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Attentional Bias Modification for Social Anxiety Disorder: What do Patients Think and Why does it Matter?

  • Jennie M. Kuckertz (a1), Casey A. Schofield (a2), Elise M. Clerkin (a3), Jennifer Primack (a4), Hannah Boettcher (a5), Risa B. Weisberg (a6), Nader Amir (a1) and Courtney Beard (a7)...
Abstract

Background: In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has examined how anxious patients perceive ABM, and it is unclear to what extent perceptions of ABM influence outcome. Aims: To examine patient perceptions of ABM across two studies, using a mixed methods approach. Method: In the first study, participants completed a traditional ABM program and received a hand-out with minimal information about the purpose of the task. In the second study, participants completed an adaptive ABM program and were provided with more extensive rationale and instructions for changing attentional biases. Results: A number of themes emerged from qualitative data related to perceived symptom changes and mechanisms of action, acceptability, early perceptions of the program, barriers/facilitators to engagement, and responses to adaptive features. Moreover, quantitative data suggested that patients’ perceptions of the program predicted symptom reduction as well as change in attentional bias. Conclusions: Our quantitative data suggest that it may be possible to quickly and inexpensively identify some patients who may benefit from current ABM programs, although our qualitative data suggest that ABM needs major modifications before it will be an acceptable and credible treatment more broadly. Although the current study was limited by sample size and design features of the parent trials from which these data originated, our findings may be useful for guiding hypotheses in future studies examining patient perceptions towards ABM.

