Absence of evidence or evidence of absence: reflecting on therapeutic implementations of attentional bias modification

Abstract

Attentional bias modification (ABM) represents one of a number of cognitive bias modification techniques which are beginning to show promise as therapeutic interventions for emotional pathology. Numerous studies with both clinical and non-clinical populations have now demonstrated that ABM can reduce emotional vulnerability. However, some recent studies have failed to achieve change in either selective attention or emotional vulnerability using ABM methodologies, including a recent randomised controlled trial by Carlbring et al. Some have sought to represent such absence of evidence as a sound basis not to further pursue ABM as an online intervention. While these findings obviously raise questions about the specific conditions under which ABM procedures will produce therapeutic benefits, we suggest that the failure of some studies to modify selective attention does not challenge the theoretical and empirical basis of ABM. The present paper seeks to put these ABM failures in perspective within the broader context of attentional bias modification research. In doing so it is apparent that the current findings and future prospects of ABM are in fact very promising, suggesting that more research in this area is warranted, not less.

Attention bias modification via single-session dot-probe training: Failures to replicate

“…For depression, meta-analytic evidence suggests no effects of ABM on depressive symptomatology, but note that there is little research testing ABM in depressed samples (see Mogoase et al, 2014). While several recent ABM studies did not produce clinically significant changes (Boettcher, Andersson, Carlbring, & Group, 2013;Carlbring et al, 2012;Julian, Beard, Schmidt, Powers, & Smits, 2012;Neubauer et al, 2013;Rapee et al, 2013), such failures might be due to failures of ABM to change attentional bias at the training condition (group) level (Clarke, Notebaert, & MacLeod, 2014). Yet, there is large variability among trainees in attention bias acquisition following ABM delivery and such individual differences may predict anxiety levels (e.g., Clarke, Chen, & Guastella, 2012;Clarke, MacLeod, & Shirazee, 2008).…”

Impact of the temporal stability of preexistent attentional bias for threat on its alteration through attention bias modification

“…There is increasing recognition for the idea that ABM should be improved and that examination of potential individual differences moderating the efficacy of ABM is crucial (Abend et al, 2014;Clarke et al, 2014). Understanding who profits from ABM is decisive 2 As the variance of AB t2 was already included in the model as predictor, we decided to used post ABM d score (AB t3 ) and not the difference between AB t3 e AB t2 to avoid that the variance of AB t2 was included in the model as both a predictor and a dependent variable.…”

“…This work has led to several randomized controlled trials among anxious individuals reporting that, relative to control training (i.e., a sham training), this procedure reduces AB, thereby diminishing anxiety symptoms (for meta-analyses, see Hakamata et al, 2010;Mogoase et al, in press). By most standards, these results raised promising clinical avenues for ABM as it entails a very simple protocol, little contact with a mental health professional, and a potential for easy dissemination (e.g., Amir, Taylor, & Donohue, 2011;Clarke, Notebaert, & MacLeod, 2014;Heeren, Maurage, & Philippot, 2013).…”

Modificación de Sesgos Cognitivos (MSC) en depresión: Una revisión crítica de nuevos procedimientos para el cambio de sesgos cognitivos

“…Además, se ha visto necesario que los escenarios presentados en los entrenamientos sean en un inicio ambiguos para que se adquiera el sesgo de interpretación consistente con la valencia emocional de éstos (Clarke, Notebaert y MacLeod, 2014). Por consiguiente, resulta oportuno seguir delimitando las características que hacen a los procedimientos más eficaces para modificar las interpretaciones depresivas.…”

“…Si bien para algunos autores como Emmelkamp (2012) los procedimientos de MSC no añaden nada clínicamente útil y deben ser abandonados, nos parece más sensato, como sugieren otros autores (Clarke et al, 2014;Hertel y Mathews, 2011), perseverar en esta línea de investigación para fijar las condiciones de utilidad de estos nuevos procedimientos y, sobre todo, efectuar ensayos clínicos aleatorizados escrupulosos con participantes clínicos y muestras grandes (Cristea et al, 2015). Creemos que merece la pena el esfuerzo, pues en principio se trata de opciones poco costosas y accesibles, ya que requieren una mínima supervisión, son flexibles y poco demandantes para el participante (Yiend et al, 2014).…”