Reward Processes and Rehearsal in Exposure Therapy

NCT06132425 | Completed Results

• 1 other identifier: IRB#23-000236
• Study Type: interventional
• Target: 88
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to 1) examine the importance of self-reported relief following exposure and 2) test whether positive-focused rehearsal following exposure can improve treatment outcomes for participants who endorse fear of public speaking. Exposure therapy is an extinction-based behavioral technique, often employed in the context of cognitive behavioral therapy. It involves strategically exposing an individual to a feared stimulus in an effort to generate new non-fear associations with that stimulus. Relief refers to the positive, rewarding emotions associated with the absence of an expected aversive outcome following exposure to a feared stimulus. In the current study, participants will engage in a series of short public speaking exposures that take place over two sessions. After every two exposures, participants will be asked to complete either a positive or neutral rehearsal exercise, consisting of recalling either positive or neutral aspects of the speech exposures. At multiple points throughout the study, participants will complete ratings of reward sensitivity, positive affect, relief, and expectancy of the aversive outcome. The investigators will test the following: 1) the relationship of reward sensitivity and positive affect with relief following exposures, 2) the relationship between relief after exposure and learning rate (i.e., learning that the feared stimulus does not predict an aversive outcome), 3) potential differences in exposure outcomes between the positive and neutral rehearsal groups.

Conditions

Anxiety Disorders; Public Speaking Fear

Keywords

anxiety; extinction; positive affect; reward sensitivity

Outcome Measures

Primary Outcomes (1)

• Change in Public Speaking Anxiety

  Responses to two self-reported questions assessing public speaking anxiety and avoidance (scored from 0-8, where higher scores reflect greater public speaking anxiety and avoidance) and responses to the Personal Report of Public Speaking Anxiety (PRPSA; scored from 34-170, where higher scores reflect greater public speaking anxiety symptom severity).

  Baseline through study completion, an average of 3 weeks.

Secondary Outcomes (5)

• Learning Rate

  Sessions 1 through 2, an average of 2 weeks.

• Relief Rate

  Sessions 1 through 2, an average of 2 weeks.

• Change in Positive Affect

  Baseline through session 2, an average of 2 weeks.

• Change in Reward Sensitivity

  Baseline through session 2, an average of 2 weeks.

• Change in Reward Sensitivity

  Baseline through session 2, an average of 2 weeks.

Study Arms (2)

Positive Rehearsal

EXPERIMENTAL

After every two exposure trials, participants will complete a rehearsal exercise prompting reflection of expectancy violation and rehearsal of the inhibitory association between the conditional stimulus (i.e., speech) and the unconditional stimulus (i.e., rejection). During rehearsal, participants are prompted to identify positive emotional experiences associated with exposure trial outcomes.

Behavioral: Exposure; Behavioral: Rehearsal

Neutral Rehearsal

ACTIVE COMPARATOR

After every two exposure trials, participants will complete a rehearsal exercise prompting reflection of expectancy violation and rehearsal of the inhibitory association between the conditional stimulus (i.e., speech) and the unconditional stimulus (i.e., rejection). During rehearsal, participants are prompted to maintain a neutral, non-emotional stance and focus on overall exposure trial outcomes.

Behavioral: Exposure; Behavioral: Rehearsal

Interventions

Exposure BEHAVIORAL

All participants complete two study visits, each consisting of 8 exposure trials for durations of 1 minute each, resulting in a total of 16 exposures. For each exposure, participants are assigned a speech topic and given 1 minute to give an unprepared speech to two study confederates.

Neutral Rehearsal; Positive Rehearsal

Rehearsal BEHAVIORAL

After every two exposures, participants will complete a rehearsal task where the participant is asked to use a positive or neutral approach to remember and recount the exposures they have just completed.

Neutral Rehearsal; Positive 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 public speaking anxiety/avoidance screening questions

Sponsors & Collaborators

• University of California, Los Angeles: lead

Study Sites (1)

University of California, Los Angeles

Los Angeles, California, 90095, United States

Location

MeSH Terms

Conditions

Anxiety Disorders; Glossophobia

Condition Hierarchy (Ancestors)

Mental Disorders

Results Point of Contact

• Title: Nora Barnes-Horowitz
• Organization: University of California, Los Angeles

nbarneshorowitz@ucla.edu

(310) 825-2961

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

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

Study Record Dates

• First Submitted: November 6, 2023
• First Posted: November 15, 2023
• Study Start: April 18, 2023
• Primary Completion: December 12, 2023
• Study Completion: December 12, 2023
• Last Updated: June 13, 2025
• Results First Posted: June 13, 2025

Record last verified: 2025-05

Locations

US (1)