Attention Bias Modification Treatment (ABMT), Placebo Effect, Social Anxiety Disorder (SAD)
Conditions
Keywords
Social Anxiety; Placebo; Treatment; Attention Bias
Brief summary
This study examines whether a computerized attention-training intervention called attention bias modification (ABM) can reduce symptoms of social anxiety disorder (SAD) in adults, and whether symptom improvement is specifically related to changes in attentional processing or to nonspecific factors such as expectancy and placebo effects.
Detailed description
This study examines whether a computerized attention-training intervention called attention bias modification (ABM) can reduce symptoms of social anxiety disorder (SAD) in adults, and whether symptom improvement is specifically related to changes in attentional processing or to nonspecific factors such as expectancy and placebo effects. Social Anxiety Disorder is characterized by persistent fear of social situations and negative evaluation by others. Previous research suggests that individuals with SAD tend to direct their attention toward socially threatening information, such as angry facial expressions. ABM was developed to reduce these attentional biases by training individuals to shift attention away from threat-related stimuli. However, findings regarding the clinical efficacy of ABM have been mixed, and some studies suggest that symptom improvement may also result from placebo-related factors, including treatment expectancy and engagement with the intervention. In this randomized controlled trial, 90 adults diagnosed with Social Anxiety Disorder will be assigned to one of three study conditions: (1) active dot-probe ABM training, (2) placebo computerized training, or (3) a wait-list control group. Participants in the active and placebo training groups will complete eight computerized training sessions over four weeks. The study will assess changes in social anxiety symptoms before and after the intervention using clinical interviews, self-report questionnaires, and computerized attention tasks. In addition, the study will examine attention bias and attention bias variability (ABV), using both reaction-time-based and eye-tracking-based measures, to better understand changes in attentional processing over time. Treatment expectancy and perceived credibility of the intervention will also be evaluated. The hypothesis is that participants receiving active ABM training and placebo training will show greater reductions in social anxiety symptoms compared to the wait-list control group, and that participants in the active condition will show greater reduction in symptoms than the placebo condition. The study further hypothesizes that only the active ABM condition will produce significant changes in attention bias and attentional bias variability. Overall, the study aims to clarify the specific and nonspecific mechanisms underlying symptom improvement following Attention Bias Modification interventions for Social Anxiety Disorder.
Interventions
BEHAVIORALDot-Probe Attention Bias Modification (ABM)
Participants complete a computerized dot-probe attention training task designed to train attention away from threat-related stimuli. During each trial, angry and neutral facial expressions are presented simultaneously, followed by a probe that consistently appears in the location of the neutral face. Participants complete eight training sessions over four weeks.
BEHAVIORALPlacebo Training
Participants complete a computerized task matched to the active training condition in duration, structure, and task demands, but without exposure to emotional stimuli or attentional training contingencies. The task is designed to control for nonspecific factors such as expectancy and engagement. Participants complete eight sessions over four weeks.
Sponsors
Tel Aviv University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
Independent assessors will be clinical psychologists blind to study design or patient asignment. Participants and assessors will be instructed not to discuss treatment. The invesigator will have no direct contact with participants and will be blind to condition assignment.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18-65 years * Primary diagnosis of generalized Social Anxiety Disorder based on clinical evaluation, the MINI International Neuropsychiatric Interview (MINI), and a Liebowitz Social Anxiety Scale (LSAS) score greater than 50 * Normal or corrected-to-normal vision without color blindness * Sufficient Hebrew proficiency to complete clinical interviews, self-report questionnaires, and computerized cognitive tasks
Exclusion criteria
* Previous participation in attention bias modification training using a dot-probe task * Previous participation in eye-tracking-based attention training * Current diagnosis of Post-Traumatic Stress Disorder * Current or past diagnosis of psychotic disorder or bipolar disorder * Neurological disorder (e.g., epilepsy or traumatic brain injury) * Severe suicidal ideation * Current substance or alcohol use disorder * Concurrent pharmacological or psychosocial treatment, unless medication has been stable for at least 45 days * Pregnancy * Uncorrected visual impairment or use of multifocal glasses
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in social anxiety symptoms | a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks. | Change in social anxiety symptom severity from baseline to post-intervention as measured by the Liebowitz Social Anxiety Scale (LSAS). Min-Max values 0-80, higher scores mean worse outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in reaction-time-based attention bias measured in miliseconds | a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks. | Change in attention bias derived from reaction-time performance on the dot-probe task. |
| Change in reaction-time-based attention bias variability | a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks. | Change in attention bias variability derived from reaction-time performance on the dot-probe task. |
| Change in eye-tracking-based attention bias | a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks. | Change in attention bias measured using eye-tracking during a free-viewing task with threat-related and neutral facial stimuli. |
| Change in eye-tracking-based attention bias variability | a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks. | Change in attention bias variability measured using eye-tracking during a free-viewing task with threat-related and neutral facial stimuli. |
| Treatment Expectancy and Credibility | Baseline one-week before treatment begins | Participant-rated treatment expectancy and perceived credibility assessed using the Credibility/Expectancy Questionnaire (CEQ). 0-9 scale and 0% - 100%. Higher scores indicate greater treatment credibility and greater expectation of improvement. |
| Change in depressive symptoms | a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks. | Change in depressive symptom severity measured using the Patient Health Questionnaire-9 (PHQ-9). Scale range 0-20, higher scores mean worse outcome. |
| Change in Generalized Anxiety Symptoms | a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks. | Change in generalized anxiety symptoms measured using the Generalized Anxiety Disorder-7 scale (GAD-7). Scores range 0-21, higher scores mean worse outcome. |
| Self report change in social anxiety symptoms | a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks. | Change insocial anxiety symptom severity measured using the Social Phobia Inventory (SPIN). Scores range 0-68, higher scores mean worse outcome. |
Countries
Israel
Contacts
CONTACTYair Bar-Haim, PhD
CONTACTLital Kohn, MA
PRINCIPAL_INVESTIGATORYair Bar-Haim, PhD
Tel Aviv University
Outcome results
None listed