Optimizing Exposure Therapy Via Reward-focused Interventions in Individuals With Public Speaking Anxiety

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-01-08

Study Completion Date

2024-12-13

Brief Summary

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The present study aims to examine whether the efficacy of an exposure treatment in individuals with public speaking anxiety can be enhanced by implementing interventions that target reward processes. Optimized exposure enriched with reward-focused interventions will be compared to exposure in combination with interventions targeting cognitive flexibility. The efficacy of the exposure training will be assessed by behavioural and self-report measures of public-speaking anxiety at baseline (before intervention), intermediate-assessment (7-9 days after baseline assessment) and post-assessment (at least 7-9 days after intermediate-assessment). The investigators expect that exposure optimized by implementing reward-focused interventions is more effective in reducing public speaking anxiety compared to exposure in combination with interventions targeting cognitive flexibility.

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Detailed Description

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The present study aims to investigate the efficacy of an optimized exposure training enriched with reward-focused interventions compared to exposure in combination with interventions targeting cognitive flexibility in individuals with elevated public speaking anxiety. Cognitive behavioral therapy offers effective methods for the treatment of various anxiety disorders. However, a substantial number of patients does not benefit from such treatments or experience a return of fear following successful treatment. Emerging evidence underscores the critical involvement of reward processes in fear extinction. Incorporating reward processes in exposure treatments might help to maximize treatment outcomes. In the present study, the investigators will apply reward-focused strategies prior to and during exposure. Strategies are selected to target the core reward processes (i.e., reward anticipation, attainment and learning). Interventions involve finding the silver lining, taking ownership and imagining the positive. Finding the silver lining mainly targets reward attainment (liking) by attending to and appreciating positive aspects of past events. Taking ownership targets liking and reward learning by identifying the personal behavioral contribution to rewarding past experiences. The intervention imagining the positive targets the anticipation of reward (wanting) by training the prospective, positive imagination of future events. The investigators will use an active control group, in which a training of cognitive flexibility (CF; Barlow et al., 2018) will be performed. This training aims to promote cognitive flexibility in the context of public speaking situations. Participants will be trained to identify and modify non-adaptive thoughts (e.g. catastrophizing thoughts). All participants first receive psychoeducation (information on public speaking anxiety, maintenance of anxiety, rationale of exposure training), followed by either reward-focused interventions (Finding the Silver Lining, Taking Ownership, Imagining the Positive) or the CF intervention. Following this session, participants will be asked to practice these interventions between sessions. After one week, exposure in combination with either reward-focused or cognitive flexibility strategies will be performed. Symptom improvement will be assessed at the baseline assessment (i.e., before interventions), at the intermediate-assessment (i.e., before the exposure sessions) and at post assessment (i.e., one week after the exposure sessions). The aim of this randomized controlled trial in individuals with elevated public speaking anxiety is to investigate whether the exposure combined with reward-focused interventions is more effective in reducing public speaking anxiety compared to extinction training combined with cognitive flexibility training.

Conditions

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Public Speaking Fear

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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reward-focused intervention + exposure

Psychoeducation reward-focused interventions based on Positive Affect Treatment (Finding the silver lining, taking ownership, imagining the positive) Exposure \& reward-focused interventions before and after exposure trials

Group Type EXPERIMENTAL

exposure

Intervention Type BEHAVIORAL

All participants undergo an exposure training session lasting approximately 90 minutes, which includes three exposure trial where participants give a speech, each lasting 5 minutes.

Exposure exercises are enriched with interventions of the respective treatment group (either reward-focused or cognitive flexibility interventions).

Psychoeducation

Intervention Type BEHAVIORAL

All participants received information on anxiety, and the maintenance of anxiety as well as a rationale for the exposure session.

reward-focused intervention

Intervention Type BEHAVIORAL

Participants complete three interventions based on the Positive Affect Treatment:

* Finding the silver lining includes attending to and appreciating positive aspects of past events
* Taking ownership includes identifying the personal behavioral contribution to rewarding past experiences
* Imagining the positive includes training the prospective, positive imagination of future events

Participants are asked to practice these interventions at least three times a week (approx. 15 mins each) until the next training session.

Cognitive flexibility intervention + exposure

Psychoeducation Cognitive Flexibility based on Unified Protocol of emotional disorders Exposure \& cognitive flexibility interventions before and after exposure trials

Group Type ACTIVE_COMPARATOR

exposure

Intervention Type BEHAVIORAL

All participants undergo an exposure training session lasting approximately 90 minutes, which includes three exposure trial where participants give a speech, each lasting 5 minutes.

Exposure exercises are enriched with interventions of the respective treatment group (either reward-focused or cognitive flexibility interventions).

Psychoeducation

Intervention Type BEHAVIORAL

All participants received information on anxiety, and the maintenance of anxiety as well as a rationale for the exposure session.

cognitive flexibility intervention

Intervention Type BEHAVIORAL

This training aims to promote cognitive flexibility in the context of public speaking situations. The intervention is based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders.

Participants will be trained to identify and modify non-adaptive thoughts occurring in the context of public speaking situations.

Interventions

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exposure

All participants undergo an exposure training session lasting approximately 90 minutes, which includes three exposure trial where participants give a speech, each lasting 5 minutes.

Exposure exercises are enriched with interventions of the respective treatment group (either reward-focused or cognitive flexibility interventions).

Intervention Type BEHAVIORAL

Psychoeducation

All participants received information on anxiety, and the maintenance of anxiety as well as a rationale for the exposure session.

Intervention Type BEHAVIORAL

cognitive flexibility intervention

This training aims to promote cognitive flexibility in the context of public speaking situations. The intervention is based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders.

Participants will be trained to identify and modify non-adaptive thoughts occurring in the context of public speaking situations.

Intervention Type BEHAVIORAL

reward-focused intervention

Participants complete three interventions based on the Positive Affect Treatment:

* Finding the silver lining includes attending to and appreciating positive aspects of past events
* Taking ownership includes identifying the personal behavioral contribution to rewarding past experiences
* Imagining the positive includes training the prospective, positive imagination of future events

Participants are asked to practice these interventions at least three times a week (approx. 15 mins each) until the next training session.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Proficient in the German language.
* Elevated levels of anxiety and avoidance of public speaking situations as indicated by a score of \> 5 and \> 4, respectively, on a scale from 0 to 8 using the following items:

How anxious would you feel giving a formal speech before a live audience? How likely would you be to avoid taking a class that required taking an oral presentation?

Exclusion Criteria

* severe cardiovascular, respiratory or neurological diseases
* current psychotherapeutic/psychiatric treatment
* Intention to start psychotherapeutic/psychiatric treatment
* current suicidal ideations
* psychotic symptoms (lifetime)
* current psychopharmacological medication

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes