The effectiveness of an attention bias modification program as an adjunctive treatment for Post-Traumatic Stress Disorder

Kuckertz, Jennie M.; Amir, Nader; Boffa, Joseph W.; Warren, Ciara K; Rindt, Susan E M; Norman, Sonya B.; Ram, Vasudha; Ziajko, Lauretta; Webb-Murphy, Jennifer; McLay, Robert N.

doi:10.1016/j.brat.2014.09.002

Cited by 81 publications

(77 citation statements)

References 57 publications

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“…This is counter to previous clinical findings that ABMT may be most effective for individuals with a greater bias towards or away from threat at baseline (e.g., Kuckertz, Amir, et al, 2014; Kuckertz, Gildebrant, et al, 2014), which may be due in part to the present study’s inclusion of a moderately anxious, non-clinical sample. Results from the present study, however, do suggest that ERPs versus the behavioral attention bias measure may capture unique aspects of threat bias that are specifically relevant to training efficacy.…”

Section: Discussioncontrasting

confidence: 99%

“…The primary hypothesis, centering on individual differences, was that stress- and anxiety-reduction effects of ABMT will be amplified when prior to ABMT : ERP responses reflect reduced capture of attention allocation resources (P1), enhanced selection/discrimination (N170), and enhanced recruitment of cognitive control (N2). Comparison analyses examined whether pre-training individual differences in threat bias measured via the dot probe task predicted an enhanced positive impact of ABMT, as shown in previous studies (e.g.,Kuckertz, 2014). Given potential gender differences in the use of games and in the expression of biased attention, we explored whether males or females showed increased responsiveness to the ABMT app.…”

mentioning

confidence: 99%

“…In one study, participants with social anxiety who evidenced a pre-treatment bias towards threat showed the greatest symptom reduction (Kuckertz, Gildebrant, et al, 2014), although in another study, participants with post-traumatic stress disorder who evidence a pre-treatment bias away from threat showed the greatest symptom reduction (Kuckertz, Amir, et al, 2014). In addition to the diagnostic diversity between the two studies, it is difficult to interpret this inconsistency given that behavioral reaction time measures are far downstream of neurocognitive responses to threat and may actually reflect a number of performance-related factors (Banaschewski & Brandeis, 2007).…”

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confidence: 99%

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For whom the bell tolls: Neurocognitive individual differences in the acute stress-reduction effects of an attention bias modification game for anxiety

Dennis-Tiwary

Egan

Babkirk

et al. 2016

Behaviour Research and Therapy

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The efficacy of attention bias modification training (ABMT) for anxiety is debated, in part because individual differences in task engagement and pre-training threat bias impact training efficacy. In the present study, an engaging, gamified ABMT mobile application, or “app,” was utilized in 42 (21 females) trait-anxious adults. EEG was recorded during pre- and post-training threat bias assessment to generate scalp-recorded event-related potentials (ERPs) reflecting neurocognitive responses to threat. Following app play (ABMT versus placebo), subjective anxiety and stress responses (observed and self-reported) were measured. ABMT, versus placebo, resulted in improved behavioral performance during the stress task for females only. No difference was found between training groups in self-reported anxiety. ABMT resulted in improved performance during the stress task among those evidencing specific pre-training ERP responses: decreased P1 amplitudes, suggesting less attention allocation, but potentiated N170 amplitudes, suggesting enhanced attention selection and discrimination. Individual differences in behavioral threat bias did not moderate training effects. Results suggest that efficient initial allocation of attention to threat combined with enhanced recruitment of sensory gain mechanisms may underlie positive ABMT effects on anxiety-related stress. Targeting neurocognitive responses to threat to personalize ABMT and develop more effective methods of treatment delivery, such as gamification, are discussed.

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Section: Discussioncontrasting

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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For whom the bell tolls: Neurocognitive individual differences in the acute stress-reduction effects of an attention bias modification game for anxiety

Dennis-Tiwary

Egan

Babkirk

et al. 2016

Behaviour Research and Therapy

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“…One study administered attentional retraining in conjunction with evidence-based cognitive behavioral therapies to military personnel diagnosed with PTSD (Kuckertz, Amir, Boffa, Warren, Rindt, Norman, Ram, Ziajko, Webb-Murphy, & McLay, 2014). Compared to the control group, participants in the attentional retraining group had lower PTSD symptoms and depressive symptoms at follow-up.…”

Section: Treatment Approaches Targeting Cognitive Functionsmentioning

confidence: 99%

Cognitive Function as a Transdiagnostic Treatment Target in Stimulant Use Disorders

