CClinicalTrials.gg
CompletedNCT03415022Updated Apr 4, 2022Results posted

Computer-Based Treatment for Social Anxiety Disorder

An interventional study of computer-based treatment in Social Anxiety Disorder, sponsored by New York State Psychiatric Institute. Completed at 1 site in United States. Open to participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2022-04-04.

Sponsored by New York State Psychiatric Institute · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
41
Allocation
Randomized
Ages
18 Years to 60 Years
Sex
All
01

Study summary

The present study is an open trial that seeks to examine the feasibility, acceptability, mechanism, and efficacy of a recently developed computer-based therapy in individuals with social anxiety disorder (SAD)

Read the detailed description

This randomized clinical trial examines the feasibility, acceptability, mechanism, and relative efficacy of two "doses" (standard 4-week/8 session vs. extended 8-week/12-session) of a recently developed computer-based therapy in individuals with social anxiety disorder (SAD). The purpose of this study is to assess whether a brief computer-based research treatment, provided in 30 minutes sessions, helps improve social anxiety symptoms, and by what mechanism. The study will also assess the effect of research treatments on brain activity using magnetic resonance imaging (MRI).

02

Conditions studied

  • Social Anxiety Disorder

Keywords

  • SAD
  • Social Anxiety
  • Social Phobia
03

Who can participate

Ages eligible
18 Years to 60 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Males and females between the ages of 18 and 60
  • Current primary diagnosis of SAD
  • Score of at least 50 on the Liebowitz Social Anxiety Scale (Self-rated version)
  • Fluent in English and willing and able to give informed written consent and participate responsibly in the protocol
  • Normal or corrected-to-normal vision

Exclusion criteria

Exclusion Criteria:

  • Present or past psychotic episode, psychotic disorder, schizophrenia, schizoaffective disorder, or bipolar disorder
  • Current severe depression
  • Suicidal ideation or behavior
  • Current diagnosis of posttraumatic stress disorder, obsessive-compulsive disorder, bipolar disorder, manic episode or tic disorder
  • Current or past organic mental disorder, seizure disorder, epilepsy or brain injury
  • Current unstable or untreated medical illness
  • Severe alcohol use disorder, severe cannabis use disorder, and any severity of other substance use disorder (except nicotine use disorders allowed)
  • Use of psychiatric medication in the past month other than a stable dose of selective serotonin reuptake inhibitors (SSRIs) for a least 3 months
  • Any concurrent cognitive behavioral therapy; other psychotherapy that was initiated in the past 3 months
  • Pregnancy, or plans to become pregnant during the period of the study - will be assessed by urine
  • Contraindication to MRI scanning:
  • Paramagnetic metallic implants or devices contraindicating magnetic resonance imaging or any other non-removable paramagnetic metal in the body (e.g. pacemaker, paramagnetic metallic prosthesis, surgical clips, shrapnel, necessity for constant medicinal patch, some tattoos)
  • Being unable to tolerate the scanning procedures (i.e., severe obesity, claustrophobia)
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
41 participants (actual)

Study arms

  • Experimental
    4-week computer-based treatment

    A 4-week (8-sessions) course of computer-based treatment. Participants will receive treatment twice a week for four weeks.

    Behavioral: computer-based treatment

  • Experimental
    8-week computer-based treatment

    An 8-week (12-sessions) course of computer-based treatment. Participants will receive treatment twice a week for four weeks, and then once a week for the subsequent four weeks.

    Behavioral: computer-based treatment

Interventions

  • Behavioralcomputer-based treatment

    30 minute sessions of free viewing of faces and listening to music

05

What researchers measure

Primary outcomes

  1. Change in Percent Dwell Time on Threat Faces

    Percent dwell time on threat faces was computed as the ratio of gaze dwell time on threat faces to total dwell time on all faces as measured by eye tracking during treatment sessions. Change in percent dwell time is the value at week 8 minus value at baseline.

