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Dreyer-Oren SE, Das A, Geyer RB, Fite RE, Kiel EJ, Clerkin EM. Transitioning to college: Testing cognitive bias modification for interpretations as an inoculation tool for social anxiety in college first-years. J Behav Ther Exp Psychiatry 2024; 84:101961. [PMID: 38489952 DOI: 10.1016/j.jbtep.2024.101961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 01/09/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Reducing social anxiety development among incoming college students may improve college adjustment and mental health outcomes. This study tested whether cognitive bias modification for interpretations (CBM-I) reduces social anxiety and increases adjustment during the transition to college, and whether changes in outcomes would be mediated by changes in interpretation biases. METHODS Participants (N = 73) were randomly assigned to a 3-session weekly CBM-I condition or symptom tracking (ST) control condition. Multilevel models were used to estimate within-person trajectories from baseline to one week post-intervention and to test whether trajectories differed by condition. RESULTS Those in the CBM-I condition (vs. ST) reported higher increases in social adjustment across time. There were not significant differences between conditions for changes in social anxiety, academic adjustment, and personal adjustment. CBM-I was indirectly linked to improvements in outcome variables via more adaptive interpretation biases. LIMITATIONS CBM-I was administered in a laboratory setting, requiring more resources than some computerized interventions. CONCLUSIONS Data tentatively support CBM-I for first-year students to increase social adjustment. Further, mediation findings provide support for targeting interpretation biases to improve social anxiety and adjustment outcomes. Yet, CBM-I did not outperform ST in improving social anxiety symptoms or other areas of college adjustment, and effect sizes were small, suggesting that more work is needed to amplify the potential of CBM-I as a therapeutic tool.
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Affiliation(s)
- Sarah E Dreyer-Oren
- Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
| | | | | | - Robert E Fite
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
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Sehrawat O, Noseworthy PA, Siontis KC, Haddad TC, Halamka JD, Liu H. Data-Driven and Technology-Enabled Trial Innovations Toward Decentralization of Clinical Trials: Opportunities and Considerations. Mayo Clin Proc 2023; 98:1404-1421. [PMID: 37661149 DOI: 10.1016/j.mayocp.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/25/2023] [Accepted: 02/08/2023] [Indexed: 09/05/2023]
Abstract
Traditional trial designs have well-recognized inefficiencies and logistical barriers to participation. Decentralized trials and digital health solutions have been suggested as potential solutions and have certainly risen to the challenge during the pandemic. Clinical trial designs are now increasingly data driven. The use of distributed clinical data networks and digitization has helped to fundamentally upgrade existing research systems. A trial design may vary anywhere from fully decentralized to hybrid to traditional on-site. Various decentralization components are available for stakeholders to increase the reach and pace of their trials, such as electronic informed consent, remote interviews, administration, outcome assessment, monitoring, and laboratory and imaging modalities. Furthermore, digital health technologies can be included to enrich study conduct. However, careful consideration is warranted, including assessing verification and validity through usability studies and having various contingencies in place through dedicated risk assessment. Selecting the right combination depends not just on the ability to handle patient care and the medical know-how but also on the availability of appropriate technologic infrastructure, skills, and human resources. Throughout this process, quality of evidence generation and physician-patient relation must not be undermined. Here we also address some knowledge gaps, cost considerations, and potential impact of decentralization and digitization on inclusivity, recruitment, engagement, and retention. Last, we mention some future directions that may help drive the necessary change in the right direction.
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Affiliation(s)
- Ojasav Sehrawat
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | | | | | | | - John D Halamka
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN.
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3
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Geerts JA, Pieterse ME, Laverman GD, Waanders F, Oosterom N, Slegten JT, Salemink E, Bode C. Cognitive Bias Modification Training Targeting Fatigue in Kidney Patients: Usability study (Preprint). JMIR Form Res 2022; 7:e43636. [DOI: 10.2196/43636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
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Wang Y, Zhang X, Gao J, Zhang L, Jiang J. The effect of immersive virtual reality-based attentional bias modification on anxiety mitigation in healthy population. Psych J 2022; 11:956-967. [PMID: 35922380 DOI: 10.1002/pchj.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/02/2022] [Indexed: 11/06/2022]
Abstract
The present study compared an immersive virtual reality-based attentional bias modification (immersive VR-ABM) with the desktop version of the VR-ABM and an immersive virtual reality-based game (immersive VR-game) to examine the possible effect of the immersive presence on self-reported emotional reactions to a stressful task. One hundred and twenty participants were randomly assigned into three groups, and each group received a three-turn induction-intervention training. Anxiety symptoms were assessed at pre-induction, post-induction, and post-training. Results showed that virtual reality-based anxiety was induced and alleviated successfully in all three groups, but only the immersive VR-ABM group showed an accumulated effect on self-reported anxiety across sessions. The attentional bias based on probe latencies indicated no significant change in either the immersive or desktop VR-ABM groups. The present findings support the hypothesized VR-ABM's effect on self-reported anxiety at the immersive presence. The practical implications of using immersive VR-ABM are discussed for obtaining ecological validity.
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Affiliation(s)
- Yamin Wang
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
| | - Xiaoxiang Zhang
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
| | - Jidong Gao
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
| | - Leran Zhang
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
| | - Jinhang Jiang
- Beijing Key Laboratory of Learning and Cognition, College of Psychology, Capital Normal University, Haidian, China
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A factorial randomized controlled trial on internet-delivered combined cognitive bias modification in people with high obsessive–compulsive disorder symptoms. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Carlson JM, Fang L, Koster EH, Andrzejewski JA, Gilbertson H, Elwell KA, Zuidema TR. Neuroplastic changes in anterior cingulate cortex gray matter volume and functional connectivity following attention bias modification in high trait anxious individuals. Biol Psychol 2022; 172:108353. [DOI: 10.1016/j.biopsycho.2022.108353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 12/21/2022]
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Neophytou K, Panayiotou G. Does attention bias modification reduce anxiety in socially anxious college students? An experimental study of potential moderators and considerations for implementation. PLoS One 2022; 17:e0264256. [PMID: 35213594 PMCID: PMC8880821 DOI: 10.1371/journal.pone.0264256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
According to cognitive models, preferential attention to social threat contributes to maintenance of social anxiety. Socially anxious individuals are known to show attention biases to threatening stimuli, although there is inconsistency in the literature with regards to the type of attentional biases they present. This study examines the effect of attention bias modification (ABM) for social anxiety in non-treatment-seeking college students meeting social anxiety disorder criteria, taking into consideration previous mixed results regarding its effectiveness. Attention bias levels and types (i.e. vigilance vs avoidance) at baseline were examined and considered as potential moderators of ABM effects. Sixty-eight socially anxious individuals were randomly allocated to ABM vs placebo groups. A structured interview and self-report assessment were completed at pre-treatment and post-treatment. Results showed half of the participants presented few attention biases at baseline, and the rest presented either vigilance or avoidance. Participants with low attention biases scored higher in social anxiety than those showing avoidance and there was no difference between those showing vigilance vs avoidance. No significant effects from pre to post treatment were observed in attention biases, self-report or structured interview of anxiety in the ABM group. Baseline attention biases did not moderate these effects. Results are discussed with regards to implications for future research towards the creation of more effective protocols, based on the needs of heterogeneous social anxiety sub-groups.
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Affiliation(s)
- Klavdia Neophytou
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
- * E-mail:
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8
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Esfandiari N, Mazaheri MA, Akbari-Zardkhaneh S, Sadeghi-Firoozabadi V, Cheraghi M. Internet-Delivered Versus Face-to-Face Cognitive Behavior Therapy for Anxiety Disorders: Systematic Review and Meta-Analysis. Int J Prev Med 2022; 12:153. [PMID: 35070186 PMCID: PMC8724632 DOI: 10.4103/ijpvm.ijpvm_208_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Over the last 20 years, internet-delivered cognitive behavior therapy (ICBT) has been tested in a large number of randomized controlled trials, often with positive results. However, it is not widely known about the efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). Methods: In the present systematic review and meta-analysis, ICBT for treatment of anxiety disorders was directly compared to face- to-face CBT within the same trial. This study aimed to reinvestigate the effect of ICBT compared to face-to-face CBT for anxiety disorders. A total of 8 studies out of the 236 articles screened met all the inclusion criteria. The included studies targeting five different anxiety disorders, social anxiety disorder, adolescent anxiety, panic disorder, spider phobia, and fear of public speaking, had been carried out in Australia, Spain, and Sweden. The total number of participants was 348 in ICBT and 316 in face-to-face conditions. Results: The results of our meta-analysis are interesting both from theoretical and practical standpoints, which showed a pooled effect size posttreatment with Hedges' g = 0.01 (95% CI: −0.16 to 0.18), Conclusions: ICBT and face-to-face CBT created equivalent overall effects. in treatment of anxiety disorders. Since there have been similar systematic reviews about anxiety disorders so far, and in majority of them, ICBT has not been compared against face-to-face treatment. More research is needed to establish the general equivalence of the two treatment formats. Also, understanding what makes ICBT work is a challenge for future research.
