Behaviour Research and Therapy最新文献

{"title":"Role of psychosocial factors of symptom flares in a cohort of patients with urologic chronic pelvic pain syndrome: A cognitive-affective approach","authors":"Jeffrey M. Lackner (.) ,&nbsp;Yi Xiong ,&nbsp;Andrew H. Rogers ,&nbsp;Christopher D. Radziwon ,&nbsp;Gregory D. Gudleski ,&nbsp;Siobhan Sutcliffe ,&nbsp;Jia Wang ,&nbsp;Bruce D. Naliboff ,&nbsp;J. Quentin Clemens ,&nbsp;Teresa L. Danforth","doi":"10.1016/j.brat.2025.104942","DOIUrl":"10.1016/j.brat.2025.104942","url":null,"abstract":"<div><div>Little is known about cognitive-affective factors associated with symptom exacerbations (“flares”) in individuals with Urologic Chronic Pelvic Pain Syndrome (UCPPS) even though pain is its cardinal feature and a defining attribute of flares which are regarded as a global marker of illness severity. Disease activity is unable to explain UCPPS flares because its pathophysiology involves altered pain modulation in the central nervous system independent of peripheral pain input. We sought to characterize how different psychosocial factors correspond with distinct flare attributes in UCPPS patients. Subjects included 92 formally diagnosed UCPPS (Interstitial Cystitis/Bladder Pain Syndrome or Chronic Prostatitis/Chronic Pelvic Pain Syndrome) patients (<em>M</em>_<em>age</em> = 43, SD = 14, 82 % female) with refractory pelvic pain. Data, completed as part of baseline evaluation of an NIH clinical trial, included the Pain Discomfort Scale (pain-related suffering), Coping Strategies Questionnaire, Catastrophizing subscale, revised McGill Pain Inventory-Short Form (pain quality), Positive and Negative Affect Scale, Childhood Trauma Questionnaire, as well as flare and UCPPS symptom measures. Regression analyses were applied to characterize the association between psychosocial factors and flare dimensions. Psychosocial factors were broadly associated with multiple flare attributes. Their combined effect was strongest for flare severity with mood, and pain-related suffering, as significant predictors. This investigation breaks new ground by linking psychosocial risk factors to multiple dimensions of UCPPS flares. Further studies are needed to leverage this line of research to develop behaviorally-based flare management programs that strengthen patients’ self-regulatory capacity for reducing flares, thereby decreasing the public health burden of UCPPS.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"196 ","pages":"Article 104942"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An integrated personalized feedback intervention for community adults with hazardous alcohol use, elevated anxiety sensitivity, and subclinical PTSD symptoms","authors":"Antoine Lebeaut ,&nbsp;Eric R. Pedersen ,&nbsp;David J. Francis ,&nbsp;Michael J. Zvolensky ,&nbsp;Anka A. Vujanovic","doi":"10.1016/j.brat.2025.104935","DOIUrl":"10.1016/j.brat.2025.104935","url":null,"abstract":"<div><div>Hazardous drinking and posttraumatic stress disorder (PTSD) frequently co-occur and lead to greater impairment and dysfunction than either condition alone. Anxiety sensitivity (AS; i.e., the fear of the anxiety-related sensations and consequences) is a transdiagnostic risk factor for hazardous drinking and PTSD that may serve to inform novel, integrated intervention development for these co-occurring conditions. However, an integrated intervention to specifically target AS in the context of hazardous drinking and PTSD symptoms has not yet been developed or tested. The present study aimed to develop and test the acceptability and efficacy of an integrated, novel computer-based personalized feedback intervention (PFI) in a sample of community adults with hazardous drinking, at least subclinical PTSD symptoms, and elevated AS. Participants (<em>N</em> = 101; <em>M</em>_age = 31.7) were randomized to either an integrated PFI condition (<em>n</em> = 50) focused on PTSD, AS, and alcohol, or an active comparison condition (<em>n</em> = 51) focused exclusively on alcohol use. Compared to the active comparison condition, acceptability ratings were greater for the integrated condition. Latent growth curve models found that participants in both conditions reported statistically significant reductions in alcohol-related cravings/urges and intention to reduce drinking. Participants randomized to the integrated condition reported statistically significantly lower PTSD symptom severity and average daily drinking quantity as well as greater motivation to reduce drinking over time relative to participants in the active comparison condition. Findings provide preliminary support for an integrated approach targeting PTSD, AS, and hazardous drinking, and underscore the need for their continued development.