Brief Interpretation Bias Modification for Social Anxiety Disorder in Pakistani Young Adults: An Experimental Evaluation (BIBM-SAD-PYA)

Efficacy of Cognitive Bias Modification Itervention in Young Adult With Social Anxiety

This randomized, single-blind trial tests whether one session of interpretation bias modification reduces immediate social-evaluative anxiety and shifts interpretation bias in Pakistani university students aged 18 to 25 years with elevated social anxiety. Participants are assigned to either feedback-contingent interpretation bias modification or a structurally matched interpretation control condition. Primary and secondary outcomes are assessed before and after the intervention session using short-form state-trait anxiety measures and Word-Sentence Association Paradigm endorsement indices.

Study Overview

• Status: Not yet recruiting
• Conditions: Social Anxiety Disorder; Interpretation Bias
• Intervention / Treatment: Behavioral: WSAP-based interpretation bias modification; Behavioral: WSAP interpretation control condition

Detailed Description

Social anxiety in young adults is maintained in part by a tendency to interpret ambiguous social information as threatening. The study evaluates a behavioral interpretation training procedure delivered with OpenSesame, using trial-by-trial responses to ambiguous social sentences preceded by threat or benign prime words. In the experimental arm, feedback contingently reinforces benign endorsements and threat rejections. In the control arm, exposure and timing are matched but feedback is noncontingent and presented on half of trials. The design is a parallel two-arm randomized pretest-posttest trial with participant masking to assignment. Assessment includes the 5-item state and 5-item trait short-form State-Trait Anxiety Inventory totals and Word-Sentence Association Paradigm threat and benign endorsement proportions. The mechanistic hypothesis is that feedback-consistent learning increases benign interpretations and reduces threat interpretations, which is associated with lower post-session state anxiety. The trial was conducted as part of a PhD thesis at the University of Gujrat under formal institutional approvals.

• Study Type: Interventional
• Enrollment (Estimated): 130
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: ather mujitaba mujitaba Mujitaba, PhD Scholar; Phone Number: +923297596056; Email: ather.mujitaba@gift.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Dhok Gujra, Punjab Province, Pakistan, 51700
      • University of Gujrat
      • Contact: Dr Saima Riaz, PhD; Phone Number: +92 (53) 22600 +(92) 92532260000; Email: saim.riaz@uog.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• age 18 to 25 years
• Social Phobia Inventory score greater than 19
• at least moderate severity on the DSM-5-TR Severity Measure for Social Anxiety Disorder-Adult
• able to read study materials
• provides written informed consent.

Exclusion Criteria:

• clinically elevated depressive symptoms on Beck Depression Inventory-II at or above prespecified cutoff [above 16]
• clinically elevated general anxiety symptoms on the Beck Anxiety Inventory at or above prespecified cutoff [ above 20]
• current medical or psychiatric condition likely to interfere with safe or valid participation
• prior participation in this trial.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Interpretation Bias Modification; Single-session Word-Sentence Association Paradigm training with performance-contingent feedback across 220 trials in two 110-trial blocks; each block includes 70 social ambiguity trials and 40 non-social fillers. Correct feedback follows benign endorsement or threat rejection; incorrect feedback follows threat endorsement or benign rejection.	Behavioral: WSAP-based interpretation bias modification; Single-session Word-Sentence Association Paradigm training with performance-contingent feedback across 220 trials in two 110-trial blocks; each block includes 70 social ambiguity trials and 40 non-social fillers. Correct feedback follows benign endorsement or threat rejection; incorrect feedback follows threat endorsement or benign rejection.
Active Comparator: Interpretation Control Condition; Matched Word-Sentence Association Paradigm exposure with identical stimulus timing and response demands, feedback delivered on 50 percent of trials without contingency, favoring benign over threat interpretations.	Behavioral: WSAP interpretation control condition; Matched Word-Sentence Association Paradigm exposure with identical stimulus timing and response demands, feedback delivered on 50 percent of trials without contingency favoring benign over threat interpretations.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
short version of the Spielberger State-Trait Anxiety Inventory	The primary outcome is within-participant change in state anxiety measured with the 5-item short-form State-Trait Anxiety Inventory state subscale (STAIS-5). Items are summed to a total score, with higher scores indicating greater state anxiety. The primary comparison is the between-group difference in change score (IBM versus ICC).	Baseline (pre-intervention, same visit) and immediate post-intervention after the single-session training (same visit, approximately 30 to 60 minutes after intervention)
Spielberger short-form State-Trait Anxiety Inventory (S-STAI)	Difference between post-session and baseline STAIS-5 total score; higher scores indicate greater state anxiety.	Baseline pre-intervention and immediate post-intervention in the same visit (approximately 30 to 60 minutes after training starts).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Word-Sentence Association Paradigm threat endorsement rate.	Proportion of threat word-sentence pairings endorsed as related; lower values indicate less threat-consistent interpretation. Used as interpretation bias metrices.	Baseline pre-intervention and immediate post-intervention in the same visit.

