Exposure Therapy for Social Anxiety Disorder
(METER Trial)
Recruiting in Palo Alto (17 mi)
Overseen byTomislav D Zbozinek, PhD
Age: 18 - 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of California, Los Angeles
Disqualifiers: Bipolar, Psychosis, Substance use, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The investigators are conducting a clinical trial of therapy for public speaking anxiety. There are many eligibility criteria, but the main ones are that participants need to be socially anxious and have public speaking anxiety. In this clinical trial, all participants will do exposure therapy. Before doing exposure therapy in the study, though, participants will be randomized to do one of two treatments: i) a positive mood treatment, which is designed to increase how positive people feel, and ii) a relaxation treatment, which is designed to help people feel more relaxed. The investigators are doing this study to see whether doing the positive mood treatment or relaxation treatment first will affect how well exposure therapy works.
Will I have to stop taking my current medications?
The trial requires participants to either be medication-free or stabilized on their current psychotropic medications for a certain period (1 month for benzodiazepines and beta blockers, 3 months for SRIs/SNRIs and heterocyclics) before joining.
What data supports the effectiveness of the treatment Exposure Therapy for Social Anxiety Disorder?
Research shows that exposure therapy, often used as part of cognitive-behavioral therapy (CBT), is effective in treating social anxiety disorder. Studies indicate that combining exposure therapy with cognitive therapy can lead to significant improvements in managing social anxiety.
12345Is exposure therapy safe for treating social anxiety disorder?
Exposure therapy is generally considered safe for treating conditions like PTSD and social anxiety disorder when conducted by experienced therapists, as it involves confronting fears in a controlled and supportive environment.
46789How does Exposure Therapy for Social Anxiety Disorder differ from other treatments?
Exposure Therapy for Social Anxiety Disorder is unique because it directly involves facing social situations that cause anxiety, helping individuals gradually become less sensitive to these triggers. This approach is often combined with Positive Affect Treatment - Behavioral (PAT-B) and Relaxation Treatment, which aim to enhance positive emotions and reduce stress, offering a comprehensive strategy that differs from traditional cognitive-behavioral therapy (CBT) by focusing more on emotional and relaxation components.
1261011Eligibility Criteria
This trial is for individuals who experience social anxiety, particularly with public speaking. Participants must be anxious in social situations and should not have other psychological conditions that could interfere with the treatment.Inclusion Criteria
Elevated fear of public speaking, defined as a score of >= 66 on the Public Speaking Anxiety Scale (PSAS)
Fluent in English
To conduct MRI version of fear conditioning task, must have no MRI contraindications
+5 more
Exclusion Criteria
Substance use disorder within the last 6 months
Pregnant or planning to become pregnant for next 6 months
Lifetime history of suicide attempts
+3 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Initial Treatment
Participants are randomized to either Positive Affect Treatment - Behavioral (PAT-B) or Relaxation Treatment to address reward processing and anhedonia or to promote relaxation.
6 weeks
Sessions 1-8 (in-person)
Exposure Therapy
Participants undergo exposure therapy to reduce public speaking anxiety.
4 weeks
Sessions 1-8 (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment.
12 weeks
1 visit (in-person)
Participant Groups
The study tests if a positive mood treatment (PAT-B) or relaxation therapy affects the success of subsequent exposure therapy for social anxiety disorder related to public speaking.
2Treatment groups
Experimental Treatment
Active Control
Group I: Positive Affect Treatment - Behavioral (PAT-B)Experimental Treatment2 Interventions
Focused on improving reward processing and anhedonia using PAT-B. Expected to reduce negative affect and increase positive affect. Then, exposure therapy to reduce public speaking anxiety.
Group II: Relaxation TreatmentActive Control2 Interventions
Focused on relaxation and mindfulness using Relaxation Treatment. Expected to reduce negative affect. Then, exposure therapy to reduce public speaking anxiety.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of California, Los AngelesLos Angeles, CA
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Who Is Running the Clinical Trial?
