Reduces fluctuations in attention toward and away from threat.
A computerized attention-control training program significantly reduced combat veterans’ preoccupation with – or avoidance of — threat and attendant PTSD symptoms. By contrast, another type of computerized training, called attention bias modification – which has proven helpful in treating anxiety disorders – did not reduce PTSD symptoms. NIMH and Israeli researchers conducted parallel trials in which the two treatments were tested in US and Israeli combat veterans.
Daniel Pine, M.D., of the NIMH Emotion and Development Branch, Yair Bar-Haim, Ph.D., School of Psychological Sciences, Tel Aviv University, and colleagues, report on their findings July 24, 2015 in the American Journal of Psychiatry.
While attention bias modification trains attention either away from or toward threat, attention-control training implicitly teaches participants that threatening stimuli are irrelevant to performing their task. It requires them to attend equally to threatening and neutral stimuli. The study determined that this reduced symptoms by reducing attention bias variability. Attention control training balances such moment-to-moment fluctuations in attention bias from threat vigilance to threat avoidance, which correlated with the severity of PTSD symptoms and distinguished PTSD patients from healthy controls and patients with social anxiety or acute stress disorders.
Funding: The study was funded by NIH/National Institute of Mental Health, At Ease USA.
Source: Jules Asher – NIH
Image Credit: The image is in the public domain
Original Research: Abstract for “Effect of Attention Training on Attention Bias Variability and PTSD Symptoms: Randomized Controlled Trials in Israeli and U.S. Combat Veterans” by Badura-Brack AS, Naim R, Ryan TJ, Levy O, Abend R, Khanna MM, McDermott TJ, Pine WSD, Bar-Haim Y in American Journal of Psychiatry. Published online May 4 2015 doi:10.1176/appi.ajp.2015.14121578
Abstract for “Threat-Related Attention Bias Variability and Posttraumatic Stress” by Reut Naim, M.A., Rany Abend, M.A., Ilan Wald, Ph.D., Sharon Eldar, Ph.D., Ofir Levi, Ph.D., Eyal Fruchter, M.D., Karen Ginat, M.D., Pinchas Halpern, M.D., Maurice L. Sipos, Ph.D., Amy B. Adler, Ph.D., Paul D. Bliese, Ph.D., Phillip J. Quartana, Ph.D., Daniel S. Pine, M.D., Yair Bar-Haim, Ph.D. in American Journal of Psychiatry. Published online April 6 2015 doi:10.1176/appi.ajp.2015.14121579
Abstract
Effect of Attention Training on Attention Bias Variability and PTSD Symptoms: Randomized Controlled Trials in Israeli and U.S. Combat Veterans
Objective:
Attention allocation to threat is perturbed in patients with posttraumatic stress disorder (PTSD), with some studies indicating excess attention to threat and others indicating fluctuations between threat vigilance and threat avoidance. The authors tested the efficacy of two alternative computerized protocols, attention bias modification and attention control training, for rectifying threat attendance patterns and reducing PTSD symptoms.
Method:
Two randomized controlled trials compared the efficacy of attention bias modification and attention control training for PTSD: one in Israel Defense Forces veterans and one in U.S. military veterans. Both utilized variants of the dot-probe task, with attention bias modification designed to shift attention away from threat and attention control training balancing attention allocation between threat and neutral stimuli. PTSD symptoms, attention bias, and attention bias variability were measured before and after treatment.
Results:
Both studies indicated significant symptom improvement after treatment, favoring attention control training. Additionally, both studies found that attention control training, but not attention bias modification, significantly reduced attention bias variability. Finally, a combined analysis of the two samples suggested that reductions in attention bias variability partially mediated improvement in PTSD symptoms.
Conclusions:
Attention control training may address aberrant fluctuations in attention allocation in PTSD, thereby reducing PTSD symptoms. Further study of treatment efficacy and its underlying neurocognitive mechanisms is warranted.
“Effect of Attention Training on Attention Bias Variability and PTSD Symptoms: Randomized Controlled Trials in Israeli and U.S. Combat Veterans” by Badura-Brack AS, Naim R, Ryan TJ, Levy O, Abend R, Khanna MM, McDermott TJ, Pine WSD, Bar-Haim Y in American Journal of Psychiatry. Published online May 4 2015 doi:10.1176/appi.ajp.2015.14121578
Threat-Related Attention Bias Variability and Posttraumatic Stress
Abstract
Objective:
Threat monitoring facilitates survival by allowing one to efficiently and accurately detect potential threats. Traumatic events can disrupt healthy threat monitoring, inducing biased and unstable threat-related attention deployment. Recent research suggests that greater attention bias variability, that is, attention fluctuations alternating toward and away from threat, occurs in participants with PTSD relative to healthy comparison subjects who were either exposed or not exposed to traumatic events. The current study extends findings on attention bias variability in PTSD.
Method:
Previous measurement of attention bias variability was refined by employing a moving average technique. Analyses were conducted across seven independent data sets; in each, data on attention bias variability were collected by using variants of the dot-probe task. Trauma-related and anxiety symptoms were evaluated across samples by using structured psychiatric interviews and widely used self-report questionnaires, as specified for each sample.
Results:
Analyses revealed consistent evidence of greater attention bias variability in patients with PTSD following various types of traumatic events than in healthy participants, participants with social anxiety disorder, and participants with acute stress disorder. Moreover, threat-related, and not positive, attention bias variability was correlated with PTSD severity.
Conclusions:
These findings carry possibilities for using attention bias variability as a specific cognitive marker of PTSD and for tailoring protocols for attention bias modification for this disorder.
“Threat-Related Attention Bias Variability and Posttraumatic Stress” by Reut Naim, M.A., Rany Abend, M.A., Ilan Wald, Ph.D., Sharon Eldar, Ph.D., Ofir Levi, Ph.D., Eyal Fruchter, M.D., Karen Ginat, M.D., Pinchas Halpern, M.D., Maurice L. Sipos, Ph.D., Amy B. Adler, Ph.D., Paul D. Bliese, Ph.D., Phillip J. Quartana, Ph.D., Daniel S. Pine, M.D., Yair Bar-Haim, Ph.D. in American Journal of Psychiatry. Published online April 6 2015 doi:10.1176/appi.ajp.2015.14121579
