Effects of Attentional Bias Modification on residual symptoms in depression: a randomized controlled trial

Rune Jonassen, Catherine J Harmer, Eva Hilland, Luigi A Maglanoc, Brage Kraft, Michael Browning, Tore C Stiles, Vegard Ø Haaland, Torkil Berge, Nils Inge Landrø, Rune Jonassen, Catherine J Harmer, Eva Hilland, Luigi A Maglanoc, Brage Kraft, Michael Browning, Tore C Stiles, Vegard Ø Haaland, Torkil Berge, Nils Inge Landrø

Abstract

Background: Following treatment, many depressed patients have significant residual symptoms. However, large randomised controlled trials (RCT) in this population are lacking. When Attention bias modification training (ABM) leads to more positive emotional biases, associated changes in clinical symptoms have been reported. A broader and more transparent picture of the true advantage of ABM based on larger and more stringent clinical trials have been requested. The current study evaluates the early effect of two weeks ABM training on blinded clinician-rated and self-reported residual symptoms, and whether changes towards more positive attentional biases (AB) would be associated with symptom reduction.

Method: A total of 321 patients with a history of depression were included in a preregistered randomized controlled double-blinded trial. Patients were randomised to an emotional ABM paradigm over fourteen days or a closely matched control condition. Symptoms based on the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory II (BDI-II) were obtained at baseline and after ABM training.

Results: ABM training led to significantly greater decrease in clinician-rated symptoms of depression as compared to the control condition. No differences between ABM and placebo were found for self-reported symptoms. ABM induced a change of AB towards relatively more positive stimuli for participants that also showed greater symptom reduction.

Conclusion: The current study demonstrates that ABM produces early changes in blinded clinician-rated depressive symptoms and that changes in AB is linked to changes in symptoms. ABM may have practical potential in the treatment of residual depression.

Trial registration: ClinicalTrials.gov ID: NCT02658682 (retrospectively registered in January 2016).

Keywords: Attentional bias modification; Clinical trial; Depression.

Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was obtained before enrollment. The study was approved by The Regional Ethical Committee for Medical and Health Research for Southern Norway (2014/217/REK Sør-Øst D). The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Consent for publication

Not applicable.

Competing interests

CJH has received consultancy fees form Johnson and Johnson Inc., P1 vital and Lundbeck. MB is employed part time by P1 vital Ltd. and owns shares in P1 vital products Ltd. He has received travel expenses from Lundbeck for attending conferences. NIL has received consultancy fees and travel expenses from Lundbeck. All other authors state no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The mean symptom change at baseline and after two weeks of ABM training for HRSD. Whiskers represent the 95% CI
Fig. 2
Fig. 2
The mean symptom change at baseline and after two weeks of ABM training for BDI-II. Whiskers represent the 95% CI
Fig. 3
Fig. 3
Relationship between changes in HRSD (baseline minus two weeks follow-up) and changes in AB (two weeks follow-up minus baseline). Positive values = changes towards more positive biases (AB change) and symptom improvement (HRSD change)

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