NCT06258889

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

Optimizing Exposure Therapy Via Reward-focused Interventions: A Randomized Controlled Trial in Individuals With Public Speaking Anxiety

• Status: Completed
• Phase: N/A
• Study type: Interventional
• Enrollment: 40 (actual)
• Sponsor: Philipps University Marburg · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Accepted

Summary

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.

Detailed description

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

• Public Speaking Fear

Interventions

Type	Name	Description
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.
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.
BEHAVIORAL	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).
BEHAVIORAL	Psychoeducation	All participants received information on anxiety, and the maintenance of anxiety as well as a rationale for the exposure session.

Timeline

• Start date: 2024-01-08
• Primary completion: 2024-12-13
• Completion: 2024-12-13
• First posted: 2024-02-14
• Last updated: 2026-01-09

Locations

1 site across 1 country: Germany