Exposure Therapy With Personalized Real-Time Arousal Detection and Feedback to Alleviate Social Anxiety Symptoms in an Analogue Adult Sample: Pilot Proof-of-Concept Randomized Controlled Trial

Xiangting Bernice Lin, Tih-Shih Lee, Yin Bun Cheung, Joanna Ling, Shi Hui Poon, Leslie Lim, Hai Hong Zhang, Zheng Yang Chin, Chuan Chu Wang, Ranga Krishnan, Cuntai Guan, Xiangting Bernice Lin, Tih-Shih Lee, Yin Bun Cheung, Joanna Ling, Shi Hui Poon, Leslie Lim, Hai Hong Zhang, Zheng Yang Chin, Chuan Chu Wang, Ranga Krishnan, Cuntai Guan

Abstract

Background: Exposure therapy is highly effective for social anxiety disorder. However, there is room for improvement.

Objective: This is a first attempt to examine the feasibility of an arousal feedback-based exposure therapy to alleviate social anxiety symptoms in an analogue adult sample.

Methods: A randomized, pilot, proof-of-concept trial was conducted to evaluate the acceptability, safety, and preliminary efficacy of our treatment program. Sessions were administered once a week for 4 weeks (1 hour each) to an analogue sample of 50 young adults who reported at least minimal social anxiety symptoms. Participants in both intervention and waitlist control groups completed assessments for social anxiety symptoms at the baseline, week 5, and week 10.

Results: Most participants found the intervention acceptable (82.0%, 95% CI 69.0%-91.0%). Seven (14.9%, 95% CI 7.0%-28.0%) participants reported at least one mild adverse event over the course of study. No moderate or serious adverse events were reported. Participants in the intervention group demonstrated greater improvements on all outcome measures of public speaking anxiety from baseline to week 5 as compared to the waitlist control group (Cohen d=0.61-1.39). Effect size of the difference in mean change on the overall Liebowitz Social Anxiety Scale was small (Cohen d=0.13).

Conclusions: Our results indicated that it is worthwhile to proceed to a larger trial for our treatment program. This new medium of administration for exposure therapy may be feasible for treating a subset of social anxiety symptoms. Additional studies are warranted to explore its therapeutic mechanisms.

Trial registration: ClinicalTrials.gov NCT02493010; https://ichgcp.net/clinical-trials-registry/NCT02493010.

Keywords: arousal feedback; exposure therapy; public speaking anxiety; randomized controlled trial; social anxiety.

Conflict of interest statement

Conflicts of Interest: XL, TSL, YC, LL, HZ, ZC, CW, RK, and CG received grants from the National Medical Research Council Singapore during the study. HZ, ZC, CW, and CG have a patent Closed Loop Virtual Reality Exposure Therapy for Social Anxiety Disorder Based on Arousal Detection pending. RK reports intellectual property in related areas that have been signed to Neeuro Private Limited. RK holds ownership rights in Cennerv Pharma and is the Chief Executive Officer of Rush Health System and Chairman of National Medical Research Council, Ministry of Health Singapore. RK is also on the CHS Board of Directors and Singhealth Board of Directors.

©Xiangting Bernice Lin, Tih-Shih Lee, Yin Bun Cheung, Joanna Ling, Shi Hui Poon, Leslie Lim, Hai Hong Zhang, Zheng Yang Chin, Chuan Chu Wang, Ranga Krishnan, Cuntai Guan. Originally published in JMIR Mental Health (http://mental.jmir.org), 14.06.2019.

Figures

Figure 1
Figure 1
Locally developed, noninvasive headband.
Figure 2
Figure 2
Brief arousal control game.
Figure 3
Figure 3
Virtual audience in arousal feedback–based speech task.
Figure 4
Figure 4
Consolidated Standards of Reporting Trials (CONSORT) diagram. AUDIT: Alcohol Use Disorders Identification Test; LSAS: Liebowitz Social Anxiety Scale; PSAS: Public Speaking Anxiety Scale.

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