Clinical trial NCT02160470: Enhancing Exposure Therapy for Snake and Spider Phobias
Official title: Enhancing Exposure Therapy for Snake and Spider Phobias With Fear Retrieval and Compound Extinction
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
PHASE2
Conditions: Specific Phobia
Lead sponsor: University of Texas at Austin
Sponsor class: OTHER
Collaborators: name: National Institute of Mental Health (NIMH)
First posted: 2014-06-10
Enrollment: 120
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Primary purpose: TREATMENT

Brief summary: This study tests whether exposure therapy for fear of snakes or spiders is enhanced by the addition of a brief fear retrieval trial prior to treatment, and the use of compound extinction during treatment. The goal of the study is to determine whether these behavioral techniques enhance the efficacy of exposure therapy, one of the most empirically supported treatments for anxiety disorders.

Detailed description: This study tests whether exposure therapy for fear of snakes or spiders is enhanced by the addition of a brief fear retrieval trial prior to treatment, and the use of compound extinction during treatment. The goal of the study is to determine whether these behavioral techniques enhance the efficacy of exposure therapy, one of the most empirically supported treatments for anxiety disorders. Individuals between the ages of 18-65 with elevated fear of spiders or fear of snakes are randomly assigned to one of four treatment conditions (1) standard exposure therapy, (2) exposure therapy with fear retrieval augmentation, (3) exposure therapy with compound extinction augmentation, and (4) exposure therapy with fear retrieval and compound extinction augmentations. All participants undergo an online prescreen and a face-to-face screening assessment to determine eligibility and baseline (pre-treatment) symptom severity. Participants additionally complete assessments directly after treatment (post-treatment), and approximately one week after treatment (follow-up). The pre-treatment assessment occurs 1-14 days prior to treatment, the post-treatment assessment occurs during the treatment visit as soon as the treatment procedure is complete, and the follow-up assessment occurs within a window of 6-14 days after the completion of treatment. Participants complete two behavioral approach tests (in the treatment context and in the generalization context) at pre-treatment, post-treatment, and follow-up. Participants complete a battery of self-report questionnaires at pre-treatment and follow-up.

Eligibility criteria: Inclusion Criteria:

1. Age 18 to 65.
2. Speaks English fluently.
3. A score of 70 or higher on the Fear of Snakes/Spiders Questionnaire.
4. Demonstrates avoidance during behavioral approach tests (defined as inability to put palm flat on the bottom of a tank containing a snake/spider, and inability to touch a snake/spider with a bare finger).

Exclusion Criteria:

1. Unstable dose of psychotropic medications during the 4 weeks prior to baseline assessment.
2. Currently receiving exposure-based treatment for snake/spider phobia.
3. Currently at risk for suicide.

Primary outcomes:
measure: Change in peak subjective fear (0 - 100), behavioral approach (0 - 4), and heart rate reactivity to a live snake/spider not used during treatment (generalization context) from pre-treatment to follow-up
timeFrame: pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
Secondary outcomes:
measure: Change in peak subjective fear (0 - 100), behavioral approach (0 - 4), and heart rate reactivity to a live snake/spider not used during treatment (generalization context) from pre-treatment to post-treatment.
timeFrame: pre-treatment (window of 1-14 days prior to treatment); post-treatment (directly after the treatment procedure is completed)
measure: Change in peak subjective fear (0 - 100), behavioral approach (1 - 8), and heart rate reactivity to a live snake/spider used during treatment (treatment context) from pre-treatment to follow-up
timeFrame: pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
measure: Change in peak subjective fear (0 - 100), behavioral approach (1 - 8), and heart rate reactivity to a live snake/spider used during treatment (treatment context) from pre-treatment to post-treatment
timeFrame: pre-treatment (window of 1-14 days prior to treatment); post-treatment (directly after the treatment procedure is completed)
measure: Change in Fear of Snakes/Spiders Questionnaire from pre-treatment to follow-up
timeFrame: pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
measure: Change in Snake/Spider Belief Questionnaire from pre-treatment to follow-up
timeFrame: pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
measure: Change in Agoraphobic Cognitions Questionnaire for Snake/Spider Phobia from pre-treatment to follow-up
timeFrame: pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
measure: Change in Self-Efficacy Questionnaire for Spider/Snake Phobia from pre-treatment to follow-up
timeFrame: pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
measure: Change in Armfield and Mattiske Disgust Questionnaire from pre-treatment to follow-up
timeFrame: pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
measure: Change in Lab for the Study of Anxiety Disorders Specific Phobia Diagnostic Questionnaire from pre-treatment to follow-up
timeFrame: pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
Other outcomes:
Locations:
city: Austin
country: United States
facility: University of Texas at Austin
state: Texas
Study officials:
affiliation: University of Texas at Austin
name: Michael J Telch, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Lancaster CL, Monfils MH, Telch MJ. Augmenting exposure therapy with pre-extinction fear memory reactivation and deepened extinction: A randomized controlled trial. Behav Res Ther. 2020 Dec;135:103730. doi: 10.1016/j.brat.2020.103730. Epub 2020 Sep 19.