Salutary effects of an attention bias modification mobile application on biobehavioral measures of stress and anxiety during pregnancy

Abstract

Stress and anxiety during pregnancy are associated with a range of adverse health outcomes, thus there is an unmet need for low-barrier treatments that target stress and anxiety. One such treatment approach, attention bias modification training (ABMT), reduces the anxiety-related attentional threat bias, which is also associated with disrupted neural processing of threat. It remains unclear, however, whether reducing treatment barriers via mobile delivery of ABMT is effective and whether ABMT efficacy varies depending on individual differences in neural processing of threat. The present study tested whether mobile, gamified ABMT reduced prenatal threat bias, anxiety and stress, and whether ABMT efficacy varied with individual differences in neural responses to threat. Participants were 29 women in their 19th – 29th week of pregnancy, randomized to four weeks of ABMT versus placebo training (PT) versions of the mobile app using a double-blind design. Self-report of anxiety, depression, and stress were obtained, and salivary cortisol was collected at home and in lab in response to stressors to index biological stress reactivity. Threat bias was measured using a computerized attention assay during which EEG was recorded to generate event-related potentials (ERPs) to threat cues. Results showed lower levels of threat bias (1-tailed) and lab cortisol following ABMT versus PT. Although the main effect of ABMT on subjective anxiety was not significant, the magnitude of cortisol reduction was correlated with lower levels of subjective anxiety and threat bias. Those receiving ABMT also reported less anxiety when showing smaller ERPs to threat (P1, P2) prior to training, but, conversely reported more anxiety when showing larger ERPs to threat. Use of gamified, mobile ABMT reduced biobehavioral indices of prenatal stress and anxiety, but effects on anxiety varied with individual differences in cortisol response and neurocognitive indices of early attention to threat.

The Effects of Casual Videogames on Anxiety, Depression, Stress, and Low Mood: A Systematic Review

“…Specifically, the purpose of the CVGs can be broken down into two primary categories: games designed around psychological processes to develop skills such as ABMT (e.g., ''Personal Zen'' and ''IMPACT'') or biofeedback CVGs 24 and CVGs designed primarily for enjoyment purposes (e.g., ''Plants vs. Zombies'' and ''Bejeweled 2''). Of the reviewed studies, six studies used an ABMT or biofeedback, [22][23][24][29][30][31] while seven used CVGs designed for enjoyment purposes. 16,19,[25][26][27][28]32 The games identified represent a variety of play styles, core mechanics, and challenges.…”

“…Most studies used a randomized-controlled research design 16,19,[22][23][24] to investigate the effects of CVGs on anxiety, depression, stress, or mood symptoms. Fish et al 25 employed a quasi-experimental design with participants who had been diagnosed with clinical depression.…”

“…These results were reported across participants who reported some and no mental ill-health symptoms. 19,22,25 In the studies by Dennis and O'Toole 30 and Dennis-Tiwary et al, 23 the ABMT game was reported to demonstrate significant improvements in state and trait anxiety. In contrast, Pieters et al 29 examined the effects of a novel ABMT game to reduce negative bias and reported no significant group differences after playing.…”

“…Included studies used a variety of outcome measures, with some commonalities across studies. For instance, five studies used the STAI 19,22,23,25,30,31 to record state and trait anxiety before and after the intervention. The PHQ-9 26,28 was used to measure depressive symptoms in two studies.…”

Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review

“…We excluded a total of two reviews [19,35], five case reports [36][37][38][39][40] and two protocols [41,42]. Sixteen studies were excluded from the present systematic review because they did not use mobile applications to train cognitive functions [20,43,[52][53][54][55][56][44][45][46][47][48][49][50][51]. Eleven studies were excluded because they used mobile applications only to assess -and not to train -cognitive functions [57,58,67,[59][60][61][62][63][64][65][66].…”