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Trial registered on ANZCTR
Registration number
ACTRN12611001279910
Ethics application status
Approved
Date submitted
12/12/2011
Date registered
13/12/2011
Date last updated
15/12/2015
Type of registration
Prospectively registered
Titles & IDs
Public title
Enhancing cognitive behavioural treatment outcomes for social phobia
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Scientific title
In adults with a Diagnostic and Statistical Manual of Mental Disorders (DSM) IV diagnosis of Social Phobia, does a motivational interviewing intervention prior to a cognitive behavioural treatment (CBT) compared to a supportive counselling intervention prior to CBT, enhance changes in engagement with treatment and social phobia symptoms?
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Secondary ID [1]
273350
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None
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Universal Trial Number (UTN)
U1111-1125-7230
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Social Phobia
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Condition category
Condition code
Mental Health
279312
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0
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Anxiety
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Motivational interviewing (MI), cognitive-behavioural treatment (CBT).
Motivational interviewing will occur in weeks 1-3. Cognitive behavioural treatment will occur in weeks 4-15.
All treatment sessions will be conducted by clinical psychologists.
The MI sessions will be based on the principles of motivational interviewing outlined in Westra & Dozois (2008) with a focus on ambivalence about anxiety change and about the treatment procedures used to effect change. The program will be based on the four main principles of MI (empathy, rolling with resistance, developing discrepancy and enhancing self-efficacy). Homework exercises are optional. MI will be delivered on an individual basis for one hour per week for three weeks.
The CBT program includes the basic principles of standard CBT such as cognitive restructuring, exposure and skills training. In addition, it includes components of attentional training, cognitive change at the schema level, detailed focus on dropping safety behaviours and extensive performance feedback to increase the participant's perceptions of their performance and modify their normally negative self-evaluations to be more consistent with those of independent observers. A major component of the technique utilises video feedback following performance of a role play in group. These exercises are then reinforced during exposure by identifying novel methods of obtaining feedback in the real world. The skills learned in session are practised by participants in weekly homework exercises. CBT will be delivered in a group format for 2.5 hours once a week for 12 weeks.
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Intervention code [1]
283693
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Behaviour
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Comparator / control treatment
Supportive counselling; CBT.
Supportive counselling will be delivered in weeks 1-3 and CBt in weeks 4-15. All treatments will be delivered by clinical psychologists.
Supportive counselling will be centred on the time course of social anxiety. Therapists will be explicitly instructed to steer away from discussing the impact of social anxiety, motivation for treatment, expectations regarding treatment and CBT skills. Rather the therapist will focus on the participant’s childhood and family of origin and features of their development.
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Control group
Active
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Outcomes
Primary outcome [1]
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% or participants meeting diagnostic criteria for social phobia as assessed by the Anxiety Disorders Interview Schedule
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Assessment method [1]
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Timepoint [1]
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At baseline, post intervention and 6 months after completion of the intervention.
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Secondary outcome [1]
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Mean scores on the Social Phobia Scale/Social Interaction Anxiety Scales which assess fear and avoidance of situations where there is the prospect of being observed by others and distress when meeting or talking to other people (interaction fears)
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Assessment method [1]
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Timepoint [1]
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At baseline, post intervention and 6 months after completion of the intervention
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Secondary outcome [2]
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Mean Homework Ratings as measured by the Homework rating Scale which assesses participant understanding, completion, and barriers to completion of homework tasks set on a weekly basis.
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Assessment method [2]
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Timepoint [2]
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At the beginning of each treatment session other than the first session.
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Eligibility
Key inclusion criteria
People who meet DSM-IV criteria for social phobia. If multiple anxiety disorders are present, social phobia must be the principal diagnosis based on severity and life interference.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
current, active suicidal ideation; organic mental disorders; comorbid psychotic disorder; unmanaged substance dependence. Participants will be required to be fluent in their use of English.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Participants who contact the Emotional Health Clinic and who are assessed to meet the inclusion and exclusion criteria will be invited to participate in the study. Participants will agree to participate will be randomly allocated to receive either 3 session of motivational interviewing or three sessions of supportive counselling prior to 12 weeks of CBT.
The assignment of individuals to each block will be conducted by administrative staff via opaque envelopes at the clinic who will remain blind to the treatment condition allocated to each block throughout the study.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A random number generator will be used to allocate groups of 8 participants (to allow for group-delivery of the CBT component) to either motivational interviewing prior to CBT or supportive counselling prior to CBT..
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/02/2012
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Actual
8/02/2012
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Date of last participant enrolment
Anticipated
1/02/2015
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Actual
1/02/2015
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
250
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Accrual to date
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Final
211
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health & Medical Research Council
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Address [1]
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National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Dr Lorna Peters
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Address
Centre for Emotional Health
Department of Psychology
Macquarie University
Balaclava Rd
North Ryde NSW 2109
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
269130
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Macquarie University Human Research Ethics Committee
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Ethics committee address [1]
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Level 3, Research HUB C5C East, Macquarie University NSW 2109 Australia
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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09/11/2011
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Approval date [1]
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13/12/2011
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Ethics approval number [1]
286135
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Summary
Brief summary
Several research groups from around the world, including our own group at the Centre for Emotional Health (Macquarie University), have demonstrated the efficacy of theoretically derived cognitive behavioural treatment (CBT) protocols for Social Phobia (Clark et al, 2003; 2006; Rapee, Gaston, & Abbott, 2009). However, despite the effective treatments available there is evidence that treatment outcomes are still less than optimal due to poor engagement and motivation for treatment. For example, Issakidis & Andrews (2004) found that around 30% of clients presenting for CBT group treatment for social phobia did not commence treatment, and a further 10% discontinued their treatment. Similarly, in a large trial in our own clinic, 18% of clients who commenced treatment for social phobia discontinued after less than 3 sessions (Rapee et al, 2009). This suggests that strategies that promote engagement with and motivation for treatment may further enhance treatment outcomes. One approach that has received attention, particularly in the substance use disorders, is motivational interviewing (MI; Miller & Rollnick, 2002). This approach aims to enhance motivation for change and focuses on ambivalence about embarking upon treatment that might lead to clients not engaging fully in, or dropping out completely from, treatment (Arkowitz & Miller, 2008). While this approach has good evidence for its value in the substance-use field (Arkowitz & Miller, 2008), it is only beginning to be considered in the anxiety-disorders literature (e.g., Westra & Dozois, 2008). We have developed a program based on MI which addresses treatment expectations and engagement (called TEE). The aim of the current project is to determine whether the addition of TEE to a highly efficacious CBT treatment package for social phobia can provide a significantly greater treatment effect and improved maintenance of effects.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Lorna Peters
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Address
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Centre for Emotional Health, Department of Psychology, Balaclava Rd, North Ryde, Macquarie University, NSW 2109
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Country
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Australia
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Phone
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+61298506727
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Dr Lorna Peters
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Address
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Centre for Emotional Health
Department of Psychology
Macquarie University
Balaclava Rd
North Ryde NSW 2109
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Country
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Australia
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Phone
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+61 2 9850 6727
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Dr Lorna Peters
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Address
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Centre for Emotional Health
Department of Psychology
Macquarie University
Balaclava Rd
North Ryde NSW 2109
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Country
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Australia
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Phone
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+61 2 9850 6727
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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