Text Messages for Social Anxiety

Overseen By James M Zech, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Florida State University

Must be taking: Psychotropic medications

Disqualifiers: Psychotherapy for social anxiety

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 28

Duration: 4 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores the effectiveness of a text message-based treatment for individuals with social anxiety. It compares two approaches: one reduces behaviors that make people feel safe in social situations (Safety Behavior Fading for Social Anxiety), and the other targets unhealthy habits related to anxiety (Unhealthy Behavior Fading). Both treatments last 28 days. Individuals may qualify if they show strong signs of social anxiety and have been on the same medication for at least four weeks. As an unphased trial, this study provides a unique opportunity to contribute to innovative research and potentially benefit from new treatment strategies for social anxiety.

Do I need to stop my current medications to join the trial?

No, you don't need to stop your current medications. You must have stable psychotropic medications for 4 weeks before joining.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that both Safety Behavior Fading and Unhealthy Behavior Fading are safe for people with social anxiety. These methods involve reducing certain behaviors over 28 days using text messages.

In a small study, Safety Behavior Fading used daily text messages to help people gradually cut back on behaviors linked to social anxiety. Participants appreciated the messages, and no major negative effects were reported.

Unhealthy Behavior Fading operates similarly with text messages. Research found that this method reduced social anxiety without causing significant negative effects.

Both treatments have been tested in previous studies and have not raised major safety concerns. They focus on gradually changing behaviors, which participants seem to handle well. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for social anxiety because they focus on fading out behaviors rather than relying on medication or traditional therapy. The Safety Behavior Fading approach encourages participants to gradually reduce their reliance on behaviors that shield them from social anxiety, potentially leading to more sustainable improvement. Similarly, the Unhealthy Behavior Fading method targets behaviors that may worsen anxiety, promoting healthier habits over time. These innovative approaches could offer new, non-pharmacological options for people seeking practical strategies to manage social anxiety.

What evidence suggests that this trial's treatments could be effective for social anxiety?

Research has shown that both Safety Behavior Fading and Unhealthy Behavior Fading, studied in this trial, can help reduce social anxiety. Participants will receive one of these treatments. One study found that Safety Behavior Fading was more effective at reducing these behaviors and lowering social anxiety levels compared to a group that did not receive this treatment. Unhealthy Behavior Fading also showed promise in reducing social anxiety over time. Both treatments use text messages to help participants gradually cut back on certain behaviors. These findings suggest that focusing on small behavior changes can improve social anxiety symptoms. ^{1 2 3 4 6}

Are You a Good Fit for This Trial?

This trial is for individuals with social anxiety, as indicated by a score greater than 29 on the Social Phobia Inventory. Participants must have been on stable psychotropic medications for at least four weeks and should not be currently receiving psychotherapy specifically for social anxiety.

Inclusion Criteria

My mental health medications have been the same for the last 4 weeks.

Social Phobia Inventory Score >29

Exclusion Criteria

I am currently in therapy for social anxiety.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive daily text message interventions to fade safety or unhealthy behaviors over 28 days

4 weeks

Daily virtual check-ins via text message

Follow-up

Participants are monitored for changes in social anxiety and related symptoms after treatment

4 weeks

Assessments on Day 28 and Day 56

What Are the Treatments Tested in This Trial?

Interventions

• Safety Behavior Fading for Social Anxiety
• Unhealthy Behavior Fading

Trial Overview

The study is testing a text message-based intervention designed to reduce safety behaviors that people with social anxiety might rely on. It's being compared to an active control group to measure its effectiveness in managing symptoms of social anxiety.

How Is the Trial Designed?

Group I: Experimental: Safety Behavior Fading Experimental Treatment 1 Intervention

This treatment lasts a total of 28 days. Participants will be asked to identify common safety behaviors related to social anxiety. For the next 14 days, participants will receive instructions to fade out these behaviors. After 14 days, participants will be asked to re-select their target safety behaviors and continue to reduce them over the next two weeks.

Group II: Unhealthy Behavior Fading Active Control 1 Intervention

This treatment lasts a total of 28 days. Participants will be asked to identify common unhealthy behaviors related to social anxiety. For the next 14 days, participants will receive instructions to fade out these behaviors. After 14 days, participants will be asked to re-select their target unhealthy behaviors and continue to reduce them over the next two weeks.

Who Is Running the Clinical Trial?

