Journal of Anxiety Disorders最新文献

{"title":"Antisaccade performance in spider phobia and its association with multimodal correlates of fear","authors":"Fabian Breuer ,&nbsp;Anne Sophie Hildebrand ,&nbsp;Johannes B. Finke ,&nbsp;Leandra Bucher ,&nbsp;Udo Dannlowski ,&nbsp;Tim Klucken ,&nbsp;Kati Roesmann ,&nbsp;Elisabeth Johanna Leehr","doi":"10.1016/j.janxdis.2025.103078","DOIUrl":"10.1016/j.janxdis.2025.103078","url":null,"abstract":"<div><h3>Introduction</h3><div>This study explored inhibitory control in spider phobic (SP) and healthy control (HC) individuals using an emotional antisaccade task. Attentional control theory (ACT) suggests anxiety related deficits in inhibitory control, yet studies on antisaccade performance in anxiety disordered patients are sparse. This study addressed this research gap and additionally aimed to explore putative associations of antisaccade performance with multimodal measures of fear of spiders.</div></div><div><h3>Methods</h3><div>A sample of 76 participants (41 SP, 35 HC) completed an antisaccade task, employing schematic pictures of spiders and flowers. We measured antisaccade latencies and error rates, respectively. In a free-viewing task, we obtained psychophysiological and subjective fear responses to pictures of spiders. Self-rated fear of spiders was assessed via questionnaires and avoidance behavior was assessed in a behavioral avoidance test.</div></div><div><h3>Results</h3><div>Contrary to ACT predictions, SP exhibited shorter antisaccade latencies irrespective of stimulus category, indexing more efficient inhibitory control, while showing no differences in antisaccade error rates when compared to HC. Consistent with prior findings, SP participants showed elevated psychophysiological responding, fear ratings and avoidance behavior. No significant associations emerged between inhibitory control performance and these measures of fear.</div></div><div><h3>Discussion</h3><div>Our findings suggest enhanced inhibitory control efficiency in SP compared to HC, contrasting impairments predicted by ACT and observed in subclinical anxiety. These findings may indicate a compensatory adaptation in anxiety disorders, enabling rapid attentional avoidance of threat. Our results also imply that inhibitory control may be differentially affected across various anxiety disorders, depending on their predisposition towards fear or anxiety, while also being independent from diverse measures of fear and anxiety.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103078"},"PeriodicalIF":4.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the symptomatology and assessment of emetophobia: A comprehensive scoping review","authors":"Molly S. Harbor,&nbsp;Paul E. Jenkins,&nbsp;Kate Harvey","doi":"10.1016/j.janxdis.2025.103076","DOIUrl":"10.1016/j.janxdis.2025.103076","url":null,"abstract":"<div><div>Emetophobia, the specific fear of vomiting, is a poorly understood anxiety disorder. Despite a growing body of research, comprehensive reviews on its presentation and assessment are limited and dated. This scoping review maps, synthesises and explores existing literature on the assessment measures and symptomatology of emetophobia. Its purpose is to inform future clinical practices by identifying reliable assessment instruments and facilitating more accurate diagnosis, treatment planning, and research comparisons. Five online databases (PubMed, SCOPUS, PsycINFO, Google Scholar, PsyArXiy) were searched using terms related to emetophobia. In total, 483 unique articles were located of which 38 were eligible for inclusion (35 described symptomatology; 3 described assessment measures). Among studies exploring symptoms, 17 were single case studies, 11 were cross-sectional surveys and 7 were other designs (e.g., case series, retrospective studies). Findings indicate that emetophobia is a multifaceted condition consisting of physical, psychological and behavioural symptoms. Avoidance behaviours are the most frequently reported symptom, described in 91 % of included literature. There is little research exploring the differences in child and adult symptom presentation which may result in misdiagnosis if an adult-centric criteria is applied. Two self-report questionnaires have been created and their psychometric properties assessed but, given numerous studies relied on longer, unvalidated assessment measures, these two measures appear to need further development. This review establishes that emetophobia is a complex and debilitating condition impacting multiple domains of life. Its findings will inform future research into the development and evaluation of tailored interventions targeting the specific presentation of emetophobia.