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Affiliation(s)
- Narges Esfandiari
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mohammad A Mazaheri
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Saeed Akbari-Zardkhaneh
- Department of Applied Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Vahid Sadeghi-Firoozabadi
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mona Cheraghi
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
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No change in electrocortical measures of performance monitoring in high trait anxious individuals following multi-session attention bias modification training. NEUROIMAGE: REPORTS 2021. [DOI: 10.1016/j.ynirp.2021.100067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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10
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Tayama J, Shimazu A, Ogawa S, Nakaya N. Effect of internet-based attention bias modification on the anxiety of Japanese workers: A randomized controlled trial. J Occup Health 2021; 63:e12229. [PMID: 33932320 PMCID: PMC8088281 DOI: 10.1002/1348-9585.12229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/18/2021] [Accepted: 04/09/2021] [Indexed: 11/08/2022] Open
Abstract
Objectives This study comprised a randomized controlled trial to examine the effect of internet‐based attention bias modification (iABM) on reducing workers' anxiety. Methods In total, 300 eligible participants were randomized according to sex and age; 180 were assigned to the intervention group and 120 to the control group. The word stimuli used in the iABM included eight positive words and eight neutral words. Participants were instructed to indicate the positive word's position as quickly and accurately as possible by tapping one of the two directions on display. The intervention included five sessions per participant over 1 month, resulting in a total of 600 trials. The main outcome measure was the total state anxiety score of the State‐Trait Anxiety Inventory (STAI). Results There was no significant difference in the net change in STAI scores between the intervention and control groups. The mean reaction time of the fifth session was significantly shorter than the mean reaction time of the first session. Furthermore, although there was no effect on the index of effect size Δ, the paired t‐test showed a significant decrease in the anxiety score. Conclusions The iABM intervention in this study did not enhance the amelioration of workers' anxiety when compared with the control condition.
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Affiliation(s)
- Jun Tayama
- Faculty of Human Sciences, Waseda University, Saitama, Japan
| | - Akihito Shimazu
- Faculty of Policy Management, Keio University, Kanagawa, Japan
| | - Sayaka Ogawa
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - Naoki Nakaya
- Department of Health Sciences, Saitama Prefectural University, Saitama, Japan
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11
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Ji JL, Baee S, Zhang D, Calicho-Mamani CP, Meyer MJ, Funk D, Portnow S, Barnes L, Teachman BA. Multi-session online interpretation bias training for anxiety in a community sample. Behav Res Ther 2021; 142:103864. [PMID: 33966880 DOI: 10.1016/j.brat.2021.103864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 03/23/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
The present study assessed target engagement, preliminary efficacy, and feasibility as primary outcomes of a free multi-session online cognitive bias modification of interpretation (CBM-I) intervention for anxiety in a large community sample. High trait anxious participants (N = 807) were randomly assigned to a CBM-I condition: 1) Positive training (90% positive-10% negative); 2) 50% positive-50% negative training; or 3) no-training control. Further, half of each CBM-I condition was randomized to either an anxious imagery prime or a neutral imagery prime. Due to attrition, results from six out of eight sessions were analyzed using structural equation modeling of latent growth curves. Results for the intent-to-treat sample indicate that for target engagement, consistent with predictions, decreases in negative interpretations over time were significantly greater among those receiving positive CBM-I training compared to no-training or 50-50 training, and vice-versa for increases in positive interpretations. For intervention efficacy, the decrease in anxiety symptoms over time was significantly greater among those receiving positive CBM-I training compared to no-training. Interaction effects with imagery prime were more variable with a general pattern of stronger results for those completing the anxious imagery prime. Findings indicate that online CBM-I positive training is feasible and shows some promising results, although attrition rates were very high for later training sessions.
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Affiliation(s)
- Julie L Ji
- School of Psychological Science, University of Western Australia, Australia; Department of Psychology, University of Virginia, Virginia, United States.
| | - Sonia Baee
- School of Engineering, University of Virginia, Virginia, United States
| | - Diheng Zhang
- Department of Psychology, University of Virginia, Virginia, United States; Department of Psychology, University of Arizona, United States
| | | | - M Joseph Meyer
- Department of Psychology, University of Virginia, Virginia, United States
| | | | - Samuel Portnow
- Department of Psychology, University of Virginia, Virginia, United States
| | - Laura Barnes
- School of Engineering, University of Virginia, Virginia, United States
| | - Bethany A Teachman
- Department of Psychology, University of Virginia, Virginia, United States
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12
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Yap D, Denefrio S, Dennis-Tiwary TA. Low working memory load facilitates attention bias modification training. Behav Res Ther 2021; 139:103828. [PMID: 33618124 DOI: 10.1016/j.brat.2021.103828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 12/27/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
Implementations of attention bias modification training (ABMT) attempt to retrain attention away from rather than towards threat, thereby disrupting the anxiety-related attentional bias (AB). Yet, results of ABMT studies have been mixed due to limitations in knowledge of mechanisms underlying ABMT efficacy. Dual-process models of anxiety posit that ABMT works primarily through strengthening of the top-down cognitive control of attention to threat. If this is the case, introducing a working memory load (WML) during ABMT should reduce training efficacy. However, prior studies employing this method show mixed results (Booth, Mackintosh, Mobini, Oztop, & Nunn, 2014; Clarke et al., 2017) and fail to directly compare low and high WML with no WML or to account for individual differences in anxiety and working memory capacity (WMC). The present study (N = 306) assessed trait anxiety and WMC in neurotypical adults who were then randomly assigned to ABMT that trained attention toward or away from threat, with either no, low, or high WML, for a total of six training groups. Attentional bias was assessed before and after training. Results showed ABMT successfully trained attention under low WML, but not under high or no WML, suggesting that ABMT is facilitated by engaging but not overtaxing WML.
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Affiliation(s)
- David Yap
- Hunter College, The City University of New York, Department of Psychology, New York, NY, USA
| | - Samantha Denefrio
- Hunter College, The City University of New York, Department of Psychology, New York, NY, USA; The Graduate Center, The City University of New York, Department of Psychology, New York, NY, USA
| | - Tracy A Dennis-Tiwary
- Hunter College, The City University of New York, Department of Psychology, New York, NY, USA; The Graduate Center, The City University of New York, Department of Psychology, New York, NY, USA.
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Basanovic J, Grafton B, Ford A, Hirani V, Glance D, MacLeod C, Almeida OP. Cognitive bias modification to prevent depression (COPE): results of a randomised controlled trial. Psychol Med 2020; 50:2514-2525. [PMID: 31544719 DOI: 10.1017/s0033291719002599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although efficacious treatments for major depression are available, efficacy is suboptimal and recurrence is common. Effective preventive strategies could reduce disability associated with the disorder, but current options are limited. Cognitive bias modification (CBM) is a novel and safe intervention that attenuates biases associated with depression. This study investigated whether the delivery of a CBM programme designed to attenuate negative cognitive biases over a period of 1 year would decrease the incidence of major depression among adults with subthreshold symptoms of depression. METHODS Randomised double-blind controlled trial delivered an active CBM intervention or a control intervention over 52 weeks. Two hundred and two community-dwelling adults who reported subthreshold levels of depression were randomised (100 intervention, 102 control). The primary outcome of interest was the incidence of major depressive episode assessed at 11, 27 and 52 weeks. Secondary outcomes included onset of clinically significant symptoms of depression, change in severity of depression symptoms and change in cognitive biases. RESULTS Adherence to the interventions was modest though did not differ between conditions. Incidence of major depressive episodes was low. Conditions did not differ in the incidence of major depressive episodes. Likewise, conditions did not differ in the incidence of clinically significant levels of depression, change in the severity of depression symptoms or change in cognitive biases. CONCLUSIONS Active CBM intervention did not decrease the incidence of major depressive episodes as compared to a control intervention. However, adherence to the intervention programme was modest and the programme failed to modify the expected mechanism of action.
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Affiliation(s)
- Julian Basanovic
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Andrew Ford
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Western Australia, Australia
| | - Varsha Hirani
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
| | - David Glance
- UWA Centre for Software Practice, The University of Western Australia, Western Australia, Australia
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, The University of Western Australia, Western Australia, Australia
| | - Osvaldo P Almeida
- Medical School, The University of Western Australia, Western Australia, Australia
- Western Australian Centre for Health and Ageing, The University of Western Australia, Western Australia, Australia
- Department of Psychiatry, Royal Perth Hospital, Western Australia, Australia
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14
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Klawohn J, Hajcak G, Amir N, Kathmann N, Riesel A. Application of attentional bias modification training to modulate hyperactive error-monitoring in OCD. Int J Psychophysiol 2020; 156:79-86. [DOI: 10.1016/j.ijpsycho.2020.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/05/2020] [Accepted: 07/19/2020] [Indexed: 01/13/2023]
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15
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Ma L, Kruijt AW, Ek AK, Åbyhammar G, Furmark T, Andersson G, Carlbring P. Seeking neutral: A VR-based person-identity-matching task for attentional bias modification - A randomised controlled experiment. Internet Interv 2020; 21:100334. [PMID: 32904341 PMCID: PMC7452567 DOI: 10.1016/j.invent.2020.100334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias towards threatening information. The current study incorporated virtual reality (VR) technology and 3-dimensional stimuli with a person-identity-matching (PIM) task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms. METHODS One hundred participants with elevated social anxiety were randomised to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-month follow-up. RESULTS Change in anxiety did not correlate with change in bias (r = -0.08). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM, or between groups. For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < .001, Nagelkerke's pseudo r 2 = 0.65). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 4% of participants were classified as 'recovered' at 3-month follow-up. CONCLUSIONS A single session of VR-based PIM task did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.
