Gaze-contingent music reward therapy for social anxiety disorder: a randomized controlled trial
Open accessAbstract
OBJECTIVE: Patients with social anxiety disorder exhibit increased attentional dwelling on social threats, providing a viable target for therapeutics. This randomized controlled trial examined the efficacy of a novel gaze-contingent music reward therapy for social anxiety disorder designed to reduce attention dwelling on threats. METHOD: Forty patients with social anxiety disorder were randomly assigned to eight sessions of either gaze-contingent music reward therapy, designed to divert patients' gaze toward neutral stimuli rather than threat stimuli, or to a control condition. Clinician and self-report measures of social anxiety were acquired pretreatment, posttreatment, and at 3-month follow-up. Dwell time on socially threatening faces was assessed during the training sessions and at pre- and posttreatment. RESULTS: Gaze-contingent music reward therapy yielded greater reductions of symptoms of social anxiety disorder than the control condition on both clinician-rated and self-reported measures. Therapeutic effects were maintained at follow-up. Gaze-contingent music reward therapy, but not the control condition, also reduced dwell time on threat, which partially mediated clinical effects. Finally, gaze-contingent music reward therapy, but not the control condition, also altered dwell time on socially threatening faces not used in training, reflecting near-transfer training generalization. CONCLUSIONS: This is the first randomized controlled trial to examine a gaze-contingent intervention in social anxiety disorder. The results demonstrate target engagement and clinical effects. This study sets the stage for larger randomized controlled trials and testing in other emotional disorders.
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Lack of consensus about why conventional ABM has inconsistent effects has encouraged development of alternative methods with preliminary efficacy data.
“Lack of consensus regarding why conventional ABM threat-avoidance training has inconsistent effects (discussed earlier) has encouraged the development of various alternative methods which have preliminary data suggesting efficacy”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [69]
Clinical studies report anxiety reduction following adaptive ABM, gaze-contingent music-reward therapy combined with CBT, emotional face visual search training, and enhanced positive search training.
“Clinical studies which evaluate multi-session ABM training in individuals with anxiety disorders report anxiety reduction following adaptive ABM (uncontrolled pilot study), gaze-contingent music-reward therapy (combined with CBT), emotional face visual search training, and enhanced positive search training [21,69,72,75,76].”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [69]
Evidence for therapeutic efficacy of alternative ABM training methods is limited.
“Evidence for the therapeutic efficacy of alternative ABM training methods is limited.”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [69]
In most ABM training methods, nonthreat targets are more likely to appear in different locations from threat cues, encouraging attention-orienting away from threat.
“In most ABM training methods, nonthreat targets are more likely to appear in different locations [ 5 0 8 _ T D $ D I F F ] from threat cues, which encourages attention-orienting away from threat.”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [69]
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- Authors
- Lazarov, A., Pine, D. S., & Bar-Haim, Y.
- Affiliations
- Tel Aviv University (IL)
- From the School of Psychological Sciences and the Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; and the Section on Development and Affective Neuroscience, NIMH Intramural Research Program, Bethesda, Md.
- Venue
- American Journal of Psychiatry
- Published
- 2017-07-01
- Volume
- 174
- Issue
- 7
- Pages
- 649-656
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2574584648
- Cited by
- 125
- References
- 37
- Citations by year
- 2026: 11 · 2025: 10 · 2024: 4 · 2023: 15 · 2022: 29 · 2021: 13 · 2020: 17 · 2019: 9 · 2018: 11 · 2017: 6
- FWCI
- 15.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Music Therapy and Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- social anxiety disorder, attentional bias to threat, dwell time, threat generalization, near transfer, music reward, attention training, target engagement
- MeSH terms
- Facial Recognition, Phobia, Social, Adult, Attention, Emotions, Eye Movements, Female, Fixation, Ocular, Follow-Up Studies, Humans, Male, Middle Aged, Music Therapy, Reward, Comorbidity
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