

Gilles Bertschy

Throughout my career I have been interested in mood disorders and their treatment and more recently in their comorbidities such as ADHD. A generation of work on tachypsychia as a clinical marker contributing to the study of the distinction between bipolar and unipolar mood disorders is nearing completion. Our current involvement is focused on supporting the work of Sébastien Weibel.

Isabelle Offerlin-Meyer

Clinical Psychologist specialising in Neuropsychology, Doctor of Science.  

Research area

With an applied focus, my research concerns

1. The design and implementation, using an analytical and operational approach, of cognitive-functional care methods (ecological and tailor-made) with a view to reducing psychological disability in people suffering from schizophrenia and other psychological disorders and mental pathologies (bipolarity, autism, X-Fragile, multi dys-, TCA, etc.), based on
2. Identifying the processes involved in target activities, and devising ways of optimising them and remediation strategies aimed at achieving these objectives,

This frequently leads me to

•     Working with the three establishments specialising in vocational support for people with disabilities run by the Association Route Nouvelle Alsace, chaired by Professor Jean-Marie Danion (http://www.r-n-a.org):
•     The Etablissement et Service d'Aide par le Travail [ESAT] [Establishment and Service for Help through Work
•     The Adapted Enterprise [EA]
•     Service d'Insertion en Milieu Ordinaire de Travail [SIMOT].

Our specific approach

Born of the initial work of a collaborative network (M. Van der Linden, F. Larøi and M.-N. Levaux - Interreg IIIB project; collaboration between the University Hospitals of Liège and Strasbourg, 2003-2006), our approach is :

•     Individualised and centred on the specific activities of daily and/or professional life involving the impaired functional aspects;
•     The basic paradigm is that of multiple baselines;
•     The areas of interest to be assessed are :
•     The effectiveness and specificity of each treatment, as well as
•     The ability to generalise and transfer what has been learned.
•     The methodology used is that of the single case and multiple cases.
•     Aims of the approach :
•     To reduce the psychological handicap caused by cognitive disorders and their deleterious consequences on integration possibilities,
•     Greater autonomy for patients,
•     Improving their quality of life and self-esteem, so that they can be integrated and rehabilitated as individuals in their own right.

In practice

Since cognitive disorders are undeniably a major obstacle to the professional integration of people with mental disabilities, and one of their main complaints and concerns, we regularly offer talks at coffee meetings and training courses organised by SIMOT, with the aim of playing down these disorders by providing scientific information and presenting rehabilitation methods for people with mental disabilities.         

Between 2011 and 2016, more than 70 people with mental health problems have benefited from these contributions, in the form of

Oral presentations with a societal impact

Coffee meetings

•     "What is the link(s) between cognitive disorders, mental disability and difficulties in social and professional integration?
•     Meeting and discussion with people with mental health problems, company directors, SIMOT integration officers and social science academics.
•     Strasbourg, 14 April 2011. Offerlin-Meyer, I., Danion, J.-M.
•     "De la neuropsychologie à la réinsertion sociale et professionnelle - C'est quoi la mémoire, l'attention et la Schizophrénie? Can we reduce cognitive disorders?                
•     Speech at the request of, and for people with mental disabilities supported by SIMOT .
•     Strasbourg, 19 June 2015. Offerlin-Meyer, I., Danion, J.-M.
•  
•     "How to "tame" cognition in everyday life".                   
•     Speech for people with mental disabilities supported by SIMOT.      
•     Strasbourg, 20 November 2015. Offerlin-Meyer, I., Danion, J.-M.