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Affiliation(s)
- Lichen Ma
- Department of Psychology, Stockholm University, Frescativägen, 114 19 Stockholm, Sweden,Corresponding author at: Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden.
| | - Anne-Wil Kruijt
- Department of Psychology, Stockholm University, Frescativägen, 114 19 Stockholm, Sweden
| | - Anna-Karin Ek
- Department of Psychology, Uppsala University, P.O. Box 256, 751 05 Uppsala, Sweden
| | - Gustaf Åbyhammar
- Department of Psychology, Uppsala University, P.O. Box 256, 751 05 Uppsala, Sweden
| | - Tomas Furmark
- Department of Psychology, Uppsala University, P.O. Box 256, 751 05 Uppsala, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institute, Solnavägen 1, 171 77 Solna, Stockholm, Sweden,Department of Behavioral Sciences and Learning, Linköping University, 581 83 Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Frescativägen, 114 19 Stockholm, Sweden
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16
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Niles AN, Woolley JD, Tripp P, Pesquita A, Vinogradov S, Neylan TC, O'Donovan A. Randomized Controlled Trial Testing Mobile-Based Attention-Bias Modification for Posttraumatic Stress Using Personalized Word Stimuli. Clin Psychol Sci 2020; 8:756-772. [PMID: 34414018 DOI: 10.1177/2167702620902119] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although behavioral therapies are effective for posttraumatic stress disorder (PTSD), access for patients is limited. Attention-bias modification (ABM), a cognitive-training intervention designed to reduce attention bias for threat, can be broadly disseminated using technology. We remotely tested an ABM mobile app for PTSD. Participants (N = 689) were randomly assigned to personalized ABM, nonpersonalized ABM, or placebo training. ABM was a modified dot-probe paradigm delivered daily for 12 sessions. Personalized ABM included words selected using a recommender algorithm. Placebo included only neutral words. Primary outcomes (PTSD and anxiety) and secondary outcomes (depression and PTSD clusters) were collected at baseline, after training, and at 5-week-follow-up. Mechanisms assessed during treatment were attention bias and self-reported threat sensitivity. No group differences emerged on outcomes or attention bias. Nonpersonalized ABM showed greater declines in self-reported threat sensitivity than placebo (p = .044). This study constitutes the largest mobile-based trial of ABM to date. Findings do not support the effectiveness of mobile ABM for PTSD.
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Affiliation(s)
- Andrea N Niles
- San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Psychiatry, University of California, San Francisco
| | - Joshua D Woolley
- San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Psychiatry, University of California, San Francisco
| | - Paige Tripp
- San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Psychiatry, University of California, San Francisco
| | - Ana Pesquita
- San Francisco Veterans Affairs Medical Center, San Francisco, California.,Center for Human Brain Health, University of Birmingham
| | | | - Thomas C Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Psychiatry, University of California, San Francisco
| | - Aoife O'Donovan
- San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Psychiatry, University of California, San Francisco
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17
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Engel N, Waldorf M, Hartmann A, Voßbeck-Elsebusch A, Vocks S. Is It Possible to Train the Focus on Positive and Negative Parts of One's Own Body? A Pilot Randomized Controlled Study on Attentional Bias Modification Training. Front Psychol 2020; 10:2890. [PMID: 31920898 PMCID: PMC6934133 DOI: 10.3389/fpsyg.2019.02890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
Dysfunctional body- and shape-related attentional biases are involved in the etiology and maintenance of eating disorders (ED). Various studies suggest that women, particularly those with ED diagnoses, focus on negatively evaluated parts of their own body, which leads to an increase in body dissatisfaction. The present study aims to empirically test the hypothesis that non-ED women show an attentional bias toward negative body parts and that the focus on positive and negative parts of one’s own body can be modified by attentional bias modification training based on a dot-probe task. Although several studies have measured body-related attentional biases by using pictures of participants’ own bodies, the approach of investigating attentional bias via a dot-probe task while presenting pictures of the participants’ own body parts and modifying the biased attention using such pictures is novel. Women (n = 60) rank-ordered 10 parts of their own body regarding their attractiveness. To examine and modify the attentional focus, pictures of the self-defined positive and negative parts of one’s own body were presented by means of a dot-probe task. A paired-sample t-test revealed no difference between reaction times to negative compared to positive body parts, indicating no attentional bias toward negative parts of one’s own body. A two-way ANOVA revealed a main effect of time for pictures of positive and negative parts of one’s own body, with a decrease in reaction times from pre- to post-training. However, there was no significant interaction between time and training condition concerning reaction times to positive and negative body parts. Our findings replicate previous evidence of a balanced attentional pattern regarding one’s own body in women without ED diagnoses. However, the dot-probe task failed to modify the attentional focus. As the modifiability of state body image increases with more pronounced body dissatisfaction, the next step would be to test this approach in clinical samples of women with ED diagnoses.
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Affiliation(s)
- Nicole Engel
- Department of Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Manuel Waldorf
- Department of Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Andrea Hartmann
- Department of Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Anna Voßbeck-Elsebusch
- Department of Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany.,Department of Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
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Ma L, Kruijt AW, Nöjd S, Zetterlund E, Andersson G, Carlbring P. Attentional Bias Modification in Virtual Reality - A VR-Based Dot-Probe Task With 2D and 3D Stimuli. Front Psychol 2019; 10:2526. [PMID: 31798495 PMCID: PMC6863810 DOI: 10.3389/fpsyg.2019.02526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 10/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias toward threatening information. The current study incorporated virtual reality (VR) technology and three-dimensional stimuli with a dot-probe task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms. Methods A total of 100 participants were randomized to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-months follow-up. Results Change in anxiety did not correlate with change in bias (p = 0.24). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM (p = 0.144), or between groups (p = 0.976). For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < 0.001). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 9% of participants were classified as ‘recovered’ at 3-months follow-up. Conclusion A single session of VR-based ABM did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.
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Affiliation(s)
- Lichen Ma
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Anne-Wil Kruijt
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Sofia Nöjd
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Elin Zetterlund
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Hirsch CR, Beale S, Grey N, Liness S. Approaching Cognitive Behavior Therapy For Generalized Anxiety Disorder From A Cognitive Process Perspective. Front Psychiatry 2019; 10:796. [PMID: 31780964 PMCID: PMC6852150 DOI: 10.3389/fpsyt.2019.00796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022] Open
Abstract
Generalized anxiety disorder (GAD), with uncontrollable worry at its core, is a common psychological disorder with considerable individual and societal costs. Cognitive behavior therapy (CBT) is recommended as the first-line treatment for GAD; however, further investigation into its effectiveness in routine clinical care is indicated and improvement is required in treatment outcomes for worry. Improvements to CBT need to be guided by experimental research that identifies key mechanisms maintaining core aspects of the disorder. This paper summarizes how theory-driven experimental research guided selection and refinements of CBT techniques originally developed by Borkovec and Costello, to target key cognitive processes that maintain worry in GAD. Hirsch and Mathews' model specifies three key research-supported processes that maintain uncontrollable worry in GAD: implicit cognitive biases such as negative interpretation bias and attention bias, generalized verbal thinking style, and impaired ability to re-direct attentional control away from worry. Specific CBT techniques outlined in this paper aim to target these key processes. Clinical data from clients treated using our refined CBT protocol for GAD in a routine clinical care service with a special interest in anxiety disorders were collected as part of service procedures. Large pre-to-posttreatment effect sizes were obtained for anxiety (GAD-7), depression (PHQ-9), and worry (PSWQ) (d=.90-2.54), and a moderate effect size was obtained for quality of life (WASA; d=.74). Recovery was indicated for 74% of cases for anxiety, 78% for depression, and 53% for worry. These findings exceeded most previous effectiveness studies in routine care and were in-line with GAD efficacy trials. This paper also outlines the application of specific clinical techniques selected, adapted or developed to target key cognitive mechanisms which maintain worry in GAD.
