Public Speaking FearEXOPATNCT06258889
Optimizing Exposure Therapy Via Reward-focused Interventions in Individuals With Public Speaking Anxiety
A study testing reward-focused intervention, cognitive flexibility intervention and exposure in people with Public Speaking Fear, run by Philipps University Marburg at 1 site in Germany.
Trial summary
The present study aims to examine whether the efficacy of an exposure treatment in individuals with public speaking anxiety can be enhanced by implementing interventions that target reward processes. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Public Speaking Fear
- What is being tested?
- reward-focused intervention, cognitive flexibility intervention and exposure
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 40 participants
- Where
- 1 siteGermany
- Study dates
- 8 Jan 2024to 13 Dec 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Proficient in the German language.
- Elevated levels of anxiety and avoidance of public speaking situations as indicated by a score of > 5 and > 4, respectively, on a scale from 0 to 8 using the following items:
- How anxious would you feel giving a formal speech before a live audience? How likely would you be to avoid taking a class that required taking an oral presentation?
Who cannot join
- severe cardiovascular, respiratory or neurological diseases
- current psychotherapeutic/psychiatric treatment
- Intention to start psychotherapeutic/psychiatric treatment
- current suicidal ideations
- psychotic symptoms (lifetime)
- current psychopharmacological medication
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Optimizing Exposure Therapy Via Reward-focused Interventions: A Randomized Controlled Trial in Individuals With Public Speaking Anxiety
The present study aims to examine whether the efficacy of an exposure treatment in individuals with public speaking anxiety can be enhanced by implementing interventions that target reward processes. Optimized exposure enriched with reward-focused interventions will be compared to exposure in combination with interventions targeting cognitive flexibility. The efficacy of the exposure training will be assessed by behavioural and self-report measures of public-speaking anxiety at baseline (before intervention), intermediate-assessment (7-9 days after baseline assessment) and post-assessment (at least 7-9 days after intermediate-assessment). The investigators expect that exposure optimized by implementing reward-focused interventions is more effective in reducing public speaking anxiety compared to exposure in combination with interventions targeting cognitive flexibility.
Read the detailed description
The present study aims to investigate the efficacy of an optimized exposure training enriched with reward-focused interventions compared to exposure in combination with interventions targeting cognitive flexibility in individuals with elevated public speaking anxiety. Cognitive behavioral therapy offers effective methods for the treatment of various anxiety disorders. However, a substantial number of patients does not benefit from such treatments or experience a return of fear following successful treatment. Emerging evidence underscores the critical involvement of reward processes in fear extinction. Incorporating reward processes in exposure treatments might help to maximize treatment outcomes. In the present study, the investigators will apply reward-focused strategies prior to and during exposure. Strategies are selected to target the core reward processes (i.e., reward anticipation, attainment and learning). Interventions involve finding the silver lining, taking ownership and imagining the positive. Finding the silver lining mainly targets reward attainment (liking) by attending to and appreciating positive aspects of past events. Taking ownership targets liking and reward learning by identifying the personal behavioral contribution to rewarding past experiences. The intervention imagining the positive targets the anticipation of reward (wanting) by training the prospective, positive imagination of future events. The investigators will use an active control group, in which a training of cognitive flexibility (CF; Barlow et al., 2018) will be performed. This training aims to promote cognitive flexibility in the context of public speaking situations. Participants will be trained to identify and modify non-adaptive thoughts (e.g. catastrophizing thoughts). All participants first receive psychoeducation (information on public speaking anxiety, maintenance of anxiety, rationale of exposure training), followed by either reward-focused interventions (Finding the Silver Lining, Taking Ownership, Imagining the Positive) or the CF intervention. Following this session, participants will be asked to practice these interventions between sessions. After one week, exposure in combination with either reward-focused or cognitive flexibility strategies will be performed. Symptom improvement will be assessed at the baseline assessment (i.e., before interventions), at the intermediate-assessment (i.e., before the exposure sessions) and at post assessment (i.e., one week after the exposure sessions). The aim of this randomized controlled trial in individuals with elevated public speaking anxiety is to investigate whether the exposure combined with reward-focused interventions is more effective in reducing public speaking anxiety compared to extinction training combined with cognitive flexibility training.
