Modifying dysfunctional beliefs in social anxiety disorder with an emotion-focused approach-avoidance modification training – a feasibility study

Dysfunctional beliefs are one key factor in the development and maintenance of social phobia. Modifying the appraisal of such beliefs might be achieved with the help of approach-avoidance modification trainings (AAMTs). In these trainings individuals are instructed to push dysfunctional stimuli away and pull functional ones toward themselves via joystick- or swipe-based push/pull-movements. However, the efficacy of the AAMTs could be enhanced by using high-valence words as well as facial expressions of emotions as approach/avoidance responses. The present study aimed to examine the safety and feasibility of an emotion-focused AAMT (eAAMT) targeting dysfunctional beliefs. We conducted a feasibility study with a sample of 10 participants with social anxiety. With regard to acceptability, not all predefined cutoffs where met, indicating need for further optimization of the intervention. Regarding the therapeutic potential, the social anxiety symptom severity decreased with a large effect size (g = 0.89 [0.66, 1.79]) from T1 to T2 and with a moderate effect size (g = 0.72 [0.38, 1.31]) from T1 to T3. Thus, the results of the study confirmed the clinical safety and technical feasibility of delivering the eAAMT in a laboratory setting, albeit within a Wizard-of-Oz paradigm. Furthermore, results provide preliminary evidence for its potential efficacy.Preregistration: https://osf.io/d4ye2/overview.