Posted on 20th Dec 2012 @ 9:08 PM
To date, seven, randomized, double blind, controlled studies have
examined the effect of computerized Attentional Modification Programs
(AMP) in the treatment of anxiety (Amir, Beard, Burns, &Bomyea, 2009a;
Amir, Beard, Taylor, Klumpp, Burns, et al., 2009b;Schmidt, Richey,
Buckner, &Timpano, 2009, Heeren, Reese, McNally, & Phillippot, 2012;
Carlbring et al. 2012, Boettcher, Berger, and Renneberg, 2011,
Neubauer, von Auer, Murray, Petermann, , Helbig-Lang, Gerlach, in
press) in clinical populations. In these studies, the authors used
variations of the AMP to induce selective processing of neutral cues
when these cues compete for attentional resources with threat-relevant
cues. Although the results of the studies in the laboratory suggest an
improvement of symptoms, the three studies examining the efficacy of
internet delivered AMP (Carlbring et al., 2012, Boettcher et al ,
2011, and Neubauer et al, in press) via the did not find a group
difference between the AMP and the control condition. However, these
later studies also failed to show that the program modified attention
bias in the participants. Finally, recent meta-analyses provide
further support for the clinical utility of AMP. Hakamata and
colleagues reviewed studies that compared AMP to a control condition
and found a medium effect size for AMP on anxiety overall (d = 0.61;
CI = 0.42–0.81) with a larger effect specifically in clinical patients
(d = 0.78; CI = 0.38–1.20). Many of the studies used a double-blind,
placebo-controlled design, allowing researchers to rule out the
possibility of group differences that are due to demand effects,
expectancy, or credibility of the intervention. Finally, as Hakamata
et al. (2010) suggested, existing effect size estimates may
potentially be enhanced given the lack of rationale provided to
participants, lack of therapist contact and brevity of these initial
protocols. Bear, Sawyer, and Hofmann (2012) identified 37 studies (41
experiments) totaling 2,135 participants who were randomized to
training toward neutral, positive, threat, or appetitive stimuli or to
a control condition. Large effect size estimates were obtained for
neutral versus threat comparisons (g =1 .06), neutral versus
appetitive (g = 1.41), and neutral versus control comparisons (g
=0.80). These authors also conducted fail-safe N calculation
suggesting that the effect size estimates were robust for the training
effects on attentional biases, but not for the effect on subjective
experiences. Bear et al. concluded that AMP has a moderate and robust
effect on attention bias when using threat stimuli.
Beard, Sawyer, A. T., & Hofmann, S. (2012). Efficacy of attention bias
modification using threat and appetitive stimuli: A meta-analytic
review. Behavior Therapy, 10.1016/j.beth.2012.01.002.
Boettcher, J., Berger, T. & Renneberg, B. (2011). Internet-based
attention training for social anxiety, a randomized controlled trial.
Cognitive Therapy and Research, DOI 10.1007/s10608-011-9374-y _
Springer Science+Business Media, LLC 2011
Carlbring, P., Apelstrand, M., Sehlin, H. Amir, N., Rousseau, A.,
Hofmann, S. G. &Andersson, G. (2012). Internet-delived attentional
bias modification training in individuals with social phobia – a
double blind randomized controlled trial.
Hakamata Y., Lissek S., Bar-Haim Y., et al. (2010). Attention bias
modification treatment: a meta-analysis toward the establishment of
novel treatment for anxiety. Biological Psychiatry, 68, 982–990.
Neubauer, K, von Auer, M, Murray, E., Petermann, F., Helbig-Lang, S.
Gerlach, A (in press) Internet- delivered attention modification
training as a treatment for social phobia: A randomized controlled
trial Behaviour Research and Therapy.