Attention Disengagement Training for Social Phobia
Condition: Social Anxiety Disorder
MeSH terms: Anxiety 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 attention biases that may maintain anxiety.
    

Detailed description: 
      Generalized Social Phobia (GSP) is characterized by severe social anxiety that leads to
      functional impairment (Schneider, et al., 1992). The prevalence of GSP is 13.3% (lifetime,
      Kessler, et al., 1994), ranking third among all psychiatric disorders. Despite its high
      prevalence, over 30% of individuals with social anxiety who need treatment do not receive
      treatment for a variety of reasons (e.g., afraid of what others might think, Olfson, et al.,
      2000). Additionally, 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 treatment procedures for social phobia. This three-year
      proposal aims to test a computerized treatment for social anxiety in a double-blind,
      placebo-controlled study. Specifically, research suggests that individuals with social phobia
      direct their attention toward socially-relevant negative information. Therefore, the
      treatment will focus on changing this attention bias and thereby alleviate symptoms of social
      anxiety. We present the results of a pilot study (n=26) in treatment seeking socially phobic
      individuals demonstrating the effectiveness of the treatment. A larger study would allow us
      to test the treatment and perhaps modify its component to increase its efficacy. The
      preliminary results of the pilot are encouraging. In brief, our intervention was effective
      in: a) changing biased attention in socially anxious individuals, b) generalizing this change
      in disengagement of attention from threat to other measures of attention disengagement, c)
      reduce symptoms of social anxiety as assessed by an independent rater, d) maintain a high
      rate of compliance (0% drop out in the pilot study), and e) maintain its effects in follow-up
      assessment up to one year. This efficient and efficacious techniques for changing attention
      bias in social phobia can provide a cost-effective and easy to administer treatment that is
      grounded in basic cognitive science and may help reduce suffering in individuals with GSP. We
      will test two hypotheses in this proposal. 1) Individuals with GSP completing the Attention
      Disengagement Training (ADT) will show a larger reduction in their symptoms compared to the
      placebo group on an interviewer measure of social anxiety (Liebowitz Social Anxiety Scale,
      LSAS). 2) Individuals with GSP completing ADT will show a larger reduction in their
      self-report of social anxiety symptoms compared to the placebo group
    

Intervention name(s): Attention Disengagement Training (ADT); Placebo Condition
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Those assigned to ADT condition will receive a computer delivered attention retraining protocol designed to enhance attention disengagement from socially threatening stimuli. The ADT protocol includes eight 30-min sessions delivered over a 6-week period (i.e., bi-weekly sessions). During each session, participants will see 320 trials that consist of the various combinations of probe type (E or F) probe position (top or bottom), and emotion type (Neutral, Disgust, Anger). 256 trials will include one neutral face and one disgust face or one angry face: 2 (probe type) X 2 (probe position) X 16 (person) X 4 (repetitions). On trials where participants see one neutral face and one disgust or angry face (i.e., 80% of the trials), the probe will always follow the neutral face.; The placebo condition (PC) will be identical to the AMP condition except that during the presentation of the trials where a threat picture is present, the probe will appear with equal frequency in the position of threat and neutral pictures. Thus, neither threat nor neutral pictures have signal value with regard to the position of the probe.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Social Anxiety Disorder; Information Processing; Attention Bias