Gaze-Contingent Music Reward Therapy for Social Anxiety Disorder: A Randomized Controlled Trial

Am J Psychiatry. 2017 Jul 1;174(7):649-656. doi: 10.1176/appi.ajp.2016.16080894. Epub 2017 Jan 20.


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.

Trial registration: NCT02590770.

Keywords: Attention Allocation; Attention Bias Modification; Cognitive Therapy; Eye Tracking; Gaze-Contingency; Phobic Disorders; Social Anxiety.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attention*
  • Comorbidity
  • Emotions
  • Eye Movements*
  • Facial Recognition
  • Female
  • Fixation, Ocular*
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Music Therapy*
  • Phobia, Social / diagnosis
  • Phobia, Social / psychology
  • Phobia, Social / therapy*
  • Reward*

Associated data