The dot-probe task has been widely used in research to produce an index of biased attention based on reaction times (RTs). Despite its popularity, very few published studies have examined psychometric properties of the task, including test-retest reliability, and no previous study has examined reliability in clinically anxious samples or systematically explored the effects of task design and analysis decisions on reliability. In the current analysis, we used dot-probe data from 3 studies in which attention bias toward threat-related faces was assessed at multiple (Ն5) time-points. Two of the studies were similar (adults with social anxiety disorder, similar design features) whereas 1 was more disparate (pediatric healthy volunteers, distinct task design). We explored the effects of analysis choices (e.g., bias score formula, outlier handling method) on reliability and searched for convergent findings across the 3 studies. We found that, when concurrently considering the 3 studies, the most reliable RT index of bias used data from dot-bottom trials, comparing congruent to incongruent trials, with rescaled outliers, particularly after averaging across more than 1 assessment point. Although reliability of RT bias indices was moderate to low, within-session variability in bias (attention bias variability; ABV), a recently proposed RT index, was more reliable across sessions. Several eyetracking-based indices of attention bias (available in the pediatric healthy sample only) showed reliability that matched the optimal RT index (ABV). On the basis of these findings, we make specific recommendations to researchers using the dot-probe, particularly those wishing to investigate individual differences and/or single-patient applications.

Computer-based approaches, such as Attention Bias Modification (ABM), could help improve access to care for anxiety. Study-level meta-analyses of ABM have produced conflicting findings and leave critical questions unresolved regarding ABM’s mechanisms of action and clinical potential. We pooled patient-level datasets from randomized controlled trials of children and adults with high-anxiety. Attentional bias (AB) towards threat, the target mechanism of ABM, was tested as an outcome and a mechanistic mediator and moderator of anxiety reduction. Diagnostic remission and Liebowitz Social Anxiety Scale (LSAS) were clinical outcomes available in enough studies to enable pooling. Per-patient data were obtained on at least one outcome from 13/16 eligible studies [86% of eligible participants; n=778]. Significant main effects of ABM on diagnostic remission (ABM—22.6%, control—10.8%; OR=2.57; p=.006) and AB (β*(95%CI)=−.63(−.83, −.42); p<.00005) were observed. There was no main effect of ABM on LSAS. However, moderator analyses suggested ABM was effective for patients who were younger (≤37y), trained in the lab, and/or assessed by clinicians. Under the same conditions where ABM was effective, mechanistic links between AB and anxiety reduction were supported. Under these specific circumstances, ABM reduces anxiety and acts through its target mechanism, supporting ABM’s theoretical basis while simultaneously suggesting clinical indications and refinements to improve its currently limited clinical potential.

ISRCTN01715124.

Attention bias modification (ABM) may be an effective treatment for anxiety disorders (Beard, Sawyer, & Hofmann, 2012). As individuals with PTSD possess an attentional bias towards threat-relevant information ABM may prove effective in reducing PTSD symptoms. We examined the efficacy of ABM as an adjunct treatment for PTSD in a real-world setting. We administered ABM in conjunction with prolonged exposure or cognitive-processing therapy and medication in a community inpatient treatment facility for military personnel diagnosed with PTSD. Participants were randomized to either ABM or an attention control condition (ACC). While all participants experienced reductions in PTSD symptoms, participants in the ABM group experienced significantly fewer PTSD and depressive symptoms at post-treatment when compared to the ACC group. Moreover, change in plasticity of attentional bias mediated this change in symptoms and initial attentional bias moderated the effects of the treatment. These results suggest that ABM may be an effective adjunct treatment for PTSD.