Safety Behavior Fading Versus Progressive Muscle Relaxation for Appearance Concerns

Safety Behavior Fading Versus Progressive Muscle Relaxation for Appearance Concerns: A Randomized Clinical Trial of Digital Interventions

The current study aims to explore the efficacy of a text message based safety behavior fading intervention compared to a progressive muscle relaxation intervention for appearance concerns.

Study Overview

• Status: Recruiting
• Conditions: Social Anxiety Disorder; Eating Disorders; Body Dysmorphic Disorder
• Intervention / Treatment: Behavioral: Safety Behavior Fading for Appearance Concerns; Behavioral: Progressive Muscle Relaxation

Detailed Description

Appearance-related safety behavior fading intervention procedures will follow methodology previously used in the Cougle Lab. The safety behavior fading intervention is designed to target a decrease or elimination of appearance-related safety behaviors. Individuals randomly assigned to the safety behavior fading condition will receive instructions to decrease or eliminate their endorsed appearance-related safety behaviors. In addition, they will receive daily reminders via text message to decrease these behaviors, along with a safety behavior monitoring checklist in which the participant indicates the extent to which they decreased and/or eliminated each safety behavior over the previous day. The daily reminder will include the following language: "Hi! This is a friendly reminder to avoid using your checklist behaviors. Please tap the link below to access today's checklist: [link to checklist]." Text messages will be delivered using EZtexting a text messaging platform used for research and marketing. Note that no identifying information will be included in this platform. Each participants phone number will be accompanied with a anonymized ID code. Individuals randomly assigned to the progressive muscle relaxation condition will be instructed to try and practice it daily for the 28 days. They will also receive daily text messages to remind them to practice relaxation and they can log which of the 10 different muscle groups they tensed and released in the past day.

• Study Type: Interventional
• Enrollment (Estimated): 300
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tapan Patel, Master of Science; Phone Number: 863-517-2584; Email: patel@psy.fsu.edu

Study Locations

• United States
  • Florida
    • Tallahassee, Florida, United States, 32308
      • Recruiting
      • Florida State University
      • Contact: Tapan Patel, Master of Science; Phone Number: 8635172584; Email: patel@psy.fsu.edu

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• being between the ages of 18 and 65 years old
• having an internet-capable smart-phone
• scoring at or above the empirical cutoff for appearance concerns measured by the Social Appearance Anxiety Scale (i.e., 52)

Exclusion Criteria:

• changes in psychotropic medication in the last 4 weeks
• failing attention checks in baseline data collection

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: Safety Behavior Fading; Individuals randomly assigned to the safety behavior fading condition will receive instructions to decrease or eliminate their endorsed appearance-related safety behaviors. In addition, they will receive daily reminders via text message to decrease these behaviors, along with a safety behavior monitoring checklist in which the participant indicates the extent to which they engaged in each safety behavior over the previous day.	Behavioral: Safety Behavior Fading for Appearance Concerns; Participants are asked to reduce or eliminate safety behaviors via text message reminders and checklists to monitor progress.; Other Names: ARSB Fading
Active Comparator: Progressive Muscle Relaxation; Participants in this condition will be instructed to try and practice progressive muscle relaxation daily for 28 days. To match safety behavior fading they will also receive daily text messages to remind them to practice relaxation and they can log which of the 10 different muscle groups they tensed and released in the past day.	Behavioral: Progressive Muscle Relaxation; Participants are asked to practice relaxation daily via text message reminder and checklists to monitor progress.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Social Phobia Inventory (SPIN; Connor et al., 2000)	Self-report scale that measures social anxiety symptoms. Scores range from 0 to 68 with higher scores indicating higher levels of social anxiety.	Day 0, Day 28, Day 56
Appearance Behaviors Checklist past-week version (author constructed)	Self-report scale used to measure frequency of engaging in appearance-related safety behaviors. This scale will be used as a manipulation check. Each item is rated on a 0 to 10 scale. Total scores range from 0 to 130 with higher scores indicating greater engagement in appearance-related safety behaviors	Day 0, Day 28, Day 56
The Social Appearance Anxiety Scale (SAAS)	Self-report scale that measures appearance anxiety symptoms. Scores range from 16 to 80 with higher scores indicating higher levels of appearance concerns.	Day 0, Day 28, Day 56
Appearance Anxiety Inventory (AAI; Veale et al., 2014)	Self-report scale that measures of body dysmorphic symptoms. Scores range from 0 to 40 with higher scores indicating higher levels of body dysmorphic symptoms.	Day 0, Day 28, Day 56
Eating Disorder-15 (ED-15; Tatham et al., 2015).	Self-report scale that measures eating disorder symptoms. Scores range from 0 to 90 with higher scores indicating higher levels of eating pathology.	Day 0, Day 28, Day 56
The Eating Disorder Inventory-Body Dissatisfaction (EDI; Garner et al., 1983).	Self-report scale for measuring body dissatisfaction for use in clinical outcome studies. Each item is rated on a 0-5 scale with a total score range of 9-54 with higher scores indicating greater drive for thinness, bulimia, and body dissatisfaction.	Day 0, Day 28, Day 56
Credibility and Expectancy Questionnaire (CEQ; Devilly & Borkovec, 2000).	Self-report scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. Three items are rated on a 0-10 scale and one item is rated on a 0-100 scale with higher scores meaning greater expectancy and credibility.	Day 0

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Center for Epidemiologic Studies Depression Scale-10 (CESD; Andreson, 1994)	Self-report measure of depression symptom severity. Each item is rated on a 0 to 3 scale. Total scores range from 0 to 30 with higher scores indicating greater depression severity.	Day 0, Day 28, Day 56
Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006)	Self-report measure of anxiety symptom severity. Each item is rated on a 0 to 3 scale. Total scores range from 0 to 28 with higher scores indicating greater anxiety severity.	Day 0, Day 28, Day 56
Appearance Preference Task	Computerized forced-choice task measuring appearance importance relative to other favorable characteristics. The APT randomly presents a series of 33 word pairs and asks the participant to select the concept that is more important to them. Each pair consists of a positive appearance-related adjective and a positive character trait unrelated to appearance (e.g., beautiful-responsible). Higher scores indicate greater endorsement of appearance words.	Day 0, Day 28, Day 56
Social Interaction Scale (Author Constructed)	Single-item self-report scale that the extent to which individuals engage with their social support networks. This question asks: "what percentage of your time awake did you spend interacting with others this past week (0% =No time at all, 100% =all of the time)?"	Day 0, Day 28, Day 56
Body Dysmorphic Disorder Symptom Scale-Cognitive Subscale (Wilhelm et al., 2016)	Self-report scale that measures cognitions related to body dysmorphic disorder. Scores range from 0 to 190 with higher scores indicating higher levels of maladaptive cognitions related to body dysmorphic disorder.	Day 0, Day 28, Day 56

Collaborators and Investigators

• Sponsor: Florida State University

Study record dates

Study Major Dates

• Study Start (Actual): May 29, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: May 11, 2026
• First Submitted That Met QC Criteria: May 11, 2026
• First Posted (Actual): May 15, 2026

Study Record Updates

• Last Update Posted (Actual): June 2, 2026
• Last Update Submitted That Met QC Criteria: May 29, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Signs and Symptoms, Digestive; Phobic Disorders; Anxiety Disorders; Somatoform Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Phobia, Social; Feeding and Eating Disorders; Body Dysmorphic Disorders; Therapeutics; Mind-Body Therapies; Complementary Therapies; Psychotherapy; Behavioral Disciplines and Activities; Hypnosis; Autogenic Training
• Other Study ID Numbers: STUDY00007433

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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