Investigating the efficacy of attention bias modification in reducing high spider fear: The role of individual differences in initial bias

Abstract

Background and objectivesAttention Bias Modification (ABM) targets attention bias (AB) towards threat and is a potential therapeutic intervention for anxiety. The current study investigated whether initial AB (towards or away from spider images) influenced the effectiveness of ABM in spider fear.MethodsAB was assessed with an attentional probe task consisting of spider and neutral images presented simultaneously followed by a probe in spider congruent or spider incongruent locations. Response time (RT) differences between spider and neutral trials > 25 ms was considered ‘Bias Toward’ threat. RT difference < - 25 ms was considered ‘Bias Away’ from threat, and a difference between −25 ms and +25 ms was considered ‘No Bias’. Participants were categorized into Initial Bias groups using pre-ABM AB scores calculated at the end of the study. 66 participants' (Bias Toward n = 27, Bias Away n = 18, No Bias n = 21) were randomly assigned to ABM-active training designed to reduce or eliminate a bias toward threat and 61 (Bias Toward n = 17, Bias Away n = 18, No Bias n = 26) to ABM-control.ResultsABM-active had the largest impact on those demonstrating an initial Bias Towards spider images in terms of changing AB and reducing Spider Fear Vulnerability, with the Bias Away group experiencing least benefit from ABM. However, all Initial Bias groups benefited equally from active ABM in a Stress Task.LimitationsParticipants were high spider fearful but not formally diagnosed with a specific phobia. Therefore, results should be confirmed within a clinical population.ConclusionsIndividual differences in Initial Bias may be an important determinant of ABM efficacy.

Asymmetrical transfer effects of cognitive bias modification: Modifying attention to threat influences interpretation of emotional ambiguity, but not vice versa

“…The post hoc finding that the impact of CBM on alleviating threat bias was affected by pre-existing processing selectivity suggests it might be important in future work to consider more closely the bias profile of participants at baseline, and how this relates to subsequent change in threat bias and symptom outcomes (cf. e.g., Fox et al., 2015; MacLeod & Clarke, 2015; Maoz et al., 2013; Mogoaşe et al., 2014). Third, it would have been preferable for the attentional bias test to have included words that were not used in the retraining procedure.…”

“…There is growing evidence that CBM may be particularly efficacious for participants who have a pre-existing cognitive bias to threat, but be less beneficial for individuals with no pre-existing bias (e.g., Fox et al., 2015, Maoz et al., 2013, Mogoase et al., 2014). This could result in a reduction in statistical power (hence the trend-level finding for attention) if the intervention affected participants differently based on their pre-existing bias scores.…”

The Effects of Attention Training on Health Anxiety: An Experimental Investigation

“…According to Wells (2007), a reasonable clinical outcome of S-REF is the development of greater metacognitive awareness via attentional control training aimed at shifting attention away from threat more easily, thus ''disrupting the activation of specific styles and dimensions of thinking associated with particular disorders'' (Papageorgiou and Wells 2000, p. 407). Attentional bias modification (ABM) protocols have proven to be effective for reducing cognitive impairments that involve early attentional processes and increasing attentional control (Beard et al 2012;Enock et al 2014;Fox et al 2015;Mogoaşe et al 2014;Yang et al 2015). However, ABM protocols often rely on computerised training procedures, and the training methods have limited transferability to other stimuli.…”

Cognitive Remediation and Bias Modification Strategies in Mood and Anxiety Disorders

“…Another study found CBT to be more effective in reducing anxiety and CBM to be more effective in improving automatic threat associations[112]. Given that individuals with an anxiety disorder may exhibit a bias towards or away from a threat-relevant stimulus, findings from a recent study of ABM in patients with spider fear lend support to the notion that bias modification treatments may be most effective if tailored to an individual patient's baseline bias orientation[113]. Interventions combining cognitive remediation or bias modification strategies with CBT may be most effective[92, 109, 67].…”