Internet-delivered attention bias modification training in individuals with social anxiety disorder - a double blind randomized controlled trial

Abstract

BackgroundComputerized cognitive bias modification for social anxiety disorder has in several well conducted trials shown great promise with as many as 72% no longer fulfilling diagnostic criteria after a 4 week training program. To test if the same program can be transferred from a clinical setting to an internet delivered home based treatment the authors conducted a randomized, double-blind placebo-controlled trial.MethodsAfter a diagnostic interview 79 participants were randomized to one of two attention training programs using a probe detection task. In the active condition the participant was trained to direct attention away from threat, whereas in the placebo condition the probe appeared with equal frequency in the position of the threatening and neutral faces.ResultsResults were analyzed on an intention-to-treat basis, including all randomized participants. Immediate and 4-month follow-up results revealed a significant time effect on all measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). However, there were no time x group interactions. The lack of differences in the two groups was also mirrored by the infinitesimal between group effect size both at post test and at 4-month follow-up.ConclusionWe conclude that computerized attention bias modification may need to be altered before dissemination for the Internet.Trial registrationISRCTN01715124

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

“…Although the applied training procedure closely resembled procedures that have effectively implemented ABM (Amir et al, 2008;Van Bockstaele et al, 2011), we did not find changes in attention bias at the training condition level in response to training toward negative, positive, or away from negative with various stimulus materials (i.e., emotional scenes, words, facial expressions) and stimulus presentation durations (500ms, 750ms, 1000ms). Thus, the present findings add to recent research that did not replicate successful ABM delivery (e.g., Boettcher et al, 2013;Carlbring et al, 2012;Rapee et al, 2013).…”

“…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).…”

Attentional bias modification based on visual probe task: methodological issues, results and clinical relevance

“…[21][22][23][24][25] In the other nine studies, there were differences between groups, and AB for threat was reduced in the avoid groups, when compared with the control group.…”

“…However, several studies that compared avoid and control groups [21][22][23]52 found no differences between groups after training. One possible explanation for this phenomenon might be that avoidance training demands a greater cognitive effort, as it goes against the trend preferred by participants, whereas training to attend reinforces this trend and does not demand any special cognitive effort.…”

Hjärnan formas av psykologisk behandling

“…Two meta-analyses have demonstrated small to medium effect sizes of ABM for anxiety disorders (Hakamata et al, 2010;Hallion & Ruscio, 2011). However, the promising findings found with ABM conducted in a laboratory setting have not been replicated when the same treatment has been delivered via the internet (Boettcher, Berger, & Renneberg, 2011;Carlbring et al, 2012;Neubauer et al, 2013). It is possible that ABM only works for individuals showing an attentional bias before treatment initiation and the context where ABM is delivered may also be important (MacLeod & Grafton, 2016;Price et al, 2016).…”