Imagery Rescripting and Imaginal Exposure for Social Anxiety: Mechanisms and Outcomes in an Analog Sample

Study Overview
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Brief Summary
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This study will recruit 100 participants who self-report high symptoms of social anxiety (Social phobia inventory >30). Participants will be randomly assigned to receive either one analog intervention of Imagery Rescripting (IR) or Imaginal Exposure. We will test the efficacy and mechanisms behind each interventions.

Detailed Description
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After being informed about the study potential risks, all patients giving written informed consent will undergo screening to determine eligibility for study entry. They will be randomly assigned to two conditions (Imagery rescripting Vs. Imaginal exposure) at a 1:1 ratio. Participants will attend three  1 hour online ZOOM sessions (pre-assessment and measurement, intervention, and post assessment and measurement). Assessors will be blind to the treatment condition.

Official Title
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Imagery Based Interventions for the Treatment of Anxiety Related Disorders: Mechanisms and Optimizing Outcomes

Conditions
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Social Anxiety

Intervention / Treatment
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* Behavioral: Imaginal exposure one-session
* Behavioral: Imagery rescriptinf one-session


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: SPIN scores >= 30 - Exclusion Criteria: can't report a negative imagery related to a future social scenario. Attending active psychotherapy sessions. -

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Imaginal exposure<br>A behavioral intervention in imagery | Behavioral: Imaginal exposure one-session<br>* Participants in this arm will be asked to decide alongside with the intervention provider (a clinical PhD student or M.A student under the supervision of the principal investigator) to imagine a script based on a future distressing anxiety provoking scenarios multiple times while honing in on the most negative aspects.<br>|
| Experimental: Imagery rescripting<br>A different behavioral intervention in imagery | Behavioral: Imagery rescriptinf one-session<br>* Participants in this arm will be asked to decide alongside with the intervention provider (a clinical PhD student or M.A student under the supervision of the principal investigator) o imagine a script based on a future distressing anxiety provoking scenarios one time while honing in on the most negative aspects. Afterwards they will insert changes into the script that try to help them cope in the imagery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline in the Social phobia inventory (SPIN) at the follow-up session | The SPIN is a validated self-report instrument assessing average social phobia symptom intensity over the past week. possible scores range from 0 (not at all) to 4 (Extremly). change = (follow-up score - Baseline Score) | Will be measured at Baseline (6,9, or 12 days before intervention), Post-intervention (immediately after the intervention) and Follow-up ( 7 days after the intervention) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in the Thought fusion inventory (TFI) at the follow-up session | The TFI is a validated 14 item self-reported instrument assessing average belief in statement that describe the effects of thoughts on reality, objects and actions. Possible scores range from 0 (Do not believe at all) to 100 (completely convinced it is true) in intervals of 10. change = Follow-up - Baseline Score. | Will be measured at Baseline (6,9, or 12 days before intervention), Post-intervention (immediately after the intervention) and Follow-up ( 7 days after the intervention) | 
| Change from Baseline in the White Bear Suppresion inventory (WBSI) at the follow-up session | The WBSI is a validated 15 item self-reported instrument assessing average tendency to suppress mental thoughts. Possible scores range from 0 (Do not agree) to 5 (very much agree). change = Follow-up - Baseline Score. | Will be measured at Baseline (6,9, or 12 days before intervention), Post-intervention (immediately after the intervention) and Follow-up ( 7 days after the intervention) | 
| Change from Baseline in the Positive and Negative Affect Scale (PANAS) international version short form (10 items from the negative subscale only) at the follow-up session | The PANAS International short form is a validated 10 item self-reported instrument assessing emotions after at a certain point in time. Possible scores range from 0 (Not at all) to 5 (Extremely). It will be assessed right after the participant describes the script. change = Follow-up - Baseline Score. | Will be measured at Baseline (6,9, or 12 days before intervention) and Follow-up ( 7 days after the intervention) | 
