Journal of Anxiety Disorders 33 (2015) 35–44 Contents lists available at ScienceDirect Journal of Anxiety Disorders A randomized controlled trial of attention modification for social anxiety disorder R. Nicholas Carleton a,* , Michelle J.N. Teale Sapach a , Chris Oriet a , Sophie Duranceau a , Lisa M. Lix b , Michel A. Thibodeau a , Samantha C. Horswill a , Jordan R. Ubbens a , Gordon J.G. Asmundson a a Department of Psychology University of Regina, Regina, SK, Canada b Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada a r t i c l e i n f o Article history: Received 15 January 2015 Received in revised form 21 March 2015 Accepted 22 March 2015 Available online 20 April 2015 Keywords: Attentional bias Attention modification protocol Social anxiety disorder Randomized controlled trial Longitudinal study a b s t r a c t Social Anxiety Disorder (SAD) models implicate social threat cue vigilance (i.e., attentional biases) in symptom development and maintenance. A modified dot-probe protocol has been shown to reduce SAD symptoms, in some but not all studies, presumably by modifying an attentional bias. The current randomized controlled trial was designed to replicate and extend such research. Participants included treatment-seeking adults (n = 108; 58% women) who met diagnostic criteria for SAD. Participants were randomly assigned to a standard (i.e., control) or modified (i.e., active) dot-probe protocol condition and to participate in-lab or at home. The protocol involved twice-weekly 15-min sessions, for 4 weeks, with questionnaires completed at baseline, post-treatment, 4-month follow-up, and 8-month follow-up. Symptom reports were assessed with repeated measures mixed hierarchical modeling. There was a main effect of time from baseline to post-treatment wherein social anxiety symptoms declined significantly (p < .05) but depression and trait anxiety did not (p > .05). There were no significant interactions based on condition or participation location (ps > .05). Reductions were maintained at 8-month follow-up. Symp- tom reductions were not correlated with threat biases as indexed by the dot-probe task. The modified and standard protocol both produced significant sustained symptom reductions, whether administered in-lab or at home. There were no robust differences based on protocol type. As such, the mechanisms for benefits associated with modified dot-probe protocols warrant additional research. © 2015 Elsevier Ltd. All rights reserved. 1. Introduction Social Anxiety Disorder (SAD; American Psychiatric Association, 2013) has significant lifetime (12.1%) and 12-month (7.1%) preva- lence rates (Ruscio et al., 2008), and comparable rates for men and women (American Psychiatric Association, 2013). The disorder is marked by nervousness or discomfort in social situations (Antony & Swinson, 2000), resulting from fears of being evaluated, embar- rassed (Weeks, Carleton, Asmundson, McCabe, & Antony, 2010; Weeks, Jakatdar, & Heimberg, 2010), or making a bad impression (Antony & Swinson, 2000). SAD typically lasts for 12 or more years (Grant et al., 2005), has low remission rates (Massion et al., 2002), and high depression comorbidity (Stein & Stein, 2008). The asso- ciated social isolation and high rates of comorbid depression may explain some of the increased suicide risk for patients with SAD * Corresponding author. Tel.: +13063372473. relative to those without (Thibodeau, Welch, Sareen, & Asmundson, 2013), wherein 35% contemplate suicide regularly and 14% attempt suicide (Cougle, Keough, Riccardi, & Sachs-Ericsson, 2009). Models of SAD emphasize the central role of attentional pro- cesses and suggest that (1) heightened self-focused attention and (2) vigilance for external social threat cues influence the develop- ment and maintenance of SAD (e.g., Heimberg, Brozovich, & Rapee, 2010; Hofmann, 2007). People with SAD more rapidly engage with and spend more time attending to external social threat cues and emotional faces in anxiety-provoking social situations (Asmundson & Stein, 1994; Chen, Ehlers, Clark, & Mansell, 2002; Lee & Telch, 2008), and demonstrate biases in interpretation, attention, and imagery relative to non-anxious individuals (Hirsch & Clark, 2004). Together, these attentional processes may narrow attention, inter- fere with beneficial processing, and maintain SAD. Participants in a dot-probe protocol observe a screen on which randomly paired stimuli are presented (for ∼500 ms), one stimu- lus above the other. One stimulus is neutral (e.g., the word table) http://dx.doi.org/10.1016/j.janxdis.2015.03.011 0887-6185/© 2015 Elsevier Ltd. All rights reserved.