Efficacy of Attention Bias Modification vs. Placebo for Social Anxiety Disorder

Placebo Effects in Dot-Probe Attention Bias Modification (ABM) Among Adults With Social Anxiety Disorder.

This study examines whether a computerized attention-training intervention called attention bias modification (ABM) can reduce symptoms of social anxiety disorder (SAD) in adults, and whether symptom improvement is specifically related to changes in attentional processing or to nonspecific factors such as expectancy and placebo effects.

Study Overview

• Status: Recruiting
• Conditions: Placebo Effect; Social Anxiety Disorder (SAD); Attention Bias Modification Treatment (ABMT)
• Intervention / Treatment: Behavioral: Dot-Probe Attention Bias Modification (ABM); Behavioral: Placebo Training

Detailed Description

This study examines whether a computerized attention-training intervention called attention bias modification (ABM) can reduce symptoms of social anxiety disorder (SAD) in adults, and whether symptom improvement is specifically related to changes in attentional processing or to nonspecific factors such as expectancy and placebo effects.

Social Anxiety Disorder is characterized by persistent fear of social situations and negative evaluation by others. Previous research suggests that individuals with SAD tend to direct their attention toward socially threatening information, such as angry facial expressions. ABM was developed to reduce these attentional biases by training individuals to shift attention away from threat-related stimuli. However, findings regarding the clinical efficacy of ABM have been mixed, and some studies suggest that symptom improvement may also result from placebo-related factors, including treatment expectancy and engagement with the intervention.

In this randomized controlled trial, 90 adults diagnosed with Social Anxiety Disorder will be assigned to one of three study conditions: (1) active dot-probe ABM training, (2) placebo computerized training, or (3) a wait-list control group. Participants in the active and placebo training groups will complete eight computerized training sessions over four weeks.

The study will assess changes in social anxiety symptoms before and after the intervention using clinical interviews, self-report questionnaires, and computerized attention tasks. In addition, the study will examine attention bias and attention bias variability (ABV), using both reaction-time-based and eye-tracking-based measures, to better understand changes in attentional processing over time. Treatment expectancy and perceived credibility of the intervention will also be evaluated.

The hypothesis is that participants receiving active ABM training and placebo training will show greater reductions in social anxiety symptoms compared to the wait-list control group, and that participants in the active condition will show greater reduction in symptoms than the placebo condition. The study further hypothesizes that only the active ABM condition will produce significant changes in attention bias and attentional bias variability. Overall, the study aims to clarify the specific and nonspecific mechanisms underlying symptom improvement following Attention Bias Modification interventions for Social Anxiety Disorder.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yair Bar-Haim, PhD; Phone Number: 97236405465; Email: yair1@tauex.tau.ac.il
• Study Contact Backup: Name: Lital Kohn, MA; Phone Number: 97236405465; Email: litalkohn@tauex.tau.ac.il

Study Locations

• Israel
  • Tel Aviv, Israel
    • Recruiting
    • Tel Aviv University
    • Contact: Yuval Regev, masters; Phone Number: +97245-333-4472; Email: yuvalregev4@mail.tau.ac.il

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adults aged 18-65 years
• Primary diagnosis of generalized Social Anxiety Disorder based on clinical evaluation, the MINI International Neuropsychiatric Interview (MINI), and a Liebowitz Social Anxiety Scale (LSAS) score greater than 50
• Normal or corrected-to-normal vision without color blindness
• Sufficient Hebrew proficiency to complete clinical interviews, self-report questionnaires, and computerized cognitive tasks

Exclusion Criteria:

• Previous participation in attention bias modification training using a dot-probe task
• Previous participation in eye-tracking-based attention training
• Current diagnosis of Post-Traumatic Stress Disorder
• Current or past diagnosis of psychotic disorder or bipolar disorder
• Neurological disorder (e.g., epilepsy or traumatic brain injury)
• Severe suicidal ideation
• Current substance or alcohol use disorder
• Concurrent pharmacological or psychosocial treatment, unless medication has been stable for at least 45 days
• Pregnancy
• Uncorrected visual impairment or use of multifocal glasses

