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Bias-contingent attention bias modification and attention control training in treatment of PTSD: a randomized control trial

Published online by Cambridge University Press:  12 November 2018

Amit Lazarov ,
Benjamin Suarez-Jimenez ,
Rany Abend ,
Reut Naim ,
Erel Shvil ,
Liat Helpman ,
Xi Zhu ,
Santiago Papini ,
Ariel Duroski  and
Rony Rom
...Show all authors
Amit Lazarov*
Affiliation:
Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA, and School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
Benjamin Suarez-Jimenez
Affiliation:
Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
Rany Abend
Affiliation:
Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
Reut Naim
Affiliation:
School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
Erel Shvil
Affiliation:
New York State Psychiatric Institute, New York, NY, USA
Liat Helpman
Affiliation:
Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
Xi Zhu
Affiliation:
Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
Santiago Papini
Affiliation:
Department of Psychology, The University of Texas at Austin, Institute for Mental Health Research, TX, USA
Ariel Duroski
Affiliation:
New York State Psychiatric Institute, New York, NY, USA
Rony Rom
Affiliation:
New York State Psychiatric Institute, New York, NY, USA
Franklin R. Schneier
Affiliation:
Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
Daniel S. Pine
Affiliation:
Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
Yair Bar-Haim
Affiliation:
School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
Yuval Neria
Affiliation:
Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
*
Author for correspondence: Amit Lazarov, E-mail: [email protected]
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Abstract

Background

Randomized 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.

Methods

Fifty 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.

Results

ACT 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.

Conclusions

The 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.

Keywords

Attention bias modification (ABM)attention biasattention control training (ACT)posttraumatic stress disorder (PTSD)randomized control trial (RCT)
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 14 , October 2019 , pp. 2432 - 2440
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

This work reflects equal contribution of the first two authors.