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103076"},"PeriodicalIF":4.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive 7-day internet-delivered cognitive behavioural therapy for social anxiety disorder: A randomized controlled trial","authors":"Kayla R. Steele ,&nbsp;Emily Upton ,&nbsp;Monique Holden ,&nbsp;Amy Regan ,&nbsp;Matthew J. Coleshill ,&nbsp;Sophie Li ,&nbsp;Amy E. Joubert ,&nbsp;Alison E.J. Mahoney ,&nbsp;Michael Millard ,&nbsp;Jill M. Newby","doi":"10.1016/j.janxdis.2025.103073","DOIUrl":"10.1016/j.janxdis.2025.103073","url":null,"abstract":"<div><div>This is the first randomised controlled trial (RCT) to examine the efficacy of intensive internet-delivered CBT (iCBT) for social anxiety disorder (SAD). Adults (mean age: 44.77 years, 75.4 % female) diagnosed with SAD were randomly allocated to iCBT (<em>n</em> = 33) or a waitlist control group (WLC; <em>n</em> = 28). The iCBT group received a clinician-guided, six lesson program delivered online over seven days. Participants completed self-report measures of social anxiety and depression symptoms, and functional impairment at two- (post-treatment) and six-weeks post-baseline (one-month follow-up), and a diagnostic interview to assess SAD and major depressive disorder (MDD) at baseline and one-month follow-up. The iCBT group reported significantly lower social anxiety symptoms (Hedges’ <em>g’</em>s &gt; .96), and functional impairment at post and one-month follow-up (<em>g’s</em> &gt; .59), but there were no significant differences in depression symptoms (<em>g</em>’s = .42). Participants in the iCBT group were less likely to continue to meet criteria for SAD (47.6 %) at follow-up compared to WLC (96.4 %). Adherence (83.9 % completion) and program satisfaction (85.2 % reported being ‘mostly’ or ‘very satisfied’) were promising. Delivering iCBT over an intensive treatment period is feasible and acceptable to participants with SAD and showed promise for reducing social anxiety and functional impairment. Further research is needed to compare intensive iCBT with active control groups, using a larger and more diverse sample and longer-term outcomes.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103073"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity moderates the relationship between PTSD symptom severity and approach-avoidance conflict decision-making","authors":"Kevin M. Crombie ,&nbsp;Motoki Sato ,&nbsp;Samantha A. Chatham ,&nbsp;John Leri ,&nbsp;Mark T. Richardson ,&nbsp;Josh M. Cisler","doi":"10.1016/j.janxdis.2025.103075","DOIUrl":"10.1016/j.janxdis.2025.103075","url":null,"abstract":"<div><div>Avoidance of potentially dangerous contexts is beneficial for survival (i.e., adaptive avoidance), but the generalization of avoidance behavior to other generally safe contexts (i.e., maladaptive avoidance) can lead to detrimental mental health consequences, including diminished potential for reward. Decisions around pursuing reward in the presence of threat or avoiding threat at the cost of obtaining greater reward presents an approach-avoidance conflict (AAC). Although AAC is expected to be biased among trauma-exposed adults, especially those with posttraumatic stress disorder (PTSD), there have only been two prior behavioral investigations of AAC among adults with PTSD or experiencing PTSD symptoms. While greater levels of physical activity (PA) contribute to enhanced cognitive performance during reward-based decision-making tasks, it remains unknown whether greater PA also offers a protective effect or rather dampens the potential for greater AAC and sacrifice of reward in the presence of threat. The current study administered a trauma-related AAC behavioral task to trauma-exposed adults with varying PTSD symptom severity (N = 93), to examine potential interactive relationships between PTSD symptom severity, PA, and AAC decision-making under threat. The task involved a total of 150 trials and was divided into two phases: congruent (the option with the highest probability of a positive point outcome was also the option that was least likely to result in the presentation of a trauma-related image), and conflict (the option with the highest probability of a positive point outcome was also the option that was most likely to result in the presentation of a threat-related image). Results from linear mixed effects models revealed that PA moderated the relationship between PTSD symptom severity and AAC, as we observed a positive relationship between PTSD symptom severity and AAC for lower PA volume (i.e., greater conflict), and a more negative relationship between PTSD symptom severity and AAC as PA volume increased (i.e., less conflict). These results suggest that greater PA may promote a greater propensity to engage in goal-directed behavior and seek reward in the presence of threat in those with greater PTSD symptom severity.