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Affiliation(s)
- Colette R. Hirsch
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sarah Beale
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Sheena Liness
- Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Zhang M, Ying J, Song G, Fung DSS, Smith H. Web-Based Cognitive Bias Modification Interventions for Psychiatric Disorders: Scoping Review. JMIR Ment Health 2019; 6:e11841. [PMID: 31651410 PMCID: PMC6915808 DOI: 10.2196/11841] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 06/06/2019] [Accepted: 08/26/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Cognitive biases refer to automatic attentional or interpretational tendencies, which result in individuals with addictive disorders to automatically attend to substance-related stimuli and those with anxiety disorders to attend to threatening stimuli. To date, several studies have examined the efficacy of cognitive bias modification, and meta-analytical studies have synthesized the evidence for overall efficacy. The clinical utility of cognitive bias modification interventions has previously been limited to the confines of a laboratory, but recent advances in Web technologies can change this. OBJECTIVE This scoping review aimed to determine the scope of Web-based cognitive bias interventions and highlight their effectiveness. METHODS Databases (PubMed and MEDLINE, EMBASE, PsycINFO, ScienceDirect, and Cochrane Central) were searched from inception to December 5, 2017. The following search terminologies were used: ("attention bias" OR "cognitive bias" OR "approach bias" OR "avoidance bias" OR "interpretative bias") AND ("Internet" OR "Web" OR "Online"). The methods for this scoping review are based on the previously published protocol. For the synthesis of the evidence, a narrative synthesis was undertaken, as a meta-analysis was not appropriate, given the lack of reported effect sizes and the heterogeneity in the outcomes reported. RESULTS Of the 2674 unique articles identified, we identified 22 randomized controlled studies that met our inclusion criteria: alcohol use disorder (n=2), tobacco use disorder (n=2), depressive disorder (n=3), anxiety and depressive symptoms in adolescents (n=3), obsessive-compulsive disorder (OCD; n=2), social anxiety disorder (n=9), and anxiety disorder (n=1). The sample sizes of these studies ranged from 16 to 434 participants. There is preliminary evidence to suggest that Web-based interventions could reduce biases among adolescents with heightened symptoms of anxiety and depression and among individuals with OCD. CONCLUSIONS This is the first scoping review that mapped out the scope of cognitive bias modification interventions for psychiatric disorders. Web-based interventions have been applied predominantly for social anxiety and addictive disorders. Larger cohorts must be used in future studies to better determine the effectiveness of Web-based cognitive bias interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/10427.
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Affiliation(s)
- Melvyn Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jiangbo Ying
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel S S Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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The ReThink study: a 3-arm parallel randomized trial of cognitive bias modification, with and without adherence promotion, for adolescent anxiety disorder: trial design and protocol. BMC Psychiatry 2019; 19:306. [PMID: 31640613 PMCID: PMC6805380 DOI: 10.1186/s12888-019-2296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most common mental health problem among youth, contribute to reduced quality of daily life, and are associated with high rates of comorbidity. However, treatment rates for anxiety are very low, causing a sizeable treatment gap. There is an immediate need to identify treatment interventions that are effective, affordable, and can be delivered easily to the youth population. Cognitive Bias Modification (CBM) is one potentially effective intervention that could reach youth on a large scale, especially when self-administered at home. Thus, we aim to assess the benefit of CBM to treat youth anxiety. Further, we aim to test whether adding an adherence promotion (AP) component to the CBM intervention can improve outcomes, and whether CBM delivered both with and without the AP component is cost effective. METHODS This is a 12-month randomized controlled trial (RCT) conducted within an existing healthcare system. Potentially eligible youth (ages 12 to 17) will be identified by reviewing the electronic health record (EHR) for clinical anxiety diagnoses, which are then confirmed via research interview. We aim to enroll 498 participants and randomize them 1:1:1 to one of three arms: Arm 1 is a Low-Ratio version of the CBM program (nearly identical to the other CBM versions, but minimally effective); Arm 2 is a High-Ratio "active" CBM program; and Arm 3 is the High-Ratio CBM program with an added AP component. Participants will complete assessments at baseline, 1-, 3-, 6- and 12-months post-baseline. Youth in all three arms will self-administer the CBM program at home and will be asked to complete twelve intervention sessions over a four-week period. Arm 3 participants (High-Ratio CBM + AP) will also receive up to four telephone calls from phone coaches during the intervention period to provide technical assistance, encouragement, and motivational enhancement to increase adherence. The primary clinical outcome will be anxiety remission at 6-month follow-up. DISCUSSION This study protocol describes the method and design for an RCT to test whether self-administered CBM both with and without adherence promotion can be an effective at-home treatment for anxious youth. TRIAL REGISTRATION ClinicalTrials.gov : NCT02156531, First Posted June 5, 2014.
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Pelissolo A, Abou Kassm S, Delhay L. Therapeutic strategies for social anxiety disorder: where are we now? Expert Rev Neurother 2019; 19:1179-1189. [PMID: 31502896 DOI: 10.1080/14737175.2019.1666713] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Classical well-established treatments of social anxiety disorder (SAD) are now complemented by more recent therapeutic strategies. This review aims to summarize available therapies for SAD and discuss recent evidence-based findings on the management of this disorder.Areas covered: Recent guidelines recommend psychotherapy, particularly cognitive-behavioral therapy (CBT), and pharmacotherapy, as first-line treatments of patients with SAD, without a clear superiority of one option over the other. CBT includes classical approaches such as in vivo exposure to social situations and cognitive therapy, but new modalities and techniques have been recently developed: third-wave approaches, internet-delivered therapy, virtual reality exposure, and cognitive bias modification. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have been also extensively studied and shown to be effective in SAD. Two alternative strategies have been developed to treat SAD with disappointing results: cognitive bias modification, and pharmacological augmentation of psychotherapy using D-cycloserine during exposure sessions.Expert opinion: Personalized treatments for SAD patients are now available. Innovative strategies such as online psychotherapy and virtual reality exposure are useful alternatives to CBT and SSRIs. Future developments and optimization of attention bias modification and of pharmacological augmentation of psychotherapy can be promising.
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Affiliation(s)
- Antoine Pelissolo
- AP-HP, Psychiatry Department, Hôpitaux Universitaires Henri-Mondor, Faculté de médecine, Créteil, France
| | - Sandra Abou Kassm
- Faculty of Medical Sciences, Psychiatry Department, Lebanese University, Beirut, Lebanon
| | - Lauriane Delhay
- AP-HP, Psychiatry Department, Hôpitaux Universitaires Henri-Mondor, Créteil, France
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23
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McNally RJ. Attentional bias for threat: Crisis or opportunity? Clin Psychol Rev 2019; 69:4-13. [DOI: 10.1016/j.cpr.2018.05.005] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 05/20/2018] [Accepted: 05/20/2018] [Indexed: 01/26/2023]
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Stefanopoulou E, Lewis D, Taylor M, Broscombe J, Larkin J. Digitally Delivered Psychological Interventions for Anxiety Disorders: a Comprehensive Review. Psychiatr Q 2019; 90:197-215. [PMID: 30488330 DOI: 10.1007/s11126-018-9620-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Digital interventions for anxiety disorders have been well-researched over the past two decades. However, reviews to date have focused on internet-based cognitive behavioural therapy (iCBT), whereas other psychological interventions have received less attention. The aim of this review was therefore to evaluate the effectiveness of digitally delivered psychological therapies (CBT, Attention Bias Modification, Exposure Therapy, Applied Relaxation, Bibliotherapy, Psychodynamic Therapy, Mindfulness, Behavioural Stress Management, Counselling) compared with control conditions and/or other psychological interventions for anxiety disorders (Social Anxiety Disorder (SAD), Health Anxiety, Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Specific Phobias, Panic Disorder (PD), Generalised Anxiety Disorder (GAD)]. 68 randomised controlled trials (RCTs) were reviewed. SAD was the anxiety disorder for which the most RCTs were conducted. Overall, findings support the effectiveness of iCBT for SAD; for the remaining interventions, although some RCTs indicated significant improvement (within groups) at post-treatment and/or follow up, between group findings were less consistent and overall, methodological differences across trials failed to provide strong supporting evidence. Finally, the level of therapist contact or expertise did not appear to affect much treatment effectiveness. Additional large, methodologically rigorous trials are needed to investigate further whether different digitally delivered psychological interventions are equally effective for anxiety disorders. Moreover, further studies are pertinent in order to examine the maintenance of therapy gains after the end of treatments and understand how these work [(e.g. the influence of therapist factors, user engagement and/or satisfaction, potential access barriers and treatments with diverse population groups (e.g. BME groups)].
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Affiliation(s)
- Evgenia Stefanopoulou
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK.
| | - David Lewis
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Matthew Taylor
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - James Broscombe
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
| | - Jan Larkin
- Turning Point, Registered Charity, Standon House, 21 Mansell Street, London, E1 8AA, UK
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Teng MH, Hou YM, Chang SH, Cheng HJ. Home-delivered attention bias modification training via smartphone to improve attention control in sub-clinical generalized anxiety disorder: A randomized, controlled multi-session experiment. J Affect Disord 2019; 246:444-451. [PMID: 30599367 DOI: 10.1016/j.jad.2018.12.118] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/08/2018] [Accepted: 12/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mogg and Bradley (2016) proposed that attentional bias (to threat stimuli) among patients with generalized anxiety disorder (GAD) may be associated with the top-down attention control process. Additionally, some scholars (e.g., Enock & McNally, 2013) have designed mobile applications to enable patients to engage in home-delivered attentional bias modification (HD-ABM); however, many problems related to these training systems have not yet been addressed. METHOD A total of 82 participants (61 women, mean age = 21.47 y) who received GAD diagnoses were randomly assigned to an HD-ABM (n = 30), placebo training (n = 30), or waiting list (n = 22) group. Both the HD-ABM and placebo groups were trained with the attention training application (through Android phones three times a day for four weeks). RESULTS (1) All measures of participants' self-reported symptoms (except for trait anxiety) were significantly lower in Week 4 and in the follow-up. (2) Attentional network test (ANT) results demonstrated that all participants' alerting scores significantly increased by Week 4. (3) Participants in the HD-ABM and placebo groups demonstrated significant increases in their self-reported attention control scores, decreases in their attention bias index (ABI) scores, and progress in their executive control abilities. LIMITATIONS Self-report scales may have been insufficient for measuring effectiveness in the present study. CONCLUSIONS This study helps to elucidate the mechanism underlying changes in attention processes after HD-ABM training implemented through a mobile application in GAD.