Collaborators and Investigators

• Sponsor: Ather Mujitaba
• Investigators: Principal Investigator: Saima Riaz Riaz, PhD, University of Gujrat

Publications and helpful links

General Publications

• 1. Hofmann SG. Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cogn Behav Ther. 2007;36(4):193-209. doi:10.1080/16506070701421313. 2. Ejaz B, Muazzam A, Anjum A, Pollock G, Nawaz R. Measuring the scale and scope of social anxiety among students in Pakistani higher education institutions: an alternative social anxiety scale. Sustainability. 2020;12(6):2164. doi:10.3390/su12062164. 3. Rapee RM, Heimberg RG. A cognitive-behavioral model of anxiety in social phobia. Behav Res Ther. 1997;35(8):741-756. doi:10.1016/S0005-7967(97)00022-3. 4. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto (CA): Consulting Psychologists Press; 1983. 5. Beard C, Amir N. Negative interpretation bias mediates the effect of social anxiety on state anxiety. Cognit Ther Res. 2010;34(3):292-296. doi:10.1007/s10608-009-9258-6. 6. Hallion LS, Ruscio AM. A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychol Bull. 2011;137(6):940-958. doi:10.1037/a0024355. 7. MacLeod C, Mathews A. Cognitive bias modification approaches to anxiety. Annu Rev Clin Psychol. 2012;8:189-217. doi:10.1146/annurev-clinpsy-032511-143052. 8. Amir N, Bomyea J, Beard C. The effect of a single-session interpretation modification on attention bias in socially anxious individuals. J Anxiety Disord. 2010;24(2):178-182. doi:10.1016/j.janxdis.2009.10.005. 9. Beard C, Amir N. Interpretation in social anxiety: when meaning precedes ambiguity. Cognit Ther Res. 2009;33(4):406-415. doi:10.1007/s10608-009-9235-0. 10. Gonsalves M, Whittles RL, Weisberg RB, Beard C. A systematic review of the word sentence association paradigm (WSAP). J Behav Ther Exp Psychiatry. 2019;64:133-148. doi:10.1016/j.jbtep.2019.04.003. 11. Connor KM, Davidson JRT, Churchill LE, Sherwood A, Foa E, Weisler RH. Psychometric properties of the Social Phobia Inventory (SPIN). Br J Psychiatry. 200

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): April 1, 2026
• Study Completion (Estimated): April 1, 2026

Study Registration Dates

• First Submitted: February 5, 2026
• First Submitted That Met QC Criteria: February 5, 2026
• First Posted (Actual): February 12, 2026

Study Record Updates

• Last Update Posted (Actual): February 12, 2026
• Last Update Submitted That Met QC Criteria: February 5, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Social Anxiety Disorder; interpretation bias modification; Word-Sentence Association Paradigm; Pakistan Young Adult; Cogntive Bias Modification
• Additional Relevant MeSH Terms: Mental Disorders; Phobic Disorders; Anxiety Disorders; Phobia, Social
• Other Study ID Numbers: UOG/ORIC/2025/342

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Individual participant data are not available at this stage because the trial is ongoing and data collection is not complete. After study completion, data cleaning, and primary reporting, the team will determine whether de-identified individual participant data can be shared in line with institutional approvals, participant consent, and applicable regulations.
• IPD Sharing Time Frame: Supporting documents will be considered for release after final study completion and primary thesis/manuscript reporting. The exact release start date and duration have not yet been finalized and will be updated in the registry record after completion.
• IPD Sharing Access Criteria: Access procedures are not yet finalized. Any future sharing will be limited to de-identified materials and will require a reasonable scientific request, ethical use, and institutional approval as applicable. Final criteria will be added after study completion.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No