Social Anxiety Disorder Clinical Trial
Official title:
Neural Markers of Treatment Mechanisms and Prediction of Treatment Outcomes in Social Anxiety
The purpose of this clinical trial is to answer the question: can the investigators predict which adults with social anxiety disorder (SAD) will successfully respond to treatment? To answer this question, the investigators plan to recruit 190 adult participants who experience extreme forms of social anxiety to undergo brain imaging before and after 12 weeks of group cognitive behavioral therapy (CBT). Adults in the SAD group who do not respond enough to group CBT may be offered the opportunity to complete an additional 12 weeks of individual CBT while receiving SSRI medication (sertraline, see below) for SAD. Data collected from participants who experience anxiety will be compared to a group of 50 participants with little or no social anxiety, who will serve as a comparison group.
Status | Recruiting |
Enrollment | 240 |
Est. completion date | June 30, 2027 |
Est. primary completion date | December 1, 2026 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years to 50 Years |
Eligibility | Inclusion criteria for all participants: (1) Any gender or race between 18-50 years old. Additional inclusion criteria for healthy controls: (1) Liebowitz Social Anxiety Scale (LSAS; Mennin et al., 2002) score <= 30, does not currently meet criteria for an Axis I psychiatric condition, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013). Additional inclusion criteria for the social anxiety disorder (SAD) group: 1. Outpatients with a primary psychiatric complaint (designated by the patient as the most important source of current distress) of social anxiety with social interaction fear as defined by an Liebowitz Social Anxiety Scale (LSAS) score >= 60. 2. Overall clinical severity of at least mild as defined by Clinical Global Impressions Scale (CGI-S; Zaider et al., 2003) of at least 3. 3. Medical history interview and laboratory findings without clinically significant abnormalities. 4. Willingness and ability to participate in the informed consent process and comply with the requirements of the study protocol. Exclusion criteria: 1. A lifetime history of bipolar disorder, schizophrenia, psychosis, delusional disorders or obsessive-compulsive disorder; an eating disorder in the past 6 months; organic brain syndrome, intellectual disability, or other cognitive dysfunction that could interfere with capacity to engage in therapy; a history of substance or alcohol abuse or dependence (other than nicotine) in the last 6 months or otherwise unable to commit to refraining from alcohol, marijuana, and stimulant use during the acute period of study participation. 2. . Patients with significant suicidal ideation Montgomery-Åsberg Depression Rating Scale (10 items, self-report) or who have enacted suicidal behaviors within 6 months prior to intake will be excluded from study participation and referred for appropriate clinical intervention. 3. Patients can be taking a concurrent psychotropic medication (e.g., antidepressants, anxiolytics, beta blockers, sertraline), but the dose must be stabilized for at least 2 weeks prior to initiation of randomized treatment. 4. Significant personality dysfunction likely to interfere with study participation. 5. Serious medical illness or instability for which hospitalization may be likely within the next year. 6. Patients with a current or past history of seizures. 7. Pregnant women, lactating women, and women of childbearing potential who may become pregnant. 8. Any concurrent psychotherapy initiated within 3 months of baseline, or ongoing psychotherapy of any duration directed specifically toward treatment of the social anxiety is excluded. Individuals with prior CBT experience or treatments that included cognitive and behavioral skills and exposure procedures (e.g., assertiveness and social skills trainings) will be excluded. General supportive or insight-oriented therapy initiated > 3 months prior is acceptable. 9. Prior non-response to adequately-delivered exposure (i.e., as defined by the patient's report of receiving specific and regular exposure assignments as part of a previous treatment). 10. Patients with a history of head trauma causing loss of consciousness, seizure or ongoing cognitive impairment. 11. Contraindications for MRI including metal implants, surgical clips, probability of metal fragments, or braces. |
Country | Name | City | State |
---|---|---|---|
United States | Center for Anxiety and Related Disorders at Boston University | Boston | Massachusetts |
Lead Sponsor | Collaborator |
---|---|
Boston University Charles River Campus | Massachusetts Institute of Technology, Mclean Hospital, National Institute of Mental Health (NIMH) |
United States,
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Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Social Cost Questionnaire (SCQ) | The SCQ is a 40-item measure that examines a person's assessment of the negative consequences of a social mishap. Each item is scored 0 (not at all) to 8 (extremely). We will administer this questionnaire at each session to examine whether it differentially mediates change with CBT vs. pharmacotherapy. | Week 0, 6 weeks, 12 weeks, 19 and 25 weeks for non-responders | |