References

Amir, N, Taylor, CT and Donohue, MC (2011) Predictors of response to an attention modification program in generalized social phobia. Journal of Consulting and Clinical Psychology 79, 533–541.Google Scholar
Aupperle, RL, Melrose, AJ, Stein, MB and Paulus, MP (2012) Executive function and PTSD: disengaging from trauma. Neuropharmacology 62, 686–694.Google Scholar
Badura-Brack, AS, Naim, R, Ryan, TJ, Levy, O, Abend, R, Khanna, MM, McDermott, TJ, Pine, DS and Bar-Haim, Y (2015) Effect of attention training on attention bias variability and PTSD symptoms: randomized controlled trials in Israeli and U.S. Combat Veterans. American Journal of Psychiatry 172, 1233–1241.Google Scholar
Bardeen, JR and Orcutt, HK (2011) Attentional control as a moderator of the relationship between posttraumatic stress symptoms and attentional threat bias. Journal of Anxiety Disorders 25, 1008–1018.Google Scholar
Bardeen, JR, Tull, MT, Daniel, TA, Evenden, J and Stevens, EN (2016) A preliminary investigation of the time course of attention bias variability in posttraumatic stress disorder: the moderating role of attentional control. Behaviour Change 33, 94–111.Google Scholar
Bar-Haim, Y (2010) Research review: attention bias modification (ABM): a novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry 51, 859–870.Google Scholar
Bar-Haim, Y, Holoshitz, Y, Eldar, S, Frenkel, TI, Muller, D, Charney, DS, Pine, DS, Fox, NA and Wald, I (2010) Life-threatening danger and suppression of attention bias to threat. American Journal of Psychiatry 167, 694–698.Google Scholar
Basanovic, J, Notebaert, L, Grafton, B, Hirsch, CR and Clarke, PJF (2017) Attentional control predicts change in bias in response to attentional bias modification. Behaviour Research and Therapy 99, 47–56.Google Scholar
Beck, AT, Steer, RA and Brown, GK (1996) BDI-II Manual, 2nd Edn. San Antonio: Harcourt Brace & Company.Google Scholar
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS and Keane, TM (1995) The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress 8, 75–90.Google Scholar
Blanchard, EB, Hickling, EJ, Devineni, T, Veazey, CH, Galovski, TE, Mundy, E, Malta, LS and Buckley, TC (2003) A controlled evaluation of cognitive behaviorial therapy for posttraumatic stress in motor vehicle accident survivors. Behaviour Research and Therapy 41, 79–96.Google Scholar
Bradley, R, Greene, J, Russ, E, Dutra, L and Westen, D (2005) A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry 162, 214–227.Google Scholar
Brady, KT, Killeen, TK, Brewerton, T and Lucerini, S (2000) Comorbidity of psychiatric disorders and posttraumatic stress disorder. Journal of Clinical Psychiatry 61, 22–32.Google Scholar
Brewin, CR and Holmes, EA (2003) Psychological theories of posttraumatic stress disorder. Clinical Psychology Review 23, 339–376.Google Scholar
Bryant, RA and Harvey, AG (1997) Attentional bias in posttraumatic stress disorder. Journal of Traumatic Stress 10, 635–644.Google Scholar
Buckley, TC, Blanchard, EB and Neill, WT (2000) Information processing and PTSD: a review of the empirical literature. Clinical Psychology Review 20, 1041–1065.Google Scholar
Chemtob, CM, Roitblat, HL, Hamada, RS, Carlson, JG and Twentyman, CT (1988) A cognitive action theory of Post-Traumatic Stress Disorder. Journal of Anxiety Disorders 2, 253–275.Google Scholar
Clarke, PJF, Notebaert, L and MacLeod, C (2014) Absence of evidence or evidence of absence: reflecting on therapeutic implementations of attentional bias modification. BMC Psychiatry 14, 8.Google Scholar
Difede, J, Olden, M and Cukor, J (2014) Evidence-based treatment of post-traumatic stress disorder. Annual Review of Medicine 65, 319–332.Google Scholar
Ehlers, A and Clark, DM (2000) A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy 38, 319–345.Google Scholar
Eysenck, MW, Derakshan, N, Santos, R and Calvo, MG (2007) Anxiety and cognitive performance: attentional control theory. Emotion 7, 336–353.Google Scholar
Fani, N, Bradley-Davino, B, Ressler, KJ and McClure-Tone, EB (2011) Attention bias in adult survivors of childhood maltreatment with and without posttraumatic stress disorder. Cognitive Therapy and Research 35, 57–67.Google Scholar
First, MB, Spitzer, RL, Gibbon, M and Williams, JBW (1995) Structured Clinical Interview for DSM-IV Axis I Disorders. New York: New York State Psychiatric Institute.Google Scholar
Foa, EB and Rothbaum, BO (1998) Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD. Treatment Manuals for Practitioners. New York: Guilford Press.Google Scholar
Foa, EB, Steketee, G and Rothbaum, BO (1989) Behavioral cognitive conceptualizations of post-traumatic stress disorder. Behavior Therapy 20, 155–176.Google Scholar
Foa, EB, Feske, U, Murdock, TB, Kozak, MJ and Mccarthy, PR (1991) Processing of threat-related information in rape victims. Journal of Abnormal Psychology 100, 156–162.Google Scholar
Hallion, LS and Ruscio, AM (2011) A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychological Bulletin 137, 940–958.Google Scholar
Hamilton, M (1960) A rating scale for depression. Journal of Neurology Neurosurgery and Psychiatry 23, 56–62.Google Scholar
Hien, DA, Jiang, HP, Campbell, ANC, Hu, MC, Miele, GM, Cohen, LR, Brigham, GS, Capstick, C, Kulaga, A, Robinson, J, Suarez-Morales, L and Nunes, EV (2010) Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA's clinical trials network. American Journal of Psychiatry 167, 95–101.Google Scholar