- Conditions
- Public Speaking Fear
- Being tested
- reward-focused intervention, cognitive flexibility intervention, exposure, Psychoeducation
- Medical subject headings
- Glossophobia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
reward-focused interventionBehavioural
Participants complete three interventions based on the Positive Affect Treatment:
- Finding the silver lining includes attending to and appreciating positive aspects of past events
- Taking ownership includes identifying the personal behavioral contribution to rewarding past experiences
- Imagining the positive includes training the prospective, positive imagination of future events
Participants are asked to practice these interventions at least three times a week (approx. 15 mins each) until the next training session.
cognitive flexibility interventionBehavioural
This training aims to promote cognitive flexibility in the context of public speaking situations. The intervention is based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders.
Participants will be trained to identify and modify non-adaptive thoughts occurring in the context of public speaking situations.
exposureBehavioural
All participants undergo an exposure training session lasting approximately 90 minutes, which includes three exposure trial where participants give a speech, each lasting 5 minutes.
Exposure exercises are enriched with interventions of the respective treatment group (either reward-focused or cognitive flexibility interventions).
PsychoeducationBehavioural
All participants received information on anxiety, and the maintenance of anxiety as well as a rationale for the exposure session.
| Study group | Role | What they receive |
|---|---|---|
| reward-focused intervention + exposure | Experimental | Psychoeducation reward-focused interventions based on Positive Affect Treatment (Finding the silver lining, taking ownership, imagining the positive) Exposure \& reward-focused interventions before and after exposure trials Receives: Behavioral: reward-focused intervention; Behavioral: exposure; Behavioral: Psychoeducation |
| Cognitive flexibility intervention + exposure | Active comparator | Psychoeducation Cognitive Flexibility based on Unified Protocol of emotional disorders Exposure \& cognitive flexibility interventions before and after exposure trials Receives: Behavioral: cognitive flexibility intervention; Behavioral: exposure; Behavioral: Psychoeducation |
What is being measured
The primary outcome is the main question the study is designed to answer.
Personal Report of Public Speaking Anxiety (PRPSA)
34-item scale for measuring fear of public speaking, each item is rated on a 5-item Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Cronbach's alpha has been shown to range from 0.84 to 0.97. High scores on the scale reflect higher fear of public speaking
Measured: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Behavioral Approach Test (BAT)
Rated fear on a scale from 0 (no fear) to 100 (severe fear) during oral presentation.
Measured: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Secondary outcomes (4)
Temporal Experience of Pleasure Scale (TEPS)
the scale measures individual trait dispositions in anticipatory and consummatory experiences of pleasure, it consists of a 10-item anticipatory pleasure scale and an 8-item consummatory pleasure scale, response format is a 6-point Likert scale from 1 (very false for me) to 6 (very true for me).
Measured: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Positive and Negative Affect Schedule (PANAS)
)]: The PANAS consists of two 10-items scales, one measuring Positive Affect (PA) and the other measuring Negative Affect (NA). Each item on the measure is rated on a 5-point scale (1=not at all; 2=a little; 3=moderately; 4= quite a bit; and 5=extremely). Positive Affect (PA) "reflects the extent to which a person feels enthusiastic, active, and alert". Negative Affect (NA) is a "general dimension of subjective distress and unpleasurable engagement that subsumes a variety of aversive mood states". Higher scores on the PA dimension indicate a greater extent of positive affect, higher scores on the NA dimension indicate a greater extent of negative affect.
Measured: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Social Phobia Scale (SPS)
The SPS "assesses fears of being scrutinised during routine activities", it consists of 20 items with a 5-point Likert scale from 0 (not at all characteristic or true of me) to 4 (extremely characteristic or true of me), higher scores indicating greater distress when undertaking certain activities in the presence of others.
Measured: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Brief fear of negative evaluations (BFNE-R)
the scale is used for measuring fears of negative evaluations. It consists of 12 items with a 5-point Likert scale from 0 (not at all characteristic of me) to 4 (extremely characteristic of me), higher scores indicate a greater fear of negative evaluations.
Measured: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Feb 2024
- Study start8 Jan 2024
- Primary completion13 Dec 2024
- Study completion13 Dec 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Public Speaking FearStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 40 participants (actual)
Sponsor and investigators
- Lead sponsor
- Philipps University Marburg
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Christoph Benke, Philipps University Marburg
- Investigators
- Christoph Benke, PhD, Principal investigator, Philipps University MarburgAnton Regorius, PhD, Principal investigator, Philipps University Marburg
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06258889
- Sponsor's protocol ID
- EXOPAT_SPEAKING_ANX
- Acronym
- EXOPAT
- Status last verified
- Jan 2026
- First submitted
- 6 Feb 2024
- Last updated
- 9 Jan 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Craske MG, Meuret AE, Ritz T, Treanor M, Dour HJ. Treatment for Anhedonia: A Neuroscience Driven Approach. Depress Anxiety. 2016 Oct;33(10):927-938. doi: 10.1002/da.22490.
