Attention Bias Modification Treatment: A Meta-Analysis Toward the Establishment of Novel Treatment for Anxiety

Division of Adult Mental Health, National Institute of Mental Health, Tokyo, Japan.
Biological psychiatry (Impact Factor: 10.26). 09/2010; 68(11):982-90. DOI: 10.1016/j.biopsych.2010.07.021
Source: PubMed


Attention Bias Modification Treatment (ABMT) is a newly emerging, promising treatment for anxiety disorders. Although recent randomized control trials (RCTs) suggest that ABMT reduces anxiety, therapeutic effects have not been summarized quantitatively.
Standard meta-analytic procedures were used to summarize the effect of ABMT on anxiety. With MEDLINE, January 1995 to February 2010, we identified RCTs comparing the effects on anxiety of ABMT and quantified effect sizes with Hedge's d.
Twelve studies met inclusion criteria, including 467 participants from 10 publications. Attention Bias Modification Treatment produced significantly greater reductions in anxiety than control training, with a medium effect (d = .51 [corrected] (p < .001). Age and gender did not moderate the effect of ABMT on anxiety, whereas several characteristics of the ABMT training did.
Attention Bias Modification Treatment shows promise as a novel treatment for anxiety. Additional RCTs are needed to fully evaluate the degree to which these findings replicate and apply to patients. Future work should consider the precise role for ABMT in the broader anxiety-disorder therapeutic armamentarium.

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    • "In ABM, researchers typically modify the original task such as the probe nearly always (e.g., 95% of the trials) replaces the neutral or positive stimulus, thereby redirecting subjects' attention to nonthreatening cues. 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). "
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    ABSTRACT: Background: Attention Bias Modification (ABM) aims to reduce attentional bias for threat (AB), thereby diminishing anxiety symptoms. However, recent meta-analyses indicated mixed effects. Recent works suggest that the presence of AB prior to ABM can be considered as a critical moderating factor that may account for these mixed results. Methods: We assessed AB among highly trait-anxious individuals (n = 77) using both a face-version and a word-version of the dot-probe task at multiple time points: two weeks before ABM (t1), just prior to ABM (t2), and after ABM (t3). All participants were submitted to an ABM procedure including facial expressions. Analyses focused on 2 components of AB prior to ABM: a stable component, representing variance shared between the two baseline points (t1 and t2), and a dynamic component, representing variance that is specific to that point (t1 or t2). Results: The stable component of AB at baseline predicted the intensity of AB after ABM (t3) while the dynamic component did not. The dynamic component of AB at baseline positively predicts performance improvement during ABM procedure, while the stable component negatively predicted it. Limitations: The findings depicted above only appear with the face-version of the dot-probe task. Conclusions: The present results highlight the contribution of both the stable individual differences and dynamic components of preexistent AB. They also show the importance of moving the conceptualization of AB beyond the group-based analysis by integrating the notion and the assessment of within-person variability.
    Journal of Behavior Therapy and Experimental Psychiatry 12/2015; 49(1):69-75. DOI:10.1016/j.jbtep.2014.10.012 · 2.23 Impact Factor
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    • "CBM-A paradigms have potential as an add-on to standard psychiatric treatment given the ease by which they can be administered and the fact that they complement existing treatment approaches by addressing more automatic information processing. Indeed, one of the first meta-analyses of CBM-A for anxiety suggested medium (d = 0.61) effect sizes, which may be even larger in clinical populations (Hakamata et al., 2010) and are comparable with effect sizes of existing treatments for anxiety. More recent meta-analyses of CBM-A for anxiety and depression in adult (Cristea, Kok & Cuijpers, 2015; Heeren et al., 2015) and youth (Cristea et al., 2015; Lowther & Newman, 2014) populations rightly call for caution in the recommendation of CBM-A paradigms as clinical tools, since effects are not replicated in all studies, effect sizes are sometimes small, and studies which trial the effects of CBM-A paradigms are often poorly conducted or provide insufficient data to assess the methodological quality. "
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    ABSTRACT: Adolescence is a vulnerable time for the onset of depression. Recent evidence from adult studies suggests not only that negative attention biases are correlated with symptoms of depression, but that reducing negative attention biases through training can in turn reduce symptomology. The role and plasticity of attention biases in adolescent depression, however, remains unclear. This study examines the association between symptoms of depression and attention biases, and whether such biases are modifiable, in a community sample of adolescents. We report data from 105 adolescents aged 13–17 who completed a dot-probe measure of attention bias before and after a single session of visual search-based cognitive bias modification training. This is the first study to find a significant association between negative attention biases and increased symptoms of depression in a community sample of adolescents. Contrary to expectations, we were unable to manipulate attention biases using a previously successful cognitive bias modification task. There were no significant effects of the training on positive affect and only modest effects of the training, identified in post-hoc analyses, were observed on negative affect. Our data replicate those from the adult literature, which suggest that adolescent depression is a disorder associated with negative attention biases, although we were unable to modify attention biases in our study. We identify numerous parameters of our methodology which may explain these null training effects, and which could be addressed in future cognitive bias modification studies of adolescent depression.
    PeerJ 10/2015; 3(7):e1372. DOI:10.7717/peerj.1372 · 2.11 Impact Factor
    • "In recent years, CBM procedures have been developed to reverse cognitive biases towards negative valenced information seen in anxiety and depression (e.g. Baert et al., 2011; Bar‐Haim (2010); Beard et al., (2011); Hakamata et al., 2010; Hallion and Ruscio, 2011; Macleod (2012); Yiend et al., 2013). A recent meta-analysis indicates that CBM can remediate negative attention and interpretation biases towards emotionally relevant stimuli (e.g. "
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    ABSTRACT: Background: Patients with Anorexia Nervosa (AN) experience high levels of social difficulties and anxiety. These problems might be underpinned by negatively biased processing of social stimuli. The aim of this study was to examine the feasibility of using a novel Cognitive Bias Modification (CBM) training to target information processing biases in patients with AN. Methods: Twenty-eight patients with AN completed a baseline and end of intervention assessment of mood and social appraisals. The CBM training consisted of 5 sessions and included an attentional probe task to train attention towards positive social stimuli and an ambiguous scenarios task to train benign or neutral interpretations of ambiguous social scenarios. Results: At baseline patients displayed an attention and interpretation bias towards negative social stimuli. At the end of intervention there was a medium sized increase in attention to positive faces and fewer negative interpretations of ambiguous social stimuli. There were also lower levels of anxiety and higher levels of self-compassion in response to a judgemental video clip. Limitations: The lack of a control group is the main limitation to this preliminary study as the changes obtained may have resulted from non-specific aspects of the inpatient treatment. Conclusions: A novel CBM training is associated with more positive processing of social information in AN. It would be of interest to test the hypothesis that reducing cognitive biases towards social stimuli impacts on wider features of an eating disorder.
    Journal of Affective Disorders 09/2015; 188:188-193. DOI:10.1016/j.jad.2015.08.019 · 3.38 Impact Factor
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