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Affiliation(s)
- Min-Hung Teng
- Department of Psychology, National Chung-Cheng University, Chia-Yi, Taiwan
| | - Yuh-Ming Hou
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
| | - Sue-Hwang Chang
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Ju Cheng
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
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26
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Zhang MWB, Ying JB, Song G, Ho RCM. A review of gamification approaches in commercial cognitive bias modification gaming applications. Technol Health Care 2019; 26:933-944. [PMID: 30040771 DOI: 10.3233/thc-181313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive biases are mostly automatic processes that result in individuals giving increased attention to threatening stimuli, with the difficulties in disengaging from these stimuli. Recent reviews have reported the presence for attention bias in several psychiatric conditions and provided evidence that such biases could be subjected to modification. Web-based and mobile based bias modification have mixed efficacy and gamification techniques proposed as a solution. There remains a gap in knowledge pertaining to the gamified applications for bias modification that are commercially available. OBJECTIVE An analysis of their gamification approach will help in identification of common gaming elements adopted for use. METHODS To identify commercial applications, a manual cross-sectional search was conducted between 1 and 11 November 2017 on the Google Play store. The following search terminologies were used: "Attention bias" and "Cognitive bias". The classification of the gamification technique for both the published applications and commercial applications were based on the six approaches described by Wouter et al. [17] and the 17 gamification techniques described by Hoffman et al. [18]. RESULTS A total of nine applications were included in the current review. Five out of the nine applications involved the addition of gaming elements to an evidence-based task, and three involved the usage of intrinsic integration while leaving the evidence-based task intact. Other common gamification strategies used are that of the inclusion of digital rewards (n= 8) and the provision of feedback (n= 7). The average number of gamification techniques across all the nine applications is 3.2. CONCLUSIONS Even though most commercial applications appear to have their basis on a validated gamification approach for the delivery of attention bias modification, there remains a need for further research in evaluating these applications clinically.
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Affiliation(s)
- Melvyn W B Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Jiang Bo Ying
- National Psychiatry Residency Program, National Healthcare Group, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Brüll P, Kessels LTE, Repetto L, Dirkson A, Ruiter RAC. ERPs Reveal Disengagement Processes Related to Condom Use Embarrassment in Intention-Behavior Inconsistent Young Adults. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:521-532. [PMID: 29696551 PMCID: PMC6373258 DOI: 10.1007/s10508-018-1217-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/23/2018] [Accepted: 04/11/2018] [Indexed: 05/08/2023]
Abstract
The use of barrier protections such as condoms has consistently been reported to reduce the acquisition of sexually transmitted infections. However, it has also been reported that the association between condom use intentions and behavior is, at best, often weak. Furthermore, embarrassment associated with purchasing condoms and negotiating their use has been shown to negatively impact the frequency of condom use. Using electroencephalography to analyze P300 event-related potential components known to measure early attention allocation, we examined electrophysiological evidence of early attention disengagement for embarrassing health information. Forty young adults-34 females and six males-participated in an adapted version of Posner's visual cueing paradigm. All were high in intention to use condoms, but half were intention-behavior consistent and half were intention-behavior inconsistent. Compared to intention-behavior consistent participants, those with intention-behavior inconsistency showed a reduced P300 component when attending to a visual target opposite to the field in which embarrassing self-relevant health information was presented, indicating more efficient early attention disengagement from such embarrassing health information. In conclusion, our electrophysiological data suggest that high intention alone may be not sufficient to predict adolescents' condom use behavior.
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Affiliation(s)
- Phil Brüll
- Department of Work and Social Psychology, Maastricht University, 6200 MD, Maastricht, The Netherlands.
| | - Loes T E Kessels
- Department of Work and Social Psychology, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Linda Repetto
- University College Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Anne Dirkson
- University College Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, 6200 MD, Maastricht, The Netherlands
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Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry 2019; 18:20-28. [PMID: 30600624 PMCID: PMC6313242 DOI: 10.1002/wps.20610] [Citation(s) in RCA: 306] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, Australia
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F Dear
- MindSpot Clinic, Macquarie University, Sydney, Australia
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Alexander Rozental
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Institute of Child Health, University College London, London, UK
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Birk MV, Mandryk RL. Improving the Efficacy of Cognitive Training for Digital Mental Health Interventions Through Avatar Customization: Crowdsourced Quasi-Experimental Study. J Med Internet Res 2019; 21:e10133. [PMID: 30622095 PMCID: PMC6329434 DOI: 10.2196/10133] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/17/2018] [Accepted: 09/06/2018] [Indexed: 01/17/2023] Open
Abstract
Background The success of internet-based mental health interventions in practice—that is, in the wild—depends on the uptake and retention of the application and the user’s focused attention in the moment of use. Incorporating game-based motivational design into digital interventions delivered in the wild has been shown to increase uptake and retention in internet-based training; however, there are outstanding questions about the potential of game-based motivational strategies to increase engagement with a task in the moment of use and the effect on intervention efficacy. Objective Designers of internet-based interventions need to know whether game-based motivational design strategies can increase in-the-moment engagement and thus improve digital interventions. The aim of this study was to investigate the effects of 1 motivational design strategy (avatar customization) in an example mental health intervention (computerized cognitive training for attention bias modification). Methods We assigned 317 participants to either a customized avatar or an assigned avatar condition. After measuring state anxiety (State-Trait Anxiety Inventory), we randomly assigned half of the participants in each condition to either an attentional retraining condition (Attention Bias Modification Training) or a control condition. After training, participants were exposed to a negative mood induction using images with strong negative valance (International Affective Picture System), after which we measured state anxiety again. Results Avatar customization decreased posttraining state anxiety when controlling for baseline state anxiety for those in the attentional retraining condition; however, those who did not train experienced decreased resilience to the negative mood induction (F1,252=6.86, P=.009, ηp2=.027). This interaction effect suggests that customization increased task engagement with the intervention in the moment of use. Avatar customization also increased avatar identification (F5,252=12.46, P<.001, R2=.23), regardless of condition (F1,252=.79, P=.38). Avatar identification reduced anxiety after the negative mood induction for participants who underwent training but increased poststimulus anxiety for participants who did not undergo training, further suggesting that customization increases engagement in the task (F1,252=6.19, P=.01). The beneficial effect of avatar customization on training was driven by participants who were low in their basic satisfaction of relatedness (F10,248=18.5, P<.001, R2=.43), which is important because these are the participants who are most likely in need of digital interventions for mental health. Conclusions Our results suggest that applying motivational design—specifically avatar customization—is a viable strategy to increase engagement and subsequently training efficacy in a computerized cognitive task.
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Affiliation(s)
- Max Valentin Birk
- University of Saskatchewan, Department of Computer Science, Saskatoon, SK, Canada
| | - Regan Lee Mandryk
- University of Saskatchewan, Department of Computer Science, Saskatoon, SK, Canada
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Notebaert L, Grafton B, Clarke PJ, Rudaizky D, Chen NT, MacLeod C. Emotion-in-Motion, a Novel Approach for the Modification of Attentional Bias: An Experimental Proof-of-Concept Study. JMIR Serious Games 2018; 6:e10993. [PMID: 30487121 PMCID: PMC6291684 DOI: 10.2196/10993] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 01/29/2023] Open
Abstract
Background Individuals with heightened anxiety vulnerability tend to preferentially attend to emotionally negative information, with evidence suggesting that this attentional bias makes a causal contribution to anxiety vulnerability. Recent years have seen an increase in the use of attentional bias modification (ABM) procedures to modify patterns of attentional bias; however, often this change in bias is not successfully achieved. Objective This study presents a novel ABM procedure, Emotion-in-Motion, requiring individuals to engage in patterns of attentional scanning and tracking within a gamified, complex, and dynamic environment. We aimed to examine the capacity of this novel procedure, as compared with the traditional probe-based ABM procedure, to produce a change in attentional bias and result in a change in anxiety vulnerability. Methods We administered either an attend-positive or attend-negative version of our novel ABM task or the conventional probe-based ABM task to undergraduate students (N=110). Subsequently, participants underwent an anagram stressor task, with state anxiety assessed before and following this stressor. Results Although the conventional ABM task failed to induce differential patterns of attentional bias or affect anxiety vulnerability, the Emotion-in-Motion training did induce a greater attentional bias to negative faces in the attend-negative training condition than in the attend-positive training condition (P=.003, Cohen d=0.87) and led to a greater increase in stressor-induced state anxiety faces in the attend-negative training condition than in the attend-positive training condition (P=.03, Cohen d=0.60). Conclusions Our novel, gamified Emotion-in-Motion ABM task appears more effective in modifying patterns of attentional bias and anxiety vulnerability. Candidate mechanisms contributing to these findings are discussed, including the increased stimulus complexity, dynamic nature of the stimulus presentation, and enriched performance feedback.