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"116 ","pages":"Article 103075"},"PeriodicalIF":4.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician guidance in digital therapeutics for panic disorder: Meta-analytic dissection and implications for regulatory framing and scalable deployment","authors":"Inhye Cho ,&nbsp;Byung-Hoon Kim ,&nbsp;Hankil Lee ,&nbsp;Yun-Kyoung Song ,&nbsp;Min Jung Chang ,&nbsp;Junhyung Kim ,&nbsp;Euna Han","doi":"10.1016/j.janxdis.2025.103074","DOIUrl":"10.1016/j.janxdis.2025.103074","url":null,"abstract":"<div><h3>Background</h3><div>Digital therapeutics (DTx) have emerged as scalable and accessible treatment modalities for panic disorder.</div></div><div><h3>Objective</h3><div>This study aimed to identify the extent to which clinician guidance impacts the digital intervention effectiveness for panic disorder across multiple clinical outcomes.</div></div><div><h3>Methods</h3><div>This study included 40 randomized controlled trials of digital intervention for panic disorder published up to March 2025. Eligible studies enrolled adults with a primary diagnosis of panic disorder (with or without agoraphobia) and compared a digital therapeutic intervention against active (therapist-led or treatment-as-usual) or passive (waitlist or no-treatment) controls. Outcomes were the Panic Disorder Severity Scale (PDSS), Agoraphobic Cognitions Questionnaire (ACQ), and Body Sensations Questionnaire (BSQ). Random-effects meta-analyses, subgroup analyses, sensitivity analyses, and mixed-effects meta regressions were conducted. The moderator variables included the comparator type, guidance format (clinician-guidance or self-guided), intervention modality, and region.</div></div><div><h3>Results</h3><div>Self-guided DTx demonstrated a moderate effect size on PDSS (Hedges’ g =0.31, 95 % confidence interval [CI]: 0.05–0.68), whereas clinician-guided interventions exhibited stronger effects (g =0.95, 95 % CI: 0.44–1.46). These findings indicate that well-structured self-guided interventions can address symptom domains, involving panic frequency and physiological distress. Conversely, cognitive-focused outcome assessment using ACQ and BSQ revealed that only clinician-guided interventions yielded statistically significant and clinically meaningful improvements (ACQ: g =0.46, 95 % CI: 0.15–0.76; BSQ: g =0.67, 95 % CI: 0.30–1.05), whereas self-guided formats exhibited negligible effects (ACQ: g =0.11; BSQ: g =0.27).</div></div><div><h3>Conclusions</h3><div>This meta-analysis revealed that self-guided digital interventions effectively reduce the overall symptom severity in panic disorder, whereas clinician involvement exerts a notably stronger influence on cognition-related outcomes. These findings support a domain-specific and context-sensitive understanding of guidance. Accordingly, the DTx design and policy should match the mechanistic pathways through which psychological change will occur.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103074"},"PeriodicalIF":4.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Efficacy of imagery rescripting in treating mental disorders associated with aversive memories – An updated meta-analysis” [Journal of Anxiety Disorders 99 (2023) 102772]","authors":"Ahlke Kip ,&nbsp;Luisa Schoppe ,&nbsp;Arnoud Arntz ,&nbsp;Nexhmedin Morina","doi":"10.1016/j.janxdis.2025.103071","DOIUrl":"10.1016/j.janxdis.2025.103071","url":null,"abstract":"","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103071"},"PeriodicalIF":4.