Exposure With Acceptance-Based Versus Habituation-Based Rationale for Public Speaking Anxiety

Not Applicable

Completed

• Conditions: Public Speaking; Social Fear
• Interventions: Behavioral: Exposure w/ Acceptance-Based Rationale; Behavioral: Exposure w/ Habituation-Based Rationale

• Registration Number: NCT00842946
• Lead Sponsor: Drexel University

Brief Summary

The purpose of this study is to compare two exposure-based behavioral group treatments for public speaking anxiety. Specifically, exposure within the context of psychological acceptance will be compared to exposure within a standard habituation context. It is hypothesized that participants receiving exposure within the context of psychological acceptance will experience a greater decrease in anxiety and greater improvement in quality of life compared to the habituation-based group.

Detailed Description

Social Anxiety Disorder (SAD) is a potentially debilitating condition affecting approximately 12% of the population at some point in their life (Ruscio et al., 2008). Nongeneralized SAD refers to individuals whose fears are limited to one or two social situations, most commonly public speaking. Empirically supported treatments for public speaking anxiety generally include an exposure component involving participation in anxiety-provoking public speaking situations (usually simulated situations using an audience of confederates and/or fellow participants, as well as actual public speaking situations in the community). Exposure is often presented within the context of habituation, but cognitively- based therapies utilize a rationale for exposure based on cognitive restructuring and belief modification. Research investigating the incremental benefit of adding other treatment components to exposure has yielded mixed results; however, there is preliminary evidence that the context in which exposure is presented can have an impact on treatment outcome. Recently, acceptance-based therapies have begun to frame exposure as an opportunity to increase one's willingness to experience anxiety while engaging in valued behaviors, rather than as a vehicle for modifying maladaptive cognitions and reducing anxiety. However, little research has been conducted on the efficacy of acceptance-based therapies for public speaking anxiety, and no component control studies have examined the utility of an acceptance/cognitive defusion rationale and context for exposure for public speaking anxiety. The present study will compare two exposure-based treatments for public speaking anxiety in a clinical sample. Specifically, exposure within an acceptance/defusion context will be compared to exposure with a habituation-based rationale.

Hypotheses:

1. Participants receiving exposure within an acceptance/defusion context will experience a greater reduction in anxiety and behavioral avoidance, and greater improvement in measures of quality of life, compared to participants receiving exposure within a habituation rationale, at post-treatment.

2. Acceptance, defusion, and mindfulness will mediate treatment outcome. Specifically, greater changes on measures of these three constructs will account for a significant portion of the effect of treatment condition on the dependent variables.

3. Lower baseline levels of public speaking anxiety and overall anxiety will be associated with higher baseline quality of life, mindfulness, acceptance, defusion, and social skills.

4. Baseline levels of acceptance, defusion, and mindfulness will predict overall treatment response, regardless of intervention condition.

Study Timeline

• Study Start: 2009-02
• Study First Submitted: 2009-02-11
• Study First Submitted QC: 2009-02-11
• Study First Posted: 2009-02-12
• Primary Completion: 2009-11
• Study Completion: 2009-11
• Status Verified: 2014-05
• Results First Submitted: 2014-05-01
• Results First Submitted QC: 2014-05-01
• Last Update Submitted: 2014-05-01
• Results First Posted: 2014-06-02
• Last Update Posted: 2014-06-02

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 45

Inclusion Criteria

• Clinically diagnosable public speaking anxiety (per DSM-IV-TR criteria for nongeneralized social anxiety disorder)
• Aged 18-65
• Residence in the greater Philadelphia area

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Exclusion Criteria

• Pervasive developmental disability

• Acute suicide potential

• Inability to travel to the treatment site

• Certain comorbid Axis I diagnoses, namely:

  • generalized SAD
  • schizophrenia or other psychotic disorder
  • current substance dependence

• Comorbid diagnoses of Major Depressive or other mood or anxiety disorders are acceptable ONLY if clearly secondary to the diagnosis of public speaking anxiety

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Exposure w/ Acceptance-Based Rationale	Exposure w/ Acceptance-Based Rationale	Behavioral exposure within the context of psychological acceptance.
Exposure w/ Habituation-Based Rationale	Exposure w/ Habituation-Based Rationale	Behavioral exposure within the context of habituation.

Primary Outcome Measures

Name	Time	Method
Number of Participants in Remission (Per Structured Clinical Interview for DSM-IV Axis I Disorders (SCID))	6-weeks post-treatment	The SCID (First, Spitzer, Gibbon, \& Williams, 1996) is an extensively utilized structured diagnostic interview based on DSM-IV criteria. Estimates of interrater reliability range from moderate to high for most Axis I disorders (e.g., Williams et al., 1992; Zanarini; \& Frankenburg, 2001).

Trial Locations

Locations (1)

Drexel University; 🇺🇸 Philadelphia, Pennsylvania, United States