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Affiliation(s)
- Lies Notebaert
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Patrick Jf Clarke
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia.,School of Psychology, Curtin University, Bently, Australia
| | - Daniel Rudaizky
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Nigel Tm Chen
- School of Psychology, Curtin University, Bently, Australia
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
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Rubin M, Telch MJ. Gone in sixty (milli)seconds: Disentangling the effects of location context on attention bias. Scand J Psychol 2018; 59:594-601. [PMID: 30338528 DOI: 10.1111/sjop.12494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
Attention bias is associated with a broad range of emotional disorders. Because of its transportability, attention bias modification (ABM) training can be administered outside of the laboratory; however, some evidence suggests that ABM training may be less effective when conducted in the individual's natural environment. The aim of this study was to examine factors that might account for the attenuated effects of attentional bias (AB) when assessed remotely. One hundred fifty-eight undergraduate psychology students completed the Emotional Stroop Task on two occasions - once in the laboratory and once remotely. To help disentangle the influences of emotional state and location on attention bias, participants were randomized to view either an emotionally provocative clip or an emotionally neutral clip prior to completing the emotional Stroop task. Results showed evidence of an attentional bias only in the laboratory, among participants in the neutral emotion condition (b = -19.67, P = .008, 95% CI [-34.18, -5.15]). Exploratory analyses revealed that emotion provocation was associated with attentional bias among individuals with greater symptoms of depression, but only remotely (b = -15.70, P = 0.046, 95% CI [-31.15, -0.25]). These findings suggest that caution should be used when conducting attention bias research remotely. Limitations and future directions are discussed.
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Heitmann J, Bennik EC, van Hemel-Ruiter ME, de Jong PJ. The effectiveness of attentional bias modification for substance use disorder symptoms in adults: a systematic review. Syst Rev 2018; 7:160. [PMID: 30316302 PMCID: PMC6186103 DOI: 10.1186/s13643-018-0822-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 09/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attentional 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. METHODS We 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. RESULTS Eighteen 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. CONCLUSIONS Despite 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 REGISTRATION Registration number PROSPERO: CRD42016046823.
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Affiliation(s)
- Janika Heitmann
- Verslavingszorg Noord Nederland, Groningen, The Netherlands. .,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
| | - Elise C Bennik
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | | | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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Lazarov A, Marom S, Yahalom N, Pine DS, Hermesh H, Bar-Haim Y. Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: a randomized controlled trial. Psychol Med 2018; 48:2177-2185. [PMID: 29258631 PMCID: PMC6013362 DOI: 10.1017/s003329171700366x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cognitive-behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT. METHODS Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment. RESULTS Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores. CONCLUSIONS This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive-behavioral therapy for adult SAD. Training patients' attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.
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Affiliation(s)
- Amit Lazarov
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Sofi Marom
- Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Naomi Yahalom
- Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel S. Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Haggai Hermesh
- Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
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Tayama J, Saigo T, Ogawa S, Takeoka A, Hamaguchi T, Inoue K, Okamura H, Yajima J, Matsudaira K, Fukudo S, Shirabe S. Effect of attention bias modification on event-related potentials in patients with irritable bowel syndrome: A preliminary brain function and psycho-behavioral study. Neurogastroenterol Motil 2018; 30:e13402. [PMID: 30062816 DOI: 10.1111/nmo.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Attention bias modification normalizes electroencephalographic abnormalities in alpha and beta power percentages related to attention in patients with irritable bowel syndrome (IBS). Yet, it is unknown whether ABM contributes to the normalization of event-related potentials (ERP) in these patients. We hypothesized that ERP related to attention deficit would be normalized after ABM implementation in individuals with IBS. METHODS Thirteen patients with IBS and 10 control subjects completed a 2-month intervention that included five ABM sessions. Each session included 128 trials, resulting in a total of 640 trials during the study period. Event-related potentials were measured at the first and fifth sessions. As per the international 10-20 system for electroencephalographic electrode placement, right parietal P4 was evaluated to measure the attention component of facial expression processing. KEY RESULTS A group comparison of P100 latency at P4 revealed that latencies were significantly different between groups in session 1 (IBS vs control, 108 ± 8 vs 97 ± 14; t = -2.51, P = .0203). This difference was absent in session 5 (94 ± 11 vs 93 ± 11, respectively; t = -0.397, P = .6954, r = .09), indicating an effect of ABM in the IBS group. CONCLUSIONS AND INFERENCES Attention bias modification may have clinical utility for normalizing brain function and specifically attentional abnormalities in patients with IBS.
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Affiliation(s)
- J Tayama
- Graduate School of Education, Nagasaki University, Nagasaki, Japan
| | - T Saigo
- School of Psychological Science, Health Sciences University of Hokkaido, Sapporo, Japan
| | - S Ogawa
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - A Takeoka
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
| | - T Hamaguchi
- Department of Occupational Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan
| | - K Inoue
- Center for the Study of Higher Education and Global Admissions, Osaka University, Suita, Japan
| | - H Okamura
- Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - J Yajima
- Faculty of Literature, Beppu University, Beppu, Japan
| | - K Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo-Hospital, Tokyo, Japan
| | - S Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - S Shirabe
- Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
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Crump A, Arnott G, Bethell EJ. Affect-Driven Attention Biases as Animal Welfare Indicators: Review and Methods. Animals (Basel) 2018; 8:E136. [PMID: 30087230 PMCID: PMC6115853 DOI: 10.3390/ani8080136] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 11/17/2022] Open
Abstract
Attention bias describes the differential allocation of attention towards one stimulus compared to others. In humans, this bias can be mediated by the observer's affective state and is implicated in the onset and maintenance of affective disorders such as anxiety. Affect-driven attention biases (ADABs) have also been identified in a few other species. Here, we review the literature on ADABs in animals and discuss their utility as welfare indicators. Despite a limited research effort, several studies have found that negative affective states modulate attention to negative (i.e., threatening) cues. ADABs influenced by positive-valence states have also been documented in animals. We discuss methods for measuring ADAB and conclude that looking time, dot-probe, and emotional spatial cueing paradigms are particularly promising. Research is needed to test them with a wider range of species, investigate attentional scope as an indicator of affect, and explore the possible causative role of attention biases in determining animal wellbeing. Finally, we argue that ADABs might not be best-utilized as indicators of general valence, but instead to reveal specific emotions, motivations, aversions, and preferences. Paying attention to the human literature could facilitate these advances.
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Affiliation(s)
- Andrew Crump
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK.
| | - Gareth Arnott
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK.
| | - Emily J Bethell
- Research Centre in Brain and Behaviour, School of Natural Sciences and Psychology, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, UK.
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Emotion Regulation in Generalized Anxiety and Social Anxiety: Examining the Distinct and Shared Use of Emotion Regulation Strategies. IRANIAN JOURNAL OF PSYCHIATRY 2018; 13:160-167. [PMID: 30319698 PMCID: PMC6178328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: According to the transdiagnostic view, emotion regulation strategies are common among emotional disorders. Despite the vast majority of studies demonstrating the common role of emotion regulation strategies in emotional disorders including generalized anxiety disorder (GAD) and social anxiety disorder (SAD), distinct functions of these strategies are largely unknown. So, the aim of the present study was to assess the distinct and shared use of emotion regulation strategies in individuals with GAD and SAD symptoms. Method : Participants were recruited from a community sample of Tehran using purposive sampling method. The sample (N = 346) consisted of 269 nonclinical individuals, 47 individuals with generalized anxiety symptoms, and 30 individuals with social anxiety symptoms. Informed consent was obtained from all the participants and they were asked to fill in a series of self -report questionnaires including GAD-IV, SIAS, DERS, EQ, ACS, and RRS. Data were analyzed by discriminant function analysis using SPSS-23. Results: Findings revealed significant differences between the 3 groups in non-acceptance, focusing, shifting, brooding, and decentering (P<0.01). Results of discriminant function analysis showed 2 functions: the first accounted for 87.4% of the variance (Wilk`s Lambda = 0.81, df = 10, P<0.01, χ2 = 70.06), and the second for 12.6% of the variance (Wilk`s Lambda = 0.97, df = 4, P<0.05, χ2 = 9.43) of between group variability. Non-acceptance and focusing discriminated GAD and SAD the most. Conclusion: The findings of the present study support both splitter and lumper approaches as there were some emotion regulation strategies common between GAD and SAD, including shifting, decentering, and brooding. However, some of them were distinct, such as focusing and non-acceptance. Nevertheless, there are still inconsistencies in research about the findings, and thus examining the pathways may illuminate these findings.
