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

Abstract

Background: Randomized control trials (RCTs) comparing attention control training (ACT) and attention bias modification (ABM) in posttraumatic stress disorder (PTSD) have shown mixed results. The current RCT extends the extant literature by comparing the efficacy of ACT and a novel bias-contingent-ABM (BC-ABM), in which direction of training is contingent upon the direction of pre-treatment attention bias (AB), in a sample of civilian patients with PTSD.

Methods: Fifty treatment-seeking civilian patients with PTSD were randomly assigned to either ACT or BC-ABM. Clinician and self-report measures of PTSD and depression, as well as AB and attention bias variability (ABV), were acquired pre- and post-treatment.

Results: ACT yielded greater reductions in PTSD and depressive symptoms on both clinician-rated and self-reported measures compared with BC-ABM. The BC-ABM condition successfully shifted ABs in the intended training direction. In the ACT group, there was no significant change in ABV or AB from pre- to post-treatment.

Conclusions: The current RCT extends previous results in being the first to apply ABM that is contingent upon AB at pre-treatment. This personalized BC-ABM approach is associated with significant reductions in symptoms. However, ACT produces even greater reductions, thereby emerging as a promising treatment for PTSD.

Keywords: Attention bias modification (ABM); attention bias; attention control training (ACT); posttraumatic stress disorder (PTSD); randomized control trial (RCT).

Conflict of interest statement

Conflict of interest. None.

Figures

Fig. 1

Consort Diagram.

Fig. 2

Mean (a) CAPS scores, (b) PCL scores, (c) HRSD scores, and (d) BDI-II scores by group (BC-ABM, ACT) and Time (pretreatment, posttreatment). Note. CAPS, Clinician-Administered PTSD Scale; PCL, PTSD Checklist; HRSD, Hamilton Rating Scale for Depression; BDI-II, Beck Depression Inventory – II; BC-ABM, Bias contingent attention bias modification; ACT, Attention control training. Error bars denote standard error.

Fig. 3

Mean Bias scores by group (Bias-toward, Bias-away) and Time (pretreatment, posttreatment) for the bias contingent attention bias modification (BC-ABM) group.