    Time frame: baseline to week 8

  2. Change in Total Score of Liebowitz Social Anxiety Scale (LSAS)

    Clinician-rated scale scoring anxiety (0, none to 3, severe) and avoidance (0,none to 3, severe) in 24 social situations for a total score of 0 to 144. Higher scores indicate greater social anxiety.

    Time frame: Baseline to week 8

Secondary outcomes

  1. Change in Total Score of Social Phobia Inventory (SPIN)

    The Social Phobia Inventory (SPIN) is a self-rated questionnaire used to assess severity of social anxiety disorder. 17 items related to social anxiety each rated on a score of 0 to 4, with a minimum total score of 0 (least social anxiety), and a maximum total score of 68 (most social anxiety).

    Time frame: baseline to week 8

  2. Change in Total Score of Quality of Life Enjoyment & Satisfaction Questionnaire

    Quality of Life Enjoyment \& Satisfaction Questionnaire (Q-LES-Q): self-rated assessment of quality of life. 16 items related to life quality, each rated on a score of 1 (very poor) to 5 (very good), with a minimum total score of 16, and a maximum total score of 80.

    Time frame: baseline to week 8

  3. Change in Total Score of the Revised Social Anhedonia Scale

    40-item self-rated social anhedonia scale. Items are comprised of statements that participants agree or disagree with, by answering "yes"(1), or "no"(0), with some items reverse-coded. The minimum score is 0 (least social anhedonia); maximum score is 40 (most social anhedonia)

    Time frame: baseline to week 8

  4. Change in Total Score of the Snaith Hamilton Pleasure Scale

    Snaith Hamilton Pleasure Scale (SHAPS). Fourteen-item self-rated anhedonia scale. Items are comprised of statements that participants rate as "strongly disagree" (1), "disagree" (2), "agree" (3), or "strongly agree" (4). The lowest possible score was 14, the highest possible score was 56 (greatest anhedonia)

    Time frame: baseline to week 8

  5. Change in Total Score of the Hamilton Rating Scale for Depression - 17 Item Version

    Hamilton Rating Scale for Depression -17 item version. This standard scale will be used to assess severity of depression, minimum score is 0 (least depression); maximum score is 50 (greatest depression).

    Time frame: baseline to week 8

  6. Clinical Global Impression-Change Scale

    Clinical Global Impression-Change Scale: An observer rating of overall clinical change, with rating from 1 (very much improved) to 7 (very much worse). Responder category is defined by a score of 1 or 2.

    Time frame: week 8

06

Results

Posted Aug 11, 2020

Participant flow

Participant flow — Overall Study
Milestone4-week Computer-based Treatment8-week Computer-based Treatment
Started2120
Completed1615
Not completed55
Withdrew: Withdrawal by subject12
Withdrew: Covid-19 suspension23
Withdrew: Lost to follow-up20

Outcome measures

PrimaryChange in Percent Dwell Time on Threat Faces

Percent dwell time on threat faces was computed as the ratio of gaze dwell time on threat faces to total dwell time on all faces as measured by eye tracking during treatment sessions. Change in percent dwell time is the value at week 8 minus value at baseline.

Time frame:
baseline to week 8
Reported as:
Mean · percentage of dwell time on threat faces
Change in Percent Dwell Time on Threat Faces
percentage of dwell time on threat faces4-week Computer-based Treatment8-week Computer-based Treatment
Change in Percent Dwell Time on Threat Faces20.7 ± 20.627.1 ± 17.6
PrimaryChange in Total Score of Liebowitz Social Anxiety Scale (LSAS)

Clinician-rated scale scoring anxiety (0, none to 3, severe) and avoidance (0,none to 3, severe) in 24 social situations for a total score of 0 to 144. Higher scores indicate greater social anxiety.