Training

• "Bilan pour Agir : approche neuropsychologique des troubles cognitifs et du handicap psychique". Meeting and discussion with people with psychiatric disabilities at the Service d'Insertion en Milieu Ordinaire de Travail de l'Association RNA. Strasbourg, 14 May 2012. Offerlin-Meyer, I., Levaux, M.-N., Larøi, F., Van der Linden, M., Danion, J.-M.
• "Bilan pour Agir: approche neuropsychologique des troubles cognitifs et du handicap psychique". Meeting and discussion with people with mental disabilities at the Service d'Insertion en Milieu Ordinaire de Travail de l'Association RNA. Obernai (67), 03 December 2014. Offerlin-Meyer, I., Levaux, M.-N., Larøi, F., Van der Linden, M., Danion, J.-M.
• "Construire pour Agir : de la vertu des " petites choses " au service du bien-être". Training for people with psychological disabilities at the Service d'Insertion en Milieu Ordinaire de Travail de l'Association RNA. Strasbourg (67) 10 November 2015. Offerlin-Meyer, I.
• "Bilan pour Agir: Du handicap psychique à la renaissance et à la resocialisation - Une question de regard et de citoyenneté". Speech for people with mental disabilities supported by the RNA Association's Service d'Insertion en Milieu Ordinaire de Travail. Strasbourg, 31 May 2016 Offerlin-Meyer, I., Danion, J.-M.
• "Building for Action: The virtue of 'little things' for well-being and cognition". A presentation for people with psychological disabilities supported by the RNA Association's Service d'Insertion en Milieu Ordinaire de Travail (Integration Service in an Ordinary Working Environment). Strasbourg, 03 November 2016 Offerlin-Meyer, I., Danion, J.-M.
• "Bilan pour Agir : Capacities with regard to disability... A question of citizenship". Presentation for people with psychological disabilities supported by the Service d'Insertion en Milieu Ordinaire de Travail de l'Association RNA. Strasbourg, 03 November 2016 Offerlin-Meyer, I., Danion, J.-M.

Sébastien Weibel

My main area of research concerns attention deficit disorder with or without hyperactivity (ADHD) in adults and emotional regulation disorders, present in ADHD but also in other psychiatric disorders such as borderline personality disorder and bipolar disorder. Adult ADHD and emotional regulation difficulties are disorders that are still little recognised and little treated in France. What's more, these different disorders are often associated, making treatment more complex. My work as a researcher is linked to my work as a clinician. I'm looking to improve treatment and develop innovative therapeutic approaches. More specifically, my first line of research concerns the clinical characteristics and diagnostic limits of ADHD in adults, taking into account the complexity of co-morbidities (acceleration of thought, emotional dysregulation, borderline personality traits, temperament and sleep disorders). Secondly, I am interested in the cognitive mechanisms of attentional lapses in ADHD. We are seeking to characterise the neural mechanisms of these attention lapses, which are particularly frequent in ADHD, by comparing them with healthy controls and non-clinical participants with attention difficulties, and analysing the relationships between attention lapses and wandering thoughts. Thirdly, my projects are aimed at treating these patients. In collaboration with the Faculty of Psychology (Luisa Weiner), we are developing psychotherapeutic approaches using dialectical behaviour therapy, a therapy focusing on problems of emotional dysregulation, in patients with ADHD, borderline personality disorder, autism spectrum disorders and acquired brain injury. I am also interested in pharmacological approaches and particularly the cerebral effects of methylphenidate (the main treatment for ADHD) in people with ADHD associated with comorbidities.

Giulia Lafond-Brina

My research focuses on a better understanding of the transdiagnostic mechanisms of apathy, a clinical symptom defined as the reduction, or even absence, of the initiation of voluntary behaviour. Despite the frequency of this symptom in schizophrenia, bipolar disorders and resistant depression, and its negative impact on daily life, there is currently no effective treatment for it. To improve our understanding of the cognitive and neuronal mechanisms underlying apathy, our studies are based on a multidimensional model of apathy that considers three distinct clinical sub-forms (i.e. emotional, executive, initiation).
Our studies of healthy subjects with an isolated apathetic trait and of clinical populations - schizophrenia and unipolar and bipolar depressive disorders - are based mainly on tools developed in experimental cognitive psychology and the electroencephalography (EEG) technique.
The results of our work with Anne Bonnefond, mainly carried out as part of my neuroscience thesis, which was awarded the Prix Eurométropole de Strasbourg 2023 in 2024, a thesis prize awarded by the Société de Biologie de Strasbourg, now enable me to focus on two areas of research:

• Axis 1: To determine whether the three dimensions of multidimensional apathy could, rather than representing an early vulnerability factor for the onset of a psychiatric pathology, enable more specific prediction of the psychiatric pathology at risk.
• Axis 2: To gain a better understanding of the mechanisms of apathy in schizophrenia, mood disorders and healthy subjects with an apathetic trait, in order to determine whether the management of this disabling symptom needs to be adapted according to the dimensions of apathy and/or the associated psychiatric pathology.

