Title: The role of social anxiety on safety-learning: Bridging the gap from the lab to the clinic
Funder: Economic and Social Research Council

Abstract: Social anxiety disorder (SAD) is prevalent, chronic and can lead to significant disability in education, employment, and relationships. Exposure therapy for SAD involves direct and indirect encounters with feared social stimuli (e.g. giving a presentation). Whilst this therapy leads to clear improvements for individuals with SAD, many patients remain symptomatic or relapse after intervention. In my PhD research I simulated the process of exposure therapy and relapse using a lab-based extinction learning paradigm. With this fellowship, I aim to maximise the translational potential of my PhD research, and my future research, by engaging in research and training activities that will help me to bridge the gap between lab-based science and clinical practice. The primary aims are as follows: 1) To further develop my strong publication record by publishing three journal articles in highly regarded scientific journals: a systematic review, an experimental paper, and a theoretical piece. Editorial feedback on a systematic review carried out during my PhD highlighted that reframing the review would substantially improve its impact. Hence, I will rework and resubmit the review. I will also re-analyse and publish an experimental paper that did not make it into my PhD thesis. Further, I will focus on writing and publishing a theoretical piece that builds on and extends the discussion chapter of my thesis. 2) To extend my theoretical and practical understanding of anxiety disorders by carrying out a placement within a clinic. I will carry out a placement within the Anxiety and Depression in Young People (AnDY) clinic at the University of Reading. This will allow me to gain practical insights into how exposure is implemented within treatment for social anxiety disorder. I will gain hands-on experience interacting with patients and will extend my network to clinicians who may be able to utilise the findings of my research in their clinical work. 3) To disseminate research findings and significantly expand my network and international profile by leading the annual Reading Emotions symposium in 2022 on lab-to-clinic approaches. I will lead the organisation of the annual Reading Emotions symposium, which attracts presenters and audience members from around the world. Co-chairing and presenting at this meeting will greatly enhance my profile and will allow me to expand my network with academics from all career stages. 4) To conduct a number of patient and public involvement (PPI) groups to discuss my research findings and plans for future research. Engaging with patients and the public will help me to consider more broadly the potential impact of my research and help me to shape the research questions I will pursue in my future work. After conducting research that has been purely lab-based I am motivated to ensure that my future research is relevant for and reflects the priorities of individuals affected by social anxiety. 5) To develop a funding proposal on social anxiety and improving treatment outcome. I will utilise the knowledge and experience gained from writing the theoretical piece, my placement in the clinic and well as the PPI meetings to consolidate my future research plans and to begin to prepare grant applications for translational research that aims to improve the outcome of clinical treatments for social anxiety. 6) To enhance my career development and research skills. To ensure that I capitalise on the opportunity presented by the fellowship to further my academic career, I will complete formal training in several areas including working with the media, the use of social media to increase my profile and disseminate research outputs and using R statistical software. I will also continue to convene the Undergraduate Part 3 module "The developmental Psychopathology of Anxiety" to ensure that my teaching experience remains strong, which will support future applications for lecturer posts.

Lay abstract: In the UK, anxiety disorders affect over eight million people and cost the economy approximately £10 billion a year (McCrone et al., 2008). Social anxiety disorder (SAD) is the most common anxiety disorder, except for specific phobia (Ruscio et al., 2008), and is characterised by excessive fear and avoidance of social or performance situations. SAD typically develops during late childhood or adolescence and therefore has a significant impact on a large number of young people, as well as adults (Beesdo et al., 2007; Detweiler et al., 2014; Stein et al., 2017). Further, some level of social anxiety is experienced by most humans at some point in their lives, for example when attending a job interview or having to give a presentation. People who suffer from social anxiety symptoms report poorer life satisfaction, physical health, mental health and have more clinical complaints and disabilities compared to people with lower social anxiety symptoms, even if they do not qualify for a diagnosis (Fehm et al., 2008). Therefore, the number of people severely affected by social anxiety may in fact be higher than current estimates of the disorder indicate (Jefferies & Ungar, 2020). Cognitive Behavioural Therapy (CBT) is used for the treatment of SAD and includes exposure therapy as a main component. Exposure therapy for social anxiety includes face-to-face and imagined encounters with feared social situations, for example, starting a conversation or attending a social event, with the help of a Clinical Psychologist. Exposure to these social situations provide the patient with the opportunity to learn that the feared social situation will not always pose a threat. As the patient learns this information, they generate "safety" associations and social anxiety declines. However, treatment for SAD is often not successful. Many patients still experience symptoms or a return of fear after treatment. This suggests that there is room for improvement in the treatment of SAD. Laboratory-based research on safety learning, for example learning that something that was once threatening is now safe within an experimental task, can be carried out by researchers to further understanding of why fear may be maintained or return after exposure for people with social anxiety. Findings from this research can be used to inform Clinical Psychologists of potential methods of improving treatment for SAD. Therefore, there is a need to encourage collaboration between laboratory-based researchers and Clinical Psychologists to gather new ideas that might improve treatment outcome for SAD. This fellowship aims to maximise the potential of my laboratory-based research to bridge the gap between laboratory science and clinical practice. This project is important because it may help us to design ways to adapt exposure therapy for SAD that might lead to improved outcomes of treatment. The findings of my work are relevant for clinicians using exposure-based treatments for SAD, and this fellowship will provide the opportunity to gain clinical experience and foster connections with clinicians to maximise the societal impact of my work. Further, the fellowship will enable me to develop my track record academically through the publication of two substantial review papers and an experimental piece and engage with patients and the public to ensure that future research is informed by and reflects the priorities of people affected by social anxiety. Therefore, the fellowship will enable me to develop the track record, networks and experience required to enhance the translational impact of my research from the laboratory to clinical practice. In the long term, this work has the potential to improve the quality of life of people suffering with social anxiety and decrease the substantial societal costs associated with the disorder.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH