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La patiente avait manifesté une réponse symptomatique partielle à la thérapie cognitive-comportementale TCC malgré une bonne adhésion au traitement. Ces formulations sont enregistrées et masquées par une musique relaxante. APAP qui est accessible par Internet pourrait constituer un ajout au traitement par TCC en facilitant ou en augmentant le changement cognitif et symptomatique. Social phobia is a common and disabling anxiety disorder Keller, 2005 with an estimated lifetime prevalence of between 3% and 13% Kessler et al. 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. The current paper describes a new method for facilitating change based on psychotherapy augmentation through preconscious priming APAP Borgeat et al. 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. 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. 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. 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. With regards to symptoms of social phobia, as measured by the Liebowitz Social Phobia Scale Yao et al. The Quality of Life Systemic Inventory Duquette et al. 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.
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