The Effectiveness of Proactive Thought Control in Modification of Negative Core Beliefs and Cognitive Biases in Individual With Social Anxiety: A Pilot RCT Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 54
- 试验地点
- 1
- 主要终点
- Core Beliefs: Change in Negative Core Beliefs as Measured by the Core Belief Questionnaire (CBQ)
研究概览
简要总结
This study examines whether a proactive thought control intervention can reduce negative core beliefs, cognitive biases, and anxiety symptoms in university students with social anxiety. Participants with elevated social anxiety (screened via the Liebowitz Social Anxiety Scale) are randomly assigned to either a proactive thought control group or a reactive control group. Both groups complete two computerized tasks - a Free Association Task and a Sentence Completion Task - across 180 trials. The proactive group is trained to generate only positive or neutral associations to socially threatening cues and receives real-time AI-powered sentiment feedback, while the reactive group responds freely without sentiment-based guidance. Outcomes including negative core beliefs, interpretation bias, attentional bias, state anxiety, and trait anxiety are assessed before and after the intervention using standardized measures (CBQ, WSAP, Dot Probe Task, STAI). The study uses a parallel-group randomized controlled trial design with repeated measures and aims to establish preliminary effect size estimates for future, larger-scale trials.
详细描述
Background and Rationale Social anxiety disorder (SAD) is characterized by intense fear of negative evaluation in social situations, leading to significant avoidance and distress. Cognitive models of SAD emphasize the role of negative core beliefs (e.g., beliefs about being inferior or unacceptable to others) and cognitive biases - particularly interpretation bias and attentional bias toward threat - in the maintenance of the disorder. While cognitive bias modification (CBM) approaches have shown promise, most are reactive in nature, modifying biases after they arise. Proactive cognitive control, by contrast, involves the sustained, goal-directed maintenance of positive or neutral mental sets before threatening stimuli are encountered. This study tests whether a proactive approach to thought control, delivered through modified free association and sentence completion paradigms, can more effectively shift core beliefs and cognitive biases compared to a reactive control condition.
Study Design This is a parallel-group randomized controlled trial (RCT) with a repeated-measures (pre-post) design. Participants are randomly assigned using the fishbowl block randomization technique to either: (1) the Proactive Thought Control group, or (2) the Reactive Control group (active sham condition). Counterbalancing is applied to the order of stimuli in the WSAP and Dot Probe Task to control for practice effects.
Participants Participants are university students aged 18-24 years, recruited via purposive sampling using the Liebowitz Social Anxiety Scale - Self Report (LSAS-SR). Individuals scoring above 30 on the LSAS-SR are eligible. Exclusion criteria include current psychological treatment, psychiatric or medical comorbidities, and medication use. Of 204 initially screened, 149 met the LSAS cutoff; 54 were enrolled and randomized. Final analyses include 37-39 participants who completed both pre- and post-assessments. As a pilot trial, this sample size is consistent with recommended ranges of 15-30 participants per group for feasibility and preliminary effect size estimation.
Measures
Pre- and post-intervention assessments include:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 24 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •being 18-24 years old
- •not taking any additional psychological treatments during the trial
- •If taking medication for depression or anxiety, the dosage had to remain consistent for one month before the start of therapy.
- •Cut off score above 30 in LSAS
- •Consent to participate in the study and complete all tasks.
- •Proficiency in English
- •Regularly computer user
排除标准
- •Age below 18 or above 24 years
- •Currently receiving psychological treatment
- •Failure to provide consent or complete the study tasks
- •Have any other medical condition
- •Have any other psychiatric condition
- •Taking medicineInclusion Criteria:
研究组 & 干预措施
Proactive Thought Control
Participants in this arm completed a modified Free Association Task (FAT) and Sentence Completion Task (SCT) across 180 trials (6 blocks of 30). They were instructed to generate only positive or neutral single-word responses to socially threatening cues and could not advance within a trial until doing so. Real-time AI-powered sentiment feedback (DistilBERT) reinforced positive/neutral responses with "+2 Score" and corrective guidance for negative responses. A gamified points system sustained engagement. Pre- and post-assessments included the CBQ, STAI, WSAP, and Dot Probe Task.
干预措施: Proactive Thought Conrol (Behavioral)
Reactive Thought Control
Participants in this arm completed the same Free Association Task (FAT) and Sentence Completion Task (SCT) across 180 trials (6 blocks of 30) as the experimental group, but responded freely without any restriction on response valence. They received only neutral quality-based feedback (e.g., for repeated, misspelled, or invalid entries) with no sentiment-based reinforcement or corrective guidance. This active sham condition controlled for task engagement, the Hawthorne effect, and demand characteristics. Pre- and post-assessments were identical to those of the experimental arm.
干预措施: Reactive Thought Control (Behavioral)
结局指标
主要结局
Core Beliefs: Change in Negative Core Beliefs as Measured by the Core Belief Questionnaire (CBQ)
时间窗: Baseline (pre-intervention) and immediately after intervention completion (post-intervention)
The Core Belief Questionnaire (CBQ; Wong et al., 2017) measures negative core beliefs in socially anxious individuals across three versions: trait (beliefs about self), contingent (beliefs about self when negatively evaluated), and other (beliefs about others). Each scale contains 17 items rated on a 6-point Likert scale (1 = strongly disbelieve to 6 = strongly believe). Total scores range from 17 to 102, with higher scores indicating stronger negative core beliefs. In this study, the trait and other subscales are used. Change scores from pre- to post-intervention are compared between the proactive thought control group and the reactive control group.
Interpretation Biases: Change in Interpretation Bias as Measured by the Word Sentence Association Paradigm (WSAP)
时间窗: Baseline (pre-intervention) and immediately after intervention completion (post-intervention)
The WSAP (Beard \& Amir, 2009) is a computerized task measuring interpretation bias toward threatening versus benign interpretations of ambiguous social scenarios. Each trial presents a word cue followed by an ambiguous sentence; participants judge relatedness by pressing Y or N. Bias is scored as the proportion of trials in which participants endorse threatening word-sentence pairings. Higher proportions indicate stronger negative interpretation bias. The task includes 30 trials with threatening and benign word-sentence pairs presented in randomized, counterbalanced order across pre- and post-assessments.
Attentional Biases: Change in Attentional Bias as Measured by the Dot Probe Task
时间窗: Baseline (pre-intervention) and immediately after intervention completion (post-intervention)
The Dot Probe Task (MacLeod et al., 1986) measures attentional bias toward threatening stimuli using reaction times. Each trial presents a threatening and a neutral word simultaneously; a probe then replaces one stimulus. The Attentional Bias Index (ABI) is calculated as: mean RT on threat-incongruent trials minus mean RT on threat-congruent trials. Positive ABI scores indicate vigilance toward threat; negative scores indicate avoidance; scores near zero indicate no bias. Trials with RTs below 200 ms or above 1500 ms and incorrect responses are excluded. The task includes 30 trials in counterbalanced, randomized order across assessments.
次要结局
- State Trait Anxiety:Change in State-Trait Anxiety as Measured by the STAI - Short Form (STAI-State Subscale)(Baseline (pre-intervention) and immediately after intervention completion (post-intervention))
研究者
Saba Ahmad
Principal Investigator
GIFT University