A meta-analysis of bias at baseline in RCTs of attention bias modification: No evidence for dot-probe bias towards threat in clinical anxiety and PTSD.

Abstract

Background: Considerable effort and funding have been spent on developing Attention Bias Modification (ABM) as a treatment for anxiety disorders, theorized to exert therapeutic effects through reduction of a tendency to orient attention towards threat. However, meta-analytical evidence that clinical anxiety is characterized by threat-related attention bias is thin. The largest meta-analysis to date included dotprobe data for n=337 clinically anxious individuals. Baseline measures of biased attention obtained in ABM RCTs form an additional body of data that has not previously been meta-analyzed. Method: This paper presents a meta-analysis of threat-related dot-probe bias measured at baseline for 1005 clinically anxious individuals enrolled in 13 ABM RCTs. Results: Random-effects meta-analysis indicated no evidence that the mean bias index (BI) differed from zero (k= 13, n= 1005, mean BI = 1.8 ms, SE = 1.26 ms, p = .144, 95% CI [-0.6-4.3]. Additional Bayes factor analyses also supported the pointzero hypothesis (BF10 = .23), whereas interval-based analysis indicated that mean bias in clinical anxiety is unlikely to extend beyond the 0 to 5 ms interval. Discussion: Findings are discussed with respect to strengths (relatively large samples, possible bypassing of publication bias), limitations (lack of control comparison, repurposing data, specificity to dot-probe data), and theoretical and practical context. We suggest that it should no longer be assumed that clinically anxious individuals are characterized by selective attention towards threat. Conclusion: Clinically anxious individuals enrolled in RCTs for Attention Bias Modification are not characterized by threat-related attention bias at baseline.

Attentional Bias Modification in Virtual Reality – A VR-Based Dot-Probe Task With 2D and 3D Stimuli

“…The current study adds to a number of previous reports in finding no evidence of attentional bias in socially anxious individuals at baseline (e.g., Julian et al, 2012; Boettcher et al, 2013; Badura-Brack et al, 2015; Heeren et al, 2015a; Miloff et al, 2015; Naim et al, 2018; for a recent meta-analysis of baseline bias in ABM RCTs, see Kruijt et al, 2019). Furthermore, we failed to detect a change in attentional bias post-ABM training.…”

Attention Bias and Recognition of Sexual Images

“…Although we found our results robust and reliable, as indicated by the split-half reliability estimate, the DPT measure as such has been criticized for extremely weak reliability (Schmukle, 2005;Staugaard, 2009). It has also been claimed that the DPT cannot effectively distinguish between attention bias and the SCID and that it struggles with producing reliable findings in other research areas as well (see Kruijt et al, 2019;Strahler et al, 2019). This explanation is partially supported by our PRT results which do suggests attention bias for sexual pictures.…”

What Drives Symptom Reduction in Attention Bias Modification Treatment? A Randomized Controlled Experiment in Clinically Anxious Youths

“…Finally, the findings did not provide evidence of attention bias change from pretreatment to posttreatment in the ABM group. This result is common in ABM trials, and poor psychometrics of the dot-probe bias scores (McNally, 2019) as well as lack of baseline attention bias in participants of clinical trials (Kruijt, Parsons, & Fox, 2019) has been implicated.…”