The effects of different variants of gaze-based feedback of attentional processes: Study protocol for a randomized-controlled trial
Creators: name: Schmidt, Teresa
name: Kroczek, Leon
name: Wechsler, Theresa Friederike
name: Mühlberger, Andreas
Publisher: name: Open Science Framework
Year: 2023
Subjects: subject: Psychology
subject: FOS: Psychology
subject: Social and Behavioral Sciences
subject: Clinical Psychology
subject: Cognition and Perception

description: The main characteristic of Social Anxiety Disorder (Social Phobia) is the intense and persistent fear, anxiety or avoidance of social situations with the possibility of being scrutinized by others or of embarrassment (DSM-5; Falkai, 2018). Social Phobia is one of the most common mental disorders in the German population, with a 12-month prevalence of 2.7 % - 7.4 % and is associated with significant impairments in daily and occupational life. Based on previous research, different factors (e.g., avoidance behavior, self-focus, cognitive avoidance) are postulated for the maintenance of Social Anxiety (e.g., Clark &amp; Wells, 1995; Hofmann, 2007; Rapee &amp; Heimberg, 1997). A prominent attentional bias that occurs in all cognitive models (Clark &amp; Wells, 1995; Heimberg et al., 2010; Hofmann, 2007; Rapee &amp; Heimberg, 1997) is enhanced self-focused attention. Psychotherapeutic treatment approaches from cognitive behavioral therapy already address this attentional focus bias and integrate modules to reduce self-attention in socially anxious individuals (e.g., Bögels &amp; Mansell, 2004; Donald et al., 2014; Fergus et al., 2014). Nonetheless, some patients do not experience sufficient symptom reduction or there’s a return of anxiety symptoms after the end of therapy (Arch &amp; Craske, 2009). Accordingly, there is still a need to optimize existing empirically validated interventions (Craske et al., 2008; Pittig et al., 2015). Wechsler, Pfaller, et al. (2021) developed the first attentional training in conjunction with virtual reality exposure, in which socially anxious individuals trained a change in their attentional focus away from the self to external neutral and social objects during a speech. Studies already exist (Craske et al., 2014; Knowles &amp; Olatunji, 2019) showing that the use of variability in exposure therapy (e.g., different stimuli, context) could lead to treatment optimization. Another promising approach that could contribute to optimization comes from the treatment of specific phobias in Virtual Reality (Wechsler, Brockelmann, et al., 2021; Wechsler et al., 2023). Here, a gamified approach utilizing attention based feedback captured via eye-tracking during a spider exposure performed in Virtual Reality has already been successfully tested (Wechsler, Brockelmann, et al., 2021; Wechsler et al., 2023). The aim of a broader project will be to optimize an attentional training in Virtual Reality for socially anxious individuals and to investigate the influence of a feedback of attentional processes as well as of an instruction for variable attentional focusing. In order to investigate the influence of feedback of attentional processes regarding experienced valence and attentional focus, this preregistered study will examine approach feedback. Concretely, the participant's attentional focus on the instructed social stimuli (here: virtual agents) will be feedbacked using visual social-internal (smile of the viewed agent), auditory non-social-external (positive feedback tone) as well as auditory social-external (verbal, positive feedback) feedback. Accordingly, the following question is examined: Which characteristics (auditory, visual, social, non-social, external, internal) of gaze-related feedback realized via eye-tracking lead to a positively experienced valence as well as to an increase in focused attention?