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Naim R, Kivity Y, Bar-Haim Y, Huppert JD. Attention and interpretation bias modification treatment for social anxiety disorder: A randomized clinical trial of efficacy and synergy. J Behav Ther Exp Psychiatry 2018; 59:19-30. [PMID: 29127945 DOI: 10.1016/j.jbtep.2017.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/11/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Attention bias modification treatment (ABMT) and cognitive bias modification of interpretation (CBM-I) both have demonstrated efficacy in alleviating social anxiety, but how they compare with each other, their combination, and with a combined control condition has not been studied. We examined their relative and combined efficacy compared to control conditions in a randomized controlled trial (RCT). METHODS Ninety-five adults diagnosed with social anxiety disorder (SAD), were randomly allocated to 4 groups: ABMT + CBM-I control (hereafter ABMT; n = 23), CBM-I + ABMT control (hereafter CBM-I; n = 24), combined ABMT + CBM-I (n = 23), and combined control (n = 25). Treatment included eight sessions over four weeks. Clinician-rated and self-reported measures of social anxiety symptoms, functional impairment, and threat-related attention and interpretive biases were evaluated at baseline, post-treatment, and 3-month follow-up. RESULTS ABMT yielded greater symptom reduction as measured by both clinician-ratings (Cohen's ds = 0.57-0.70) and self-reports (ds = 0.70-0.85) compared with the CBM-I, the combined ABMT + CBM-I, and the combined control conditions. Neither of the other conditions demonstrated superior symptom change compared to the control condition. No group differences were found for functioning or cognitive biases measures. LIMITATIONS Limitations mainly include the mix of active and control treatments applied across the different groups. Therefore, the net effect of each of the treatments by itself could not be clearly tested. CONCLUSIONS Results suggest superiority of ABMT compared to CBM-I and their combination in terms of symptom reduction. Possible interpretations and methodological issues underlying the observed findings are discussed.
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Affiliation(s)
- Reut Naim
- School of Psychological Sciences, Tel Aviv University, Israel.
| | - Yogev Kivity
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Israel; The Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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Andersson G. Internet interventions: Past, present and future. Internet Interv 2018; 12:181-188. [PMID: 30135782 PMCID: PMC6096319 DOI: 10.1016/j.invent.2018.03.008] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/30/2018] [Accepted: 03/30/2018] [Indexed: 02/07/2023] Open
Abstract
Internet interventions have been around now for about 20 years. While the field still suffers from a scattered terminology a large number of programs and studies exist. In the present paper I present an overview of my experiences of studying internet-supported cognitive-behaviour therapy (ICBT), but also mention other approaches including the use of smartphones. The paper covers the history of ICBT, short-term effects in controlled trials for a range of conditions, long-term effects, comparisons against face-to-face therapy, effectiveness studies, prediction studies, how the treatment is perceived, critique, and finally future directions. I conclude that we have now reached a stage in which we have numerous evidence-based treatments and procedures, and increasingly internet interventions including ICBT are disseminated.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, SE-581 83 Linköping, Sweden.
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Training Less Threatening Interpretations Over the Internet: Impact of Priming Anxious Imagery and Using a Neutral Control Condition. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9922-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Zhang M, Ying J, Song G, Fung DS, Smith H. Attention and Cognitive Bias Modification Apps: Review of the Literature and of Commercially Available Apps. JMIR Mhealth Uhealth 2018; 6:e10034. [PMID: 29793899 PMCID: PMC5992457 DOI: 10.2196/10034] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/19/2018] [Accepted: 05/10/2018] [Indexed: 01/12/2023] Open
Abstract
Background Automatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically. Objective The objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically. Methods To identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were “attention bias” OR “cognitive bias” AND “smartphone” OR “smartphone application” OR “smartphone app” OR “mobile phones” OR “mobile application” OR mobile app” OR “personal digital assistant.” To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were “attention bias” and “cognitive bias.” We also conducted a manual search on the apps with published evaluations. Results The effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature. Conclusions This is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically.
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Affiliation(s)
- Melvyn Zhang
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - JiangBo Ying
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Daniel Ss Fung
- Medical Board / Department of Development Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Helen Smith
- Department of Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Firth J, Torous J, Carney R, Newby J, Cosco TD, Christensen H, Sarris J. Digital Technologies in the Treatment of Anxiety: Recent Innovations and Future Directions. Curr Psychiatry Rep 2018; 20:44. [PMID: 29779065 PMCID: PMC7006989 DOI: 10.1007/s11920-018-0910-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW This review aims to provide a comprehensive overview of the efficacy, limitations, and future of e-health treatments for anxiety. Within this, we provide detail on "first-generation" e-health approaches, such as computerized therapies. Additionally, we assess the emergence and early efficacy of newer methods of treatment delivery, including smartphone apps and virtual reality interventions, discussing the potential and pitfalls for each. RECENT FINDINGS There is now substantial clinical research demonstrating the efficacy of internet-delivered cognitive behavioral therapy in the treatment of anxiety. However, the ability of these interventions for engaging patients in "real-world" settings is unclear. Recently, smartphone apps for anxiety have presented a more popular and ubiquitous method of intervention delivery, although the evidence base supporting these newer approaches drastically falls behind the extensive marketing and commercialization efforts currently driving their development. Meanwhile, the increasing availability of novel technologies, such as "virtual reality" (VR), introduces further potential of e-health treatments for generalized anxiety and anxiety-related disorders such as phobias and obsessive compulsive disorder, while also creating additional challenges for research. Although still in its infancy, e-health research is already presenting several promising avenues for delivering effective and scalable treatments for anxiety. Nonetheless, several important steps must be taken in order for academic research to keep pace with continued technological advances.
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Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, University of Western Sydney, Campbelltown, Sydney, NSW, 2560, Australia. .,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - John Torous
- Department of Psychiatry and Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Rebekah Carney
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK,Youth Mental Health Research Unit, Greater Manchester West Mental Health Foundation Trust, Manchester, UK
| | - Jill Newby
- School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia
| | - Theodore D. Cosco
- Gerontology Research Centre, Simon Fraser University, Vancouver, Canada,Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Helen Christensen
- Black Dog Institute, UNSW Sydney, Sydney, Australia,School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Jerome Sarris
- NICM Health Research Institute, University of Western Sydney, Campbelltown, Sydney, NSW 2560, Australia,Department of Psychiatry, University of Melbourne, Professorial Unit, The Melbourne Clinic, Melbourne, Australia
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Attentional Bias Modification for Social Anxiety Disorder: What do Patients Think and Why does it Matter? Behav Cogn Psychother 2018; 47:16-38. [PMID: 29729676 DOI: 10.1017/s1352465818000231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has examined how anxious patients perceive ABM, and it is unclear to what extent perceptions of ABM influence outcome. AIMS To examine patient perceptions of ABM across two studies, using a mixed methods approach. METHOD In the first study, participants completed a traditional ABM program and received a hand-out with minimal information about the purpose of the task. In the second study, participants completed an adaptive ABM program and were provided with more extensive rationale and instructions for changing attentional biases. RESULTS A number of themes emerged from qualitative data related to perceived symptom changes and mechanisms of action, acceptability, early perceptions of the program, barriers/facilitators to engagement, and responses to adaptive features. Moreover, quantitative data suggested that patients' perceptions of the program predicted symptom reduction as well as change in attentional bias. CONCLUSIONS Our quantitative data suggest that it may be possible to quickly and inexpensively identify some patients who may benefit from current ABM programs, although our qualitative data suggest that ABM needs major modifications before it will be an acceptable and credible treatment more broadly. Although the current study was limited by sample size and design features of the parent trials from which these data originated, our findings may be useful for guiding hypotheses in future studies examining patient perceptions towards ABM.
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Positive online attentional training as a means of modifying attentional and interpretational biases among the clinically depressed: An experimental study using eye tracking. J Clin Psychol 2018. [DOI: 10.1002/jclp.22617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Cai W, Pan Y, Chai H, Cui Y, Yan J, Dong W, Deng G. Attentional bias modification in reducing test anxiety vulnerability: a randomized controlled trial. BMC Psychiatry 2018; 18:1. [PMID: 29304757 PMCID: PMC5756356 DOI: 10.1186/s12888-017-1517-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/26/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A tendency to selectively process a threat to positive information may be involved in the etiology of anxiety disorders. The aim of this study is to examine whether attentional bias modification (ABM) can be used to modify high test-anxiety individuals' attention to emotional information and whether this change is related to anxiety vulnerability. METHODS Seventy-seven undergraduates were included: 28 individuals received a 5-day modified dot probe task as ABM training, 29 individuals received a 5-day classic dot probe task as placebo, and 20 individuals did not receive an intervention between the two test sections. In addition to the measure of biased attention, salivary α-amylase (sAA) and the visual analogue scale of anxiety were assessed as emotional reactivity to stress. RESULTS A repeated measurement of variance analysis and paired sample t-test indicated that the ABM group showed a significant change in attentional bias scores after the 5-day training, whereas there were no changes in the attentional bias scores in the placebo or waiting list groups. Importantly, anxiety vulnerability with attention to threats was significantly decreased in the training group. CONCLUSIONS These results suggest that attentional bias toward threat stimuli may play an important role in anxiety vulnerability. The attentional bias modification away from the threat is effective for the individuals preparing for an exam. TRIAL REGISTRATION This trial was retrospectively registered on June 22, 2017 with the registration number ChiCTR-IOR-17011745 and the title 'Attentional Bias in high anxiety individuals and its modification'.
