Attention Disengagement Training for Social Phobia

描述（由申请人提供）：广泛性社交恐惧症（GSP）的特征在于导致功能障碍的严重社交焦虑（Schneider等人，1992年）。GSP的患病率为13.3%（终生，Kessler等人，1994年），在所有精神疾病中排名第三。尽管其患病率很高，但超过30%的需要治疗的社交焦虑症患者由于各种原因（例如，害怕别人会怎么想，Olfson等人，2000年）。此外，40%的接受治疗的个体没有反应（39% Heimberg等人，1998; 42%，Liebowitz等人，2005年）。因此，显然需要开发用于社交恐惧症的高度有效和高效的治疗程序。这项为期三年的提案旨在通过一项双盲、安慰剂对照的研究来测试一种针对社交焦虑症的计算机化治疗方法。具体来说，研究表明，社交恐惧症患者会将注意力集中在与社交相关的负面信息上。因此，治疗将集中在改变这种注意力偏差，从而减轻社交焦虑的症状。我们提出了一个试点研究的结果（n=26）在寻求治疗社交恐惧症的个人证明治疗的有效性。一项更大规模的研究将使我们能够测试这种治疗方法，并可能修改其成分以提高其疗效。试点的初步结果令人鼓舞。简而言之，我们的干预在以下方面是有效的：a）改变社交焦虑个体的偏向注意力，B）将注意力脱离威胁的这种变化推广到其他注意力脱离的措施，c）减少由独立评定者评估的社交焦虑症状，d）保持高依从率（试点研究中0%脱落），以及e）在长达一年的随访评估中保持其效果。这种改变社交恐惧症注意力偏差的有效技术可以提供一种基于基础认知科学的具有成本效益且易于管理的治疗方法，并可能有助于减少GSP患者的痛苦。我们将在本提案中检验两个假设。1)与安慰剂组相比，完成注意力脱离训练（ADT）的GSP个体在社交焦虑的面试官测量（Liebowitz社交焦虑量表，LSAS）上表现出更大的症状减轻。2)与安慰剂组相比，GSP完成ADT的个体在社交焦虑症状的自我报告中表现出更大的减少。

DESCRIPTION (provided by applicant): Generalized Social Phobia (GSP) is characterized by severe social anxiety that leads to functional impairment (Schneider, et al., 1992). The prevalence of GSP is 13.3% (lifetime, Kessler, et al., 1994), ranking third among all psychiatric disorders. Despite its high prevalence, over 30% of individuals with social anxiety who need treatment do not receive treatment for a variety of reasons (e.g., afraid of what others might think, Olfson, et al., 2000). Additionally, 40% of individuals who present for treatment do not respond (39% Heimberg, et al., 1998; 42%, Liebowitz et al., 2005). Thus, there is a clear need to develop highly effective and efficient treatment procedures for social phobia. This three-year proposal aims to test a computerized treatment for social anxiety in a double-blind, placebo-controlled study. Specifically, research suggests that individuals with social phobia direct their attention toward socially-relevant negative information. Therefore, the treatment will focus on changing this attention bias and thereby alleviate symptoms of social anxiety. We present the results of a pilot study (n=26) in treatment seeking socially phobic individuals demonstrating the effectiveness of the treatment. A larger study would allow us to test the treatment and perhaps modify its component to increase its efficacy. The preliminary results of the pilot are encouraging. In brief, our intervention was effective in: a) changing biased attention in socially anxious individuals, b) generalizing this change in disengagement of attention from threat to other measures of attention disengagement, c) reduce symptoms of social anxiety as assessed by an independent rater, d) maintain a high rate of compliance (0% drop out in the pilot study), and e) maintain its effects in follow-up assessment up to one year. This efficient and efficacious techniques for changing attention bias in social phobia can provide a cost-effective and easy to administer treatment that is grounded in basic cognitive science and may help reduce suffering in individuals with GSP. We will test two hypotheses in this proposal. 1) Individuals with GSP completing the Attention Disengagement Training (ADT) will show a larger reduction in their symptoms compared to the placebo group on an interviewer measure of social anxiety (Liebowitz Social Anxiety Scale, LSAS). 2) Individuals with GSP completing ADT will show a larger reduction in their self-report of social anxiety symptoms compared to the placebo group.