Attentional bias modification and attention control training in PTSD: a systematic review and meta-analysis
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PROVIDER: S-EPMC11022678 | biostudies-literature | 2024 Jan
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Project description:BackgroundRandomized control trials (RCTs) comparing attention control training (ACT) and attention bias modification (ABM) in posttraumatic stress disorder (PTSD) have shown mixed results. The current RCT extends the extant literature by comparing the efficacy of ACT and a novel bias-contingent-ABM (BC-ABM), in which direction of training is contingent upon the direction of pre-treatment attention bias (AB), in a sample of civilian patients with PTSD.MethodsFifty treatment-seeking civilian patients with PTSD were randomly assigned to either ACT or BC-ABM. Clinician and self-report measures of PTSD and depression, as well as AB and attention bias variability (ABV), were acquired pre- and post-treatment.ResultsACT yielded greater reductions in PTSD and depressive symptoms on both clinician-rated and self-reported measures compared with BC-ABM. The BC-ABM condition successfully shifted ABs in the intended training direction. In the ACT group, there was no significant change in ABV or AB from pre- to post-treatment.ConclusionsThe current RCT extends previous results in being the first to apply ABM that is contingent upon AB at pre-treatment. This personalized BC-ABM approach is associated with significant reductions in symptoms. However, ACT produces even greater reductions, thereby emerging as a promising treatment for PTSD.
| S-EPMC6520210 | biostudies-literature
Project description:BackgroundSmartphone-delivered attentional bias modification training (ABMT) intervention has gained popularity as a remote solution for alleviating symptoms of mental health problems. However, the existing literature presents mixed results indicating both significant and insignificant effects of smartphone-delivered interventions.ObjectiveThis systematic review and meta-analysis aims to assess the impact of smartphone-delivered ABMT on attentional bias and symptoms of mental health problems. Specifically, we examined different design approaches and methods of administration, focusing on common mental health issues, such as anxiety and depression, and design elements, including gamification and stimulus types.MethodsOur search spanned from 2014 to 2023 and encompassed 4 major databases: MEDLINE, PsycINFO, PubMed, and Scopus. Study selection, data extraction, and critical appraisal were performed independently by 3 authors using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. When necessary, we pooled the standardized mean difference with a 95% CI. In addition, we conducted sensitivity, subgroup, and meta-regression analyses to explore moderator variables of active and placebo ABMT interventions on reducing symptoms of mental health problems and attentional bias.ResultsOur review included 12 papers, involving a total of 24,503 participants, and we were able to conduct a meta-analysis on 20 different study samples from 11 papers. Active ABMT exhibited an effect size (Hedges g) of -0.18 (P=.03) in reducing symptoms of mental health problems, while the overall effect remained significant. Similarly, placebo ABMT showed an effect size of -0.38 (P=.008) in reducing symptoms of mental health problems. In addition, active ABMT (Hedges g -0.17; P=.004) had significant effects on reducing attentional bias, while placebo ABMT did not significantly alter attentional bias (Hedges g -0.04; P=.66).ConclusionsOur understanding of smartphone-delivered ABMT's potential highlights the value of both active and placebo interventions in mental health care. The insights from the moderator analysis also showed that tailoring smartphone-delivered ABMT interventions to specific threat stimuli and considering exposure duration are crucial for optimizing their efficacy. This research underscores the need for personalized approaches in ABMT to effectively reduce attentional bias and symptoms of mental health problems.Trial registrationPROSPERO CRD42023460749; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=460749.
| S-EPMC11406109 | biostudies-literature
Project description:BackgroundDepression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM.MethodsSeven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).ResultsA total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = -0.48, 95% CI -0.80 to -0.17, I2 = 82%) and rumination (MD = -3.46, 95% CI -6.06 to -0.87, I2 = 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI -0.52 to 6.65, I 2 = 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left-right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist.ConclusionDue to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression.Systematic Review Registration: [PROSPERO], identifier [No. CRD42021279163].
