Augmentation Study of A Computerized Treatment for Social Anxiety Disorder
Condition: Social Anxiety Disorder
MeSH terms: Anxiety Disorders; Phobia, Social
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether briefly reactivating a fear memory 10
      minutes prior to administering a social anxiety treatment will enhance the durability of
      treatment effects.
    

Detailed description: 
      This study examines whether cognitive bias modification of interpretation (CBM-I) for
      socially anxious individuals can be augmented with the inclusion of a fear memory
      reactivation prior to administration of CBM. To date, CBM-I generally involves presenting
      participants with short vignettes that have ambiguous meaning. The ambiguity is resolved by
      having the subject complete a word stem at the conclusion of the paragraph, resolving the
      ambiguity in a positive/negative/neutral fashion. CBM attempts to retrain the tendency for
      socially phobic individuals to adopt negative interpretations of ambiguous events by
      repeatedly presenting trials resolving in a positive fashion. An inert control can be
      administered by having the majority of CBM trials resolve in a neutral fashion, without
      having the vignette end in either a positive or negative fashion.

      Reactivating a fear memory, followed by a short break, purportedly opens a window of several
      hours during which the fear memory is rendered labile, and so CBM given during this time
      should show greater durability of effects. However, manipulations given outside of this
      timeframe will presumably have no increased effects. Individuals exhibiting clinical levels
      of social anxiety, as measured with the 5th edition of the Diagnostic and Statistical Manual
      of Mental Disorders (DSM-5) criteria, will be randomly assigned to one of three conditions:
      (1) fear reactivation administered 10 minutes prior to CBM, (2) fear reactivation
      administered 12-36 hours prior to CBM, and (3) fear reactivation administered 12-36 hours
      prior to an inert form of CBM. A variety of measures measuring anxiety, interpretation bias,
      and cognitions will be repeatedly assessed across the study, including at pretreatment, post
      treatment, and at one and two week follow up. Additionally, several potential moderators of
      treatment outcome will be assessed prior to engaging in treatment. At two week follow up,
      participants will also be given a speech stressor task to determine its effect on subsequent
      interpretation bias.
    

Intervention name(s): CBM With Active Fear Reactivation; CBM With Inert Fear Reactivation; Inert CBM With Inert Fear Reactivation
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Participants will undergo a fear reactivation trial, which involves giving a one-minute impromptu speech after only 30 seconds of preparation time. 10 minutes afterwards, they will be given CBM for interpretation bias. Training will involve 84 social scenario vignettes, with 70 resolving positively, 7 resolving negatively, and 7 resolving neutrally. This training takes places during the "memory reconsolidation window" that opens after fear reactivation, during which time the fear memory is in a labile state and thus more amenable to rewriting.; Participants will undergo a fear reactivation trial, which involves giving a one-minute impromptu speech after only 30 seconds of preparation time. 12 to 36 hours afterwards, they will be given CBM for interpretation bias. Training will involve 84 social scenario vignettes, with 70 resolving positively, 7 resolving negatively, and 7 resolving neutrally. Because this training takes places well outside of the "memory reconsolidation window" that opens shortly after fear reactivation, the reactivation is not expected to have any effect, and only serves as a control.; Participants will undergo a fear reactivation trial, which involves giving a one-minute impromptu speech after only 30 seconds of preparation time. 12 to 36 hours afterwards, they will be given an inert form of CBM, which should not influence the direction of interpretation bias. Training will involve 84 social scenario vignettes, with 70 resolving neutrally, 7 resolving positively, and 7 resolving negatively. Because the CBM training takes places well outside of the "memory reconsolidation window" that opens after fear reactivation, the reactivation is not expected to have any effect, and the inert CBM training is not expected to have any effect either. This condition only serves as a control for the other two conditions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Social Anxiety Disorder; Social Phobia; Reconsolidation; Cognitive Bias Modification; Interpretation Bias