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.
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