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Affiliation(s)
- Wenpeng Cai
- 0000 0004 0369 1660grid.73113.37Faculty of Psychology and Mental Health, Second Military Medical University, Xiangyin Road 800, Shanghai, 200433 China
| | - Yu Pan
- 0000 0004 1761 8894grid.414252.4Department of Medical Psychology, General Hospital of PLA, Beijing, 100853 China
| | - Huangyangzi Chai
- Department of Engineering and Information, Nanjing City Vocational College, Nanjing, 210038 China
| | - Yi Cui
- 0000 0004 0369 1660grid.73113.37Faculty of Psychology and Mental Health, Second Military Medical University, Xiangyin Road 800, Shanghai, 200433 China
| | - Jin Yan
- 0000 0004 0369 1660grid.73113.37Faculty of Psychology and Mental Health, Second Military Medical University, Xiangyin Road 800, Shanghai, 200433 China
| | - Wei Dong
- Faculty of Psychology and Mental Health, Second Military Medical University, Xiangyin Road 800, Shanghai, 200433, China.
| | - Guanghui Deng
- Faculty of Psychology and Mental Health, Second Military Medical University, Xiangyin Road 800, Shanghai, 200433, China.
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Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther 2017; 47:1-18. [PMID: 29215315 DOI: 10.1080/16506073.2017.1401115] [Citation(s) in RCA: 628] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, -.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.
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Affiliation(s)
- Per Carlbring
- a Department of Psychology , Stockholm University , Stockholm , Sweden
| | - Gerhard Andersson
- b Department of Behavioural Sciences and Learning , Swedish Institute for Disability Research, Linköping University , Linköping , Sweden.,c Department of Clinical Neuroscience, Division of Psychiatry , Karolinska Institutet , Stockholm , Sweden
| | - Pim Cuijpers
- d Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology , Vrije Universiteit , Amsterdam , The Netherlands
| | - Heleen Riper
- d Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology , Vrije Universiteit , Amsterdam , The Netherlands.,e VU University Medical Centre/GGZ inGeest , Amsterdam , The Netherlands.,f Amsterdam Public Health Research Institute , Amsterdam , The Netherlands.,g Faculty of Health Science, Telepsychiatric Unit , University of Southern Denmark, University Hospital , Odense , Denmark
| | - Erik Hedman-Lagerlöf
- h Department of Clinical Neuroscience, Osher Center for Integrative Medicine and Division of Psychology , Karolinska Institutet , Stockholm , Sweden
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46
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Price RB, Kuckertz JM, Amir N, Bar-Haim Y, Carlbring P, Wallace ML. Less is more: Patient-level meta-analysis reveals paradoxical dose-response effects of a computer-based social anxiety intervention targeting attentional bias. Depress Anxiety 2017; 34:1106-1115. [PMID: 28453890 PMCID: PMC5660671 DOI: 10.1002/da.22634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/27/2017] [Accepted: 04/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The past decade of research has seen considerable interest in computer-based approaches designed to directly target cognitive mechanisms of anxiety, such as attention bias modification (ABM). METHODS By pooling patient-level datasets from randomized controlled trials of ABM that utilized a dot-probe training procedure, we assessed the impact of training "dose" on relevant outcomes among a pooled sample of 693 socially anxious adults. RESULTS A paradoxical effect of the number of training trials administered was observed for both posttraining social anxiety symptoms and behavioral attentional bias (AB) toward threat (the target mechanism of ABM). Studies administering a large (>1,280) number of training trials showed no benefit of ABM over control conditions, while those administering fewer training trials showed significant benefit for ABM in reducing social anxiety (P = .02). These moderating effects of dose were not better explained by other examined variables and previously identified moderators, including patient age, training setting (laboratory vs. home), or type of anxiety assessment (clinician vs. self-report). CONCLUSIONS Findings inform the optimal dosing for future dot-probe style ABM applications in both research and clinical settings, and suggest several novel avenues for further research.
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Clarke PJF, Branson S, Chen NTM, Van Bockstaele B, Salemink E, MacLeod C, Notebaert L. Attention bias modification training under working memory load increases the magnitude of change in attentional bias. J Behav Ther Exp Psychiatry 2017; 57:25-31. [PMID: 28257926 DOI: 10.1016/j.jbtep.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/16/2016] [Accepted: 02/10/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Attention bias modification (ABM) procedures have shown promise as a therapeutic intervention, however current ABM procedures have proven inconsistent in their ability to reliably achieve the requisite change in attentional bias needed to produce emotional benefits. This highlights the need to better understand the precise task conditions that facilitate the intended change in attention bias in order to realise the therapeutic potential of ABM procedures. Based on the observation that change in attentional bias occurs largely outside conscious awareness, the aim of the current study was to determine if an ABM procedure delivered under conditions likely to preclude explicit awareness of the experimental contingency, via the addition of a working memory load, would contribute to greater change in attentional bias. METHODS Bias change was assessed among 122 participants in response to one of four ABM tasks given by the two experimental factors of ABM training procedure delivered either with or without working memory load, and training direction of either attend-negative or avoid-negative. RESULTS Findings revealed that avoid-negative ABM procedure under working memory load resulted in significantly greater reductions in attentional bias compared to the equivalent no-load condition. LIMITATIONS The current findings will require replication with clinical samples to determine the utility of the current task for achieving emotional benefits. CONCLUSIONS These present findings are consistent with the position that the addition of a working memory load may facilitate change in attentional bias in response to an ABM training procedure.
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Affiliation(s)
- Patrick J F Clarke
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia; School of Psychology and Speech Pathology, Curtin University, Australia.
| | - Sonya Branson
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia
| | - Nigel T M Chen
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia
| | - Bram Van Bockstaele
- Addiction, Development, and Psychopathology Lab (Adapt Lab), Department of Psychology, University of Amsterdam, The Netherlands
| | - Elske Salemink
- Addiction, Development, and Psychopathology Lab (Adapt Lab), Department of Psychology, University of Amsterdam, The Netherlands
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia; School of Psychology, Babes-Bolyai University, Romania
| | - Lies Notebaert
- Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, Australia
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Abstract
Internet-assisted cognitive-behavioral therapy (ICBT) is a way to deliver cognitive-behavioral therapy (CBT) that has been found to generate similar effects as face-to-face CBT in some studies. Results have been replicated by different research groups. This article presents the treatment format and reviews evidence for mood and anxiety disorders. Future developments are discussed, including the lack of theories specific for the treatment format and ways to handle comorbidity. Although some programs have been implemented there is a need for further studies in clinical settings. Overall, clinician-assisted ICBT is becoming one of the most evidence-based forms of psychological treatment.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, SE-581 83, Linköping SE-581 83, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm SE-106 91, Sweden
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Grafton B, MacLeod C, Rudaizky D, Holmes EA, Salemink E, Fox E, Notebaert L. Confusing procedures with process when appraising the impact of cognitive bias modification on emotional vulnerability †. Br J Psychiatry 2017; 211:266-271. [PMID: 29092835 DOI: 10.1192/bjp.bp.115.176123] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/06/2017] [Accepted: 03/22/2017] [Indexed: 11/23/2022]
Abstract
If meta-analysis is to provide valuable answers, then it is critical to ensure clarity about the questions being asked. Here, we distinguish two important questions concerning cognitive bias modification research that are not differentiated in the meta-analysis recently published by Cristea et al (2015) in this journal: (1) do the varying procedures that investigators have employed with the intention of modifying cognitive bias, on average, significantly impact emotional vulnerability?; and (2) does the process of successfully modifying cognitive bias, on average, significantly impact emotional vulnerability? We reanalyse the data from Cristea et al to address this latter question. Our new analyses demonstrate that successfully modifying cognitive bias does significantly alter emotional vulnerability. We revisit Cristea et al's conclusions in light of these findings.
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Affiliation(s)
- Ben Grafton
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Colin MacLeod
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Daniel Rudaizky
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Emily A Holmes
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Elske Salemink
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Elaine Fox
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
| | - Lies Notebaert
- Ben Grafton, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Colin MacLeod, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia, School of Psychology, Babes-Bolyai University, Romania; Daniel Rudaizky, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia; Emily A. Holmes, PhD, Medical Research Council, Cognition and Brain Sciences Unit, Cambridge, UK, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Elske Salemink, PhD, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Elaine Fox, PhD, Oxford Centre for Emotion and Affective Neuroscience, and Department of Experimental Psychology, University of Oxford, UK; Lies Notebaert, PhD, Centre for the Advancement of Research on Emotion, School of Psychology, University of Western Australia
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Attention bias modification training for adolescents with chronic pain: a randomized placebo-controlled trial. Pain 2017; 159:239-251. [DOI: 10.1097/j.pain.0000000000001084] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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