Cognitive bias modification for social anxiety in adults who stutter: a feasibility study of a randomised controlled trial

Abstract

ObjectiveTo determine the feasibility and acceptability of a computerised treatment for social anxiety disorder for adults who stutter including identification of recruitment, retention and completion rates, large cost drivers and selection of most appropriate outcome measure(s) to inform the design of a future definitive trial.DesignTwo-group parallel design (treatment vs placebo), double-blinded feasibility study. Participants: 31 adults who stutter.InterventionAttention training via an online probe detection task in which the stimuli were images of faces displaying neutral and disgusted expressions.Main outcome measuresPsychological measures: Structured Clinical Interview Global Assessment of Functioning score; Liebowitz Social Anxiety Scale; Social Phobia and Anxiety Inventory; State-Trait Anxiety Inventory; Unhelpful Thoughts and Beliefs about Stuttering. Speech fluency: percent syllables stuttered. Economic evaluation: resource use questionnaire; EuroQol three-dimension questionnaire.Acceptability: Likert Scale questionnaire of experience of trial, acceptability of the intervention and randomisation procedure.ResultsFeasibility of recruitment strategy was demonstrated. Participant feedback indicated that the intervention and definitive trial, including randomisation, would be acceptable to adults who stutter. Of the 31 participants who were randomised, 25 provided data at all three data collection points.ConclusionsThe feasibility study informed components of the intervention. Modifications to the design are needed before a definitive trial can be undertaken.Trial registration numberI SRCTN55065978; Post-results.

Effectiveness of nonpharmacological stuttering interventions on communication and psychosocial functioning in adults: A systematic review and meta‐analysis of randomized controlled trials

“…One non‐English study 59 was excluded due to an inability to source the study in English using two Irish university library services. A final total of nine studies, all RCTs, were included in the review 60‐68 with seven of these used for the meta‐analysis 60,61,63‐66,68 . Two studies were not included in the meta‐analysis due to limited reporting of data and the inability to request the data from the authors due to no email contact details provided 62,67 .…”

“…Details of the final nine studies are presented in Table S3. Seven studies used comparator group design 60‐63,65,66,68 and one study used a no treatment controlled design 64 . One study used both comparator and no treatment controlled group design 67 .…”

“…Five studies used participant inclusion criteria related to stuttering severity which was assessed using clinician‐rated informal measures (%SS greater than or equal to 2%) 60,66 or formal measures (SSI‐3/SS1‐4) 33,37 with participants included if they had at least a “mild” stuttering diagnosis on assessment, 64 or at least a “moderate” stuttering diagnosis 61,68 . One study had no criteria for stuttering severity 65 while three did not report details of such criteria 62,63,67 …”

“…Studies were categorized according to their intervention type, with four main categories identified: (1) speech restructuring interventions; 60,64 (2) speech restructuring plus psychological interventions; 62,66 (3) interventions with stimulating techniques, 61,63,68 and (4) interventions targeting anxiety 65,67 (Table S3). Outcome measures used by studies were classified into four core groups using the ICF domains 1 : body functions and structures; activities and participation, environmental and personal factors (Table S4).…”

Cognitive bias and stuttering in adolescence

“…While attention can be successfully trained to do so, its generalization to improved mental health outcomes have received mixed findings. This was the case in the one study that investigated an eight-session attentional bias modification intervention among adults who stutter which did not lead to longterm benefits in anxiety outcomes (McAllister et al, 2017). As there are other cognitive factors involved in the experience of stuttering beyond anxiety, it would be important to examine whether attentional training could lead to benefits in not only mental health outcomes but also quality of life measures.…”