Brief Interpretation Bias Modification for Social Anxiety Disorder in Pakistani Young Adults: An Experimental Evaluation

Efficacy of Cognitive Bias Modification Itervention in Young Adult With Social Anxiety

This randomized, single-blind trial tests whether one session of interpretation bias modification reduces immediate social-evaluative anxiety and shifts interpretation bias in Pakistani university students aged 18 to 25 years with elevated social anxiety. Participants are assigned to either feedback-contingent interpretation bias modification or a structurally matched interpretation control condition. Primary and secondary outcomes are assessed before and after the intervention session using short-form state-trait anxiety measures and Word-Sentence Association Paradigm endorsement indices.

Social anxiety in young adults is maintained in part by a tendency to interpret ambiguous social information as threatening. The study evaluates a behavioral interpretation training procedure delivered with OpenSesame, using trial-by-trial responses to ambiguous social sentences preceded by threat or benign prime words. In the experimental arm, feedback contingently reinforces benign endorsements and threat rejections. In the control arm, exposure and timing are matched but feedback is noncontingent and presented on half of trials. The design is a parallel two-arm randomized pretest-posttest trial with participant masking to assignment. Assessment includes the 5-item state and 5-item trait short-form State-Trait Anxiety Inventory totals and Word-Sentence Association Paradigm threat and benign endorsement proportions. The mechanistic hypothesis is that feedback-consistent learning increases benign interpretations and reduces threat interpretations, which is associated with lower post-session state anxiety. The trial was conducted as part of a PhD thesis at the University of Gujrat under formal institutional approvals.

Inclusion Criteria:

• age 18 to 25 years
• Social Phobia Inventory score greater than 19
• at least moderate severity on the DSM-5-TR Severity Measure for Social Anxiety Disorder-Adult
• able to read study materials
• provides written informed consent.

Exclusion Criteria:

• clinically elevated depressive symptoms on Beck Depression Inventory-II at or above prespecified cutoff [above 16]
• clinically elevated general anxiety symptoms on the Beck Anxiety Inventory at or above prespecified cutoff [ above 20]
• current medical or psychiatric condition likely to interfere with safe or valid participation
• prior participation in this trial.