Improving Psychosocial Functioning among Veterans with Social Anxiety: A Pilot Evaluation of Self-Monitoring Intervention to Reduce Safety Behaviors

Background: Social anxiety (SA), which broadly consists of fears related to being negatively evaluated and avoidance of social situations (Alden & Taylor, 2010), is prevalent among both civilians and Veterans (Byrne et al., 2021; Kessler et al., 2007). SA is associated with impairment across a range of social/interpersonal domains. As a result, individuals with SA are at heightened risk for

experiencing loneliness, low self-efficacy, depression, and substance use, as well as unemployment and poorer workplace productivity relative to individuals without SA. Despite its prevalence and impact on functioning, the majority of individuals with SA do not seek treatment. Significance: The proposed project has significant and immediate relevance to Veterans and the VHA in that it seeks to

assess the feasibility and acceptability of a self-monitoring intervention to decrease safety behaviors (DSB-I) among Veterans with SA and SA associated functional impairment. The proposed intervention is informed by a successful trial of the intervention in a community setting (Cougle et al., 2020) and will be further developed and refined for optimal use with Veterans and for the VA in the

proposed SPiRE. Aside from addressing the critical need for targeted intervention within VA for SA related impairment, the proposed study is innovative in its use of a novel technology-based intervention that is resource light in terms of patient and provider demands and mitigates traditional barriers to

care. The proposed study design is also strengthened by a mixed methods approach heavily informed by patient stakeholder feedback. Specific Aims: Aim 1: Establish feasibility and acceptability of study methods and recruitment strategy using a single-arm study design of N=30 Veterans with SA and SA related impairment enrolled in a VA Compensated Work Therapy (CWT)

program. All Veterans will be enrolled to receive DSB-I. Variables of interest will include feasibility of recruitment (e.g., proportion of Veterans approached/enrolled, proportion of Veterans who complete the study assessments and intervention); Aim 2: Evaluate response to the intervention using post-

intervention survey data collected as part of Aim 1, and qualitative data (i.e., individual thematic interviews) from a subset of Veterans who start DSB-I, to better evaluate participant response to the intervention (e.g., ease of use of DSB-I, credibility/expectancy related to DSB-I, satisfaction with

DSB-I) as well as solicit suggestions for refinement of the intervention; Aim 3: Based on Veteran feedback, refine the intervention and study methods as indicated for optimal use within VA and for Veterans enrolled in CWT to support a future large scale RCT focused on efficacy of outcomes related to improved functional recovery, social integration, and quality of life among Veterans seeking

reintegration into the workforce. Research Design & Methods: The proposed study will employ a mixed-methods (quantitative/qualitative) approach with N=30 Veterans with SA enrolled in CWT. Veterans of all ages, genders, ethnic/racial groups, military eras will be included in the study. All enrolled Veterans will receive the intervention (DSB-I) and will be assessed post intervention. A

subset of ~20 Veterans who start the intervention will also be invited to participate in an individual thematic interview during the post assessment window. Findings from this 2-year project will be used to support a future larger randomized controlled trial focused on efficacy of outcomes related to

improved functional recovery, social integration, and quality of life among Veterans with SA.