Other | Kaufman Brief Intelligence Test (KBIT) | The Kaufman Brief Intelligence Test is used to measure verbal and non-verbal intelligence in individuals from ages 4 through 90 years. This measure will be administered at baseline for consideration as a potential moderator of treatment response. Verbal and non-verbal scales are finally scored, standardized for age, and are able to be transformed into an IQ score with a mean of 100 and standard deviation of 15. Overall scores range from 40 to 160, with higher scores indicating a better outcome. | Week 0 | |
Other | Credibility/Expectancy Questionnaire (CEQ) | The Credibility/Expectancy Questionnaire is the most widely used measure of treatment credibility and expectancy in psychotherapy research. This measure will be administered at baseline as a potential moderator of treatment response. This questionnaire utilizes two scales, 1-9 and 0-100%, with higher scores meaning a better outcome. | Week 0 | |
Primary | Change in Clinical Global Impression-Improvement Scale (CGI-I) | The CGI-S is a 7-point scale that requires the clinician to rate the improvement of the patient's illness at the time of assessment compared to baseline. To aid CGI scoring, the clinician will use the Social Phobic Disorders Severity and Change Form (SPD-SC). Treatment responder status will be defined as a CGI-I score of 1 (very much improved) or 2 (much improved) | 6 weeks, 12 weeks, 19 and 25 weeks for non-responders | |
Primary | Change in Liebowitz Social Anxiety Scale (LSAS) | The LSAS is a questionnaire developed by Dr. Michael R. Liebowitz, a psychiatrist and researcher. This measure assesses the way that social phobia plays a role in the participant's life across a variety of situations. LSAS greater than or equal to 60 meets criteria for inclusion in the treatment group. | Before Week 0, 6 weeks, 12 weeks, 19 and 25 weeks for non-responders | |
Secondary | Change in Clinical Global Impression Severity scale (CGI-S) | The CGI-S is a 7-point scale that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis. Ratings range from 1 (normal) to 7 (most extremely ill patients). CGI-S greater than or equal to 3 meets criteria for inclusion in SAD treatment group. | Week 0, 6 weeks, 12 weeks, 19 and 25 weeks for non-responders | |
Secondary | Social Phobia Inventory (SPIN) | The Social Phobia Inventory (abbreviated as SPIN ) is a 17-item questionnaire developed by the Psychiatry and Behavioral Sciences Department at Duke University. Each item is rated 0 (not at all) to 4 (extremely). It is effective in screening for, and measuring the severity of social anxiety disorder. | Weekly up through week 12, and weekly from weeks 14-25 | |
Secondary | The Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) | The Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) is a 16-item self-report measure designed to enable investigators to easily obtain sensitive measures of the degree of enjoyment and satisfaction experienced by subjects in various areas of daily functioning. The measure rates aspects of quality of life, including physical health, mood, activities of daily living, and overall life satisfaction on a scale from 1 (very poor) to 5 (very good). | Week 0, 6 weeks, 12 weeks, 19 and 25 weeks for non-responders | |
Secondary | Social Network Index (SNI) | The 12-item SNI questionnaire assesses 12 types of social relationships. This measure will be included in secondary exploratory analyses as a baseline measure for change with treatment. Assessment scores are summed with 0 being the most isolated, and 2, 3, and 4 forming categorizations of increasing social connectedness. | Week 0, 6 weeks, 12 weeks, 19 and 25 weeks for non-responders | |
Secondary | Patient Health Questionnaire-9 (PHQ-9) | The PHQ-9 is a nine-item diagnostic self-report questionnaire which psychologists use to measure the severity of depressive symptoms in patients with mood disorders. This measure will be used to monitor weekly depression symptoms, and scores greater than or equal to 4 indicate clinical levels of depression. Each item is scored on a scale of 0 to 3, with 0 indicating "not at all" and 3 denoting "present nearly every day". The total score range is 0-27. | Weekly up through week 12, and weekly from weeks 14-25 | |
Secondary | General Anxiety Disorder-7 (GAD-7) | The GAD-7 is a seven-item diagnostic self-report questionnaire which psychologists use to measure the severity of anxiety symptoms in patients with mood disorders. This measure will be used to monitor weekly anxiety symptoms, and scores greater than or equal to 5 indicate clinical levels of anxiety. Each item is scored on a scale of 0 to 3, with 0 meaning "not at all" and 3 denoting "present nearly every day". The total score range is 0-21. | Week 0, 6 weeks, 12 weeks, 19 and 25 weeks for non-responders | |
Secondary | Social Anxiety Questionnaire (SAQ) | The SAQ is a 30-item measure of social anxiety consisting of 30 items and five subscales. Each item is rated on a 5-point scale, with a high score indicating a higher social anxiety level. | Week 0, 6 weeks, 12 weeks, 19 and 25 weeks for non-responders | |
Secondary | Changes in the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND) | The DIAMOND is a semi-structured interview guide for making the major DSM-5 diagnoses. It is administered by a clinician or trained mental health professional who is familiar with the DSM-5 classification and diagnostic criteria. This measure will be used to determine eligibility for the study in conjunction with other primary outcome measures. | Week 0, 6 weeks, 12 weeks, 19 and 25 weeks for non-responders |
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