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Active ABM Training; Mechanized Dot-Probe Attention Bias Modification (ABM) training attention away from threat faces. Participants identify the direction of an arrowehead presented at the location of neutral faces.	Behavioral: Dot-Probe Attention Bias Modification (ABM); Participants complete a computerized dot-probe attention training task designed to train attention away from threat-related stimuli. During each trial, angry and neutral facial expressions are presented simultaneously, followed by a probe that consistently appears in the location of the neutral face. Participants complete eight training sessions over four weeks.; Other Names: ABM
Placebo Comparator: Placebo Training; Mechanized Intervention: Placebo Training, presenting a single, centered, non-face oval shape in each trial. Participants identify the direction of an arrowehead centrally presented.	Behavioral: Placebo Training; Participants complete a computerized task matched to the active training condition in duration, structure, and task demands, but without exposure to emotional stimuli or attentional training contingencies. The task is designed to control for nonspecific factors such as expectancy and engagement. Participants complete eight sessions over four weeks.
No Intervention: Wait-List Control; No Intervention / Wait-List, assessments at the same intervals as the active and placebo conditions without intervention in between.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in social anxiety symptoms	Change in social anxiety symptom severity from baseline to post-intervention as measured by the Liebowitz Social Anxiety Scale (LSAS). Min-Max values 0-80, higher scores mean worse outcome.	a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in reaction-time-based attention bias measured in miliseconds	Change in attention bias derived from reaction-time performance on the dot-probe task.	a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks.
Change in reaction-time-based attention bias variability	Change in attention bias variability derived from reaction-time performance on the dot-probe task.	a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks.
Change in eye-tracking-based attention bias	Change in attention bias measured using eye-tracking during a free-viewing task with threat-related and neutral facial stimuli.	a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks.
Change in eye-tracking-based attention bias variability	Change in attention bias variability measured using eye-tracking during a free-viewing task with threat-related and neutral facial stimuli.	a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks.
Treatment Expectancy and Credibility	Participant-rated treatment expectancy and perceived credibility assessed using the Credibility/Expectancy Questionnaire (CEQ). 0-9 scale and 0% - 100%. Higher scores indicate greater treatment credibility and greater expectation of improvement.	Baseline one-week before treatment begins
Change in depressive symptoms	Change in depressive symptom severity measured using the Patient Health Questionnaire-9 (PHQ-9). Scale range 0-20, higher scores mean worse outcome.	a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks.
Change in Generalized Anxiety Symptoms	Change in generalized anxiety symptoms measured using the Generalized Anxiety Disorder-7 scale (GAD-7). Scores range 0-21, higher scores mean worse outcome.	a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks.
Self report change in social anxiety symptoms	Change insocial anxiety symptom severity measured using the Social Phobia Inventory (SPIN). Scores range 0-68, higher scores mean worse outcome.	a) Baseline one-week before treatment begins; b) an average of 2 weeks following treatment completion. Total time frame (baseline-post) an average of 6 weeks.

Collaborators and Investigators

• Sponsor: Tel Aviv University
• Investigators: Principal Investigator: Yair Bar-Haim, PhD, Tel Aviv University

Study record dates

Study Major Dates

• Study Start (Actual): June 15, 2026
• Primary Completion (Estimated): October 30, 2026
• Study Completion (Estimated): June 30, 2027

Study Registration Dates

• First Submitted: June 15, 2026
• First Submitted That Met QC Criteria: June 18, 2026
• First Posted (Actual): June 24, 2026

Study Record Updates

• Last Update Posted (Actual): June 24, 2026
• Last Update Submitted That Met QC Criteria: June 18, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Social Anxiety; Placebo; Treatment; Attention Bias
• Additional Relevant MeSH Terms: Mental Disorders; Phobic Disorders; Anxiety Disorders; Phobia, Social
• Other Study ID Numbers: ABM_P

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