CBT Versus CBT With Virtual Reality Exposure for Social Anxiety Disorder and Agoraphobia
- Conditions
- AgoraphobiaSocial Anxiety Disorder
- Interventions
- Behavioral: CBT in vivoBehavioral: CBT with virtual reality exposure therapy
- Registration Number
- NCT03845101
- Lead Sponsor
- Mental Health Services in the Capital Region, Denmark
- Brief Summary
Introduction: Anxiety disorders have a high lifetime prevalence, early-onset, and long duration or chronicity. Exposure therapy is considered one of the most effective elements in cognitive behavioral therapy (CBT) for anxiety, but in vivo exposure can be challenging to access and control, and is sometimes rejected by patients because they consider it too aversive. Virtual reality allows flexible and controlled exposure to challenging situations in an immersive and protected environment.
Aim: The SoREAL-trial aims to investigate the effect of group cognitive-behavioral therapy (CBT-in vivo) versus group cognitive behavioral therapy with virtual reality exposure (CBT-in virtuo) for patients diagnosed with social anxiety disorder and/or agoraphobia, in mixed groups.
Methods \& Analysis: The design is an investigator-initiated randomized, assessor-blinded, parallel-group and superiority-designed clinical trial. Three hundred two patients diagnosed with social anxiety disorder and/or agoraphobia will be included from the regional mental health centers of Copenhagen and North Sealand and the Northern Region of Denmark. All patients will be offered a manual-based 14-week cognitive behavioral group treatment program, including eight sessions with exposure therapy. Therapy groups will be centrally randomized with concealed allocation sequence to either CBT-in virtuo or CBT-in vivo. Patients will be assessed at baseline, post-treatment and one-year follow-up by treatment blinded researchers and research assistants. The primary outcome will be diagnosis-specific symptoms measured with the Liebowitz Social Anxiety Scale for patients with social anxiety disorder and the Mobility Inventory for Agoraphobia for patients with agoraphobia. Secondary outcome measures will include depression symptoms, social functioning, and patient satisfaction. Exploratory outcomes will be substance and alcohol use, working alliance and quality of life.
Ethics and dissemination: The trial has been approved by the research ethics committee in the Capital Region of Denmark. All results, positive, negative as well as inconclusive, will be published as quickly as possible and still in concordance with Danish law on the protection of confidentially and personal information. Results will be presented at national and international scientific conferences.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 302
- Fulfilling diagnostic criteria for social anxiety disorder (ICD-code: F40.1) and/or Agoraphobia (ICD-code: 40.0)
- Age 18-75 years
- Sufficient knowledge of the Danish language
- Informed consent
- Alcohol or drug dependence (ICD-code: F10-19.20-26).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description CBT in vivo CBT in vivo Active comparator, receives CBT in group format. Treatment as usual. CBT in virtuo CBT with virtual reality exposure therapy Receives CBT in group format with Virtual Reality Exposure Therapy
- Primary Outcome Measures
Name Time Method Change in symptom severity of primary diagnosis Between 30 to 1 day(s) before treatment, between 0 and 14 days after treatment ends and between 365 to 395 days after first assesment. Total scores on the Liebowitz Social Anxiety Scale (LSAS) for patients with social anxiety disorder and the Mobility Inventory for Agoraphobia (MIA) for patients with Agoraphobia measured pre-treatment, post-treatment and at one-year follow-up converted to the 'Percentage of Maximum Possible Score' (POMP) and averaged within treatment arms. POMP calculations can bring differently measured items to the same metric and do not change the multivariate distribution and covariance matrix of the transformed variables.
Ranges from 0 to 100. Higher is worse.
- Secondary Outcome Measures
Name Time Method Change in Work and Social Adjustment Scale score Between 30 to 1 day(s) before treatment, between 0 and 14 days after treatment ends and between 365 to 395 days after first assesment. Self-report. Total score is measured, ranging from 0 to 40. Higher is better.
Treatment response on agoraphobia symptoms Between 0 and 14 day(s) after treatment ends and between 365 to 395 days after first assesment. Mobility Inventory for Agoraphobia total score below 2 or a 0.5 points drop
Ranges from 0 to 5. Higher is worse.Remission from social anxiety disorder Between 0 and 14 day(s) after treatment ends and between 365 to 395 days after first assesment. Liebowitz Social Anxiety Scale total score below 25 and not qualifying for social anxiety disorder as measured using the MINI-7.
Ranges from 0 to 144. Higher is worse.Change in Brief Version of the Fear of Negative Evaluation Scale score Between 30 to 1 day(s) before treatment, between 0 and 14 days after treatment ends and between 365 to 395 days after first assesment. Self-report, total score is measured, ranging from 12 to 60. Higher is worse.
Client Satisfaction Questionnaire Measured between 0 and 14 days after treatment ends Measures satisfaction with treatment. Total score is measured, ranging from 8 to 32. Higher is better. Self-report.
Change in WHO Well-Being Index 5 items, score Between 30 to 1 day(s) before treatment, between 0 and 14 day(s) after treatment ends and between 365 to 395 days after first assesment. Measures overall quality of life. Total score is measured. Ranges from 0 to 25. Higher is better. Self-report.
Remission from agoraphobia Between 0 and 14 day(s) after treatment ends and between 365 to 395 days after first assesment. MIA total score below 1.5 and not qualifying for agoraphobia as measured using the MINI-7.
Ranges from 0 to 5. Higher is worse.Change in Hamilton Depression Rating Scale, 6 item score Between 30 to 1 day(s) before treatment, between 0 and 14 days after treatment ends and between 365 to 395 days after first assesment. Measures symptoms of depression for the last 3 days.Total score will be measured. Ranges from 0 to 22. Higher is worse.
Treatment response on social anxiety disorder symptoms Between 0 and 14 day(s) after treatment ends and between 365 to 395 days after first assesment. Liebowitz Social Anxiety Scale total score below 50 or a 15 points drop.
Ranges from 0 to 144. Higher is worse.
Trial Locations
- Locations (5)
Ambulatorium for Angst og Tvangssygdomme
🇩🇰Aalborg, Denmark
Psykoterapeutisk Ambulatorium
🇩🇰Brøndby, Copenhagen, Denmark
Psykoterapeutisk Klinik, Nannasgade
🇩🇰Copenhagen, Captial Region Of Denmark, Denmark
Psykoterapeutisk klinik, Frederiksberg
🇩🇰Frederiksberg, Copenhagen, Denmark
Psykoterapeutisk Center Stolpegård
🇩🇰Gentofte, Copenhagen, Denmark