Florida State University

Lead Sponsor

Trials

234

Recruited

41,100+

Published Research Related to This Trial

Safety behaviors, which are used by individuals with social anxiety disorder (SAD) to cope with anxiety in social situations, can actually maintain and worsen social anxiety over time by preventing the disconfirmation of negative beliefs about social interactions.

Reducing the use of safety behaviors during exposure therapy can enhance treatment outcomes for SAD, as highlighted by a review of research that builds on earlier findings from Wells and colleagues, indicating the importance of addressing these behaviors in therapeutic settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety Behaviors in Adults With Social Anxiety: Review and Future Directions. Piccirillo, ML., Taylor Dryman, M., Heimberg, RG.[2018]

A study involving 133 adults who stutter found that nearly all participants (132) reported using safety behaviors during social interactions, which are strategies intended to prevent negative outcomes.

The use of these safety behaviors was linked to higher levels of fear of negative evaluation and negative thoughts about stuttering, suggesting that these behaviors may contribute to maintaining anxiety and hinder effective treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety Behaviors and Stuttering. Lowe, R., Helgadottir, F., Menzies, R., et al.[2018]

The Subtle Avoidance Frequency Examination (SAFE) is a newly developed tool that effectively assesses safety-seeking behaviors in individuals with social anxiety, showing strong internal consistency and good construct validity.

The SAFE can differentiate between clinical and non-clinical participants and is responsive to treatment effects, making it a valuable resource for studying safety strategies in social anxiety and evaluating treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: development and psychometric properties. Cuming, S., Rapee, RM., Kemp, N., et al.[2009]

A study involving 115 participants with social anxiety disorder found that a two-week intervention to reduce safety behaviors (SBs) significantly decreased social anxiety symptoms compared to a control group.

The SB fading intervention also modestly increased participants' self-reported openness to self-disclosure and led to greater observer-rated disclosure during a speech task, particularly among those who were already more open by nature.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of safety behavior fading on social anxiety and emotional disclosure. Stentz, LA., Cougle, JR.[2022]

Individuals with generalized social anxiety disorder (SAD) performed significantly worse in a speech task compared to healthy controls, indicating that SAD negatively impacts performance skills.

The use of safety behaviors during the speech was found to mediate the relationship between SAD diagnosis and performance ratings, suggesting that reducing these behaviors should be a key focus in cognitive behavioral therapy for improving outcomes in SAD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A false sense of security: safety behaviors erode objective speech performance in individuals with social anxiety disorder. Rowa, K., Paulitzki, JR., Ierullo, MD., et al.[2018]

In a study of 134 socially anxious adolescents aged 14 to 15, those who used more safety behaviors showed greater psychosocial impairments and evaluative fears compared to their peers.

The research indicates that high levels of safety behaviors are linked to observable deficits in social skills during interactions, suggesting that these behaviors may hinder effective social functioning in adolescents with social anxiety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adolescent Safety Behaviors and Social Anxiety: Links to Psychosocial Impairments and Functioning with Unfamiliar Peer Confederates. Okuno, H., Rezeppa, T., Raskin, T., et al.[2022]

A new transdiagnostic measure for assessing safety behaviors in adolescents was developed and validated, providing a useful tool for future research.

In a study of 51 anxious and depressed adolescents, it was found that reducing safety behaviors is linked to improved treatment outcomes, highlighting the importance of addressing these behaviors in therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychometric Properties of the Safety Maneuver Scale for Adolescents (SMS-A) and Relationship to Outcomes of a Transdiagnostic Treatment. Kennedy, SM., Ehrenreich-May, J.[2020]

Individuals with social anxiety disorder (SAD) preferred using voice/text mediums over visual mediums for social interactions, but using visual mediums led to immediate increases in positive perceptions and emotions.

The study, which involved 88 participants over 21 days, suggests that incorporating visual mediums into exposure interventions could enhance emotional responses and perceptions in individuals with SAD, potentially aiding in their treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Medium is the Message: Effects of Mediums of Communication on Perceptions and Emotions in Social Anxiety Disorder. Oren-Yagoda, R., Aderka, IM.[2021]

A study involving 94 individuals with elevated social anxiety demonstrated that a text message intervention aimed at reducing safety behaviors (SBs) significantly decreased both the frequency of these behaviors and social anxiety symptoms over a 1-month period.

The results suggest that targeting the elimination of safety behaviors through brief text reminders can be an effective and accessible treatment strategy for managing social anxiety disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text message safety behavior reduction for social anxiety: A randomized controlled trial. Cougle, JR., Mueller, NE., McDermott, KA., et al.[2020]

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