| S-EPMC10036757 | biostudies-literature
Project description:Although attentional bias modification has been shown effective in several appetitive domains, results have been mixed. A major contributor seems to be the choice of control condition. The aim of the present study was to compare attentional bias modification for chocolate against a new control condition, sham-n (neutral or no-contingency) training. Using a modified dot probe protocol, participants (N = 192; 17-30 years) were randomly trained to attend to chocolate pictures, avoid chocolate pictures, or received sham-n training. In the attend and avoid conditions, stimulus pairs consisted of one chocolate and one non-chocolate picture, and probes replaced most often (90/10) chocolate or non-chocolate pictures, respectively. In the sham-n training condition, stimulus pairs consisted of two chocolate or two non-chocolate pictures, and probes replaced pictures within pairs with equal frequency (50/50). Attentional bias for chocolate increased following attend training, decreased following avoidance training, and did not change following sham-n training. The findings clearly demonstrate that both attend and avoidance training alter (in opposite direction) attentional bias for chocolate, whereas sham-n training is inert. This makes sham-n training particularly promising for use in clinical samples who tend to show strong initial biases.
| S-EPMC8604310 | biostudies-literature
Project description:Attention bias modification (ABM) therapy aims to reduce anxiety by changing threat-related attention patterns using computerized training tasks. We examined changes in brain microstructure following ABM training. Thirty-two participants were randomly assigned to one of two training conditions: active ABM training shifting attention away from threat or attention control training involving no attention modification. Participants completed six lab visits, including five training sessions and three diffusion tensor imaging scans: immediately before and after the first training session, and at the end of the training series. Indices of local and global changes in microstructure and connectivity were measured. Significant longitudinal differences in fractional anisotropy (FA) between the active and control training regimens occurred in inferior temporal cortex. Changes in FA occurred across groups within ventromedial prefrontal cortex and middle occipital gyrus. These results indicate specific effects of active ABM on brain structure. Such changes could relate to clinical effects of ABM.
| S-EPMC6718329 | biostudies-literature
Project description:ObjectiveAttention bias modification training (ABMT) is purported to reduce depression by targeting and modifying an attentional bias for sadness-related stimuli. However, few tests of this hypothesis have been completed.MethodThe present study examined whether change in attentional bias mediated a previously reported association between ABMT condition (active ABMT, sham ABMT, assessments only; N = 145) and depression symptom change among depressed adults. The preregistered, primary measure of attention bias was a discretized eye-tracking metric that quantified the proportion of trials where gaze time was greater for sad stimuli than neutral stimuli.ResultsContemporaneous longitudinal simplex mediation indicated that change in attentional bias early in treatment partially mediated the effect of ABMT on depression symptoms. Specificity analyses indicated that in contrast to the eye-tracking mediator, reaction time assessments of attentional bias for sad stimuli (mean bias and trial level variability) and lapses in sustained attention did not mediate the association between ABMT and depression change. Results also suggested that mediation effects were limited to a degree by suboptimal measurement of attentional bias for sad stimuli.ConclusionWhen effective, ABMT may improve depression in part by reducing an attentional bias for sad stimuli, particularly early on during ABMT. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
| S-EPMC9392903 | biostudies-literature
Project description:BackgroundAttentional bias toward sleep-related information is believed to play a key role in insomnia. If attentional bias is indeed of importance, changing this bias should then in turn have effects on insomnia complaints. In this double-blind placebo controlled randomized trial we investigated the efficacy of attentional bias modification training in the treatment of insomnia.MethodWe administered baseline, post-test, and one-week follow-up measurements of insomnia severity, sleep-related worry, depression, and anxiety. Participants meeting DSM-5 criteria for insomnia were randomized into an attentional bias training group (n = 67) or a placebo training group (n = 70). Both groups received eight training sessions over the course of two weeks. All participants kept a sleep diary for four consecutive weeks (one week before until one week after the training sessions).ResultsThere was no additional benefit for the attentional bias training over the placebo training on sleep-related indices/outcome measures.ConclusionsThe absence of the effect may be explained by the fact that there was neither attentional bias at baseline nor any reduction in the bias after the training. Either way, this study gives no support for attentional bias modification training as a stand-alone intervention for ameliorating insomnia complaints.
