Person:

McNally, Richard

Social Phobics exhibit an attentional bias for threat in probe detection and probe discrimination paradigms. Attention training programs, whereby probes always replace nonthreat cues, reduce attentional bias for threat and self-reported anxiety. However, it remains unclear whether the therapeutic benefits of attention training result from people learning to disengage attention from threat cues or acquiring greater control over their attention by learning to deploy it flexibly. Moreover, researchers have seldom taken behavioral measures, and have never taken physiological measures of fear reduction. Investigating these questions, we found that training to disengage attention from threat is more effective than training to deploy it flexibly in social phobia. Indeed, the former condition reduced self-report, behavioral and physiological measures of anxiety.

Research on attention bias modification (ABM) for social anxiety disorder (SAD) is inconclusive, with some studies finding clear positive effects and other studies finding no significant benefit relative to control training procedures. In this meta-analysis, we assessed the efficacy of ABM for SAD on symptoms, reactivity to speech challenge, attentional bias (AB) toward threat, and secondary symptoms at posttraining as well as SAD symptoms at 4-month follow-up. A systematic search in bibliographical databases uncovered 15 randomized studies involving 1043 individuals that compared ABM to a control training procedure. Data were extracted independently by two raters. The Q statistic was used to assess homogeneity across trials. All analyses were conducted on intent-to-treat data. ABM produced a small but significant reduction in SAD symptoms (g = 0.27), reactivity to speech challenge (g = 0.46), and AB (g = 0.30). These effects were moderated by characteristics of the ABM procedure, the design of the study, and trait anxiety at baseline. However, effects on secondary symptoms (g = 0.09) and SAD symptoms at 4-month follow-up (g = 0.09) were not significant. Although there was no indication of significant publication bias, the quality of the studies was substandard and wedged the effect sizes. From a clinical point of view, these findings imply that ABM is not yet ready for wide-scale dissemination as a treatment for SAD in routine care. Theoretical implications for the integration of AB in the conceptualization of SAD are discussed.

Testing feasibility and efficacy of psychological treatment via mobile devices is important, given its potential benefits for high-dosage treatment delivery, widespread and inexpensive dissemination, and efficient research methods. We conducted the first randomized controlled trial of attention bias modification training delivered via smartphones, comparing this training to control training in a double-blind design, also including a waitlist condition. All participants performed a variant of dot-probe training involving faces with neutral and disgust (representative of social threat) expressions in brief sessions three times daily over 4 weeks on their own smartphones, at home or anywhere they chose. Attention bias modification, also known as cognitive bias modification of attention, training included a contingency to induce attentional deployment away from disgust faces, whereas the control training included no contingency. Participants completed weekly Internet-based self-report symptom assessments as well as smartphone-delivered dot-probe attention bias assessments, whose reliability findings supported the viability of using smartphones for reaction-time based assessments. The between-groups training effect on attention bias scores was small, showing statistical significance in some analyses and not in others. On measures ofsocial anxiety, intention-to-treat analyses (n = 326) revealed significant pre–post treatment declines with medium to large effect sizes in both training groups, whereas small declines in a waitlist group were nonsignificant. Both training groups showed greater reductions in social anxiety than did waitlist; however, the benefits under these two training conditions were statistically indistinguishable. Improvements in the two training conditions beyond those of waitlist could be attributable to any factors common to them, but not to the contingency training specific to active attention bias modification training.