Efficacy of Attention Bias Modification Training for Depressed Adults: A Randomized Clinical Trial

Abstract

Background: This study examined the efficacy Attention Bias Modification Training (ABMT) for the treatment of depression. Methods: In this randomized clinical trial, 145 adults (77% female, 62% white) with at least moderate depression severity (i.e., self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) ≥ 13) and a negative attention bias were randomized to active ABMT, sham ABMT, or assessments only. Training consisted of two in-clinic and three (brief) at-home ABMT sessions per week for four weeks (2,224 training trials total). The pre-registered primary outcome was change in QIDS-SR. Secondary outcomes were the 17-item Hamilton Depression Rating Scale (HRSD) and anhedonic depression and anxious arousal from the Mood and Anxiety Symptom Questionnaire (MASQ). Primary and secondary outcomes were administered at baseline and four weekly assessments during ABMT. Results: Intent-to-treat analyses indicated that, relative to assessment only, active ABMT significantly reduced QIDS-SR and HRSD scores by an additional 0.62 ± 0.23 (p = .008, d = -0.57) and 0.74 ± 0.31 (p = .021, d = -0.49) points per week. Similar results were observed for active vs sham ABMT: a greater symptom reduction of 0.44 ± 0.24 QIDS-SR (p = .067, d = -0.41) and 0.69 ± 0.32 HRSD (p = .033, d = -0.42) points per week. Sham ABMT did not significantly differ from the assessment-only condition. No significant differences were observed for the MASQ scales.Conclusion: Depressed individuals with at least modest negative attentional bias benefitted from active ABMT.

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

“…As previously reported (Hsu et al, 2021), intent-to-treat analyses of the time x group interaction indicated that active ABMT reduced depression symptom severity on the primary outcome, the QIDS-SR, to a greater extent than the other conditions. Compared to assessment only, depression was reduced by an additional 0.62 ± 0.23 (p = .008, d = -0.57) points per week.…”

“…These group differences were maintained at a 3 month follow-up (Yang et al, 2015). A larger study (N = 145) compared the efficacy of active versus sham ABMT to an assessment only comparison condition among adults with depression and at least a moderate negative attentional bias (Hsu et al, 2021). In that study, active ABMT reduced gaze bias for sad stimuli and improved self-reported and interviewer-rated depression symptoms to a greater extent than assessment only (ds = -.57, -.49) and sham .…”

“…Given these treatment efficacy findings, the current study examines putative mediators of active ABMT in the previously reported clinical trial (Hsu et al, 2021). Here, we focus on the ABMT treatment target-attentional bias for sad information measured with eye gaze-as a putative mediator.…”

“…Detailed descriptions of the randomized clinical trial have been published elsewhere (Hsu et al, 2018 andHsu et al, 2021). Briefly, participants in this single center, randomized, blinded clinical trial (NCT 02880215) were 145 adults 18 to 40 years old recruited from the Austin, TX, USA community through social media advertisements, flyering, and community postings among other approaches.…”

“…Given that the scales of raw QIDS-SR and attentional bias scores differ by an order of magnitude, some form of standardization is necessary. In the primary analyses of outcomes (Hsu et al, 2021), we calculated effect sizes based on the pooled standard deviation observed at the final time point of measurement. By using the same divisor to scale the measurements here, the units of the subsequent effects decomposition analysis can likewise be interpreted as a Cohen's d measure of treatment differences at the end of the study.…”