Augmentation de la psychothérapie par amorçage préconscient (APAP)Â : étude d'un cas

Social phobia is a common and disabling anxiety disorder (Keller, 2005) with an estimated lifetime prevalence of between 3% and 13% (Kessler et al., 2005). The treatment of social phobia may include medication (Rickels et Rynn, 2002) or Cognitive Behavioral Therapy (CBT) - a generally effective and widely studied form of psychotherapy for social phobia (Bernier et Simard, 2007). However, some patients, either those who have received group or individual psychotherapy, do not respond or are still symptomatic after CBT (Garakani et al., 2006). The current paper describes a new method for facilitating change based on psychotherapy augmentation through preconscious priming (APAP) (Borgeat et al., 2013) and its use in the treatment of Caroline, a 34-year-old patient suffering from severe social phobia. Preconscious priming is an approach that has been in development for several years and shows that perceptions received outside the normal field of consciousness can influence attitudes, emotions, perceptions and thoughts (Borgeat et al., 1989; Kouider et Dehaene, 2007; Van den Bussche et al., 2009; Victor et al., 2010; Daltrozzo et al., 2011). Caroline had been socially anxious since her childhood with a high level of anxiety and discomfort in various social situations. Previously, the patient had shown only a partial response to CBT despite good adherence to treatment. Following this treatment, the patient completed the APAP process, which consisted of six steps during which alternative, more functional thoughts and beliefs were formulated, relevant to the idiosyncratic difficulties experienced by the patient. Subsequently, these formulations were recorded and mixed with masking relaxing music, following which the patient listened to the recordings in a passive state twice daily for 20 minutes for a period of 8 weeks. The effect of this strategy was evaluated by quantitative and qualitative measures administered before treatment with the APAP program, at 8 weeks, 16 weeks and 24 weeks. In addition, idiosyncratic ratings of dysfunctional thoughts, symptoms of anxiety, global functioning and quality of life were assessed at baseline and at 24 weeks. Results showed a significant reduction in dysfunctional thoughts reported by Caroline. Scores of the Social Interaction Self Statement Test (SISST) (Musa et al., 2004) showed an increase in positive cognitions which were fairly well-maintained throughout treatment, as well as a decrease in negative cognitions at weeks 8 and 16. However, an increase in SISTT negative cognitions scores was observed at week 24. Scores at the Fear of Negative Evaluation Scale (FNE) (Musa et al., 2004) decreased at week 8 and 16 to some extent, and increased at week 24. The observed results of the FNE and the SISST negative at week 24 were likely due to recent life events related to the re-appearance of her biological mother. There was substantial clinical improvement in anxiety symptoms as measured by the Beck Anxiety Inventory (Beck et al., 1988) at different points in comparison to baseline. With regards to symptoms of social phobia, as measured by the Liebowitz Social Phobia Scale (Yao et al., 1999), there was a modest reduction in symptoms with a score of 71 at baseline, to a score of 63 at week 8, and a score of 59 at week 24. The Quality of Life Systemic Inventory (Duquette et al., 1994) showed significant improvement compared to baseline with a score of 70 - representing a good quality of life. In addition, Caroline reported other improvements, including making new friends and actively pursuing an exhibition of her paintings. In conclusion, the APAP intervention had a positive impact on the patient. Results showed that APAP led to positive cognitive changes and clinically significant improvement in anxiety symptoms and global functioning in our patient, which were maintained long-term. APAP, which is accessed through Internet, could be a valuable addition to CBT by facilitating or enhancing cognitive and symptom change.