The Efficacy of Prospective Mental Imagery in Enhancing Approach Motivation Among Socially Anxious Individuals: A Randomized Controlled Trial

With numerous studies demonstrating its long-term effectiveness, exposure therapy is currently considered the leading evidence-based treatment for anxiety disorders. However, a major limitation in its application is that patients often discontinue treatment due to their unwillingness to confront themselves with the feared situation. Considering that targeting avoidance behaviors and maladaptive fear responses are at the core of exposure therapy, strategies are needed to enhance both approach motivation as well as behavioral engagement with the feared situation. Among individuals with depression, prospective mental imagery has been demonstrated to increase motivation and behavioral engagement in pleasurable activities by elevating anticipated reward as well as anticipatory and anticipated pleasure ('motivational amplifier' hypothesis). Given alterations in motivational and reward processes in individuals with social anxiety, prospective mental imagery may enhance reward anticipation and facilitate approach motivation and engagement in exposure to socially feared situations. The current online study will compare the use of a prospective mental-imagery task to an active control group (verbal reasoning) in improving approach motivation and behavioral engagement with feared situations in individuals with heightened social anxiety. Participants in both conditions will receive psychoeducation. Participants in the experimental group will vividly imagine themselves successfully mastering the feared social situation. Participants in the control condition are asked to reflect on the pros and cons of confronting themselves with the feared social situation. Approach motivation as well as reward anticipation, anticipated and anticipatory pleasure will be assessed before and after the imagery or verbal reasoning task. Engagement with the feared social situation will be assessed one week later. Aim of the randomized controlled trial is to investigate whether prospective mental imagery is effective in enhancing self-reported motivation and engagement with feared situations compared to an active control group. In an exploratory analysis, we will examine whether the efficacy of the prospective imagery training is modulated by individuals' levels of reward sensitivity and anhedonia.