Chaoyang Peng

This PhD project explores the link between time perception impairments and the sense of self in schizophrenia. Patients struggle with time continuity, likely due to impaired predictive mechanisms. Using EEG and virtual reality (VR) starfield tasks, the project studies how time prediction works in patients and its role in self-perception. Preliminary findings show VR helps restore time prediction. The project aims to develop a biomarker for these impairments and test augmented reality glasses to improve time perception and self-awareness, offering the potential for prevention and therapy in schizophrenia.

Catherine Bastian

My thesis project aims to characterise the neural correlates of attentional lapses, moments when our attention disengages from an ongoing activity. While these lapses exist in the general population, they are particularly frequent in patients suffering from Attention Deficit Disorder with or without Hyperactivity (ADHD). The aim of this project is therefore to study the neuronal mechanisms involved in the occurrence of lapses, both in healthy subjects and in adult ADHD patients, using EEG. More specifically, one of the avenues being explored is the intrusion of delta waves, brain waves typically observed during sleep. 

Pierre Orselli

TRACE Project (Trauma, Conceptual self and Evolution)

Autobiographical memory brings together all the personal memories of an individual and forms the basis of the ‘temporally extended self’, i.e. the perception that each person has of their past, present and future identity. Exposure to a traumatic event puts this construction to the test and can lead to the development of post-traumatic stress disorder (PTSD), now considered a memory pathology.

Under the supervision of Fabrice Berna and Amaury Mengin, this thesis project stems from a number of observations::

• The ICD-11 distinguishes two forms of PTSD: the simple form and the complex form (PTSDc).
• 40% of patients do not respond to currently recommended therapies. It is therefore crucial to identify the factors associated with remission in order to help them.
• Research into PTSD(c) has mainly focused on the past and present, leaving the future dimension of the self little studied.
• A new therapy is emerging: Written Exposure Therapy (WET). It has a number of advantages: a brief format, similar effectiveness to other recommended therapies, a lower drop-out rate, written accounts of the trauma are collected at the end of each session, and standardisation makes it suitable for a research protocol.
• The incoherence of the trauma narrative, considered to be an explanatory factor in post-traumatic symptomatology, is still the subject of debate in the scientific literature.

A number of avenues have emerged for understanding these different points:

• PTSDc is characterised by a more marked alteration in the organisation of the self. It is therefore necessary to identify precisely the alterations in the temporally extended self specific to each of the two forms of PTSD in order to improve their respective management.
• Changes in the future dimension of the self could be a factor in remission after trauma-focused psychotherapy. By placing greater emphasis on this dimension, existing therapies could become more effective.
• Some recent data suggest that WET may act by modifying specific aspects of the temporally extended self. It also appears to be effective in patients with forms similar to cPTSD.
• Incoherence in the traumatic narrative is most apparent when patients relate the worst moments of their experience, as is the case in exposure therapy.

In this project, two groups will be set up: a group of resilient people (exposed to trauma without having developed any pathology) and a group of PTSD/PTSDc patients.

1. We will assess the different dimensions of the temporally extended self (autobiographical memory, self-concepts, future self) within these groups.
2. A subgroup of patients (PTSD/TSPTc) will follow the WET, while another subgroup of patients (PTSD/TSPTc) placed on the waiting list and the resilient group will keep a diary in which they will write autobiographical narratives allowing us to control for the effect of expressive writing and the recall of personal memories.
3. All the dimensions of the temporally extended self will be reassessed six weeks after these two interventions.

Ultimately, this project could:

1. Determine the characteristics of the temporally extended self specific to PTSD and cPTSD, making it possible ultimately to identify therapeutic targets specific to each of these forms.
2. Demonstrate the role of the different dimensions of the temporally extended self, in particular the future dimension of the self, in reducing post-traumatic symptoms following trauma therapy.
3. To validate the effectiveness of WET in the treatment of cPTSD.
4. Resolve the controversy over the inconsistency of traumatic memory in both the maintenance and remission of PTSD/cPTSD.