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The screen for child anxiety related emotional disorders scale: A longitudinal validation study based on Chinese children and adolescents","authors":"Xiang Li,&nbsp;Daniel T.L. Shek,&nbsp;Xintong Zhang","doi":"10.1016/j.janxdis.2025.103072","DOIUrl":"10.1016/j.janxdis.2025.103072","url":null,"abstract":"<div><div>As anxiety disorders are common and clinically significant psychiatric disorders in children and adolescents linked to a broad spectrum of psychiatric problems, we need valid assessment instruments of anxiety. The Screen for Child Anxiety Related Emotional Disorders (SCARED) is widely used to assess anxiety symptoms. However, its factor structure remains debated, and its psychometric properties are underexplored in China. This study examined the factor structure of the SCARED and its measurement invariance across gender, age, and time among Chinese students. Specifically, this study used a two-wave longitudinal design, with a six-month interval (Time 1: December 2019–January 2020; Time 2: June 2020–July 2020). Data included 6176 children and adolescents aged 8–19 years (51.6 % boys; mean age = 11.52, <em>SD</em> = 1.62) from Sichuan, China. Confirmatory factor analyses supported a five-factor model as the best fit. Measurement invariances across gender, age, and time were established at the configural, metric, scalar, error variance, factor variance, and factor covariance levels, as supported by changes in the comparative fit index (CFI ≤ 0.004) and root mean square error of approximation (RMSEA ≤ 0.002). Furthermore, structured means modeling analyses showed that girls experienced more anxiety than did boys. Children experienced higher separation anxiety but lower general anxiety and school phobia than did adolescents. Moreover, participants experienced fewer anxiety symptoms at Time 2. Overall, the SCARED was valid and reliable for measuring anxiety symptoms in Chinese children and adolescents, confirming its utility as an objective outcome measure.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103072"},"PeriodicalIF":4.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145117821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing reliable change, MCID, treatment response, and remission using the Pediatric Anxiety Rating Scale (PARS) in youth with anxiety disorders","authors":"Matti Cervin ,&nbsp;Philip C. Kendall ,&nbsp;John C. Piacentini ,&nbsp;Elizabeth A. Gosch ,&nbsp;Jeffrey J. Wood ,&nbsp;Sophie C. Schneider ,&nbsp;Alison Salloum ,&nbsp;Boris Birmaher ,&nbsp;Andrew G. Guzick ,&nbsp;David Mataix-Cols ,&nbsp;Eric A. Storch","doi":"10.1016/j.janxdis.2025.103070","DOIUrl":"10.1016/j.janxdis.2025.103070","url":null,"abstract":"<div><div>Youth anxiety disorders are common and heterogeneous. The Pediatric Anxiety Rating Scale (PARS) is a clinician-administered tool designed to assess overall anxiety severity, independent of specific symptoms. The thresholds on PARS for the reliable change index (RCI), the minimal clinically important difference (MCID), treatment response, and full and partial remission remain unclear. Using the Clinical Global Impression (CGI) scales and diagnostic interviews as benchmark measures, several thresholds for the 6-item PARS were estimated using data from 904 youth with anxiety disorders, of which 36 % had an autism diagnosis. Data were drawn from 9 clinical trials conducted in the United States. Threshold accuracy was evaluated in a holdout sample and in an independent Swedish sample (<em>n</em> = 49). The reliable change index (RCI) was 3.39 points. A raw score reduction of ≥ 4 points or a ≥ 20 % reduction best defined the MCID. A raw score reduction of ≥ 8 points or a ≥ 43 % reduction best defined treatment response. Scores of 0–10 after treatment accurately defined full and partial remission, and scores of 0–5 defined full remission. Threshold accuracies ranged from 74–91 % in the holdout and 67–78 % in the Swedish sample. Treatment response accuracy was similar across samples, while MCID accuracy was lower in the Swedish sample. Similar cutoffs emerged in youth with and without autism and across age groups and genders. Threshold accuracies for the 5- and 7-item PARS versions were comparable to the 6-item version. This study establishes response and remission thresholds for PARS that are applicable across age groups, genders, and autism status. We advise against using the RCI as it does not exceed the MCID.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103070"},"PeriodicalIF":4.