Time frame:
Baseline to week 8
Reported as:
Mean · score on a scale
Change in Total Score of Liebowitz Social Anxiety Scale (LSAS)
score on a scale4-week Computer-based Treatment8-week Computer-based Treatment
Change in Total Score of Liebowitz Social Anxiety Scale (LSAS)23.68 ± 32.4422.38 ± 22.87
SecondaryChange in Total Score of Social Phobia Inventory (SPIN)

The Social Phobia Inventory (SPIN) is a self-rated questionnaire used to assess severity of social anxiety disorder. 17 items related to social anxiety each rated on a score of 0 to 4, with a minimum total score of 0 (least social anxiety), and a maximum total score of 68 (most social anxiety).

Time frame:
baseline to week 8
Reported as:
Mean · score on a scale
Change in Total Score of Social Phobia Inventory (SPIN)
score on a scale4-week Computer-based Treatment8-week Computer-based Treatment
Change in Total Score of Social Phobia Inventory (SPIN)17.7 ± 18.510.1 ± 13.5
SecondaryChange in Total Score of Quality of Life Enjoyment & Satisfaction Questionnaire

Quality of Life Enjoyment \& Satisfaction Questionnaire (Q-LES-Q): self-rated assessment of quality of life. 16 items related to life quality, each rated on a score of 1 (very poor) to 5 (very good), with a minimum total score of 16, and a maximum total score of 80.

Time frame:
baseline to week 8
Reported as:
Mean · score on a scale
Change in Total Score of Quality of Life Enjoyment & Satisfaction Questionnaire
score on a scale4-week Computer-based Treatment8-week Computer-based Treatment
Change in Total Score of Quality of Life Enjoyment & Satisfaction Questionnaire-8.8 ± 15.3-4.8 ± 12.4
SecondaryChange in Total Score of the Revised Social Anhedonia Scale

40-item self-rated social anhedonia scale. Items are comprised of statements that participants agree or disagree with, by answering "yes"(1), or "no"(0), with some items reverse-coded. The minimum score is 0 (least social anhedonia); maximum score is 40 (most social anhedonia)

Time frame:
baseline to week 8
Reported as:
Mean · units on a scale
Change in Total Score of the Revised Social Anhedonia Scale
units on a scale4-week Computer-based Treatment8-week Computer-based Treatment
Change in Total Score of the Revised Social Anhedonia Scale1.7 ± 5.61.8 ± 4.9
SecondaryChange in Total Score of the Snaith Hamilton Pleasure Scale

Snaith Hamilton Pleasure Scale (SHAPS). Fourteen-item self-rated anhedonia scale. Items are comprised of statements that participants rate as "strongly disagree" (1), "disagree" (2), "agree" (3), or "strongly agree" (4). The lowest possible score was 14, the highest possible score was 56 (greatest anhedonia)

Time frame:
baseline to week 8
Reported as:
Mean · units on a scale
Change in Total Score of the Snaith Hamilton Pleasure Scale
units on a scale4-week Computer-based Treatment8-week Computer-based Treatment
Change in Total Score of the Snaith Hamilton Pleasure Scale2.2 ± 6.2-1.0 ± 5.8
SecondaryChange in Total Score of the Hamilton Rating Scale for Depression - 17 Item Version

Hamilton Rating Scale for Depression -17 item version. This standard scale will be used to assess severity of depression, minimum score is 0 (least depression); maximum score is 50 (greatest depression).

Time frame:
baseline to week 8
Reported as:
Mean · units on a scale
Change in Total Score of the Hamilton Rating Scale for Depression - 17 Item Version
units on a scale4-week Computer-based Treatment8-week Computer-based Treatment
Change in Total Score of the Hamilton Rating Scale for Depression - 17 Item Version1.8 ± 4.41.8 ± 5.8
SecondaryClinical Global Impression-Change Scale

Clinical Global Impression-Change Scale: An observer rating of overall clinical change, with rating from 1 (very much improved) to 7 (very much worse). Responder category is defined by a score of 1 or 2.

