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This pilot study compares two 4-week, smartphone-based treatments for social anxiety: one uses a psychodynamic therapy approach and the other uses a cognitive behavioral therapy approach. Both treatments are guided by an AI assistant rather than a human therapist. The AI assistant is programmed to support participants in reflecting on core therapeutic principles, much like a well-informed coach would.
Participants are randomly assigned to one of three groups: psychodynamic therapy with AI support, cognitive behavioral therapy with AI support, or a waitlist control. Those in the waitlist group can receive an active treatment after the 4-week waiting period. All participants complete weekly online questionnaires to monitor anxiety and any changes in mood or well-being.
This study builds upon earlier findings from the STePS project by investigating the feasibility and effectiveness of two brief, smartphone-delivered treatments for social anxiety, delivered entirely through an AI-guided platform. The study is a randomized, controlled pilot trial with three arms. Two intervention groups receive a 4-week treatment via smartphone: one group receives a psychodynamic therapy approach and the other receives a cognitive behavioral therapy approach. In both treatments, the AI assistant prompts reflection and engagement with the therapeutic material instead of a traditional therapist. The third group serves as a waitlist control, with participants given the option to choose one of the active treatments after the study period.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Smartphone-based psychodynamic therapy with AI support | Experimental | This arm features a 4-week smartphone-delivered psychodynamic therapy intervention guided by an AI assistant. Participants will access structured treatment modules that emphasize emotional awareness, reduction of avoidance behaviors, and enhancement of affect regulation in social contexts. The AI assistant provides real-time reflection prompts, motivational support, and automated feedback based on the established psychodynamic material, ensuring consistent engagement throughout the treatment period. Weekly assessments monitor symptom changes, with data collected to evaluate the intervention's effectiveness in reducing social anxiety. |
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| Smartphone-based cognitive behavior therapy with AI support | Experimental | This arm features a 4-week smartphone-delivered cognitive behavioral therapy (CBT) intervention guided by an AI assistant. Participants will access structured treatment modules that focus on psychoeducation about anxiety, cognitive restructuring to challenge and modify unhelpful thoughts, behavioral exposure techniques, and behavioral experiments to reduce avoidance. The AI assistant provides real-time reflection prompts, task reminders, motivational support, and automated feedback based on established CBT protocols, ensuring consistent engagement throughout the treatment period. Weekly assessments will monitor symptom changes, with data collected to evaluate the intervention's effectiveness in reducing social anxiety. |
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| Waitlist | No Intervention | This arm involves a waitlist control condition where participants do not receive an active intervention during the 4-week period. Instead, they complete the same weekly assessments used in the active treatment arms to monitor changes in social anxiety symptoms and overall well-being. After the study period, participants will be offered the option to choose one of the active treatment approaches if desired. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ai chatbot | Behavioral | This intervention uses an AI-enabled chatbot within a smartphone app to deliver psychotherapy modules. The chatbot guides participants through the modules by providing reflective prompts, motivational support and automated reminders to enhance engagement. All communication is encrypted to protect privacy. |
| Measure | Description | Time Frame |
|---|---|---|
| Social Phobia Inventory (SPIN) | The Social Phobia Inventory (SPIN) is a 17-item self-report questionnaire that measures fear, avoidance and physiological symptoms of social anxiety. Each item is rated on a 5-point Likert scale (0 = "not at all" to 4 = "extremely"), yielding a total score range from 0 to 68. Higher scores indicate more severe social anxiety symptoms. | Baseline (pre-randomization), weekly during the 4-week intervention, post-treatment at week 4, and 1-month follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Liebowitz Social Anxiety Scale Self-Report (LSAS-SR) | The Liebowitz Social Anxiety Scale Self-Report (LSAS-SR) is a 24-item self-report instrument measuring the severity of social anxiety by assessing fear and avoidance across 24 social and performance situations. Total scores range from 0 to 144, with higher scores indicating greater social anxiety severity. It supplements the primary Social Phobia Inventory (SPIN) measure by providing additional insight into the participants' subjective experience of social anxiety and functional impairment. |
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| Name | Affiliation | Role |
|---|---|---|
| Per Carlbring, PhD | Stockholm University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Stockholm university | Stockholm | Stockholm County | 10691 | Sweden |
The individual participant data (IPD) that will be shared (Figshare or OSF) include de-identified, participant-level data from all phases of the study. Specifically, this dataset will contain (limited) demographic information, screening results, baseline assessments, and all primary and secondary outcome measures as well as some treatment engagement data. Data will be stripped of any identifying information and aggregated where appropriate to ensure confidentiality and compliance with data protection regulations.
Anticipated during 2025.
By visiting Figshare or OSF.
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| Baseline, 4 weeks, and 1 month |
| Patient Health Questionnaire-9 (PHQ-9) | The Patient Health Questionnaire-9 (PHQ-9) is a 9-item self-report measure assessing depressive symptom severity over the past two weeks. Total scores range from 0 to 27, with higher scores indicating more severe depressive symptoms. A 2-item short form (Patient Health Questionnaire-2) is administered weekly to monitor mood, while the full 9-item version is collected at baseline, 4 weeks, and 1 month. This measure captures any effects of the intervention on depressive symptoms alongside anxiety outcomes. | Baseline, weekly during weeks 1 through 4 (Patient Health Questionnaire-2 short form), 4 weeks (full scale), and 1 month |
| Generalized Anxiety Disorder-7 (GAD-7) | The Generalized Anxiety Disorder-7 (GAD-7) is a 7-item self-report scale assessing the severity of generalized anxiety symptoms over the past two weeks. Total scores range from 0 to 21, with higher scores indicating more severe anxiety. A 2-item short form (Generalized Anxiety Disorder-2) is administered weekly, while the full 7-item version is collected at baseline, 4 weeks, and 1 month. This measure evaluates treatment effects on overall anxiety alongside social anxiety symptoms. | Baseline, weekly during weeks 1 through 4 (Generalized Anxiety Disorder-2 short form), 4 weeks (full scale), and 1 month |
| ID | Term |
|---|---|
| D000072861 | Phobia, Social |
| ID | Term |
|---|---|
| D010698 | Phobic Disorders |
| D001008 | Anxiety Disorders |
| D001523 | Mental Disorders |
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