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RecruitingNCT06564402APEXUpdated Jan 9, 2026

Augmentation of Exposure Using Positive Mental Rehearsal in Individuals With Increased Social Anxiety

An interventional study of Positive Mental Rehearsal and Mental Rehearsal in Social Anxiety and Social Phobia, sponsored by Philipps University Marburg. Recruiting at 1 site in Germany. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-01-09.

Sponsored by Philipps University Marburg · Not applicable, Interventional, and Treatment

From the registry’s dates

  • Primary completion was expected by Feb 2026, 9 months ago, but the record still lists the study as recruiting.
  • Started May 2024; still recruiting 2 years 5 months later.
Phase
Not applicable
Study type
Interventional
Enrollment
40
Allocation
Randomized
Ages
18 Years and older
Sex
All
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Study summary

Efficacy of an optimized exposure therapy training is investigated in individuals with heightened social anxiety. Participants will undergo a one-session standardized exposure training, followed by either standard or positive mental rehearsal of the exposure experience. The efficacy is measured by symptom improvement according to subjective ratings one week later.

Read the detailed description

Exposure therapy is widely recognized as the gold-standard treatment for anxiety disorders, but its clinically significant response rates remain around 50%. Thus, innovative approaches are needed to improve the efficacy of exposure therapy. One strategy is the mental rehearsal of exposure treatment as a way of supporting the retrieval and consolidation of the exposure memory, which has been demonstrated to be an effective supplement to exposure therapy in a recent study. New conceptualizations also emphasize the role of reward processing and its importance in extinction learning. Several strategies have been proposed to target these reward processes to improve the outcomes of exposure therapy. The present study will examine the use of a positive-focused rehearsal strategy. Participants in the optimized exposure group will engage in an imaginal recounting task focusing on the positive aspects (i.e. emotions, thoughts, behavior) of the exposure. Rehearsal of the positive aspects may increase positive affect, with positive mood thought to be associated with deeper mental rehearsal of stored information. Therefore, the efficacy of using positive mental rehearsal (i.e., imaginal recounting) post-exposure will be investigated, with the use of standard mental rehearsal as an active control group. Participants will be asked to repeat the rehearsal experience at home at two-day intervals. Post-treatment assessment will be conducted one week later. The study will be conducted on healthy participants with an elevated level of social anxiety. The aim of this randomized controlled trial in healthy individuals with increased social anxiety is to investigate whether optimized exposure training (exposure + positive mental rehearsal) is more effective in reducing fear of social interaction compared to an active control group (exposure + mental rehearsal).

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Conditions studied

  • Social Anxiety
  • Social Phobia

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03

In context

Phobia, Social

367 studies on the registry are indexed under Phobia, Social; 58 are open to participants now.

This study's planned enrollment of 40 is below the median of 76 across 338 interventional studies indexed under Phobia, Social.

Browse Phobia, Social studies →

Lead sponsor

Philipps University Marburg is the lead sponsor of 116 studies on the registry; 12 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Elevated score on Social Interactions Anxiety Scale (SIAS) > 26

Exclusion criteria

Exclusion Criteria:

  • Current psychotherapeutic/psychiatric treatment
  • Plans to start psychotherapeutic/psychiatric treatment in upcoming weeks
  • Current suicidal intent
  • Severe cardiovascular, respiratory or neurological diseases
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Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Participant)
Enrollment
40 participants (estimated)

Study arms

  • Experimental
    Exposure + Positive Mental Rehearsal

    Mental rehearsal of the positive aspects of exposure experience

    Behavioral: Positive Mental Rehearsal · Behavioral: Exposure

  • Active comparator
    Exposure + Mental rehearsal

    Mental rehearsal of the exposure experience

    Behavioral: Mental Rehearsal · Behavioral: Exposure

Interventions

  • BehavioralPositive Mental Rehearsal

    After exposure trial, participants are asked about the positive aspects of their exposure experience (e.g., thoughts, feelings), based on which an imagination script is formulated and recounted

  • BehavioralMental Rehearsal

    After exposure, participants are asked about what happened during the exposure experience and whether their central concerns/expected outcome actually occurred during exposure

  • BehavioralExposure

    All participants complete exposure exercises (i.e., talking on the phone and talking with a stranger) before positive mental rehearsal is executed

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What researchers measure

Primary outcomes

  1. Social Interaction Anxiety Scale (SIAS)

    20-item questionnaire on a 5-point Likert scale (0 = 'not at all'; 4 = 'very strongly') assessing severity of anxiety experienced in social interactions and situations. Total score range: 0 to 80. Higher scores indicate higher severity of social anxiety.

    Time frame: Change from baseline to post-treatment (i.e., 7-9 days)

  2. Liebowitz Social Anxiety Scale (LSAS)

    2-items from the Liebowitz Social Anxiety Scale (LSAS) on a 4-point Likert scale (fear: 0 = 'none'; 3 = 'high'; avoidance: 0 = 'never'; 3 = 'usually') assessing fear and avoidance of the in the intervention exposed situations. Higher scores indicating greater level of fear and avoidance.

