This study examines whether a proactive thought control intervention can reduce negative core beliefs, cognitive biases, and anxiety symptoms in university students with social anxiety. Participants with elevated social anxiety (screened via the Liebowitz Social Anxiety Scale) are randomly assigned to either a proactive thought control group or a reactive control group. Both groups complete two computerized tasks - a Free Association Task and a Sentence Completion Task - across 180 trials. The proactive group is trained to generate only positive or neutral associations to socially threatening cues and receives real-time AI-powered sentiment feedback, while the reactive group responds freely without sentiment-based guidance. Outcomes including negative core beliefs, interpretation bias, attentional bias, state anxiety, and trait anxiety are assessed before and after the intervention using standardized measures (CBQ, WSAP, Dot Probe Task, STAI). The study uses a parallel-group randomized controlled trial design with repeated measures and aims to establish preliminary effect size estimates for future, larger-scale trials.

Background and Rationale Social anxiety disorder (SAD) is characterized by intense fear of negative evaluation in social situations, leading to significant avoidance and distress. Cognitive models of SAD emphasize the role of negative core beliefs (e.g., beliefs about being inferior or unacceptable to others) and cognitive biases - particularly interpretation bias and attentional bias toward threat - in the maintenance of the disorder. While cognitive bias modification (CBM) approaches have shown promise, most are reactive in nature, modifying biases after they arise. Proactive cognitive control, by contrast, involves the sustained, goal-directed maintenance of positive or neutral mental sets before threatening stimuli are encountered. This study tests whether a proactive approach to thought control, delivered through modified free association and sentence completion paradigms, can more effectively shift core beliefs and cognitive biases compared to a reactive control condition.

Study Design This is a parallel-group randomized controlled trial (RCT) with a repeated-measures (pre-post) design. Participants are randomly assigned using the fishbowl block randomization technique to either: (1) the Proactive Thought Control group, or (2) the Reactive Control group (active sham condition). Counterbalancing is applied to the order of stimuli in the WSAP and Dot Probe Task to control for practice effects.

Participants Participants are university students aged 18-24 years, recruited via purposive sampling using the Liebowitz Social Anxiety Scale - Self Report (LSAS-SR). Individuals scoring above 30 on the LSAS-SR are eligible. Exclusion criteria include current psychological treatment, psychiatric or medical comorbidities, and medication use. Of 204 initially screened, 149 met the LSAS cutoff; 54 were enrolled and randomized. Final analyses include 37-39 participants who completed both pre- and post-assessments. As a pilot trial, this sample size is consistent with recommended ranges of 15-30 participants per group for feasibility and preliminary effect size estimation.

Measures

Pre- and post-intervention assessments include:

Core Belief Questionnaire (CBQ): Measures negative core beliefs about self and others in social anxiety (trait and other subscales used).

Spielberger State-Trait Anxiety Inventory - Short Form (STAI): Assesses state and trait anxiety (5 items each; 4-point Likert scale).

Word Sentence Association Paradigm (WSAP): Computerized task measuring interpretation bias; participants judge relatedness of threatening/benign word-sentence pairs. Bias scored as proportion of threatening endorsements.

Dot Probe Task: Computerized task measuring attentional bias toward threat using reaction time differences (Attentional Bias Index = mean RT threat-incongruent minus mean RT threat-congruent trials).

Screening measures include the LSAS-SR and DASS-12 (for baseline distress comparability).

Intervention The intervention comprises 180 trials divided into six blocks (framed as "game levels"): three blocks of Free Association Task (FAT) and three blocks of Sentence Completion Task (SCT). Each block contains 25 socially threatening stimuli and 5 positive/neutral stimuli, presented in randomized order.

Free Association Task (FAT): Participants see a single threatening or neutral word cue and respond with the first word that comes to mind. The proactive group is instructed to produce only positive or neutral single-word associations and cannot advance until doing so. The reactive group responds freely.

Sentence Completion Task (SCT): Participants complete unfinished sentence stems (e.g., "They stared, and I felt ___"). The proactive group must provide positive or neutral completions; the reactive group responds without restriction.

A real-time AI feedback system powered by DistilBERT-base-uncased-finetuned-SST-2-English (a lightweight transformer model fine-tuned for binary English sentiment classification) evaluates responses. Both groups receive quality-based feedback (for repetitions, spelling errors, and invalid inputs). The proactive group additionally receives sentiment-based reinforcement: +2 points and "Correct" feedback for positive/neutral responses, and corrective guidance for negative responses. The reactive group receives no sentiment feedback. This gamified point system reinforces goal-directed positive thinking in the proactive group.

Procedure Participants are recruited in-person (paper-based classroom administration) and online (Google Form). Following informed consent and LSAS/DASS screening, eligible participants complete pre-assessment (CBQ, STAI, WSAP, Dot Probe Task) via OpenSesame software, then complete the intervention tasks, followed immediately by post-assessment using the same battery.

Data Analysis Data cleaning and scoring are conducted using Excel and R (packages: jsonlite, readxl, dplyr, tidyr, stringr, writexl). Statistical analyses are conducted in SPSS and include: chi-square for attrition analysis; descriptive statistics for demographics; Mixed ANOVA for main and interaction effects (Group × Time); paired-sample t-tests for within-group pre-post comparisons; independent-sample t-tests for between-group comparisons; and ANCOVA to isolate intervention effects from baseline differences.

Inclusion Criteria

• being 18-24 years old
• not taking any additional psychological treatments during the trial
• If taking medication for depression or anxiety, the dosage had to remain consistent for one month before the start of therapy.
• Cut off score above 30 in LSAS
• Consent to participate in the study and complete all tasks.
• Proficiency in English
• Regularly computer user Exclusion Criteria
• Age below 18 or above 24 years
• Currently receiving psychological treatment
• Failure to provide consent or complete the study tasks
• Have any other medical condition
• Have any other psychiatric condition
• Taking medicineInclusion Criteria:

Plan Description:

De-identified individual participant data (IPD) underlying the primary and secondary outcome analyses will be shared, including pre- and post-intervention scores on the Core Belief Questionnaire (CBQ), Word Sentence Association Paradigm (WSAP), Dot Probe Task, and State-Trait Anxiety Inventory (STAI). Raw reaction time data from the WSAP and Dot Probe Task, demographic data, and group assignment variables will also be made available. Data will be de-identified in accordance with standard anonymization procedures to protect participant confidentiality. Screening data (SCID, LSAS-SR and DASS-12) will be shared at aggregate level only.

IPD and supporting information will be available beginning 6 months after publication of primary study findings and will remain accessible for a minimum of 5 years following initial data sharing.

De-identified IPD will be available to qualified academic researchers for non-commercial research purposes. Requestors must submit a brief research proposal describing the intended use of the data, confirm compliance with applicable ethical and data protection regulations, and sign a data use agreement. Requests will be reviewed by the principal investigator. Data will be shared via a secure file transfer or repository link upon approval.