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"196 ","pages":"Article 104935"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circadian and gut–brain axis modulation is associated with neuroimmune and symptom recovery after rectal cancer surgery: An exploratory randomized controlled trial","authors":"Shengjie Pan ,&nbsp;Gang Wang","doi":"10.1016/j.brat.2025.104943","DOIUrl":"10.1016/j.brat.2025.104943","url":null,"abstract":"<div><h3>Background</h3><div>Disruption of circadian and neuroimmune regulation after rectal cancer surgery contributes to psychological distress, inflammation, and impaired recovery. This exploratory randomized controlled trial evaluated whether a perioperative multicomponent behavioral program targeting circadian and gut–brain processes was associated with improvements in neuroimmune profiles and symptom outcomes.</div></div><div><h3>Methods</h3><div>A total of 184 patients with stage I–III low rectal cancer undergoing ultra-low anterior resection were randomized to receive either standard ERAS care or an integrative perioperative intervention that combined emotion-regulation strategies (mindfulness-based stress reduction, heart-rate-variability biofeedback, neurofeedback) with structured sleep and circadian therapy (cognitive behavioral therapy for insomnia, controlled-release melatonin, circadian scheduling). Co-primary outcomes were depressive symptoms (Beck Depression Inventory-II) and sleep quality (Pittsburgh Sleep Quality Index) at 6 months. Secondary outcomes included inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-α), gastrointestinal recovery indices, and skeletal muscle index (SMI). Disease-free and overall survival were examined as pre-specified exploratory endpoints.</div></div><div><h3>Results</h3><div>Compared with standard care, the integrative intervention was associated with greater 6-month improvements in depressive symptoms and sleep quality (both p &lt; 0.01), lower postoperative inflammation (e.g., POD7 interleukin-6: 39.7 vs 52.3 pg/mL; p &lt; 0.001), and faster gastrointestinal recovery. Preservation of SMI at 12 months was associated with improved disease-free survival (hazard ratio 0.51, 95 % CI 0.29–0.92; p = 0.027). Two-year disease-free survival showed an exploratory signal favoring the intervention (89.7 % vs 74.0 %; hazard ratio 0.46, 95 % CI 0.23–0.93), although survival analyses were not powered for definitive inference.</div></div><div><h3>Conclusions</h3><div>Perioperative modulation of circadian and gut–brain processes was associated with improvements in depressive symptoms, sleep quality, postoperative inflammatory profiles, and functional recovery. Survival findings represent preliminary exploratory signals and require confirmation in larger, adequately powered randomized trials.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"196 ","pages":"Article 104943"},"PeriodicalIF":4.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On bias and balance: Updating agentic and communal self-beliefs in social anxiety and depression","authors":"Zohar Klein ,&nbsp;Reut Zabag ,&nbsp;Dan E. Hay ,&nbsp;Einat Levy-Gigi ,&nbsp;Eva Gilboa-Schechtman","doi":"10.1016/j.brat.2025.104905","DOIUrl":"10.1016/j.brat.2025.104905","url":null,"abstract":"<div><div>Cognitive models propose that biased information processing in social anxiety (SA) and depression facilitates negative and inhibits the processing of positive self-information. These biases are postulated to reinforce persistent negative views of the self. Biased updating of self-beliefs in response to valanced new information in both SA and depression is theoretically postulated. The results, however, are not fully consistent with theoretical postulations. Importantly, self-information is structured around two main domains - agency (e.g., competence, assertiveness) and communion (e.g., warmth, connectedness). These domains distinctly influence the way information about the self is processed and integrated. However, this distinction is missing from the examination of self-belief updating. The current study examined how individuals update agentic and communal self-beliefs in response to negative and positive social feedback. We employed a novel ‘SocialMirror’ paradigm in a large subclinical sample (N = 560). In this two-phase reversal learning task, participants received negative feedback followed by positive feedback