4 - (SYM 68) Real-time Intervention for Social Anxiety: Reprocessing Social Interactions Through Expectancy Violations

Social anxiety (SA) is marked by extreme, enduring fear and avoidance of social interactions. While social fears are central to SA, new experience-sampling data show that people with SA frequently socialize. These social interactions may act as naturally-occurring exposures for people with SA, providing ripe opportunities to intervene in real time. However, simply participating in social interactions does not necessarily extinguish social fears. For exposure to be effective, individuals need tools to modify biased cognitive processes.

            In this pilot study, we tested the efficacy of Social Fear Expectancy Tracker (S-FET), a novel ecological momentary intervention. The S-FET is grounded in inhibitory learning, which suggests that when a feared situation violates a person’s expectations, this violation can prompt the formation of new, less threatening mental representations of the event. Community adults (N=23) with elevated SA completed 7 daily surveys for one week. Participants reported whether their feared outcome occurred in their most recent social interaction, worries about whether their feared outcome would come true in future social interaction, and state (i.e., current) SA and avoidance. To strengthen new learning and memory consolidation, participants described what they learned when feared events did not occur.

Throughout the intervention, state SA decreased (b=-0.04; t=-3.648, p< .001) and avoidance did not change (b=.02, t=1.93, p=.06). Depression symptoms decreased from baseline to follow-up (t=5.22; p</em>< .001), but social anxiety symptoms did not change (t=0.84, p=0.41). When expectancy violations occurred, participants reported a small reduction in worry about the same feared outcomes occurring in a future social interaction. In terms of feasibility and acceptability, most participants found the intervention to be intuitive (70%) and easy to complete (87%). At a 2-month follow up, 54% of participants had used expectancy violation exercises, and 66% had noticed a reduction in SA.

Together, these findings support the efficacy of a brief intervention that socially anxious individuals can use immediately after social stressors. By leveraging expectancy violations, S-FET encourages individuals to reprocess and reinterpret past social encounters, which in turn fosters more adaptive memories and reduces social fear.