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Corresponding author
Correspondence to Jennie Kuckertz, 6386 Alvarado Ct, Suite 301, San Diego, CA 92120, USA. E-mail: jkuckertz@sdsu.edu
References
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Amir, N., Beard, C., Burns, M. and Bomyea, J. (2009a). Attention modification program in individuals with generalized anxiety disorder. Journal of Abnormal Psychology, 118, 2833. https://doi.org/10.1037/a0012589
Amir, N., Beard, C., Taylor, C. T., Klumpp, H., Elias, J., Burns, M. and Chen, X. (2009b). Attention training in individuals with generalized social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 961–73. https://doi.org/10.1037/a0016685
Amir, N., Kuckertz, J. M. and Strege, M. V. (2016). A pilot study of an adaptive, idiographic, and multi-component attention bias modification program for social anxiety disorder. Cognitive Therapy and Research, 40, 661671. https://doi.org/10.1007/s10608-016-9781-1
Bantin, T., Stevens, S., Gerlach, A. L. and Hermann, C. (2016). What does the facial dot-probe task tell us about attentional processes in social anxiety? A systematic review. Journal of Behavior Therapy and Experimental Psychiatry, 50, 4051. https://doi.org/10.1016/j.jbtep.2015.04.009
Bar-Haim, Y. (2010). Research review: Attention bias modification (ABM): a novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 51, 859870. https://doi.org/10.1111/j.1469-7610.2010.02251.x
Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J. and van IJzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological Bulletin, 133, 124. https://doi.org/10.1037/0033-2909.133.1.1
Beard, C. and Amir, N. (2008). A multi-session interpretation modification program: changes in interpretation and social anxiety symptoms. Behaviour Research and Therapy, 46, 11351141. https://doi.org/10.1016/j.brat.2008.05.012
Beard, C., Sawyer, A. T. and Hofmann, S. G. (2012a). Efficacy of attention bias modification using threat and appetitive stimuli: a meta-analytic review. Behavior Therapy, 43, 724740. https://doi.org/10.1016/j.beth.2012.01.002
Beard, C., Weisberg, R. B. and Amir, N. (2011). Combined cognitive bias modification treatment for social anxiety disorder: a pilot trial. Depression and Anxiety, 28, 981988. https://doi.org/10.1002/da.20873
Beard, C., Weisberg, R. B. and Primack, J. (2012b). Socially anxious primary care patients’ attitudes toward cognitive bias modification (CBM): a qualitative study. Behavioral and Cognitive Psychotherapy, 40, 618633. https://doi.org/doi:10.1017/S1352465811000671
Beats, B. C., Sahakian, B. J. and Levy, R. (1996). Cognitive performance in tests sensitive to frontal lobe dysfunction in the elderly depressed. Psychological Medicine, 26, 591603. https://doi.org/10.1017/S0033291700035662
Boettcher, J., Berger, T. and Renneberg, B. (2012). Internet-based attention training for social anxiety: a randomized controlled trial. Cognitive Therapy and Research, 36, 522536. https://doi.org/10.1007/s10608-011-9374-y
Borkovec, T. D. and Costello, E. (1993). Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 61, 611619. https://doi.org/10.1037/0022-006X.61.4.611
Carlbring, P., Apelstrand, M., Sehlin, H., Amir, N., Rousseau, A., Hofmann, S. G. and Andersson, G. (2012). Internet-delivered attention bias modification training in individuals with social anxiety disorder – a double blind randomized controlled trial. BMC Psychiatry, 12, 66. https://doi.org/10.1186/1471-244X-12-66
Clarke, P. J. F., Notebaert, L. and MacLeod, C. (2014). Absence of evidence or evidence of absence: reflecting on therapeutic implementations of attentional bias modification. BMC Psychiatry, 14, 8. https://doi.org/10.1186/1471-244X-14-8
Craske, M. G., Treanor, M., Conway, C., Zbozinek, T. and Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006
Dennis-Tiwary, T. A., Egan, L. J., Babkirk, S. and Denefrio, S. (2016). For whom the bell tolls: neurocognitive individual differences in the acute stress-reduction effects of an attention bias modification game for anxiety. Behaviour Research and Therapy, 77, 105117. https://doi.org/10.1016/j.brat.2015.12.008
Devilly, G. J. and Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 7386. https://doi.org/10.1016/S0005-7916(00)00012-4
Emmelkamp, P. M. (2012). Attention bias modification: the Emperor's new suit? BMC Medicine, 10. https://doi.org/10.1186/1741-7015-10-63
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. (2002). Structured clinical interview for DSMIV-TR Axis I disorders, research version, patient edition (SCID-I/P). New York, NY.
Foa, E. B. and McLean, C. P. (2016). The efficacy of exposure therapy for anxiety-related disorders and its underlying mechanisms: the case of OCD and PTSD. Annual Review of Clinical Psychology, 12, 128. https://doi.org/10.1146/annurev-clinpsy-021815-093533
Fresco, D. M., Coles, M. E., Heimberg, R. G., Liebowitz, M. R., Hami, S., Stein, M. B. and Goetz, D. (2001). The Liebowitz Social Anxiety Scale: a comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine, 31, 10251035. https://doi.org/10.1017/S0033291701004056
Greenberg, R. P., Constantino, M. J. and Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical Psychology Review, 26, 657678. https://doi.org/10.1016/j.cpr.2005.03.002
Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E. et al. (2010). Attention bias modification treatment: a meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982990. https://doi.org/10.1016/j.biopsych.2010.07.021
Heeren, A., Mogoașe, C., Philippot, P. and McNally, R. J. (2015). Attention bias modification for social anxiety: a systematic review and meta-analysis. Clinical Psychology Review, 40, 7690. https://doi.org/10.1016/j.cpr.2015.06.001
Hertel, P. T. and Mathews, A. (2011). Cognitive bias modification: past perspectives, current findings, and future applications. Perspectives on Psychological Science: A Journal of the Association for Psychological Science, 6, 521536. https://doi.org/10.1177/1745691611421205
Hsieh, H.-F. and Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 12771288. https://doi.org/10.1177/1049732305276687
Krebs, G., Hirsch, C. R. and Mathews, A. (2010). The effect of attention modification with explicit vs. minimal instructions on worry. Behaviour Research and Therapy, 48, 251256. https://doi.org/10.1016/j.brat.2009.10.009
Kuckertz, J. M., Gildebrant, E., Liliequist, B., Karlström, P., Väppling, C., Bodlund, O. et al. (2014). Moderation and mediation of the effect of attention training in social anxiety disorder. Behaviour Research and Therapy, 53, 3040. https://doi.org/10.1016/j.brat.2013.12.003
Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141173. http://www.ncbi.nlm.nih.gov/pubmed/2885745
MacLeod, C. and Clarke, P. J. F. (2015). The attentional bias modification approach to anxiety intervention. Clinical Psychological Science, 3, 5878. https://doi.org/10.1177/2167702614560749
Nishiguchi, Y., Takano, K. and Tanno, Y. (2015). Explicitly guided attentional bias modification promotes attentional disengagement from negative stimuli. Emotion, 15, 731741. https://doi.org/10.1037/a0039117
Notebaert, L., Clarke, P. J. F., Grafton, B. and MacLeod, C. (2015). Validation of a novel attentional bias modification task: the future may be in the cards. Behaviour Research and Therapy, 65, 93100. https://doi.org/10.1016/j.brat.2014.12.007
Posner, M. I. (1980). Orienting of attention. Quarterly Journal of Experimental Psychology, 32, 325. doi: 10.1080/00335558008248231
Price, R. B., Kuckertz, J. M., Siegle, G. J., Ladouceur, C. D., Silk, J. S., Ryan, N. D. et al. (2015). Empirical recommendations for improving the stability of the dot-probe task in clinical research. Psychological Assessment, 27, 365376. https://doi.org/10.1037/pas0000036
Price, R. B., Wallace, M., Kuckertz, J. M., Amir, N., Graur, S., Cummings, L. et al. (2016). Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias. Clinical Psychology Review, 50, 3749. https://doi.org/10.1016/j.cpr.2016.09.009
Schmidt, N. B., Richey, J. A., Buckner, J. D. and Timpano, K. R. (2009). Attention training for generalized social anxiety disorder. Journal of Abnormal Psychology, 118, 514. https://doi.org/10.1037/a0013643
Schmukle, S. C. (2005). Unreliability of the dot probe task. European Journal of Personality, 19, 595605. https://doi.org/10.1002/per.554
Sportel, B. E., de Hullu, E., de Jong, P. J. and Nauta, M. H. (2013). Cognitive bias modification versus CBT in reducing adolescent social anxiety: a randomized controlled trial. PLoS ONE, 8. https://doi.org/10.1371/journal.pone.0064355
Strauss, A. and Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: SAGE Publications, Inc.
Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Palo Alto, CA: Stanford University Press.
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Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
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