on their personality traits. SA was uniquely associated with increased negative updating of agentic, but not communal, self-beliefs. Depression was uniquely associated with reduced positive updating across both domains. Notably, these findings remained evident even after statistically controlling for initial beliefs. Across the sample, updating was domain dependent, with agentic traits being less malleable. These findings suggest domain- and valence-related patterns of self-belief updating in SA and depression. Results are interpreted in light of Bayesian models, emphasizing the need to integrate motivational aspects into cognitive theory. We highlight the implications of these findings for interventions aimed at updating self-belief in psychopathology.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104905"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The imagery rescripting protocol for obsessive-compulsive disorder (ImRs-OCD): A decade of iterative refinement in treatment sequencing following ERP","authors":"Gayle Maloney ,&nbsp;Arnoud Arntz ,&nbsp;Christopher Pittenger","doi":"10.1016/j.brat.2025.104878","DOIUrl":"10.1016/j.brat.2025.104878","url":null,"abstract":"<div><div>Obsessive-Compulsive Disorder (OCD) is a debilitating psychological condition that remains resistant to treatment in a significant proportion of clients, even following completion of first-line psychological and pharmacological treatments. This paper describes a sequenced treatment protocol combining Exposure and Response Prevention (ERP) with Imagery Rescripting for OCD (ImRs-OCD) as an adjunctive intervention for individuals with treatment-resistant OCD. The ImRs-OCD protocol has undergone multiple rounds of refinement over the past 10 years through iterative protocol development, based on clinician and client feedback. We describe the evolution of the protocol, key adaptations for OCD, illustrative case examples, and preliminary evidence supporting its efficacy. A standardised 10-step ImRs-OCD protocol is presented, along with guidelines for implementation and a set of standard rescripting questions and handouts. This work aims to provide guidance to clinicians and to encourage further research into imagery rescripting as a comprehensive treatment approach for treatment-resistant OCD.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104878"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145303968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone-based approach-avoidance bias modification training for anorexia nervosa - A randomized clinical trial","authors":"Maximilian Blomberg ,&nbsp;Rachel Schaper ,&nbsp;Anahita Bonabi ,&nbsp;Johanna Sophie Oppermann ,&nbsp;Hilmar Zech ,&nbsp;Wally Wünsch-Leiteritz ,&nbsp;Timo Brockmeyer","doi":"10.1016/j.brat.2025.104900","DOIUrl":"10.1016/j.brat.2025.104900","url":null,"abstract":"<div><h3>Background</h3><div>Effective treatments for anorexia nervosa (AN) are available, yet many patients do not respond to treatment or experience relapse. Cognitive bias modification aims to ameliorate cognitive biases that are assumed to contribute to the development and maintenance of AN. This study examines the efficacy of a novel mobile approach-avoidance bias modification training (ABMT) with food cues for AN.</div></div><div><h3>Method</h3><div>In this RCT, 90 inpatients with AN received six sessions of active or sham ABMT with food cues or no training, alongside treatment-as-usual. Primary outcome was self-reported eating disorder psychopathology; secondary outcomes included food-related approach-avoidance bias, fear of food, and BMI. Outcomes were assessed at baseline, end-of-training and at 6-month follow-up.</div></div><div><h3>Results</h3><div>Active ABMT did not result in greater reductions in eating disorder psychopathology. Similarly, treatment conditions did not differ regarding in change in BMI, approach-avoidance bias or fear of food, neither in the short term nor in the long term. Changes in approach-avoidance bias did not mediate training effects on any outcomes.</div></div><div><h3>Conclusions</h3><div>This first RCT on ABMT for AN found no superiority of active ABMT over sham or no ABMT in reducing eating disorder psychopathology. ABMT also appeared insufficient to alter food-related approach bias. Mobile ABMT with food cues in its current form does not seem to be an efficacious adjunct treatment to inpatient TAU for patients with AN. Further research may explore whether modified training protocols and personalized approaches are more promising in this regard.