University of California, Los AngelesLead Sponsor
National Institute of Mental Health (NIMH)Collaborator
References
New Developments in Cognitive-Behavioral Therapy for Social Anxiety Disorder. [2018]Social anxiety disorder (SAD) is a highly prevalent and chronic disorder that causes considerable psychosocial impairment. This article reviews recent changes in the definition of SAD in DSM-5 and summarizes the current evidence for effective cognitive-behavioral treatments in adults, children, and adolescents. Current data suggests that cognitive-behavioral therapy (CBT) is efficacious in the treatment of this condition. Among different CBT approaches, individual cognitive therapy may be associated with the largest effect sizes. In this review, interventions targeting dysfunctional cognitive processes that contribute to the effective treatment of SAD are discussed. Some recent findings from neuroimaging research and studies on the augmentation of CBT using neuroenhancers indicate that changes in emotion regulation as well as fear extinction are important psychological mediators of positive outcome. Furthermore, internet-delivered CBT is a promising field of technological innovation that may improve access to effective treatments. Despite the availability of effective treatments, treatment-resistant SAD remains a common problem in clinical practice that requires more research efforts. Finally, potential areas for further development of CBT as well as its dissemination in health care are summarized.
Non-drug treatment for social phobia. [2019]When controlled studies on currently available non-drug treatments for social phobia were reviewed, short-term effectiveness was evident for social skills training, exposure therapy and cognitive therapy. The combination of exposure and cognitive therapy may have some superiority over the separate treatments. Group therapy and individual therapy did not differ clearly in outcome, while attempts to match treatment and patient characteristics have so far failed to produce consistently better results. With follow-up periods of either less than a year or more than a year, the therapies reviewed appeared to lead to stable results, although the available data allowed no firm conclusions because of attrition and additional treatments during the follow-up period. Except for the recent landmark study by Heimberg and Liebowitz, cognitive behavior therapy has not been adequately compared to medication. Studies are needed to assess the value of cognitive behavior therapy in combination with medication and to explore the possibilities of self-help manuals in such combination studies.
Cognitive-behavioral therapy for social anxiety disorder: model, methods, and outcome. [2018]Cognitive-behavioral therapy for social anxiety disorder has typically emphasized cognitive-restructuring and exposure interventions, delivered alone or in combination, in either individual or group formats. Treatment programs emphasizing these interventions are associated with both acute improvements and longer term maintenance of treatment gains. In this article, the nature and application of these interventions are reviewed in relation to a cognitive-behavioral model of the development and maintenance of social anxiety disorder. Strategies for change and outcome findings are discussed, with attention to both individual studies and meta-analytic reviews of the literature. Strategies for improving outcomes and future directions for research are also discussed.
New developments in cognitive-behavioral therapy for social phobia. [2018]Significant advances in cognitive-behavioral therapy for social phobia have occurred during the past 5 years. A new psychobiological model of social anxiety is described, and recent controlled clinical trials are reviewed. An effective cognitive-behavioral approach to therapy for social phobia developed in the authors' setting is described with case studies. Finally, future directions in cognitive-behavioral approaches to therapy for social anxiety, including clinical trials of interactive approaches that combine drug therapy with behavioral therapy and of intensive treatment of patients with avoidant personality disorder, are described briefly.
[Cognitive-behavioral therapy for treatment of social anxiety disorder]. [2018]There is good evidence for the effectiveness of exposure-based cognitive-behavioral therapy (CBT) in the treatment of social anxiety disorder (SAD). In this article, the Clark's cognitive model of SAD is presented, followed by the description of general CBT strategies, such as the shift from internal to external attention and the correction of anticipatory/postevent processing. Typical schemata in SAD and comorbid avoidant personality disorder are then illustrated, along with schema-focused approaches. Finally, a four-step CBT for SAD is suggested.
Manualized Cognitive-Behavioral Treatment of Social Anxiety Disorder: A Case Study. [2021]Social anxiety disorder (SAD), also known as social phobia, is one of the most common anxiety disorders and has been shown to be effectively treated using cognitive-behavioral therapy (CBT). Recently, a manualized CBT treatment for SAD has been developed (Hope, Heimberg, & Turk, 2006), with research demonstrating superior treatment outcomes with CBT relative to alternatives (e.g., psychotropic medication). The current case study of Henry, a 26-year old Caucasian male with SAD, implemented this manualized CBT for SAD. Treatment consisted of 15 individual sessions, with follow-ups occurring 2 and 8 months post-treatment. Henry showed marked reductions in SAD symptoms throughout the course of treatment, resulting in complete remission of SAD at the end of formal treatment. His SAD continued to be in remission at the 2-and 8-month follow-up sessions. This case study demonstrates the usefulness of a manualized, individual CBT treatment for SAD.
The Scarier the Better: Maximizing Exposure Therapy Outcomes for Spider Fear. [2019]While exposure therapy effectively reduces anxiety associated with specific phobias, not all individuals respond to treatment and some will experience a return of fear after treatment ceases.
