A new clinical trial conducted at Tel Aviv University (TAU) has demonstrated an effective technology-driven alternative to psychiatric medications for people with social anxiety.

The groundbreaking study found that Gaze-Contingent Music Reward Therapy (GC-MART) is as effective in treating social anxiety disorder as drugs from the SSRI family. The study found that the innovative treatment, developed at TAU, relieved the symptoms of about 50% of the participating patients. The researchers hope that this therapy will soon be available as an effective alternative to psychiatric medications.

The study was led by Professor Yair Bar-Haim, Director of the Adler Center for Child Development and Psychopathology and TAU’s Center for Traumatic Stress and Resilience, together with research students Gal Arad and Omer Azriel of TAU’s School of Psychological Sciences. Other collaborators included the NIH, the Tel Aviv Sourasky (Ichilov) and Sheba Medical Centers, and TAU’s Professor Amit Lazarov. The paper was published on March 22, 2023, in the American Journal of Psychiatry.

“About 4-12% of the population will develop social anxiety disorder at some stage of their lives,” Professor Bar-Haim explains. “Quite often, people with this disorder avoid social situations at a heavy interpersonal, professional, and economic price.

“At present, psychiatry and psychology offer sufferers two types of treatment: Selective Serotonin Reuptake Inhibitor (SSRI) drugs, such as Cipralex, and Cognitive-Behavioral Therapy (CBT). CBT requires 12-20 sessions with a qualified clinical psychologist, in which symptoms are relieved through gradual exposure to the cause of anxiety. While effective, CBT is a complex treatment necessitating the presence of a highly skilled therapist and requiring patients to face their deepest fears, a requirement that often leads to treatment dropout.

“Because CBT is demanding, expensive, and not readily accessible, many patients turn to medication. However, psychiatric drugs like Cipralex have their own drawbacks: first, some patients prefer not to use psychiatric drugs; second, entire populations, such as young children, pregnant women, and individuals with specific diseases, cannot take SSRI drugs; and third, in some cases the drug has certain side effects.”

The TAU researchers have developed a third option, which is easy-to-use, quick and simple, and apparently no less effective than psychiatric drugs. Moreover, since the treatment is highly patient-friendly, a much lower dropout rate may be expected.

In the clinical trial, 105 Israeli adults with social anxiety disorder were assigned into three groups: one group was treated with SSRI drugs, in this case Cipralex; a second group was treated with GC-MART; and a control group. After ten 30-minute training sessions, about 50% of the patients provided with the new therapy demonstrated significant improvement in their symptoms, a result similar to the outcome reported for patients who took Cipralex.

“The therapy we developed is based on eye-tracking combined with a musical reward,” Professor Bar-Haim says. “The patients choose the music they would like to hear – Israeli, classical, hip hop, etc., – and are shown a simulation of a crowd on a computer screen. Usually, individuals with social anxiety disorder tend to dwell on scowling or threatening facial expressions, quickly picking them out and unable to look away. Consequently, they often interpret the crowd or social situations as hostile, negative, or critical. People without social anxiety disorder, on the other hand, prefer to focus on positive or neutral faces in a crowd.

“In the new therapy, the music chosen by the patient provides positive feedback for a normal focus of attention on facial expressions in the crowd presented on the screen. Gradually, through training, patients’ biased attention is normalized, and symptoms recede.

“All participants in our trial underwent a comprehensive clinical assessment both before and after the treatment and were also asked to report on the symptoms and their severity. Results indicated that the new treatment significantly reduced symptoms of social anxiety, with an efficacy that is similar to that of SSRI drugs.”

“Our findings are encouraging for both therapists and patients,” Professor Bar-Haim concludes. “With efficacy similar to that of an existing first-line drug treatment, the new treatment does not require the patient to take medications regularly. The new treatment is simple and patient-friendly. It does not necessitate the prolonged intervention of a highly skilled psychologist, but rather interaction with social images on a screen, and therefore potentially offers accessible, effective, and convenient treatment for social anxiety disorder.”