    Time frame: Change from baseline to post-treatment (i.e., 7-9 days)

  3. Communication Anxiety Inventory (CAI) - Trait Version

    21-item questionnaire on a 4-point Likert scale (0 = 'almost never'; 3 = 'almost always') assessing an individual's general level of anxiety in communication situations. Total range score: 0 to 84. Higher scores indicate greater level of communication anxiety.

    Time frame: Change from baseline to post-treatment (i.e., 7-9 days)

Secondary outcomes

  1. Communication Anxiety Inventory (CAI) - State Version

    20-item questionnaire on a 4-point Likert scale (0 = 'not at all'; 3 = 'very strongly' assessing an individual's level of anxiety related to a specific communication situation.

    Time frame: Baseline

  2. Positive and Negative Affect Schedule (PANAS)

    20-item questionnaire on a 5-point Likert scale (0 = 'not at all'; 4 = 'extremely' assessing the presence and intensity of both positive and negative emotions. Total score range for positive affect (PA) and negative affect (NA), respectively: 0 to 50. Higher scores indicate on either scale indicate a higher level of that emotion.

    Time frame: Change from baseline to post-treatment (i.e., 7-9 days)

  3. Post-Event Processing Inventory (PEPI) - Trait Version

    12-item questionnaire on a 5-point Likert scale (0 = 'strongly disagree; 4 = 'strongly agree') assessing an individual's general tendency to engage in post-event processing. Total score range: 0 to 60. Higher total scores indicate a greater tendency to ruminate or engage in negative post-event processing.

    Time frame: Change from baseline to post-treatment (i.e., 7-9 days)

  4. Post-Event Processing Inventory (PEPI) - State Version

    12-item questionnaire on a 5-point Likert scale (0 = 'strongly disagree; 4 = 'strongly agree') assessing an individual's level of rumination or post-event processing related to a specific context/situation. Total score range: 0 to 60. Higher total scores indicate a greater engagement in rumination and post-event processing.

    Time frame: Post-treatment

  5. Plymouth Sensory Imagery Questionnaire (PSI-Q)

    21-item questionnaire across five modalities (visual, auditory, olfactory, gustatory, tactile, and kinesthetic imagery) on a 10-point Likert scale (0 = 'not at all'; 9 = 'mental image as clear and vivid as in real life') assessing how intensively and in detail people can imagine sensory experiences in their mind. Total score range: 0 to 210. Higher total scores indicate a more vivid and detailed sensory imagination.

    Time frame: Baseline

  6. Snaith-Hamilton-Pleasure-Scale (SHAPS)

    14-item questionnaire on a 4-point Likert scale (0 = 'strongly disagree'; 3 = 'strongly agree') measuring anhedonia. Scores are transformed to a dichotomous scale: 0 = absence of anhedonia; 1 = presence of anhedonia). Total score range: 0 to 14. Higher total scores indicate greater levels of anhedonia.

    Time frame: Change from baseline to post-treatment (i.e., 7-9 days)

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Study locations

1 of 1 sites recruiting
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References and documents

Publications

  • Rosenberg BM, Barnes-Horowitz NM, Zbozinek TD, Craske MG. Reward processes in extinction learning and applications to exposure therapy. J Anxiety Disord. 2024 Aug;106:102911. doi: 10.1016/j.janxdis.2024.102911. Epub 2024 Jul 29. PubMed 39128178 ↗
  • McGlade AL, Craske MG. Optimizing exposure: Between-session mental rehearsal as an augmentation strategy. Behav Res Ther. 2021 Apr;139:103827. doi: 10.1016/j.brat.2021.103827. Epub 2021 Feb 11. PubMed 33607459 ↗
  • Craske MG, Meuret AE, Echiverri-Cohen A, Rosenfield D, Ritz T. Positive affect treatment targets reward sensitivity: A randomized controlled trial. J Consult Clin Psychol. 2023 Jun;91(6):350-366. doi: 10.1037/ccp0000805. Epub 2023 Mar 9. PubMed 36892884 ↗
  • Craske MG, Meuret AE, Ritz T, Treanor M, Dour H, Rosenfield D. Positive affect treatment for depression and anxiety: A randomized clinical trial for a core feature of anhedonia. J Consult Clin Psychol. 2019 May;87(5):457-471. doi: 10.1037/ccp0000396. PubMed 30998048 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jan 9, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT06564402
Responsible party
Christoph Benke (Principal Investigator, Philipps University Marburg) — Principal investigator
First posted
Aug 21, 2024
Start date
May 28, 2024
Primary completion
Feb 1, 2026 (estimated)
Completion
Mar 1, 2026 (estimated)
Last update
Jan 9, 2026

Study contacts

Andrea Stoliarov, M.Sc.
Contact
andrea.stoliarov@uni-marburg.de
+4964212826991
Christoph Benke, PhD
Contact
christoph.benke@uni-marburg.de
+4964212824091

Oversight

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

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