PubMed 27699943Craske MG, Meuret AE, Ritz T, Treanor M, Dour H, Rosenfield D. Positive affect treatment for depression and anxiety: A randomized clinical trial for a core feature of anhedonia. J Consult Clin Psychol. 2019 May;87(5):457-471. doi: 10.1037/ccp0000396.
PubMed 30998048Barlow DH, Farchione TJ, Bullis JR, Gallagher MW, Murray-Latin H, Sauer-Zavala S, Bentley KH, Thompson-Hollands J, Conklin LR, Boswell JF, Ametaj A, Carl JR, Boettcher HT, Cassiello-Robbins C. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Sep 1;74(9):875-884. doi: 10.1001/jamapsychiatry.2017.2164.
PubMed 28768327
Study at a glance
From the registry record, last updated by the sponsor on 9 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Optimizing Exposure Therapy Via Reward-focused Interventions: A Randomized Controlled Trial in Individuals With Public Speaking Anxiety
- ClinicalTrials.gov ID
- NCT06258889
- Acronym / sponsor ID
- EXOPAT / EXOPAT_SPEAKING_ANX
- Conditions
- Public Speaking Fear
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 40 participants (actual)
- Lead sponsor
- Philipps University MarburgUniversity, hospital or other
- Study start
- 8 Jan 2024 (actual)
- Primary completion
- 13 Dec 2024 (actual)
- Study completion
- 13 Dec 2024 (actual)
- First posted
- 14 Feb 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The present study aims to examine whether the efficacy of an exposure treatment in individuals with public speaking anxiety can be enhanced by implementing interventions that target reward processes. Optimized exposure enriched with reward-focused interventions will be compared to exposure in combination with interventions targeting cognitive flexibility. The efficacy of the exposure training will be assessed by behavioural and self-report measures of public-speaking anxiety at baseline (before intervention), intermediate-assessment (7-9 days after baseline assessment) and post-assessment (at least 7-9 days after intermediate-assessment). The investigators expect that exposure optimized by implementing reward-focused interventions is more effective in reducing public speaking anxiety compared to exposure in combination with interventions targeting cognitive flexibility.
Detailed description
The present study aims to investigate the efficacy of an optimized exposure training enriched with reward-focused interventions compared to exposure in combination with interventions targeting cognitive flexibility in individuals with elevated public speaking anxiety. Cognitive behavioral therapy offers effective methods for the treatment of various anxiety disorders. However, a substantial number of patients does not benefit from such treatments or experience a return of fear following successful treatment. Emerging evidence underscores the critical involvement of reward processes in fear extinction. Incorporating reward processes in exposure treatments might help to maximize treatment outcomes. In the present study, the investigators will apply reward-focused strategies prior to and during exposure. Strategies are selected to target the core reward processes (i.e., reward anticipation, attainment and learning). Interventions involve finding the silver lining, taking ownership and imagining the positive. Finding the silver lining mainly targets reward attainment (liking) by attending to and appreciating positive aspects of past events. Taking ownership targets liking and reward learning by identifying the personal behavioral contribution to rewarding past experiences. The intervention imagining the positive targets the anticipation of reward (wanting) by training the prospective, positive imagination of future events. The investigators will use an active control group, in which a training of cognitive flexibility (CF; Barlow et al., 2018) will be performed. This training aims to promote cognitive flexibility in the context of public speaking situations. Participants will be trained to identify and modify non-adaptive thoughts (e.g. catastrophizing thoughts). All participants first receive psychoeducation (information on public speaking anxiety, maintenance of anxiety, rationale of exposure training), followed by either reward-focused interventions (Finding the Silver Lining, Taking Ownership, Imagining the Positive) or the CF intervention. Following this session, participants will be asked to practice these interventions between sessions. After one week, exposure in combination with either reward-focused or cognitive flexibility strategies will be performed. Symptom improvement will be assessed at the baseline assessment (i.e., before interventions), at the intermediate-assessment (i.e., before the exposure sessions) and at post assessment (i.e., one week after the exposure sessions). The aim of this randomized controlled trial in individuals with elevated public speaking anxiety is to investigate whether the exposure combined with reward-focused interventions is more effective in reducing public speaking anxiety compared to extinction training combined with cognitive flexibility training.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| reward-focused intervention + exposure | Experimental | Behavioral: reward-focused intervention, Behavioral: exposure, Behavioral: PsychoeducationPsychoeducation reward-focused interventions based on Positive Affect Treatment (Finding the silver lining, taking ownership, imagining the positive) Exposure \& reward-focused interventions before and after exposure trials |
| Cognitive flexibility intervention + exposure | Active comparator | Behavioral: cognitive flexibility intervention, Behavioral: exposure, Behavioral: PsychoeducationPsychoeducation Cognitive Flexibility based on Unified Protocol of emotional disorders Exposure \& cognitive flexibility interventions before and after exposure trials |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Proficient in the German language.