| Change from Baseline to follow-up in the amount of negative and positive/neutral content details the participant provides while describing the negative imagery. The imagery will be probed using the Waterloo Image and Memories Interview (WIMI). | The WIMI is a validated 10 item interview for assessing content of imagery. valence of the details will be scored using a trained coder. change = Follow-up - Baseline Score. | Will be measured at Baseline (6,9, or 12 days before intervention) and Follow-up ( 7 days after the intervention) | 
| Change from Baseline to follow-up in negativity of the core-beliefs that the participant link to the negative imagery provided in the WIMI. | The WIMI is a validated 10 item interview for assessing content of imagery and core-beliefs. Core beliefs are related to the participant perception of himself, others and the world. valence of the beliefs will be scored using a trained coder. change = Follow-up - Baseline Score. | Will be measured at Baseline (6,9, or 12 days before intervention) and Follow-up ( 7 days after the intervention) | 
| imaginal Behavioral Approach Test (iBAT) that measures the participant's willingness to interact with pre-scripted distressing scenarios in imagination | The iBAT is currently being developed in our lab. The more levels the participants passes (listen to imaginal scenario in full without pressing skip) the higher the score (from 0 to 10) Recruitment is under way and pre-registration is available at the open science frame work website: https://osf.io/bp42h/?view_only=5211617cedf94f71a4daa746e98d924a | Will be measured at Baseline (6,9, or 12 days before intervention) and Follow-up ( 7 days after the intervention) | 
| Sentence Completion Task (SCT). Measures participants automatic interpretation bias while being presented with 10 ambiguous social scenarios. | The SCT has been found to correlate with social anxiety symptoms and differentiate between clinical and non clinical population. participants enters words that complete scenario described in a sentence. Participant's answers are coded to negative, positive and neutral valence. Then, the participant ratio negative bias is calculated from 0 (complete positive bias) to 1 (complete negative bias) | Will be measured at Baseline (6,9, or 12 days before intervention) and Follow-up ( 7 days after the intervention) | 
| The Patient's Experience of Attunement and Responsiveness Scale (PEAR) measures participants' feelings of acceptance by the intervention and interview providers | the PEAR is a well validated self-report instrument. It has 20 items total. Each item is scored from 0 (not at all) to 3 (very much) | Will be measured at Baseline (6,9, or 12 days before intervention), Post-intervention (immediately after the intervention) and Follow-up ( 7 days after the intervention) | 
| The Brief core schema scale (BCSS) measures participants' self beliefs about themselves and others. | the BCSS is a well validated self-report instrument. It has 24 items total. Each item is scored from 1 (believe it slightly) to 3 (believe it totally) | Will be measured at Baseline (6,9, or 12 days before intervention), Post-intervention (immediately after the intervention) and Follow-up ( 7 days after the intervention) | 
| Change across time in the Mini Social phobia inventory - revised (mini SPIN-R) from baseline to pre-treatment and from pre-treatment to follow-up. | The Mini SPIN-R is a validated self-report instrument assessing average social phobia symptom intensity over the past day. possible scores range from 0 (not at all) to 4 (Extremly). measured once at the end of each day. | Daily, from Baseline to follow-up (a total of 14, 17, or 20 days) | 
| Daily questionnaire about negative intrusive imagery in general and specific to the imagery provided in the interview. | Participants are asked alongside the MINI-SPIN-R (see above) whether they had negative imagery during that day (In general) or the specific image they provided (specific). If the report they did experience images they rate two items from the TFI and two items from WBSI adapted for daily measurment. One item about feelings of mastery on the image. 4 items from the BCSS (2 related to the self, one negative and one positive and 2 related to others, one negative and one positive belief). With regards to the specific image they also report on a 0-100 analog scale how vivid, intrusive, distressing that image was for them. | Daily, from Baseline to follow-up (a total of 14, 17, or 20 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Social anxiety symptoms