A neuromarker of clinical outcome in attention bias modification therapy for social anxiety disorder

Abstract

Background Attention bias modification (ABM) therapy aims to modify threat‐related attention patterns via computerized tasks. Despite showing medium clinical effect sizes for anxiety disorders, underlying neural‐cognitive mechanisms of change remain unclear. We used visual mismatch negativity (vMMN), an event‐related potential sensitive to violations of learned statistical contingencies, to assess therapy‐related contingency extraction processes in healthy participants and in patients with social anxiety disorder (SAD). We then assessed whether vMMN amplitude predicts ABM treatment outcome. Methods A modified version of the dot‐probe task was used to elicit vMMN, in which 80% of trials were standard and 20% were deviant. In study 1, 30 healthy adults were randomly assigned to one of two ABM conditions: one in which threat‐congruent targets were deviant trials and threat‐incongruent targets were standard trials, and another in which the contingency was reversed. Electroencephalography (EEG) was continuously measured and vMMN analyzed. In study 2, 38 patients with SAD underwent six sessions of ABM therapy. We tested whether rule extraction in the ABM task, indicated by vMMN amplitude, predicts treatment outcome. Results vMMN clearly emerged over prespecified scalp locations indicating contingency extraction during ABM (study 1). vMMN amplitude predicted clinical improvement after ABM therapy, uniquely accounting for 7% and 14.4% of the variance in clinician‐rated and self‐reported posttreatment SAD symptoms, respectively. Conclusions vMMN emerges as a neural marker for contingency learning in ABM, suggesting a significant role for contingency extraction processes in the clinical efficacy of this therapy.

A systematic review of event‐related potentials as outcome measures of attention bias modification

“…Thus, future research should continue to assess the role of these factors in moderating ABM efficacy as well as other potential moderators such as age (Abend et al., 2019). Beyond utilizing ERPs as outcome measures of ABM, a small number of studies have assessed the ability of ERPs measured prior to ABM training (i.e., at baseline) to predict ABM outcome at an individual level (Arad et al., 2019; Dennis‐Tiwary et al., 2016). Given that not everyone appears to benefit from ABM equally, additional research using ERPs to identifying who is the most likely to benefit from ABM training is warranted.…”

Event‐related alpha power in early stage of facial expression processing in social anxiety: Influence of language context

“…The data of all subjects in this study were obtained from the previous study (Song, Zhao, Gao, et al, 2022). Based on the score in the Chinese version of the Liebowitz Social Anxiety Scale (LSAS) (He & Zhang, 2004) and the Beck Depression Inventory‐II (BDI‐II) (Beck & Clark, 1997; Wang et al, 2011), participants were divided into two groups, social anxiety group (SA, LSAS >50 points, Arad et al, 2019) and healthy control group (HC, LSAS <38 points, He & Zhang, 2004; Xiao et al, 2007). None of the participants had severe depressive symptoms (all participants scored BDI‐II ≤8 points).…”

Does attention bias modification reduce anxiety in socially anxious college students? An experimental study of potential moderators and considerations for implementation

“…Threatening facial expressions are considered an ancient signal for submissiveness in evolutionary history [64], and are therefore fearful, especially to individuals with social anxiety. Angry faces are often used in studies of SAD [for such studies using the TAU/NIMH protocol see 23,25,65]. During the task, pairs of stimuli, angry-neutral faces or neutral-neutral faces of the same actor are presented vertically in the centre of the screen.…”