Time frame:
week 8
Reported as:
Mean · units on a scale
Clinical Global Impression-Change Scale
units on a scale4-week Computer-based Treatment8-week Computer-based Treatment
Clinical Global Impression-Change Scale2.8 ± 1.22.7 ± 0.9

Adverse events

Collected over 20 weeks (8 weeks of active treatment phase and 3 month follow-up phase). Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
4-week Computer-based Treatment0/21 (0%)0/21 (0%)0/21 (0%)
8-week Computer-based Treatment0/20 (0%)0/20 (0%)0/20 (0%)

Baseline characteristics

Participants who started treatment sessions

Age, Categorical
Age, Categorical(Participants)4-week Computer-based Treatment8-week Computer-based TreatmentTotal
<=18 years000
Between 18 and 65 years212041
>=65 years000
Age, Continuous
Age, Continuous(years)4-week Computer-based Treatment8-week Computer-based TreatmentTotal
Mean27.7 ± 5.0829.15 ± 7.1328.61 ± 6.19
Sex: Female, Male
Sex: Female, Male(Participants)4-week Computer-based Treatment8-week Computer-based TreatmentTotal
Female121325
Male9716
Race (NIH/OMB)
Race (NIH/OMB)(Participants)4-week Computer-based Treatment8-week Computer-based TreatmentTotal
American Indian or Alaska Native011
Asian369
Native Hawaiian or Other Pacific Islander000
Black or African American358
White10616
More than one race527
Unknown or Not Reported000
Region of Enrollment
Region of Enrollment(participants)4-week Computer-based Treatment8-week Computer-based TreatmentTotal
United States212041
Liebowitz Social Anxiety Scale
Liebowitz Social Anxiety Scale(units on a scale)4-week Computer-based Treatment8-week Computer-based TreatmentTotal
Mean83.8 ± 16.8187.6 ± 11.3286.05 ± 14.28
07

Study locations

1 site
  • New York State Psychiatric Institute
    New York, New York 10032, United States
08

