Optimizing Exposure Therapy With Mental Rehearsal

NCT03934385 | Completed DMC

• 1 other identifier: AM74RL539
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

Treatment response rates for cognitive behavioral therapy (CBT) across anxiety disorders average approximately 50% post-treatment (Loerinc et al, 2015), evidencing significant 'return of fear', the re-emergence of a partially or fully extinguished fear (Rachman, 1989). Thus, recent research has amplified efforts toward improving treatment methodology in an attempt to optimize clinical outcomes. Many efforts have targeted exposure therapy, an evidence-based behavioral technique during which a patient is strategically and repeatedly exposed to his or her feared stimulus in an effort to generate new non-fear associations with that stimulus. One such effort involves mental rehearsal, where information is reinstated using either a cue from extinction training or imaginal recounting of previous successful exposures (Craske et al, 2014). Prior research has assessed the effects of mental rehearsal via reinstatement of the extinction context (i.e., treatment context) or of cues/items from the treatment context that may indicate safety (e.g., Mystkowski et al, 2006; Culver, Stoyanova, \& Craske, 2011). However, this research has produced inconsistent results and contains an inherent limitation, as retrieval cues may become a safety signal and inhibit new learning (Dibbets, Havermans, \& Arntz, 2008). In an effort to address these limitations, the current study recruits spider-fearful participants for a treatment trial consisting of exposures in conjunction with either a mental rehearsal intervention, or a control rehearsal intervention. The overarching goal of this project is to evaluate the extent to which a between-session, technology-guided mental rehearsal intervention may optimize exposure therapy outcomes. We also seek to evaluate potential mechanisms of mental rehearsal. Participants complete three laboratory visits, including two sessions of exposures with live spiders. Participants are randomized to either a mental rehearsal or control rehearsal condition to measure potential mechanisms and moderators of mental rehearsal. Laboratory-based assessments include measures of subjective, behavioral, and psychophysiological responses to spiders.

Conditions

Anxiety Disorders; Arachnophobia

Keywords

anxiety; consolidation; extinction; mental rehearsal

Outcome Measures

Primary Outcomes (6)

• Spider Phobia Questionnaire (SPQ; Klorman et al, 1974)

  31-item true/false questionnaire assessing symptoms of arachnophobia. Scores range from 0 to 31, with greater scores representing greater fear of spiders. Spider phobic individuals have obtained mean scores of 23.20 (SD = 2.90) and 23.76 (SD = 3.80) on the SPQ (Klorman et al, 1974; Murris \& Merckelbach, 1996).

  Change from baseline to post-treatment (i.e., 8-10 days)

• Behavioral Approach Test (BAT) steps

  Number of test steps fully completed

  Change from baseline to post-treatment (i.e., 8-10 days)

• SCR anticipation

  Change in SCR from baseline to BAT anticipation

  Change from baseline to post-treatment (i.e., 8-10 days)

• SCR across BAT steps

  SCR during each 30-second test step fully completed

  Change from baseline to post-treatment (i.e., 8-10 days)

• Confidence ratings

  Repeated confidence ratings on a scale from 0 (no confidence) to 100 (complete confidence) recorded throughout BAT

  Change from baseline to post-treatment (i.e., 8-10 days)

• Distress ratings

  Repeated anticipatory and maximum distress ratings on a scale from 0 (no distress) to 100 (severe distress) recorded throughout BAT

  Change from baseline to post-treatment (i.e., 8-10 days)

Secondary Outcomes (6)

• Depression Anxiety Stress Scales (DASS-21; Lovibond & Lovibond, 1995)

  Baseline

• Pittsburgh Sleep Quality Index (PSQI; Buysse et al, 1989)

  Baseline

• Aerobic exercise

  Baseline

• Surprise

  Session 1 and Session 2 (i.e., 3 days)

• US expectancy

  Session 1 and Session 2 (i.e., 3 days)

Study Arms (2)

Mental Rehearsal

EXPERIMENTAL

Between-session rehearsal/retrieval exercises focused upon consolidating non-fear learning gained from exposures by prompting reflection of expectancy violation and rehearsal of the inhibitory association between the conditioned stimulus (i.e., spider) and unconditioned stimulus (e.g., bite/attack).

Behavioral: Mental Rehearsal; Behavioral: Exposure

Control Rehearsal

ACTIVE COMPARATOR

Between-session rehearsal/retrieval exercises focused upon an unrelated, recent academic experience.

Behavioral: Exposure

Interventions

Mental Rehearsal BEHAVIORAL

After each exposure session, participants complete three rehearsal/retrieval exercises that involve viewing images of spiders and completing multiple-choice and free-response questions. Exercises involve retrieving information specific to the spider exposures, reflecting on the experience, and highlighting expectancy violation (i.e., that the participant's feared outcome did not occur).

Also known as: mental retrieval

Mental Rehearsal

Exposure BEHAVIORAL

All participants complete two exposure sessions. The first set of exposures consists of ten 30-second trials hovering one's hand 3 inches over a live tarantula. The second set of exposures consists of ten 30-second trials placing one's hand inside the spider's terrarium with all five fingertips touching the bottom.

Control Rehearsal; Mental Rehearsal

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• English-speaking
• Elevated score on Spider Phobia Questionnaire (SPQ)

You may not qualify if:

• Severe allergies to bees/spiders/insects

Sponsors & Collaborators

• University of California, Los Angeles: lead

Study Sites (1)

University of California, Los Angeles

Los Angeles, California, 90095, United States

Location

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MeSH Terms

Conditions

Anxiety Disorders; Arachnophobia

Condition Hierarchy (Ancestors)

Mental Disorders

Study Officials

• Anastasia L McGlade, MA

  University of California, Los Angeles

  PRINCIPAL INVESTIGATOR

• Michelle G Craske, PhD

  University of California, Los Angeles

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: April 25, 2019
• First Posted: May 1, 2019
• Study Start: October 23, 2018
• Primary Completion: November 26, 2019
• Study Completion: November 26, 2019
• Last Updated: December 18, 2019

Record last verified: 2019-12

Locations

US (1)