Shari Gelber’s research while affiliated with Weill Cornell Medicine and other places

Stress and anxiety during pregnancy are associated with a range of adverse health outcomes, thus there is an unmet need for low-barrier treatments that target stress and anxiety. One such treatment approach, attention bias modification training (ABMT), reduces the anxiety-related attentional threat bias, which is also associated with disrupted neural processing of threat. It remains unclear, however, whether reducing treatment barriers via mobile delivery of ABMT is effective and whether ABMT efficacy varies depending on individual differences in neural processing of threat. The present study tested whether mobile, gamified ABMT reduced prenatal threat bias, anxiety and stress, and whether ABMT efficacy varied with individual differences in neural responses to threat. Participants were 29 women in their 19th–29th week of pregnancy, randomized to four weeks of ABMT versus placebo training (PT) versions of the mobile app using a double-blind design. Self-report of anxiety, depression, and stress were obtained, and salivary cortisol was collected at home and in lab in response to stressors to index biological stress reactivity. Threat bias was measured using a computerized attention assay during which EEG was recorded to generate event-related potentials (ERPs) to threat cues. Results showed lower levels of threat bias (1-tailed) and lab cortisol following ABMT versus PT. Although the main effect of ABMT on subjective anxiety was not significant, the magnitude of cortisol reduction was correlated with lower levels of subjective anxiety and threat bias. Those receiving ABMT also reported less anxiety when showing smaller ERPs to threat (P1, P2) prior to training, but, conversely reported more anxiety when showing larger ERPs to threat. Use of gamified, mobile ABMT reduced biobehavioral indices of prenatal stress and anxiety, but effects on anxiety varied with individual differences in cortisol response and neurocognitive indices of early attention to threat.

Prenatal stress affects a range of health outcomes in both the mother and developing fetus (Glover, 2014). Cost-effective and easily-accessible treatments to reduce such stress are needed for pregnant women. Computerized attention bias modification training (ABMT) is one such treatment approach. ABMT capitalizes on research identifying exaggerated neurocognitive responses to threat, or threat bias, as a mechanism in the development and remediation of anxiety (Bar-Haim, 2007). During ABMT, attention is trained away from threat, leading to reductions in anxiety and stress reactivity (Hakamata et al., 2010). The present study explored whether four weeks of mobile, gamified ABMT versus placebo training (via an iOS application, or app) reduced subjective anxiety, threat bias, and stress reactivity measured via self-reported anxiety and observed stress behaviors during a social stressor, in a group of pregnant women (n = 19) between their 15th and 25th week of pregnancy. Given high comorbidity between anxiety and depression (Lamers et al., 2011), baseline (pre-treatment) depression was used as a covariate in analyses. As predicted, the ABMT group showed less stress reactivity than the placebo training group following app play [F(1, 15) = 5.06, p = .04]. To examine associations between anxious and depressed mood and neurocognitive responses to threat, scalp-recorded event-related potentials (ERPs) to angry face cues during the threat bias assessment (the dot probe) were measured before and after app play – attention allocation (P1), configural processing (N170), emotional evaluation (P2), and cognitive control (N2). At baseline, greater trait anxiety was associated with enhanced configural processing of threat (N170: r = -.48, p = .04), depression was associated with dampened emotional evaluation of threat (P2: r = -.55, p = .01), and both anxiety and depression were associated with reduced controlled processing of threat (N2: r = .60, p = .009 and r = .76, p < .001, respectively). Taken together, results are the first to demonstrate that extended use of a mobile, gamified ABMT app effectively reduced behavioral stress reactivity during pregnancy. In addition, patterns of neurocognitive responses to threat varied with anxious and depressed mood, suggesting that ERPs could serve as treatment-relevant measures of threat processing in ABMT research.