Neural Markers of Treatment Mechanisms and Prediction of Treatment Outcomes in Social Anxiety

Eligibility Criteria

• 1. A lifetime history of bipolar disorder, schizophrenia, psychosis, delusional disorders or obsessive-compulsive disorder; an eating disorder in the past 6 months; organic brain syndrome, intellectual disability, or other cognitive dysfunction that could interfere with capacity to engage in therapy; a history of substance or alcohol abuse or dependence (other than nicotine) in the last 6 months or otherwise unable to commit to refraining from alcohol, marijuana, and stimulant use during the acute period of study participation.
• 2. . Patients with significant suicidal ideation Montgomery-Åsberg Depression Rating Scale (10 items, self-report) or who have enacted suicidal behaviors within 6 months prior to intake will be excluded from study participation and referred for appropriate clinical intervention.
• 3. Patients can be taking a concurrent psychotropic medication (e.g., antidepressants, anxiolytics, beta blockers, sertraline), but the dose must be stabilized for at least 2 weeks prior to initiation of randomized treatment.
• 4. Significant personality dysfunction likely to interfere with study participation.
• 5. Serious medical illness or instability for which hospitalization may be likely within the next year.
• 6. Patients with a current or past history of seizures.
• 7. Pregnant women, lactating women, and women of childbearing potential who may become pregnant.
• 8. Any concurrent psychotherapy initiated within 3 months of baseline, or ongoing psychotherapy of any duration directed specifically toward treatment of the social anxiety is excluded. Individuals with prior CBT experience or treatments that included cognitive and behavioral skills and exposure procedures (e.g., assertiveness and social skills trainings) will be excluded. General supportive or insight-oriented therapy initiated \> 3 months prior is acceptable.
• 9. Prior non-response to adequately-delivered exposure (i.e., as defined by the patient's report of receiving specific and regular exposure assignments as part of a previous treatment).
• 10. Patients with a history of head trauma causing loss of consciousness, seizure or ongoing cognitive impairment.
• 11. Contraindications for MRI including metal implants, surgical clips, probability of metal fragments, or braces.