Exposure With Acceptance-Based Versus Habituation-Based Rationale for Public Speaking Anxiety

The recruitment status of this study is unknown because the information has not been verified recently.
Verified September 2009 by Drexel University.
Recruitment status was  Active, not recruiting
Information provided by:
Drexel University
ClinicalTrials.gov Identifier:
First received: February 11, 2009
Last updated: October 13, 2009
Last verified: September 2009

The purpose of this study is to compare two exposure-based behavioral group treatments for public speaking anxiety. Specifically, exposure within the context of psychological acceptance will be compared to exposure within a standard habituation context. It is hypothesized that participants receiving exposure within the context of psychological acceptance will experience a greater decrease in anxiety and greater improvement in quality of life compared to the habituation-based group.

Condition Intervention
Public Speaking Anxiety
Nongeneralized Social Anxiety Disorder
Behavioral: Exposure with Acceptance-Based Rationale
Behavioral: Exposure with Habituation-Based Rationale

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Exposure With Acceptance-Based Versus Habituation-Based Rationale for Public Speaking Anxiety

Resource links provided by NLM:

Further study details as provided by Drexel University:

Primary Outcome Measures:
  • Personal Report of Communication Apprehension (PRCA-24) [ Time Frame: Assessments will be taken at baseline, at mid-treatment (3 weeks), at post-treatment (6 weeks), and at 6-week follow-up (12 weeks). ] [ Designated as safety issue: No ]

Estimated Enrollment: 60
Study Start Date: February 2009
Estimated Study Completion Date: November 2009
Estimated Primary Completion Date: November 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Acceptance
Behavioral exposure within the context of psychological acceptance.
Behavioral: Exposure with Acceptance-Based Rationale
Treatment will first focus on the ineffectiveness of participants' past attempts to control or reduce their anxiety in public speaking situations. As an alternative to these control attempts, the notion of acceptance of one's private experiences (thoughts, feelings, sensations) will be introduced. Treatment will focus on "willingness" to experience unwanted thoughts and feelings while simultaneously engaging in valued activities, especially those related to public speaking. A second key concept, cognitive defusion, will focus on teaching participants to view themselves as separate from their internal experiences, thereby allowing the private experiences to occur without preventing the participant's engagement in exposure exercises. Techniques designed to foster acceptance and defusion will be presented and practiced prior to and during exposure exercises, as well as assigned for homework between sessions.
Active Comparator: Habituation
Behavioral exposure within the context of habituation.
Behavioral: Exposure with Habituation-Based Rationale
Context for exposure to feared public speaking situations will involve explanations of behavioral principles, including classical/operant conditioning and habituation. Participants will be told that, according to principles of classical conditioning, they have learned to associate public speaking situations with unwanted feelings of anxiety. It will be explained that, when they avoid or escape public speaking situations, the resulting decrease in anxiety raises the likelihood that they will do so in the future. Participants will then be taught the underlying principle of habituation; that is, that anxiety tends to decrease as a result of repeated and prolonged exposure to feared situations. When engaging in exposure exercises (both in session and assigned homework exercises), participants will be encouraged to remain in the feared speaking situation until their subjective ratings of anxiety decrease.

Detailed Description:

Social Anxiety Disorder (SAD) is a potentially debilitating condition affecting approximately 12% of the population at some point in their life (Ruscio et al., 2008). Nongeneralized SAD refers to individuals whose fears are limited to one or two social situations, most commonly public speaking. Empirically supported treatments for public speaking anxiety generally include an exposure component involving participation in anxiety-provoking public speaking situations (usually simulated situations using an audience of confederates and/or fellow participants, as well as actual public speaking situations in the community). Exposure is often presented within the context of habituation, but cognitively- based therapies utilize a rationale for exposure based on cognitive restructuring and belief modification. Research investigating the incremental benefit of adding other treatment components to exposure has yielded mixed results; however, there is preliminary evidence that the context in which exposure is presented can have an impact on treatment outcome. Recently, acceptance-based therapies have begun to frame exposure as an opportunity to increase one's willingness to experience anxiety while engaging in valued behaviors, rather than as a vehicle for modifying maladaptive cognitions and reducing anxiety. However, little research has been conducted on the efficacy of acceptance-based therapies for public speaking anxiety, and no component control studies have examined the utility of an acceptance/cognitive defusion rationale and context for exposure for public speaking anxiety. The present study will compare two exposure-based treatments for public speaking anxiety in a clinical sample. Specifically, exposure within an acceptance/defusion context will be compared to exposure with a habituation-based rationale.


  1. Participants receiving exposure within an acceptance/defusion context will experience a greater reduction in anxiety and behavioral avoidance, and greater improvement in measures of quality of life, compared to participants receiving exposure within a habituation rationale, at post-treatment.
  2. Acceptance, defusion, and mindfulness will mediate treatment outcome. Specifically, greater changes on measures of these three constructs will account for a significant portion of the effect of treatment condition on the dependent variables.
  3. Lower baseline levels of public speaking anxiety and overall anxiety will be associated with higher baseline quality of life, mindfulness, acceptance, defusion, and social skills.
  4. Baseline levels of acceptance, defusion, and mindfulness will predict overall treatment response, regardless of intervention condition.

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Clinically diagnosable public speaking anxiety (per DSM-IV-TR criteria for nongeneralized social anxiety disorder)
  • Aged 18-65
  • Residence in the greater Philadelphia area

Exclusion Criteria:

  • Pervasive developmental disability
  • Acute suicide potential
  • Inability to travel to the treatment site
  • Certain comorbid Axis I diagnoses, namely:

    • generalized SAD
    • schizophrenia or other psychotic disorder
    • current substance dependence
  • Comorbid diagnoses of Major Depressive or other mood or anxiety disorders are acceptable ONLY if clearly secondary to the diagnosis of public speaking anxiety
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00842946

United States, Pennsylvania
Drexel University
Philadelphia, Pennsylvania, United States, 19102
Sponsors and Collaborators
Drexel University
  More Information

No publications provided

Responsible Party: James Herbert, Ph.D., Professor of Psychology, Drexel University, Psychology Department
ClinicalTrials.gov Identifier: NCT00842946     History of Changes
Other Study ID Numbers: DRX-17819
Study First Received: February 11, 2009
Last Updated: October 13, 2009
Health Authority: United States: Institutional Review Board

Additional relevant MeSH terms:
Anxiety Disorders
Phobic Disorders
Mental Disorders

ClinicalTrials.gov processed this record on April 17, 2014