| S-EPMC5396867 | biostudies-literature
Project description:RationaleAttentional bias toward drug-related stimuli is a feature of drug addiction that is linked to craving and drug-seeking behavior.Objectives/methodAn attentional bias modification (ABM) program was tested in 42 methamphetamine-dependent clients (DSM-IV criteria) receiving residential treatment for their drug use. Participants were randomly assigned to one of two groups (N = 21 each), receiving 12 sessions of either computerized ABM training (designed to train attention away from methamphetamine stimuli 100% of the time) or an attentional control condition (designed to train attention away from methamphetamine stimuli 50% of the time). Outcome measures included attentional bias to methamphetamine-related stimuli on a probe detection task, self-reported craving, and preferences to view methamphetamine-related images on a Simulated Drug Choice Task. A subset of participants (N = 17) also underwent fMRI in a cue-induced craving paradigm.ResultsPoor split-half reliability was observed for the probe detection task. Using this task, attentional bias toward methamphetamine-related stimuli was greater after training than at baseline, irrespective of group (p = 0.037). Spontaneous and cue-induced methamphetamine craving diminished with time (ps < 0.01), but ABM training did not influence these effects (group by time interactions, ps > 0.05). ABM training did not influence selection of methamphetamine-related pictures in the Simulated Drug Choice task (p > 0.05). In the fMRI assessment, cue-induced activation in the ventromedial prefrontal cortex was reduced over time, without an effect of ABM training.ConclusionsABM training did not improve several clinically relevant variables in treatment-seeking methamphetamine users. Additional research is needed to improve the measurement of attentional bias.
| S-EPMC6415773 | biostudies-literature
Project description:BackgroundAttentional bias modification (ABM) interventions have been developed to address addiction by reducing attentional bias for substance-related cues. This study provides a systematic review of the effectiveness of ABM interventions in decreasing symptoms of addictive behaviour, taking baseline levels of attentional bias and changes in attentional bias into account.MethodsWe included randomised and non-randomised studies that investigated the effectiveness of ABM interventions in heavy-using adults and treatment-seeking individuals with symptoms of substance use disorder to manipulate attentional bias and to reduce substance use-related symptoms. We searched for relevant English peer-reviewed articles without any restriction for the year of publication using PsycINFO, PubMed, and ISI Web in August 2016. Study quality was assessed regarding reporting, external validity, internal validity, and power of the study.ResultsEighteen studies were included: nine studies reported on ABM intervention effects in alcohol use, six studies on nicotine use, and three studies on opiate use. The included studies differed with regard to type of ABM intervention (modified dot probe task n = 14; Alcohol Attention Control Training Programme n = 4), outcome measures, amount and length of provided sessions, and context (clinic versus laboratory versus home environment). The study quality mostly ranged from low average to high average (one study scored below the quality cut-off). Ten studies reported significant changes of symptoms of addictive behaviour, whereas eight studies found no effect of ABM interventions on symptoms. However, when restricted to multi-session ABM intervention studies, eight out of ten studies found effects on symptoms of addiction. Surprisingly, these effects on symptoms of addictive behaviour showed no straightforward relationship with baseline attentional bias and its change from baseline to post-test.ConclusionsDespite a number of negative findings and the diversity of studies, multi-session ABM interventions, especially in the case of alcohol and when the Alcohol Attention Control Training Programme was used, appear to have positive effects on symptoms of addictive behaviour. However, more rigorous well-powered future research in clinical samples is needed before firm conclusions regarding the effectiveness of ABM interventions can be drawn.Systematic review registrationRegistration number PROSPERO: CRD42016046823.
| S-EPMC6186103 | biostudies-literature
Project description:Identifying neurocognitive mechanisms underlying optimism bias is essential to understand its benefits for well-being and mental health. The combined cognitive biases hypothesis suggests that biases (e.g., in expectancies and attention) interact and mutually enforce each other. Whereas, in line with this hypothesis, optimistic expectancies have been shown to guide attention to positive information, reverse causal effects have not been investigated yet. Revealing such bidirectional optimism-attention interactions both on a behavioral and neural level could explain how cognitive biases contribute to a self-sustaining upward spiral of positivity. In this behavioral study, we hypothesized that extensive training to direct attention to positive information enhances optimism bias. To test this hypothesis, for 2 weeks, 149 participants underwent either daily online 80-trial attention bias modification training (ABMT) toward accepting faces and away from rejecting faces or neutral control training. Participants in the ABMT group were instructed to click as quickly as possible on the accepting face among 15 rejecting faces randomly displayed on a 4-by-4 matrix; participants in the control group were instructed to click on the five-petaled flower depicted among 15 seven-petaled flowers. Comparative optimism bias and state optimism were measured via questionnaires before training, after one training week, and after two training weeks. ABMT enhanced comparative optimism bias, whereas control training did not. Our findings reveal that ABMT toward positive social information causally influences comparative optimism bias and may, thereby trigger the biases' benefits for well-being and mental health. These results can (a) stimulate future neurophysiological research in the area of positive psychology; and (b) reveal an innovative low-cost and easy-to-access intervention that may support psychotherapy in times of rising numbers of patients with psychological disorders.
| S-EPMC6629951 | biostudies-literature