Text message safety behavior reduction for social anxiety: A randomized controlled trial.

Objective: Cognitive models of social anxiety disorder propose that maladaptive safety behaviors (SBs; i.e., behaviors intended to avoid, prevent, or manage threat) play an important maintaining role in the disorder. Though targeting these behaviors for elimination is one component of contemporary cognitive-behavioral therapies for social anxiety, it has rarely been examined as a specific treatment strategy, and, to our knowledge, it has not yet been examined in isolation as an intervention for social anxiety. The current study evaluated an SB reduction intervention for social anxiety that consisted of brief text message reminders. Method: Individuals with elevated social anxiety (N = 94) were recruited from across the United States and randomized to receive one of two 1-month text message interventions consisting of 16 text message reminders to avoid SBs or focus on the present. Symptoms were assessed at pre- and posttreatment, as well as at 1-month follow-up. Results: Both treatments were associated with substantial symptom reduction. Compared to the present-focused text message condition, SB elimination led to lower SB frequency at posttreatment (sr(2) = .044, p = .048) and lower social anxiety at follow-up (sr(2) = .096, p = .005). Conclusions: These preliminary findings provide novel evidence for the importance of SBs in social anxiety and suggest text message SB reduction may be an effective, highly accessible intervention for individuals with social anxiety.