</div></div><div><h3>Trial registration</h3><div>This study's design was registered at the German Clinical Trials Register [<span><span>https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00022078</span><svg><path></path></svg></span>]</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104900"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145394340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Episodic Threat Conditioning’: a novel approach to simultaneously measure Pavlovian threat conditioning and episodic memory","authors":"Olivier T. de Vries ,&nbsp;Sascha B. Duken ,&nbsp;Nadža Džinalija ,&nbsp;Merel Kindt ,&nbsp;Vanessa A. van Ast","doi":"10.1016/j.brat.2025.104882","DOIUrl":"10.1016/j.brat.2025.104882","url":null,"abstract":"<div><div>The powerful ways future behavior and cognition can be affected by emotional events are typically studied either by means of Pavlovian conditioning or episodic memory paradigms, which both rest on the idea that associations are formed between distinct stimuli experienced closely together in space or time. However, due to their incompatible methods, little is known about how physiological read-outs of Pavlovian conditioning and episodic memory work in concert to affect behavior and other cognitive processes, how they relate to each other, or whether they reflect the activity of distinct associative processes in the first place. To shed light on such questions, a paradigm is needed that can assess both conditioned psychophysiology and episodic memory. We reasoned that multimodal stimuli, consisting of congruent image-sound combinations, have the potential to serve as potent unconditioned stimuli in a paradigm where participants encode a large number ‘mini-conditioning events’. Measuring both pupil dilation and facial electromyography, we found that psychophysiological responses to 20 unique aversive USs – but not positive USs - transferred to arbitrary predictors already after a single paired presentation in this novel paradigm. Real-life emotional aversive and stressful events are likely to involve both Pavlovian conditioning and episodic memory processes. The ‘Episodic Threat Conditioning’ paradigm enables their simultaneous assessment, thereby providing an opportunity to gain more holistic insight into how different expressions of memory interact in mental health and disease.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104882"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imagery rescripting for social anxiety disorder via internet videoconferencing: An open trial","authors":"Halaina R. Winter ,&nbsp;Alice R. Norton ,&nbsp;Bethany M. Wootton","doi":"10.1016/j.brat.2025.104914","DOIUrl":"10.1016/j.brat.2025.104914","url":null,"abstract":"<div><div>Imagery rescripting (ImR) has demonstrated efficacy in reducing symptoms of social anxiety disorder (SAD). However, there are many logistical and psychological barriers that prevent individuals with SAD from accessing treatment. The efficacy of remote treatment methodologies, such as internet videoconferencing, has recently been demonstrated across a range of mental disorders. However, the efficacy of videoconferencing-delivered ImR (vImR) has not yet been examined. The present study aims to examine the efficacy and acceptability of vImR for SAD in a multiple baseline trial utilising the waitlist control group from a larger randomised controlled trial (RCT). 35 participants (<em>M</em>_age = 37.86; <em>SD</em> = 12.90) received no intervention for 8-weeks, then received an 8-session manualised vImR treatment protocol. Within-group analyses indicated negligible effect sizes from baseline to pre-treatment (SIAS-6: <em>d</em> = 0.22; 95 % CI: 0.25 – 0.69; SPS-6: <em>d</em> = −0.03; 95 % CI: 0.49 – 0.44). Large effect sizes were found from pre-treatment to post-treatment (SIAS-6: <em>d</em> = 0.81; 95 % CI: 0.32–1.29; SPS-6: <em>d</em> = 0.80; 95 % CI: 0.30–1.27) and pre-treatment to 3-month follow-up (SIAS-6: <em>d</em> = 0.85; 95 % CI: 0.36–1.33; SPS-6: <em>d</em> = 0.90; 95 % CI: 0.40–1.38). At post-treatment, 66 % of participants no longer met criteria for SAD (74 % at 3-month follow-up). Benchmarking analyses indicated similar treatment effect sizes to in-person ImR for SAD. Participants rated the program as highly acceptable. The results indicate that the mechanisms of ImR appear to be transferable to vImR and therefore this may be a viable remote treatment option for individuals with SAD who do not respond to first-line treatments.