Imel, ZE, Laska, K, Jakupcak, M and Simpson, TL (2013) Meta-analysis of dropout in treatments for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 81, 394–404.Google Scholar
Krell, HV, Leuchter, AF, Morgan, M, Cook, IA and Abrams, M (2004) Subject expectations of treatment effectiveness and outcome of treatment with an experimental antidepressant. The Journal of Clinical Psychiatry 65, 1174–1179.Google Scholar
Kuckertz, JM, Amir, N, Boffa, JW, Warren, CK, Rindt, SEM, Norman, S, Ram, V, Ziajko, L, Webb-Murphy, J and McLay, R (2014 a) The effectiveness of an attention bias modification program as an adjunctive treatment for post-traumatic stress disorder. Behaviour Research and Therapy 63, 25–35.Google Scholar
Kuckertz, JM, Gildebrant, E, Liliequist, B, Karlstrom, P, Vappling, C, Bodlund, O, Stenlund, T, Hofmann, SG, Andersson, G, Amir, N and Carlbring, P (2014 b) Moderation and mediation of the effect of attention training in social anxiety disorder. Behaviour Research and Therapy 53, 30–40.Google Scholar
Lazarov, A, Abend, R, Seidner, S, Pine, DS and Bar-Haim, Y (2017 a) The effects of training contingency awareness during attention bias modification on learning and stress reactivity. Behavior Therapy 48, 638–650.Google Scholar
Lazarov, A, Marom, S, Yahalom, N, Pine, DS, Hermesh, H and Bar-Haim, Y (2017 b) Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: a randomized controlled trial. Psychological Medicine 48, 2177–2185.Google Scholar
Linetzky, M, Pergamin-Hight, L, Pine, DS and Bar-Haim, Y (2015) Quantitative evaluation of the clinical efficacy of attention bias modification treatment for anxiety disorders. Depression and Anxiety 32, 383–391.Google Scholar
Litz, BT and Keane, TM (1989) Information processing in anxiety disorders: application to the understanding of post-traumatic stress disorder. Clinical Psychology Review 9, 243–257.Google Scholar
MacLeod, C and Clarke, PJF (2015) The attentional bias modification approach to anxiety intervention. Clinical Psychological Science 3, 58–78.Google Scholar
MacLeod, C and Grafton, B (2016) Anxiety-linked attentional bias and its modification: illustrating the importance of distinguishing processes and procedures in experimental psychopathology research. Behaviour Research and Therapy 86, 68–86.Google Scholar
MacLeod, C, Mathews, A and Tata, P (1986) Attentional bias in emotional disorders. Journal of Abnormal Psychology 95, 15–20.Google Scholar
Meffert, SM, Metzler, TJ, Henn-Haase, C, McCaslin, S, Inslicht, S, Chemtob, C, Neylan, T and Marmar, CR (2008) A prospective study of trait anger and PTSD symptoms in police. Journal of Traumatic Stress 21, 410–416.Google Scholar
Naim, R, Abend, R, Wald, I, Eldar, S, Levi, O, Fruchter, E, Ginat, K, Halpern, P, Sipos, ML, Adler, AB, Bliese, PD, Quartana, PJ, Pine, DS and Bar-Haim, Y (2015) Threat-related attention bias variability and posttraumatic stress. American Journal of Psychiatry 172, 1242–1250.Google Scholar
Ruggiero, KJ, Del Ben, K, Scotti, JR and Rabalais, AE (2003) Psychometric properties of the PTSD checklist – civilian version. Journal of Traumatic Stress 16, 495–502.Google Scholar
Sarapas, C, Weinberg, A, Langenecker, SA and Shankman, SA (2017) Relationships among attention networks and physiological responding to threat. Brain and Cognition 111, 63–72.Google Scholar
Schoorl, M, Putman, P and van Der Does, W (2013) Attentional bias modification in posttraumatic stress disorder: a randomized controlled trial. Psychotherapy and Psychosomatics 82, 99–105.Google Scholar
Sipos, ML, Bar-Haim, Y, Abend, R, Adler, AB and Bliese, PD (2014) Postdeployment threat-related attention bias interacts with combat exposure to account for PTSD and anxiety symptoms in soldiers. Depression and Anxiety 31, 124–129.Google Scholar
Sullivan, GM and Neria, Y (2009) Pharmacotherapy of PTSD: current status and controversies. Psychiatric Annals 39, 342–347.Google Scholar
Tottenham, N, Tanaka, J, Leon, A, McCarry, T, Nurse, M, Hare, T, Marcus, D, Westerlund, A, Casey, BJ and Nelson, CB (2009) The NimStim set of facial expressions: judgments from untrained research participants. Psychiatry Research 168, 242–249.Google Scholar
Van Etten, ML and Taylor, S (1998) Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis. Clinical Psychology & Psychotherapy 5, 126–144.Google Scholar
Vens, M and Ziegler, A (2012) Generalized estimating equations and regression diagnostics for longitudinal controlled clinical trials: a case study. Computational Statistics & Data Analysis 56, 1232–1242.Google Scholar
Weathers, F, Litz, BT, Huska, JA and Keane, TM (1991) The PTSD Checklist (PCL). Boston, VA: Medical Centre: Boston.Google Scholar
Weathers, FW, Keane, TM and Davidson, JRT (2001) Clinician-administered PTSD scale: a review of the first ten years of research. Depression and Anxiety 13, 132–156.Google Scholar
Williams, JBW (1988) A structured interview guide for the Hamilton depression rating-scale. Archives of General Psychiatry 45, 742–747.Google Scholar
Zeger, SL and Liang, KY (1986) Longitudinal data-analysis for discrete and continuous outcomes. Biometrics 42, 121–130.Google Scholar
Zeger, SL, Liang, KY and Albert, PS (1988) Models for longitudinal data – a generalized estimating equation approach. Biometrics 44, 1049–1060.Google Scholar