Les effets à long terme d'une approche interpersonnelle pour le traitement de la phobie sociale : un suivi de 8 à 15 ans
Social phobia has typically been described as a chronic problem.  To alter this clinical course, several treatment regimens have been devised.  Their efficacy has been shown in a number of studies.  However, are the reported gains maintained years following treatment? The present study sought to investigate this issue.   A literature review firstly allowed us to conduct a critical analysis of the evidence pertaining to the durability of the therapeutic effects of contemporary treatments. This review showed that studies including follow-ups exceeding one year are scarce. In the few found studies, the alleviation of anxiety has generally been the main parameter examined. In general, evidence regarding the long term maintenance of gains associated with other features, namely social functioning, and remission is scant.  To bridge this gap, the maintenance of therapeutic gains, 8 to 15 years following treatment guided by an interpersonal approach (IA) was assessed in the current study. This approach aims at the dissolution of self-protective patterns of behaviour by improving social participation and facilitating the development of more adaptive relational patterns. Fifty eight individuals who initially met criteria for social phobia took part in the study.  They reported significant gains up to one year following treatment. Thus, the evolution of social anxiety, general distress and social functioning from the 1-year follow-up to the 8-to-15-year follow-up were assessed. The statistical and clinical effects obtained over time, as well as the individual differences, were examined.  Results showed that the IA treatment regimen produced durable effects on the features examined, since the one-year follow-up.  Most remitted participants at the 1-year follow-up were still in remission about 10 years later. Those who reported clinically significant changes on social distress one year following treatment displayed a similar trajectory.  Furthermore, a significant increase in remission rates was observed. In consistency, a functional analysis revealed an improvement in patterns of social behaviour for the majority of participants, suggesting a dynamic change reflecting the transition from self-protection to social participation. Moreover, a hypothesis drawn from the interpersonal perspective of social phobia and its treatment was supported : A concordance between the changes found on the anxious and the interpersonal features was noted.  Taken together, these results lend support to the long term effectiveness of the IA approach.
Signification clinique Social phobia Treatment Long term follow-up Interpersonal approach to the treatment of social phobia Social functioning Remission Clinical significance