Recruiting

Reward Processing

Sponsor:

UCLA

Code:

NCT06776991

Conditions

Social Anxiety Disorder (Social Phobia)

Public Speaking Anxiety

Anhedonia

ANXIETY DISORDERS (or Anxiety and Phobic Neuroses)

Phobic Disorders

Eligibility Criteria

Sex: All

Age: 18 - 60

Healthy Volunteers: Not accepted

Interventions

Positive Affect Treatment - Behavioral (PAT-B)

Relaxation Treatment

Exposure Therapy

Study Details

Brief summary:

The investigators are conducting a clinical trial of therapy for public speaking anxiety. There are many eligibility criteria, but the main ones are that participants need to be socially anxious and have public speaking anxiety. In this clinical trial, all participants will do exposure therapy. Before doing exposure therapy in the study, though, participants will be randomized to do one of two treatments: i) a positive mood treatment, which is designed to increase how positive people feel, and ii) a relaxation treatment, which is designed to help people feel more relaxed. The investigators are doing this study to see whether doing the positive mood treatment or relaxation treatment first will affect how well exposure therapy works.

Conditions

Social Anxiety Disorder (Social Phobia)

Public Speaking Anxiety

Anhedonia

ANXIETY DISORDERS (or Anxiety and Phobic Neuroses)

Phobic Disorders

Study ID

NCT06776991

Start date

Sep 26, 2024

Status verified date

Mar, 2026

Completion date

Apr 30, 2029

Anticipated

Primary completion date

Apr 30, 2029

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: All

Age: 18 - 60

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • Diagnosis of social anxiety disorder from the Structural Clinical Interview for DSM 5.
  • Elevated fear of public speaking, defined as a score of >= 66 (+1SD from the mean of population norms on a scale of 17-85) on the Public Speaking Anxiety Scale (PSAS; Bartholomay, E. M., \& Houlihan, D. D. (2016). Public Speaking Anxiety Scale: Preliminary psychometric data and scale validation. Personality and individual differences, 94, 211-215), which is a self-report scale measuring anxiety of public speaking.
  • Low reward processing, defined as a score of <56 (less than the population mean) on the Dimensional Anhedonia Rating Scale (DARS) (Rizvi, S. J., Quilty, L. C., Sproule, B. A., Cyriac, A., Bagby, R. M., \& Kennedy, S. H. (2015). Dimensional Anhedonia Rating Scale (DARS) \[Database record\]. APA PsycTests).
  • Medication-free or stabilized on psychotropic medications for a minimum standard length of time (1 month for benzodiazepines and beta blockers, 3 months for SRIs/SNRIs and heterocyclics).
  • Psychotherapy-free or stabilized on alternative psychotherapies other than cognitive or behavioral therapies that were not focused on their anxiety disorder for at least 6 months prior to study entry.
  • Age 18-60.
  • Fluent in English.
  • To conduct MRI version of fear conditioning task, must have no MRI contraindications.

Exclusion Criteria (none of the following):

  • Recent suicidal ideation with intent or plan - defined as suicidal ideation with intent or plan in the past year.
  • Lifetime history of suicide attempts.
  • History of bipolar disorder, psychosis, intellectual disability, or organic brain damage.
  • Substance use disorder within the last 6 months.
  • Major respiratory, cardiovascular, pulmonary, neurological, or muscular-skeletal diseases.
  • Pregnant or planning to become pregnant for next 6 months.

Study Design

Enrollment

94 participants

Anticipated

Allocation

Randomized

Intervention Model

Parallel Assignment

Primary purpose

Treatment

Interventions and Outcome Measures

Arms

experimental: Positive Affect Treatment - Behavioral (PAT-B)

Focused on improving reward processing and anhedonia using PAT-B. Expected to reduce negative affect and increase positive affect. Then, exposure therapy to reduce public speaking anxiety.

active comparator: Relaxation Treatment

Focused on relaxation and mindfulness using Relaxation Treatment. Expected to reduce negative affect. Then, exposure therapy to reduce public speaking anxiety.

Interventions

Positive Affect Treatment - Behavioral (PAT-B)

8 therapy sessions conducted individually with a therapist. Focuses on improving reward processing to increase positive emotional experience. Specific techniques include psychoeducation on mood cycle and positive emotions, mood monitoring, behavioral activation, and imaginal recounting and savoring of behavioral activation events. Intervention includes between-session practice.

Relaxation Treatment

8 therapy sessions conducted individually with a therapist. Focuses on mindfulness and relaxation skills. Specific techniques include mindfulness approaches from dialectical behavior therapy, diaphragmatic breathing, and progressive muscle relaxation. Intervention includes between-session practice.

Exposure Therapy

8 therapy sessions conducted individually with a therapist using the inhibitory retrieval model of exposure therapy. Sessions are designed to include four exposures each (32 exposures total). Each exposure is a public speech delivered to an audience. Goal of this treatment is to reduce public speaking anxiety. Principles of exposure therapy that will be incorporated are maximizing prediction error, maintaining attention to the situation/stimuli that are perceived predictors of the feared outcome (e.g., social rejection), removing safety signals, variability, engaging in post-exposure rehearsal/consolidation, deepened extinction, and positive occasion setter extinction. Intervention does not include between-session practice.

Primary outcome measure

  • Public Speaking Anxiety Scale (PSAS) [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). Also Sessions 2, 4, 6, 8 of each therapy (corresponding to ~weeks 1, 2, 3, 4, 7, 8, 9, 10). ]
  • Behavioral Approach Task - Anxiety [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]
  • Behavioral Approach Task - Likelihood Expectancy [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]
  • Behavioral Approach Task - Severity Expectancy [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]
  • Behavioral Approach Task - Like/Dislike of Speech [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]
  • Behavioral Approach Task - Skin Conductance [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]
  • Behavioral Approach Task - Electrocardiography HF-HRV [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]
  • Behavioral Approach Task - Electrocardiography RMSSD HRV [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]
  • Behavioral Approach Task - Electrocardiography LF/HF-HRV [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]
  • Behavioral Approach Task - Speech Duration [ Time Frame: Pre Tx (week 0), Post Tx-1 (after PAT-B or Relaxation Treatment) (~week 6), Post Tx-2 (after Exposure Therapy) (~week 12), 3-Month Follow-Up (~week 24). ]

Central Contacts and Locations

Central contacts

Tomislav D Zbozinek, PhD

6027502348tzbozinek@ucla.edu

Locations

University of California, Los Angeles

Recruiting

Los Angeles, California, United States, 90024

Contacts

Tomislav D Zbozinek, PhD

6027502348tzbozinek@ucla.edu

University of California, Los Angeles

Recruiting

Los Angeles, California, United States, 90024

Contacts

Tomislav D Zbozinek, PhD

310-206-9191tzbozinek@ucla.edu

More Information

Sponsor

University of California, Los Angeles

Last update posted

Apr 2, 2026

Last verified

Mar, 2026

Keywords

  • Exposure Therapy
  • Anxiety
  • Social Anxiety
  • Public Speaking Anxiety
  • Anhedonia
  • Reward Processing
  • Inhibitory Retrieval
  • Positive Affect Treatment
  • Relaxation Treatment

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-09. This information was provided to ClinicalTrials.gov by University of California, Los Angeles on 2026-04-02.