References and documents

Publications

  • Chevallier C, Tonge N, Safra L, Kahn D, Kohls G, Miller J, Schultz RT. Measuring Social Motivation Using Signal Detection and Reward Responsiveness. PLoS One. 2016 Dec 1;11(12):e0167024. doi: 10.1371/journal.pone.0167024. eCollection 2016. PubMed 27907025 ↗
  • Cisler JM, Koster EH. Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clin Psychol Rev. 2010 Mar;30(2):203-16. doi: 10.1016/j.cpr.2009.11.003. Epub 2009 Dec 14. PubMed 20005616 ↗
  • Gur RC, Schroeder L, Turner T, McGrath C, Chan RM, Turetsky BI, Alsop D, Maldjian J, Gur RE. Brain activation during facial emotion processing. Neuroimage. 2002 Jul;16(3 Pt 1):651-62. doi: 10.1006/nimg.2002.1097. PubMed 12169250 ↗
  • Heeren A, Mogoase C, Philippot P, McNally RJ. Attention bias modification for social anxiety: A systematic review and meta-analysis. Clin Psychol Rev. 2015 Aug;40:76-90. doi: 10.1016/j.cpr.2015.06.001. Epub 2015 Jun 6. PubMed 26080314 ↗
  • Klumpp H, Angstadt M, Phan KL. Shifting the focus of attention modulates amygdala and anterior cingulate cortex reactivity to emotional faces. Neurosci Lett. 2012 Apr 18;514(2):210-3. doi: 10.1016/j.neulet.2012.03.003. Epub 2012 Mar 8. PubMed 22425719 ↗
  • Klumpp H, Post D, Angstadt M, Fitzgerald DA, Phan KL. Anterior cingulate cortex and insula response during indirect and direct processing of emotional faces in generalized social anxiety disorder. Biol Mood Anxiety Disord. 2013 Apr 2;3:7. doi: 10.1186/2045-5380-3-7. eCollection 2013. PubMed 23547713 ↗
  • Lazarov A, Abend R, Bar-Haim Y. Social anxiety is related to increased dwell time on socially threatening faces. J Affect Disord. 2016 Mar 15;193:282-8. doi: 10.1016/j.jad.2016.01.007. Epub 2016 Jan 12. PubMed 26774515 ↗
  • Lazarov A, Pine DS, Bar-Haim Y. Gaze-Contingent Music Reward Therapy for Social Anxiety Disorder: A Randomized Controlled Trial. Am J Psychiatry. 2017 Jul 1;174(7):649-656. doi: 10.1176/appi.ajp.2016.16080894. Epub 2017 Jan 20. PubMed 28103714 ↗
  • Linetzky M, Pergamin-Hight L, Pine DS, Bar-Haim Y. Quantitative evaluation of the clinical efficacy of attention bias modification treatment for anxiety disorders. Depress Anxiety. 2015 Jun;32(6):383-91. doi: 10.1002/da.22344. Epub 2015 Feb 24. Erratum In: Depress Anxiety. 2018 Jan;35(1):111-112. doi: 10.1002/da.22690. PubMed 25708991 ↗
  • Mogoase C, David D, Koster EH. Clinical efficacy of attentional bias modification procedures: an updated meta-analysis. J Clin Psychol. 2014 Dec;70(12):1133-57. doi: 10.1002/jclp.22081. Epub 2014 Mar 20. PubMed 24652823 ↗
  • Morrison AS, Heimberg RG. Social anxiety and social anxiety disorder. Annu Rev Clin Psychol. 2013;9:249-74. doi: 10.1146/annurev-clinpsy-050212-185631. PubMed 23537485 ↗
  • Richey JA, Rittenberg A, Hughes L, Damiano CR, Sabatino A, Miller S, Hanna E, Bodfish JW, Dichter GS. Common and distinct neural features of social and non-social reward processing in autism and social anxiety disorder. Soc Cogn Affect Neurosci. 2014 Mar;9(3):367-77. doi: 10.1093/scan/nss146. Epub 2012 Dec 7. PubMed 23223206 ↗
  • Spreckelmeyer KN, Krach S, Kohls G, Rademacher L, Irmak A, Konrad K, Kircher T, Grunder G. Anticipation of monetary and social reward differently activates mesolimbic brain structures in men and women. Soc Cogn Affect Neurosci. 2009 Jun;4(2):158-65. doi: 10.1093/scan/nsn051. Epub 2009 Jan 27. PubMed 19174537 ↗
  • Van Bockstaele B, Verschuere B, Tibboel H, De Houwer J, Crombez G, Koster EH. A review of current evidence for the causal impact of attentional bias on fear and anxiety. Psychol Bull. 2014 May;140(3):682-721. doi: 10.1037/a0034834. Epub 2013 Nov 4. PubMed 24188418 ↗

Study documents

  • Protocol and statistical analysis plan · Jul 20, 2020

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Yes — Data will be shared through the National Database for Clinical Trials related to Mental Illness (NDCT). We will generate a Global Unique Identifier (GUID) for each participant. The key clinical rating scale measures (LSAS, SPIN, QLESQ, HRSD) are all included.

Supporting information: Analytic code

09

Registry details

Key details

Study ID
NCT03415022
Lead sponsor
New York State Psychiatric Institute
Responsible party
Franklin Schneier (Research Psychiatrist, New York State Psychiatric Institute) — Principal investigator
First posted
Jan 30, 2018
Start date
Jan 30, 2018
Primary completion
Mar 31, 2020
Completion
Mar 31, 2020
Results posted
Aug 11, 2020
Last update
Apr 4, 2022

Study contacts

Franklin Schneier, MD
principal investigator · New York State Psychiatric Institute

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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