Sofuoglu

DeVito

Waters

et al. 2016

Journal of Dual Diagnosis

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Stimulant use disorder is an important public health problem, with an estimated 2.1 million current users in the United States alone. No pharmacological treatments are approved by the U.S. Food and Drug Administration (FDA) for stimulant use disorder and behavioral treatments have variable efficacy and limited availability. Most individuals with stimulant use disorder have other comorbidities, most with overlapping symptoms and cognitive impairments. The goal of this article is to present a rationale for cognition as a treatment target in stimulant use disorder, and to outline potential treatment approaches. Rates of lifetime comorbid psychiatric disorders among people with stimulant use disorders are estimated at 65% - 73%, with the most common being mood disorders (13% - 64%) and anxiety disorders (21% - 50%), as well as non-substance induced psychotic disorders (under 10%). There are several models of addictive behavior, but the dual process model particularly highlights the relevance of cognitive impairments and biases to the development and maintenance of addiction. This model explains addictive behavior as a balance between automatic processes and executive control, which in turn are related to individual (genetics, comorbid disorders, psychosocial factors) and other (craving, triggers, drug use) factors. Certain cognitive impairments, such as attentional bias and approach bias, are most relevant to automatic processes, while sustained attention, response inhibition, and working memory are primarily related to executive control. These cognitive impairments and biases are also common in disorders frequently comorbid with stimulant use disorder, and predict poor treatment retention and clinical outcomes. As such, they may serve as feasible trans-diagnostic treatment targets. There are promising pharmacological, cognitive, and behavioral approaches that aim to enhance cognitive function. Pharmacotherapies target cognitive impairments associated with executive control and include cholinesterase inhibitors (e.g., galantamine, rivastigmine) and monoamine transporter inhibitors (e.g., modafinil, methylphenidate). Cognitive behavioral therapy and cognitive rehabilitation also enhance executive control, while cognitive bias modification targets impairments associated with automatic processes. Cognitive enhancements to improve treatment outcomes is a novel and promising strategy, but its clinical value for the treatment of stimulant use disorder, with or without other psychiatric comorbidities, remains to be determined in future studies.

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“…Innovative treatments targeting attention-level processes have recently emerged as promising interventions for PTSD, including attention bias modification treatment (ABMT), which trains attention away from threat (i.e., avoidance; Kuckertz et al, 2014), and attention control treatment (ACT), which trains participants to ignore threat-related contingencies and focus on the task at hand (Badura-Brack et al, 2015). Both treatments employ computer programs designed to normalize threat-related attention patterns by requiring participants to complete a neutral cognitive task in the face of threat-provoking stimuli (Beard, Sawyer, & Hofmann, 2012; Hakamata et al, 2010; Hallion & Ruscio, 2011; Linetzky, Pergamin-Hight, Pine, & Bar-Haim, 2015).…”

mentioning

confidence: 99%

Attention training improves aberrant neural dynamics during working memory processing in veterans with PTSD

McDermott

Badura-Brack

Becker

et al. 2016

Cogn Affect Behav Neurosci

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Posttraumatic stress disorder (PTSD) is associated with executive functioning deficits, including disruptions in working memory (WM). Recent studies suggest that attention training reduces PTSD symptomatology, but the underlying neural mechanisms are unknown. We used high-density magnetoencephalography (MEG) to evaluate whether attention training modulates brain regions serving WM processing in PTSD. Fourteen veterans with PTSD completed a WM task during a 306-sensor MEG recording before and after 8 sessions of attention training treatment. A matched comparison sample of 12 combat-exposed veterans without PTSD completed the same WM task during a single MEG session. To identify the spatiotemporal dynamics, each group's data were transformed into the time-frequency domain, and significant oscillatory brain responses were imaged using a beamforming approach. All participants exhibited activity in left hemispheric language areas consistent with a verbal WM task. Additionally, veterans with PTSD and combat-exposed healthy controls each exhibited oscillatory responses in right hemispheric homologue regions (e.g., right Broca's area); however, these responses were in opposite directions. Group differences in oscillatory activity emerged in the theta band (4–8 Hz) during encoding and in the alpha band (9–12 Hz) during maintenance and were significant in right prefrontal and right supramarginal and inferior parietal regions. Importantly, following attention training, these significant group differences were reduced or eliminated. This study provides initial evidence that attention training improves aberrant neural activity in brain networks serving WM processing.

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The effectiveness of an attention bias modification program as an adjunctive treatment for Post-Traumatic Stress Disorder

Cited by 81 publications

References 57 publications

For whom the bell tolls: Neurocognitive individual differences in the acute stress-reduction effects of an attention bias modification game for anxiety

For whom the bell tolls: Neurocognitive individual differences in the acute stress-reduction effects of an attention bias modification game for anxiety

Cognitive Function as a Transdiagnostic Treatment Target in Stimulant Use Disorders

Attention training improves aberrant neural dynamics during working memory processing in veterans with PTSD

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