Personalized attention control therapy for PTSD: effectiveness and moderators of outcome in a randomized controlled trial

Abstract

Background Previous randomized controlled trials (RCTs) suggest that attention control therapy (ACT), targeting aberrant fluctuations of attention toward and away from threats in patients with PTSD, may be effective in reducing symptoms. The current RCT examined whether the use of personalized-trauma stimuli enhances ACT efficacy in patients with PTSD. Additional moderators of treatment outcome were tested on an exploratory basis. Methods Sixty patients with PTSD were randomly assigned to either personalized ACT, non-personalized ACT, or a control condition. Changes in symptoms were examined across pre-treatment, post-treatment, and a 3-month follow-up. Attentional interference was examined pre- and post-treatment. Baseline clinical and cognitive indices as well as the time elapsed since the trauma were tested as potential moderators of treatment outcome. Results A significant reduction in clinical symptoms was noted for all three conditions with no between-group differences. Attention bias variability decreased following ACT treatment. Personalized ACT was more effective relative to the control condition when less time had elapsed since the trauma. Baseline clinical and cognitive indices did not moderate treatment outcome. Conclusions In this RCT of patients with PTSD, ACT was no more effective in reducing PTSD symptoms than a control condition. The data also suggest a potential benefit of personalized ACT for patients who experienced their trauma more recently.

A randomized controlled trial of supervised remotely-delivered attention bias modification for posttraumatic stress disorder

“…It is conceivable that previous in-clinic studies of ABM/ACT were conducted among samples with lower rates of depression compared to the current sample (Badura-Brack et al, 2015 ). The current findings are also compatible with a recent RCT showing the moderating effect of the time elapsed since trauma in patients with PTSD (Segal et al, 2020 ). Future studies could test these specific moderators using a-priori and pre-registered analyses.…”

“…Contrary to our expectations (Badura-Brack et al, 2015;Lazarov et al, 2019a), even though symptoms lessened with a medium-to-large effect size, reductions did not differ between groups. Instead, results align with studies showing no group differences (Schoorl et al, 2013;Segal et al, 2020). The current RCT was similar to previous RCTs in design (e.g.…”

“…are also compatible with a recent RCT showing the moderating effect of the time elapsed since trauma in patients with PTSD (Segal et al, 2020). Future studies could test these specific moderators using a-priori and pre-registered analyses.…”

“…Finally, time elapsed since trauma may moderate outcomes (Segal, Pine, & Bar-Haim, 2020 ). Recently acquired maladaptive threat-related attentional patterns may be less entrenched than chronic patterns.…”

Attention allocation to negatively-valenced stimuli in PTSD is associated with reward-related neural pathways

“…Extant attention training procedures in PTSD have all exclusively targeted aberrant attention patterns using contrasting threat and neutral stimuli (e.g. threat v. neutral words, anger v. neutral faces, or trauma-related v. neutral pictures; Alon, Azriel, Pine, & Bar-Haim, 2022 ; Badura-Brack et al, 2015 ; Kuckertz et al, 2014 ; Lazarov et al, 2019a , 2019b ; Niles et al, 2020 ; Schoorl, Putman, & van Der Does, 2013 ; Segal, Pine, & Bar-Haim, 2020 ), with no study to date exploring the clinical efficacy of training procedures contrasting positive/rewarding stimuli (e.g. positive words, happy faces, or positive pictures) with either threat or neutral ones.…”