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain-heart coupling in response to imminent threat in panic disorder, social anxiety disorder, and healthy controls","authors":"Sarah-Louise Unterschemmann ,&nbsp;Christian Panitz ,&nbsp;Pauline Petereit ,&nbsp;Hannah Comtesse ,&nbsp;Matthias F.J. Sperl ,&nbsp;Erik M. Mueller","doi":"10.1016/j.janxdis.2025.103069","DOIUrl":"10.1016/j.janxdis.2025.103069","url":null,"abstract":"<div><h3>Background</h3><div>Imminent threat does not only capture attention but also triggers defensive psychophysiological responses associated with fight-flight-freeze behavior. However, within-subject associations between central markers of attentional stimulus processing and peripheral components of early defensive activation (e.g., cardiac acceleration) are not well understood. These associations may be especially important in understanding dynamics of anxiety disorders that are characterized by cardiovascular symptoms such as panic disorder.</div></div><div><h3>Methods</h3><div>We analyzed data from <em>N</em> = 90 participants with panic disorder (PD), social anxiety disorder (SAD), as well as healthy controls (CG) who completed a threat conditioning paradigm with face stimuli as conditioned stimuli (CS) and an aversive white noise burst as unconditioned stimulus (US). In addition to univariate analyses of ERPs and heartbeat, single-trial EEG evoked by the noise burst at centromedial sites and heart period were used to calculate intraindividual coupling of unconditioned cortico-cardiac responses.</div></div><div><h3>Results</h3><div>The noise burst evoked strong cardiac acceleration and an event-related potential with a pronounced N100 component. Importantly, the magnitude of single-trial cardiac acceleration was predicted within individuals by the preceding single-trial N100 magnitude. This cortico-cardiac coupling, but not the N100 component or cardiac acceleration per se, was enhanced in individuals with panic disorder compared to social anxiety disorder, with intermediate levels of coupling observed in healthy controls.</div></div><div><h3>Conclusion</h3><div>The present results suggest a central role of early attentional stimulus processing in subsequent cardiac defensive responses. Furthermore, they indicate that cortico-cardiac defensive responses may be altered in individuals with panic disorder specifically, rather than in anxiety disorders in general.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103069"},"PeriodicalIF":4.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145105067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety behavior fading for social anxiety: A randomized controlled trial of a self-monitoring intervention","authors":"James M. Zech ,&nbsp;Tapan A. Patel ,&nbsp;Jesse R. Cougle","doi":"10.1016/j.janxdis.2025.103068","DOIUrl":"10.1016/j.janxdis.2025.103068","url":null,"abstract":"<div><div>Safety behaviors (SBs) are hypothesized to play a key role in social anxiety and present as a viable target of psychosocial treatments. While SB reduction is a component of some cognitive-behavioral therapies for social anxiety, prior research suggests safety behavior fading also represents a viable, standalone digital treatment for social anxiety. The aim of the present study was to test a one-month self-monitoring SB treatment in individuals reporting elevated social anxiety symptoms against a credible control condition. Participants (<em>N</em> = 201) were randomized to either a SB fading condition (<em>n</em> = 99) or an unhealthy behavior fading control (<em>n</em> = 102). Compared to control, SB fading led to lower SB use at post but not one-month follow-up. Contrary to predictions, both conditions saw significant and comparable reductions in social anxiety and related outcomes (depression, loneliness) at posttreatment and follow-up. Treatment credibility and expectancy moderated the effect of condition, such that among participants with more positive beliefs about treatment (after being provided with the rationale), those in the SB condition reported significantly lower follow-up social anxiety than those in control. Further, in the SB condition, both higher social interaction frequency and lower loneliness at baseline were predictive of lower social anxiety at follow-up. Overall, our findings show limitations to SB fading as a standalone intervention and suggest this strategy is more effective among those who interact with others more frequently and who are more confident in this treatment approach. We discuss clinical implications and future research directions, including potential refinements to SB treatment protocols.</div></div>","PeriodicalId":48390,"journal":{"name":"Journal of Anxiety Disorders","volume":"115 ","pages":"Article 103068"},"PeriodicalIF":4.5,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}