Attentional bias modification treatment for depression: Study protocol for a randomized controlled trial

A review of attentional bias modification trainings for depression

Negative attentional bias is a basic character of depression. The attentional bias modification training (ABMT), being a highly promising and easy-to-use depression intervention technique, has attracted much attention to alleviate depressive symptoms in recent years. However, the effectiveness of ABMT programs was mixed across studies, since it remained unclear the underlying mechanisms of ABMT on alleviating depressive symptoms. We systematically analyzed the main ABMT paradigms to clarify possible mechanisms of effective training and reasons of ineffective training. Valid ABMT programs might alleviate depressive symptoms through regulating self-related rumination or two subcomponents of attentional bias: facilitated attention and impaired attentional disengagement. The reasons for the invalidity of ABMT mainly included the suboptimal design of training procedures, mixed effects of participants' personal characteristics, and the unclear relationship between attentional bias and depression. The ABMT is promising for alleviating depressive symptoms, but training procedures are required to be improved to obtain stable training effects.

Change in negative attention bias mediates the association between attention bias modification training and depression symptom improvement

OBJECTIVE

Attention 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.

METHOD

The 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.

RESULTS

Contemporaneous 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.

CONCLUSION

When 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).

Efficacy of attention bias modification training for depressed adults: a randomized clinical trial

BACKGROUND

This study examined the efficacy of attention bias modification training (ABMT) for the treatment of depression.

METHODS

In this randomized clinical trial, 145 adults (77% female, 62% white) with at least moderate depression severity [i.e. self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) ⩾13] and a negative attention bias were randomized to active ABMT, sham ABMT, or assessments only. The training consisted of two in-clinic and three (brief) at-home ABMT sessions per week for 4 weeks (2224 training trials total). The pre-registered primary outcome was change in QIDS-SR. Secondary outcomes were the 17-item Hamilton Depression Rating Scale (HRSD) and anhedonic depression and anxious arousal from the Mood and Anxiety Symptom Questionnaire (MASQ). Primary and secondary outcomes were administered at baseline and four weekly assessments during ABMT.

RESULTS

Intent-to-treat analyses indicated that, relative to assessment-only, active ABMT significantly reduced QIDS-SR and HRSD scores by an additional 0.62 ± 0.23 (p = 0.008, d = -0.57) and 0.74 ± 0.31 (p = 0.021, d = -0.49) points per week. Similar results were observed for active v. sham ABMT: a greater symptom reduction of 0.44 ± 0.24 QIDS-SR (p = 0.067, d = -0.41) and 0.69 ± 0.32 HRSD (p = 0.033, d = -0.42) points per week. Sham ABMT did not significantly differ from the assessment-only condition. No significant differences were observed for the MASQ scales.

CONCLUSION

Depressed individuals with at least modest negative attentional bias benefitted from active ABMT.

Attentional bias for emotional faces in depressed and non-depressed individuals: an eye-tracking study

Current assessment tools for clinicians in mental health evaluation relies mostly on patient self-report and clinician's judgement. Recent studies suggest that affective disorders are correlated to attentional bias for visual information. This study used eye-tracking technology to measure attentional bias for faces in depressed and non-depressed individuals. The experiment was based on a free-viewing task of pair of faces including 4 types of expressions: neutral, sad, happy and angry. 69 individuals took part in this study. All the participants completed the Beck Depression Inventory II (BDI-II) to evaluate the severity of depressive symptoms. The attention indexes were total time for eye events, total fixation duration, ratio of total fixation and eye events, and fixation duration on each face. The results showed that depressed individuals have a significant (p = 0.005) difference in the total time of eye events (302.4±41.2) compared to non-depressed individuals (331.5±39.3) and revealed a tendency to disengage from emotional stimuli with differences in the total fixation in pair of faces. The study demonstrated that the use of eye-tracking is a valuable tool to asses attentional bias and important technology that could be used to improve diagnosis technics.