Interpretation Modification Program for Social Phobia
Condition: Social Anxiety Disorder; Social Phobia
MeSH terms: Anxiety Disorders; Phobic Disorders; Phobia, Social
Study type: Interventional

Summary: 
      Generalized Social Phobia is characterized by severe social anxiety that leads to functional
      impairment (Schneider et al., 1992). Despite its high prevalence, many individuals do not
      receive treatment or are unresponsive to current therapies. Thus there is a clear need to
      continue to develop highly effective and efficient treatments for social phobia. This three
      year project aims to test a computerized treatment for social phobia in a double-blind,
      placebo-controlled study designed to modify interpretation biases that may maintain anxiety.
    

Detailed description: 
      Social phobia is characterized by severe social anxiety leading to functional impairment
      (Schneider et al., 1992). Despite its high prevalence (13%, Kessler et al., 1994) over 30% of
      individuals with social anxiety who need treatment do not receive treatment (Olfson, et al.,
      2000) and 40% of individuals who present for treatment do not respond (39%, Heimberg, et al.,
      1998; 42%, Liebowitz et al., 2005). Thus, there is a clear need to develop highly effective
      and efficient treatments for GSP. Reducing negative interpretation of social events is an
      efficacious treatment for SP because:

        1. benign interpretations is associated with improvement in social anxiety after treatment
           (e.g., Franklin, Huppert, Langner, Leiberg, & Foa, 2005)

        2. negative interpretations are implicated in the pathogenesis of SP (e.g., Rapee &
           Heimberg, 1997)

        3. SPs have more negative interpretations of social events than non-anxious controls and
           individuals with other anxiety disorders (e.g., Amir et al, 1998)

        4. this bias ameliorates after successful treatment (e.g., Stopa & Clark, 2000).

      Therefore, changing negative interpretations is an efficacious treatment for SP, and current
      cognitive-behavioral therapies use cognitive restructuring (CR) to target negative
      interpretations and replace them with more benign interpretations (Heimberg, et al., 1998).
      The goal of the current proposal is to test a new computerized treatment for SP that is
      designed to change negative interpretations. We chose a computerized intervention to increase
      efficiency and ease of delivery. We chose to test this intervention in GSP because
      interpretation bias is especially relevant to this clinical population. The long-term goal of
      this project is to improve service delivery using a widely available and economical
      intervention for GSP. More specifically, we will test three hypotheses in this proposal:

        1. Individuals with GSP completing the Interpretation Modification Program (IMP) will show
           a reduction in their negative interpretation

        2. Participants in the IMP will show a decrease in their social anxiety symptoms

        3. Change in social anxiety symptoms will be mediated by the change in interpretation
           scores, suggesting that interpretation change reduced social anxiety symptoms.

      Pilot data (n=34) suggest that this intervention is efficacious. Thus, we aim to develop
      further and validate this highly efficient treatment for changing interpretations as a
      cost-effective treatment for patients with social phobia.
    

Intervention name(s): Interpretation Modification Program; Interpretation Control Condition
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The IMP protocol includes twelve 30-min sessions delivered over a 6-week period. Each session will comprise 220 trials. In each trial, participants will first see either a non-threat or a threat (e.g. "graceful" or "clumsy") word on the computer screen. They will then see an ambiguous sentence (e.g. "You dance at the party") and will be asked to indicate if the word and sentence were related by pressing a corresponding key. Participants will receive positive feedback (i.e., "You are correct!") when they endorse a non-threat interpretation or reject a threat interpretation of an ambiguous sentence. Participants will receive negative feedback (i.e., "You are incorrect.") when they endorse a threat interpretation or reject a non-threat interpretation of an ambiguous sentence.; Participants assigned to the PC completed an identical procedure to the IMP procedure except that feedback about participants' performance was not contingent on the type of interpretation (i.e., non-threat or threat) endorsed. Thus, participants in the PC received positive feedback 50% of the time when viewing a threat interpretation and 50% of the time when viewing a non-threat interpretation.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Social Anxiety; Information Processing; Interpretation