Clinical trial NCT06977087: The Efficacy of Prospective Mental Imagery in Enhancing Approach Motivation Among Socially Anxious Individuals
Official title: The Efficacy of Prospective Mental Imagery in Enhancing Approach Motivation Among Socially Anxious Individuals: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Social Anxiety
Social Phobia
Lead sponsor: Philipps University Marburg
Sponsor class: OTHER
First posted: 2025-05-18
Enrollment: 58
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The efficacy of an online intervention aimed at enhancing approach motivation and behavioral engagement in confronting anxiety-inducing social situations is examined among individuals with elevated social anxiety. Participants will receive psychoeducation, followed by either a prospective mental-imagery task or a verbal reasoning task. Efficacy of the intervention is measured by ratings of experienced and anticipated pleasure, approach motivation and self-reported engagement with feared situations one week later.

Detailed description: With numerous studies demonstrating its long-term effectiveness, exposure therapy is currently considered the leading evidence-based treatment for anxiety disorders. However, a major limitation in its application is that patients often discontinue treatment due to their unwillingness to confront themselves with the feared situation. Considering that targeting avoidance behaviors and maladaptive fear responses are at the core of exposure therapy, strategies are needed to enhance both approach motivation as well as behavioral engagement with the feared situation. Among individuals with depression, prospective mental imagery has been demonstrated to increase motivation and behavioral engagement in pleasurable activities by elevating anticipated reward as well as anticipatory and anticipated pleasure ('motivational amplifier' hypothesis). Given alterations in motivational and reward processes in individuals with social anxiety, prospective mental imagery may enhance reward anticipation and facilitate approach motivation and engagement in exposure to socially feared situations. The current online study will compare the use of a prospective mental-imagery task to an active control group (verbal reasoning) in improving approach motivation and behavioral engagement with feared situations in individuals with heightened social anxiety. Participants in both conditions will receive psychoeducation. Participants in the experimental group will vividly imagine themselves successfully mastering the feared social situation. Participants in the control condition are asked to reflect on the pros and cons of confronting themselves with the feared social situation. Approach motivation as well as reward anticipation, anticipated and anticipatory pleasure will be assessed before and after the imagery or verbal reasoning task. Engagement with the feared social situation will be assessed one week later. Aim of the randomized controlled trial is to investigate whether prospective mental imagery is effective in enhancing self-reported motivation and engagement with feared situations compared to an active control group. In an exploratory analysis, we will examine whether the efficacy of the prospective imagery training is modulated by individuals' levels of reward sensitivity and anhedonia.

Eligibility criteria: Inclusion Criteria:

* Elevated score on Mini-Social Phobia Inventory (Mini-SPIN) \> 6
* Moderate fear and avoidance of two specified social situations (i.e., giving a stranger a compliment and asking for a restaurant recommendation), each rated above 5 on a Likert scale ranging from 0 (not at all) to 10 (extremely), respectively
* Avoidance of the two specified social situations (i.e., giving a stranger a compliment and asking for a restaurant recommendation), indicated by not having engaged in either behaviors in the past 7 days

Primary outcomes:
measure: Anticipatory Pleasure
timeFrame: Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task)
measure: Anticipated Pleasure
timeFrame: Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task)
measure: Reward Anticipation
timeFrame: Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task)
measure: Motivation
timeFrame: Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task)
measure: Frequency of Exposure
timeFrame: Post-treatment (i.e., 7 days after baseline)
Secondary outcomes:
measure: Social Phobia Inventory (SPIN)
timeFrame: Change from baseline to post-treatment (i.e., 7 days)
measure: Mood State Questionnaire
timeFrame: Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task)
measure: Liebowitz Social Anxiety Scale (LSAS)
timeFrame: Change from baseline to post-treatment (i.e., 7 days)
measure: Patient Health Questionnaire-9 (PHQ-9)
timeFrame: Baseline
measure: Positive and Negative Affect Schedule (PANAS)
timeFrame: Baseline
measure: Snaith-Hamilton-Pleasure-Scale (SHAPS)
timeFrame: Baseline
measure: Positive Valence System Scale (PVSS-21)
timeFrame: Baseline
measure: Vividness of Mental Imagination
timeFrame: Immediately after assigned interventions (prospective mental imagery and verbal reasoning task) at baseline
measure: Verbal Reasoning
timeFrame: Immediately after assigned interventions (prospective mental imagery and verbal reasoning task) at baseline
Other outcomes:
Locations:
city: Marburg
country: Germany
facility: Germany Philipps University
Study officials:
References:
citation: Hallford DJ, Farrell H, Lynch E. Increasing anticipated and anticipatory pleasure through episodic thinking. Emotion. 2022 Jun;22(4):690-700. doi: 10.1037/emo0000765. Epub 2020 Jun 18.
citation: Renner F, Werthmann J, Paetsch A, Bar HE, Heise M, Bruijniks SJE. Prospective Mental Imagery in Depression: Impact on Reward Processing and Reward-Motivated Behaviour. Clin Psychol Eur. 2021 Jun 18;3(2):e3013. doi: 10.32872/cpe.3013. eCollection 2021 Jun.
citation: Renner F, Murphy FC, Ji JL, Manly T, Holmes EA. Mental imagery as a "motivational amplifier" to promote activities. Behav Res Ther. 2019 Mar;114:51-59. doi: 10.1016/j.brat.2019.02.002. Epub 2019 Feb 5.
citation: Ji JL, Geiles D, Saulsman LM. Mental imagery-based episodic simulation amplifies motivation and behavioural engagement in planned reward activities. Behav Res Ther. 2021 Oct;145:103947. doi: 10.1016/j.brat.2021.103947. Epub 2021 Aug 15.