Brief Interpretation Bias Modification for Social Anxiety Disorder in Pakistani Young Adults: An Experimental Evaluation

Official title

Efficacy of Cognitive Bias Modification Itervention in Young Adult With Social Anxiety

Overview

This randomized, single-blind trial tests whether one session of interpretation bias modification reduces immediate social-evaluative anxiety and shifts interpretation bias in Pakistani university students aged 18 to 25 years with elevated social anxiety. Participants are assigned to either feedback-contingent interpretation bias modification or a structurally matched interpretation control condition. Primary and secondary outcomes are assessed before and after the intervention session using short-form state-trait anxiety measures and Word-Sentence Association Paradigm endorsement indices.

Detailed description

Social anxiety in young adults is maintained in part by a tendency to interpret ambiguous social information as threatening. The study evaluates a behavioral interpretation training procedure delivered with OpenSesame, using trial-by-trial responses to ambiguous social sentences preceded by threat or benign prime words. In the experimental arm, feedback contingently reinforces benign endorsements and threat rejections. In the control arm, exposure and timing are matched but feedback is noncontingent and presented on half of trials. The design is a parallel two-arm randomized pretest-posttest trial with participant masking to assignment. Assessment includes the 5-item state and 5-item trait short-form State-Trait Anxiety Inventory totals and Word-Sentence Association Paradigm threat and benign endorsement proportions. The mechanistic hypothesis is that feedback-consistent learning increases benign interpretations and reduces threat interpretations, which is associated with lower post-session state anxiety. The trial was conducted as part of a PhD thesis at the University of Gujrat under formal institutional approvals.

Interventions

• Behavioral WSAP-based interpretation bias modification
  Single-session Word-Sentence Association Paradigm training with performance-contingent feedback across 220 trials in two 110-trial blocks; each block includes 70 social ambiguity trials and 40 non-social fillers. Correct feedback follows benign endorsement or threat rejection; incorrect feedback follows threat endorsement or benign rejection.
• Behavioral WSAP interpretation control condition
  Matched Word-Sentence Association Paradigm exposure with identical stimulus timing and response demands, feedback delivered on 50 percent of trials without contingency favoring benign over threat interpretations.

Primary outcome measures

• short version of the Spielberger State-Trait Anxiety Inventory [Time frame: Baseline (pre-intervention, same visit) and immediate post-intervention after the single-session training (same visit, approximately 30 to 60 minutes after intervention)]
• Spielberger short-form State-Trait Anxiety Inventory (S-STAI) [Time frame: Baseline pre-intervention and immediate post-intervention in the same visit (approximately 30 to 60 minutes after training starts).]

Secondary outcome measures (1)

• Change in Word-Sentence Association Paradigm threat endorsement rate. [Time frame: Baseline pre-intervention and immediate post-intervention in the same visit.]

Eligibility criteria

Inclusion criteria

• age 18 to 25 years
• Social Phobia Inventory score greater than 19
• at least moderate severity on the DSM-5-TR Severity Measure for Social Anxiety Disorder-Adult
• able to read study materials
• provides written informed consent.

Exclusion criteria

• clinically elevated depressive symptoms on Beck Depression Inventory-II at or above prespecified cutoff \[above 16\]
• clinically elevated general anxiety symptoms on the Beck Anxiety Inventory at or above prespecified cutoff \[ above 20\]
• current medical or psychiatric condition likely to interfere with safe or valid participation
• prior participation in this trial.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• University of Gujrat — Dhok Gujra

Publications

• 1. Hofmann SG. Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn Behav Ther. 2007;36(4):193-209. doi:10.1080/16506070701421313. 2. Ejaz B, Muazzam A, Anjum A, Pollock G, Nawaz R. Measuring the scale and scope of social anxiety among students in Pakistani higher education institutions: an alternative social anxiety scale. Sustainabil

Identifiers

NCT: NCT07406321 · UOG/ORIC/2025/342

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