- Elevated levels of anxiety and avoidance of public speaking situations as indicated by a score of > 5 and > 4, respectively, on a scale from 0 to 8 using the following items:
- How anxious would you feel giving a formal speech before a live audience? How likely would you be to avoid taking a class that required taking an oral presentation?
Key exclusion criteria (6 listed)
- severe cardiovascular, respiratory or neurological diseases
- current psychotherapeutic/psychiatric treatment
- Intention to start psychotherapeutic/psychiatric treatment
- current suicidal ideations
- psychotic symptoms (lifetime)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| reward-focused interventionParticipants complete three interventions based on the Positive Affect Treatment: * Finding the silver lining includes attending to and appreciating positive aspects of past events * Taking ownership includes identifying the personal behavioral contribution to rewarding past experiences * Imagining the positive includes training the prospective, positive imagination of future events Participants are asked to practice these interventions at least three times a week (approx. 15 mins each) until the next training session. | Behavioural | reward-focused intervention + exposure |
| cognitive flexibility interventionThis training aims to promote cognitive flexibility in the context of public speaking situations. The intervention is based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Participants will be trained to identify and modify non-adaptive thoughts occurring in the context of public speaking situations. | Behavioural | Cognitive flexibility intervention + exposure |
| exposureAll participants undergo an exposure training session lasting approximately 90 minutes, which includes three exposure trial where participants give a speech, each lasting 5 minutes. Exposure exercises are enriched with interventions of the respective treatment group (either reward-focused or cognitive flexibility interventions). | Behavioural | Cognitive flexibility intervention + exposure, reward-focused intervention + exposure |
| PsychoeducationAll participants received information on anxiety, and the maintenance of anxiety as well as a rationale for the exposure session. | Behavioural | Cognitive flexibility intervention + exposure, reward-focused intervention + exposure |
Primary outcome
Personal Report of Public Speaking Anxiety (PRPSA)
Time frame: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
34-item scale for measuring fear of public speaking, each item is rated on a 5-item Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Cronbach's alpha has been shown to range from 0.84 to 0.97. High scores on the scale reflect higher fear of public speaking
Behavioral Approach Test (BAT)
Time frame: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Rated fear on a scale from 0 (no fear) to 100 (severe fear) during oral presentation.
4 secondary outcomes
Temporal Experience of Pleasure Scale (TEPS)
Time frame: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Positive and Negative Affect Schedule (PANAS)
Time frame: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Social Phobia Scale (SPS)
Time frame: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Brief fear of negative evaluations (BFNE-R)
Time frame: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Jan 2026.
- Background: PubMed 27699943Craske MG, Meuret AE, Ritz T, Treanor M, Dour HJ. Treatment for Anhedonia: A Neuroscience Driven Approach. Depress Anxiety. 2016 Oct;33(10):927-938. doi: 10.1002/da.22490.
- Background: PubMed 30998048Craske MG, Meuret AE, Ritz T, Treanor M, Dour H, Rosenfield D. Positive affect treatment for depression and anxiety: A randomized clinical trial for a core feature of anhedonia. J Consult Clin Psychol. 2019 May;87(5):457-471. doi: 10.1037/ccp0000396.
- Background: PubMed 28768327Barlow DH, Farchione TJ, Bullis JR, Gallagher MW, Murray-Latin H, Sauer-Zavala S, Bentley KH, Thompson-Hollands J, Conklin LR, Boswell JF, Ametaj A, Carl JR, Boettcher HT, Cassiello-Robbins C. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Sep 1;74(9):875-884. doi: 10.1001/jamapsychiatry.2017.2164.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Christoph Benke, PhD principal investigator
Philipps University Marburg
Anton Regorius, PhD principal investigator
Philipps University Marburg
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing reward-focused intervention, cognitive flexibility intervention and exposure in people with Public Speaking Fear, run by Philipps University Marburg at 1 site in Germany.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 9 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Personal Report of Public Speaking Anxiety (PRPSA) (time frame: Change from baseline to intermediate-assessment (i.e., 7-9 days later) to post assessment (i.e., at least 7 days after intermediate-assessment)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06258889, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jan 2026.