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104914"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a brief, online imagery rescripting intervention targeting fear-of-self in high obsessive-compulsive participants","authors":"Eliza M. Ferguson,&nbsp;David D.J. Cooper,&nbsp;Jessica R. Grisham","doi":"10.1016/j.brat.2025.104903","DOIUrl":"10.1016/j.brat.2025.104903","url":null,"abstract":"<div><div>Emerging evidence suggests that rescripting aversive memories related to obsessive-compulsive disorder (OCD) may improve symptoms and OCD-relevant cognitive and affective outcomes. We aimed to validate an online, audio-guided imagery rescripting protocol by comparing it with a focused, thought-listing control. A sample of Prolific online workers (<em>n</em> = 112) with high OCD symptoms identified a memory associated with OCD-related experiences, then were randomly assigned to complete either the rescripting or control task. Select outcomes were re-assessed one-week post-experiment. Feared self-perceptions improved for the rescripting, but not the control condition; these improvements were maintained for idiosyncratic and state feared-self beliefs, but not trait fear-of-self. Participants in the rescripting condition also reported significantly greater reductions in state anxiety and urge to neutralise, compared to controls. No changes were observed in obsessional beliefs for either condition. There were no between-condition differences in engagement in behavioural neutralisation post-experiment. A small but significant increase in reporting OCD symptoms was found at follow-up; this did not differ between conditions and was consistent with heightened awareness of symptoms. These findings provide preliminary evidence that imagery rescripting in a standardised audio-guided format may be an effective adjunctive treatment for OCD to facilitate cognitive and affective change.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104903"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Augmenting in vivo exposure with reward-focused strategies: A randomized controlled trial providing preliminary evidence for improved outcomes in individuals with elevated anhedonia","authors":"Anton Regorius ,&nbsp;Jule Lepper ,&nbsp;Christiane A. Melzig ,&nbsp;Christoph Benke","doi":"10.1016/j.brat.2025.104907","DOIUrl":"10.1016/j.brat.2025.104907","url":null,"abstract":"<div><h3>Objective</h3><div>Exposure therapy is a first-line treatment for social anxiety, yet many individuals show limited response or relapse after treatment. Deficits in reward processes have been linked to impaired extinction learning and may undermine exposure efficacy. This study investigated whether supplementing in-vivo exposure with reward-enhancing strategies can improve outcomes for public speaking anxiety, particularly in individuals with elevated anhedonia.</div></div><div><h3>Method</h3><div>This preregistered study (ClinicalTrials: NCT06258889) randomized 40 adults with public speaking anxiety to: in-vivo exposure paired with reward-focused (EXP + RF) or cognitive restructuring (EXP + CR) techniques. Participants completed a preparatory and exposure session. Outcomes were assessed at baseline, intermediate and post-treatment. Primary outcomes included public speaking anxiety, assessed via <em>Personal Report of Public Speaking Anxiety</em> (PRPSA), and mean fear ratings during a behavioral approach test (BAT; standardized 3-min speech). Baseline anhedonia, assessed via <em>Temporal Experience of Pleasure Scale</em> (TEPS), was examined as a moderator.</div></div><div><h3>Results</h3><div>Both groups improved significantly in public speaking anxiety and fear during BAT from baseline to post-treatment, with no between-group differences. Exploratory analyses revealed that treatment efficacy in public speaking anxiety differed between treatment groups as a function of individuals’ levels of anhedonia. In individuals with high anhedonia, EXP + RF led to greater reduction in public speaking anxiety than EXP + CR (<em>d</em> = 1.43, <em>p</em> = .04). No differences emerged for low or medium anhedonia. Anhedonia did not moderate other outcomes.</div></div><div><h3>Conclusion</h3><div>Individuals with elevated anhedonia derived greater benefit from exposure therapy for social anxiety when augmented with reward-enhancing strategies, highlighting treatment optimization in this subgroup and stratified treatment planning.</div></div>","PeriodicalId":48457,"journal":{"name":"Behaviour Research and Therapy","volume":"195 ","pages":"Article 104907"},"PeriodicalIF":4.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}