Self-Distancing for Specific Phobia in Youth
- Conditions
- Specific Phobias
- Interventions
- Behavioral: Self-Distancing (EXSD)Behavioral: Classic Exposure (EXC)
- Registration Number
- NCT06339463
- Lead Sponsor
- Columbia University
- Brief Summary
Self-Distancing is a cognitive technique that involves a shift in self-talk characterized by replacing first-person (e.g., "I") with second- or third-person pronouns (i.e., "you", one's own name) to promote an adaptive, self-reflective stance in emotionally charged situations. This trial aims to help learn how self-distancing may increase behavioral approach during exposures. To find out if self-distancing works by helping children approach fear-inducing stimuli, the study will look at behaviors and physiological responses related to approach, as well as symptom severity, before and after this cognitive technique.
The study hypothesizes that Self-Distancing will lead to greater increases in approach behaviors and a larger decrease in symptom severity compared to a control condition (first-person self-talk).
- Detailed Description
Anxiety disorders impact 1 in 3 youths by the time of adolescence, and can lead to depression, substance use, school issues, and suicide risk. Specific phobia is the earliest occurring and most common anxiety disorder and increases risk for later onset of other anxiety disorders (e.g., separation, social, generalized anxiety disorders), OCD, depression, and substance abuse problems. Exposure therapy is the standard treatment for specific phobia, but many still struggle with symptoms even after treatment. For exposure therapy to be effective, youth with specific phobia must actively approach feared situations to learn that feared outcomes do not occur. Therefore, strategies to facilitate approach behaviors during exposure therapy may improve treatment outcomes.
Self-distancing (SD) is a technique that may help youths approach their fears in exposure therapy. SD utilizes second or third-person language to enhance a person's psychological distance from self, helping them to "take a step back" from emotional situations and adopt a more objective perspective. In community samples, SD has been found to boost determination and persistence during difficult tasks, including those that induce anxiety (e.g., giving a speech). However, SD has yet to be tested as a strategy for helping clinically anxious youth engage with exposures. Additionally, objective measures of approach are needed for measuring and modifying novel exposure therapy augmentation strategies, such as SD, to improve treatment outcomes.
This study will examine if SD increases the ability to approach feared stimuli during a behavioral approach test (BAT). 20 youth (7-12.99 years) with specific phobia of spiders will be randomized to either a SD or a control condition. In the SD condition, participants will engage with the exposure task (BAT) from a self-distanced view (e.g., "Emily will touch a spider"), while in the control condition the subject will use first-person perspective (e.g., "I will touch a spider") Before and after the exposure therapy session, a BAT will be applied. This study will assess: 1) Approach -indexed using both behavioral (ability to get physically closer to spider, and video-derived motion analysis) and neuro-physiological (i.e., electroencephalogram \[EEG\], heart rate \[HR\], heart rate variability \[HRV\] and electrodermal activity \[EDA\]) metrics, collected during a BAT and 2) severity of specific phobia using validated self-report scales. During SD or control intervention, continuous audio and video data will be collected to derive behavioral metrics of engagement with the intervention (i.e., video-derived motion analysis and audio-derived linguistic metrics) and participants will be asked to subjectively rate their distress and engagement with the activity. Data will be analyzed to determine whether SD improves behavioral, neural, and physiological markers of approach to feared stimuli in youth with specific phobia and reduces symptom severity, and to explore the degree to which changes in video and audio-derived objective metrics of behavioral engagement with the intervention associate with changes in subjective ratings of fear/distress, subjective self-report of engagement and symptom severity.
Recruitment & Eligibility
- Status
- SUSPENDED
- Sex
- All
- Target Recruitment
- 35
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Self-Distancing Self-Distancing (EXSD) Youth will be randomized to OST exposure therapy with Self-Distancing. In this arm, participants will be instructed to describe exposure tasks from a self-distanced perspective (e.g., "Emily is going to touch the spider"). Classic Exposure Classic Exposure (EXC) Youth will be randomized to OST using classic exposure. In this arm, participants will be instructed to describe exposure tasks from a self-immersed perspective (e.g.,"I'm going to touch the spider")
- Primary Outcome Measures
Name Time Method Behavioral Approach Test (BAT) Immediately before and after intervention. The BAT will be utilized to evaluate participants' behavioral approach towards a spider before and after the exposure therapy session. Participants will be instructed to approach a spider, contained in a plastic container at the opposite end of the room, as quickly and closely as they can manage, stopping when their fear becomes overwhelming. The BAT outcomes will be assessed by the distance approached (marked on the floor), ranging from 0, where participants will refuse to enter the room or to move from the starting point- to 10 feet, where they will touch the spider with a fingertip.
Spider Phobia Questionnaire (SPQ-C) At baseline (~1 week before the intervention) and immediately after the intervention. The SPQ-C is a validated self-report assessment of spider fear for children 8-12 years, consisting of 29 true/false items, 8 of which are reversed-scored. Total scores range from 0 to 29. Higher scores indicate a greater degree of spider fear.
Treatment Engagement and Adherence Ratings (TEARS) Immediately after the intervention. The TEARS is a brief questionnaire assessing youth and therapist reports of youth's adherence to their assigned exposure condition, and their approach toward the exposure. Adherence and engagement are rated on a Likert scale from 1-7, with higher scores indicating greater engagement and adherence.
Subjective Units of Distress Scale (SUDS) Immediately before and after the intervention. Subjective Units of Distress (SUDs) scale-a self-assessment tool that quantifies the intensity of an individual's distress. During BAT, participants will be asked to indicate their level of anxiety on a scale ranging from 0 "no distress" to 100 "extreme distress".
- Secondary Outcome Measures
Name Time Method Heart Rate Variability Immediately before and after the intervention. HRV is a widely recognized indicator of the autonomic nervous system's regulation of the heart, reflecting the body's capacity to adapt to stress and relaxation. HRV has been extensively used in clinical and physiological research to assess cardiovascular function and autonomic engagement.
Electrodermal activity Immediately before and after the intervention. Electrodermal activity (EDA) refers to the changes in the skin's ability to conduct electricity, which is influenced by the activity of the sweat glands. These changes are primarily driven by the sympathetic nervous system, which is activated in response to emotional and physiological arousal. Meta-analyses research suggest that anxious and non-anxious individuals differ in their EDA-estimated fear conditioned responses.
Electroencephalogram (EEG) Immediately before and after the intervention. EEG has become a valuable tool for understanding the neural mechanisms underlying anxiety and phobia, offering high temporal resolution to capture rapid neural responses to fear-related stimuli. Research indicates that increased beta and gamma band activity during exposure to feared stimuli is associated with heightened arousal and fear responses in individuals with specific phobias, while reductions in alpha power are linked to increased anxiety. This outcome will measure the changes in these frequency bands before and after the intervention and compare them with the control condition.
Trial Locations
- Locations (1)
Columbia University Irving Medical Center
🇺🇸New York, New York, United States