Exposure therapy for posttraumatic stress disorder. [2018]Exposure therapy is a well-established treatment for Posttraumatic Stress Disorder (PTSD) that requires the patient to focus on and describe the details of a traumatic experience. Exposure methods include confrontation with frightening, yet realistically safe, stimuli that continues until anxiety is reduced. A review of the literature on exposure therapy indicates strong support from well-controlled studies applied across trauma populations. However, there are many misconceptions about exposure therapy that may interfere with its widespread use. These myths and clinical guidelines are addressed. It is concluded that exposure therapy is a safe and effective treatment for PTSD when applied as directed by experienced therapists.
Does reducing safety behaviours improve treatment response in patients with social phobia? [2018]This study assessed the efficacy of instructions to drop 'safety behaviours' during exposure tasks in a cognitive-behaviour therapy (CBT) group treatment program for social phobia.
Brief Cognitive Behavioral Group Therapy and Verbal-Exposure-Augmented Cognitive Behavioral Therapy for Social Anxiety Disorder in University Students: A Randomized Controlled Feasibility Trial. [2022]Considering the need for developing and examining evidenced-based programs using a brief group format for management of social anxiety disorder (SAD) at the community level, we studied the efficacy of two brief versions of cognitive-behavioral therapy (CBT) programs, brief cognitive-behavioral group therapy (bCBGT), and verbal exposure augmented cognitive behavioral therapy (VE-CBT), on social anxiety among university students.
Social phobia. Longitudinal course and long-term outcome of cognitive-behavioral treatment. [2018]Interest in social phobia has increased dramatically in the past decade, and our knowledge of this previously understudied disorder has increased as well. We now know that social phobia is a chronic condition and that patients with this disorder are unlikely to experience significant improvement without intervention. It is also a highly prevalent condition affecting as many as 13% of the adult population of the Unites States. Although our understanding of the causes of social phobia remains limited, we do know that it is associated with serious impairment and disability in multiple spheres. Thus, the development of treatments with proven long-term efficacy is an important research goal. In this article, we have reviewed studies that examined either exposure, cognitive restructuring, social skills training, or some combination of these treatments. Here, we summarize the major findings of this review. Exposure has fared well as a treatment for social phobia and, in every case, within-group analyses show that patients have improved after treatment. Methodologic problems in some studies, however, limit the conclusions that can be drawn about the comparative efficacy of exposure, social skills training, and relaxation therapy. Conceptual models of social phobia have stressed the importance of cognitive processes in the development and maintenance of social phobia and much attention has been directed at the long-term efficacy of cognitive-behavioral techniques. It has been hypothesized that exposure plus cognitive restructuring would be a particularly effective combination and several methodologically sound studies have examined this combination. These studies have demonstrated consistently clinically significant within-group changes and superiority to control conditions. Heimberg's CBGT is probably the most widely studied of these treatments. CBGT has been shown to be more effective than an equally credible attention-placebo group. Patients receiving CBGT have maintained their advantage over patients in the attention-placebo group, even 5 years after treatment although flaws in that follow-up study limit generalizability of its results. Generalized and nongeneralized social phobic patients respond equivalently to this highly integrated treatment, and it has been applied effectively by researchers outside the center where it was developed. Despite the successes of combined exposure and cognitive restructuring treatments, it remains unclear as to what the effective component(s) of these and similar treatments are and, therefore, whether or not the integration of therapy components is really necessary. A number of the studies reviewed addressed this question with mixed results. Three studies showed that the combination therapy was superior to either treatment alone. There is also evidence that patients treated with exposure only may show some deterioration during follow-up whereas patients treated with cognitive restructuring and exposure may continue to improve. Still, other studies found no differences in long-term outcome among exposure alone, RET, or the combined treatment. Hope et al found that exposure alone was as effective as an integrated treatment combining exposure and cognitive restructuring (CBGT), and Taylor and colleagues (submitted for publication, 1995) reported that exposure was not enhanced by initial treatment with cognitive restructuring. These results are disappointing in light of all that has been written about the likely benefits of combining cognitive and behavioral therapy in the treatment of social phobia. For example, it has been hypothesized that fear of negative evaluation is a key factor in social phobia and that change in this construct should be the goal of treatment. There is some research that supports this claim and other evidence that suggests that exposure alone is not particularly effective in producing those changes. Butler concluded that the treatment of social phobia is made more difficult whe