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Completed

NCT Number: NCT07009444

The Role of Mental Imagery on Approach Motivation and Behavioral Engagement in Social Anxiety

Efficacy of an online intervention aimed at enhancing both approach motivation and behavioral engagement in facing anxiety-provoking social situations among individuals with heightened social anxiety is investigated. Upon receiving psychoeducation, participants will either undergo a prospective mental-imagery task or no additional task. The intervention's efficacy will be assessed by ratings of experienced and expected pleasure, approach motivation as well as self-reported engagement with feared situation one week later.

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Key information

Conditions

Social Anxiety Anxiety Disorders Mental Disorders Phobia, Social Phobic Disorders Social Phobia

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Germany Philipps University

Marburg, 35037, Germany

About this study

Although exposure therapy is widely considered the gold standard for treating anxiety disorders, its effectiveness is often hindered by treatment discontinuation. Many individuals avoid facing feared situations, yet exposure is crucial for successful extinction learning. Therefore, there is a need for strategies to enhance both approach motivation and behavioral engagement in anxiety-provoking situations. Within the depression literature, imagery-based interventions have already gained some support in increasing motivation and behavioral engagement in pleasurable activities through enhancement of reward anticipation as well as anticipatory and anticipated pleasure ('motivational amplifier' hypothesis). Considering that social anxiety is characterized by disruptions in motivational and reward processes, prospective mental imagery may strengthen approach motivation and behavioral engagement in exposure to socially feared situations. Thus, the present online study will investigate the effect of a prospective mental-imagery task on approach motivation and behavioral engagement in socially anxious individuals. Following psychoeducation, participants in the experimental group will vividly imagine having successfully mastered the fear-provoking situation. The control group will receive only psychoeducation. Approach motivation as well as reward anticipation, anticipated and anticipatory pleasure will be assessed before and after the psychoeducation and imagery task. Engagement with the feared social situation will be assessed one week later. The aim of this randomized controlled trial in healthy individuals with heightened social anxiety is to investigate whether prospective mental imagery is effective in enhancing self-reported motivation and engagement with feared situation compared to a psychoeducation-only control group. In an exploratory analysis, we will investigate whether individuals' levels of reward sensitivity and anhedonia influence the effectiveness of prospective imagery training.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Elevated score on Mini-Social Phobia Inventory (Mini-SPIN) > 6

Exclusion criteria

-

Treatment and study plan

Psychoeducation

Behavioral

Providing information about social anxiety, role of safety and avoidance behaviors in maintaining social anxiety, rationale for exposure to feared social situations

Prospective Mental Imagery

Behavioral

A standard imagination script is recounted in which participants have successfully mastered the socially feared situation

Primary outcomes

  1. Anticipatory Pleasure

    Time frame: Baseline (prior to the assigned intervention) and immediately post-intervention (following prospective mental imagery or psychoeducation)

    2-item questionnaire on a scale 0 (not at all) to 100 (extremely) assessing current pleasure when imaging approaching and having approached the feared situation.

  2. Anticipated Pleasure

    Time frame: Baseline (prior to the assigned intervention) and immediately post-intervention (following prospective mental imagery or psychoeducation)

    2-item questionnaire on a scale 0 (not at all) to 100 (extremely) assessing expected pleasure when approaching and having approached the feared situation.

  3. Reward Anticipation

    Time frame: Baseline (prior to the assigned intervention) and immediately post-intervention (following prospective mental imagery or psychoeducation)

    2-item questionnaire on a scale 0 (not at all) to 100 (extremely) assessing expected reward related to approaching and having approached the feared situation.

  4. Motivation

    Time frame: Baseline (prior to the assigned intervention) and immediately post-intervention (following prospective mental imagery or psychoeducation)

    Self-reported motivation to approach the feared situation on a scale of 0 (not at all) to 100 (extremely).

  5. Frequency of Exposure

    Time frame: Post-treatment (i.e., 7 days after baseline)

    Self-reported frequency of exposure to the feared situation. Scale: 0 to 10, indicating the frequency of exposure to the feared situation.

Secondary outcomes

  1. Social Phobia Inventory (SPIN)

    Time frame: Change from baseline to post-treatment (i.e., 7 days)

    17-item questionnaire on a 5-point Likert scale (0 = 'not at all'; 4 = 'extremely') assessing symptom severity related to social anxiety (i.e., fear, avoidance, physical symptoms). Total range score: 0 to 68. Higher scores indicating greater severity of social anxiety.

  2. Liebowitz Social Anxiety Scale (LSAS)

    Time frame: Change from baseline to post-treatment (i.e., 7 days)

    24-item questionnaire on a 4-point Likert scale (fear: 0 = 'none'; 3 = 'severe'; avoidance: 0 = 'never'; 3 = 'usually') assessing both fear/anxiety and avoidance of social situations, respectively. Total range score: 0 to 144. Higher scores indicating greater fear and avoidance as well as severity of social anxiety.

  3. Patient Health Questionnaire-9 (PHQ-9)

    Time frame: Change from baseline to post-treatment (i.e., 7 days)

    9-item questionnaire on a 4-point Likert scale (0 = 'not at all'; 3 = 'nearly every day') assessing the presence and severity of depressive symptoms. Total range score: 0 to 27. Higher scores indicating more severe depression.

  4. Positive and Negative Affect Schedule (PANAS)

    Time frame: Change from baseline to post-treatment (i.e., 7 days)

    20-item questionnaire on a 5-point Likert scale (0 = 'not at all'; 4 = 'extremely') assessing the presence and intensity of both positive and negative emotions. Total score range for positive affect (PA) and negative affect (NA), respectively: 0 to 50. Higher scores indicate on either scale indicate a higher level of that emotion.

  5. BIS/BAS Scales

    Time frame: Baseline

    24-item questionnaire on a 4-point Likert scale (1 = 'strongly disagree'; 4 = 'strongly agree') assessing an individual's tendency toward reward-seeking and punishment-avoidance behavior. Total score range BIS: 7 to 25. Higher scores indicating an increased sensitivity to threats or punishment (BIS). Total score range BAS: 13 to 52. Higher scores indicating a greater propensity to seek rewards and engage in approach behavior.

  6. Temporal Experience of Pleasure Scale (TEPS)

    Time frame: Baseline

    18-item questionnaire on a 6-point Likert scale (1 = 'strongly disagree'; 6 = 'strongly agree') assessing anticipatory and consummatory pleasure. Total score range: 18 to 108. Higher total scores indicating a greater capacity for pleasure.

  7. Vividness of Mental Imagination

    Time frame: Immediately after prospective mental imagery at baseline

    Vividness of imagination on a scale from 0 (not at all) to 100 (extremely vivid) assessed immediately after imagination exercise.

Sponsors and collaborators

Lead sponsor

Philipps University Marburg

Other

Registry information

Important dates

Study start
2023
Primary completion
2023
Study completion
2023
First posted
Jun 6, 2025
Registry last updated
Jan 9, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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