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Cited by 185Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPsychological Treatments and Assessments

QUANTITATIVE EVALUATION OF THE CLINICAL EFFICACY OF ATTENTION BIAS MODIFICATION TREATMENT FOR ANXIETY DISORDERS: Review: ABMT for Anxiety Disorders: A Meta-Analysis

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Linetzky, Marian, Pergamin-Hight, Lee, Pine, Daniel S., Bar-Haim, Yair·2015·Depression and Anxiety
DOI 10.1002/da.22344
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Abstract

BACKGROUND: Attention bias modification treatment (ABMT) is a novel treatment for anxiety disorders. Although a number of other meta-analytic reviews exist, the purpose of the present meta-analysis is to examine issues unaddressed in prior reviews. Specifically, the review estimates the efficacy of ABMT in clinically anxious patients and examines the effect of delivery context (clinic vs. home) on symptom reduction. METHODS: A literature search using PsychInfo and Web of Science databases was performed. Only randomized controlled trials (RCTs) examining dot-probe-based ABMT in clinically diagnosed anxious patients were included. From 714 articles located through the search, 36 ABMT studies were identified and 11 studies met inclusion criteria (N = 589 patients). RESULTS: ABMT was associated with greater clinician-rated reductions in anxiety symptoms relative to control training: between-groups effect (d = 0.42, P = .001, confidence interval (CI) = 0.18-0.66), contrast of within-group effects (Q = 7.25, P < .01). More patients in the treatment group no longer met formal diagnostic criteria for their anxiety disorder posttreatment relative to patients in the control condition (P < .05). Analyses of patients' self-reported anxiety were nonsignificant for the between-groups contrast (P = .35), and were at a trend level of significance for the contrast between the within-group effects (P = .06). Moderation analysis of the between-groups effect revealed a significant effect for ABMT delivered in the clinic (d = 0.34, P = 0.01, CI = 0.07-0.62), and a nonsignificant effect for ABMT delivered at home (d = -0.10, P = 0.40, CI = -0.33-0.13). CONCLUSIONS: The current meta-analysis provides support for ABMT as a novel evidenced-based treatment for anxiety disorders. Overall, ABMT effects are mainly evident when it is delivered in the clinic and when clinical outcome is evaluated by a clinician. More RCTs of ABMT in specific anxiety disorders are warranted.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 11 randomized controlled trials (N = 589 clinically diagnosed anxiety patients) finds that dot-probe attention bias modification treatment (ABMT) produces a significant, medium-sized clinician-rated reduction in anxiety symptoms relative to control training, but self-reported effects are nonsignificant overall and emerge only when ABMT is delivered in a clinic rather than at home. The authors conclude ABMT is a promising evidence-based treatment for anxiety disorders, with effects most evident in clinic-delivered, clinician-rated outcomes.

Key findings

  • Clinician-rated anxiety showed a significant between-groups effect favoring ABMT (d = 0.42, P = .001, CI = 0.18–0.66, k = 6, fail-safe N = 14); within-group reductions were larger for ABMT (d = 1.00, P < .001) than control (d = 0.42, P < .001), Q = 7.25, P < .01.
  • Significantly more ABMT patients no longer met DSM criteria for their anxiety disorder posttreatment versus controls (d = 0.40, P < .05, CI = 0.02–0.78, k = 8, fail-safe N = 14).
  • Self-reported anxiety was nonsignificant between groups (d = 0.08, P = .35, CI = −0.09–0.26, k = 10) and only trend-level for the within-group contrast (Q = 3.49, P = .06); follow-up showed a similar pattern (Q = 3.43, P = .06).
  • Delivery context moderated self-reported effects: clinic-delivered ABMT was significant (d = 0.34, P = .01, CI = 0.07–0.62, k = 6) while home/Internet-delivered ABMT was not (d = −0.10, P = .40, CI = −0.33–0.13, k = 4), with a significant difference between them (Q = 5.85, P < .05). Attention bias showed the same pattern (clinic d = 1.27, P < .01; home d = 0.07, P = .72; Q = 6.33, P < .05).

Methods

  • Literature search of PsychInfo and Web of Science (plus reference lists of prior ABM meta-analyses and publications by leading researchers); from 714 articles, 36 were identified as potentially eligible and 11 RCTs met inclusion criteria (N = 589).
  • Inclusion required formally diagnosed primary anxiety disorder per DSM criteria, dot-probe-based ABMT, randomized double-blind controlled design, and pre/post anxiety data permitting effect-size computation; studies combining ABMT with another intervention (e.g., CBT) were excluded.
  • Effect sizes were computed under a random-effects model using Comprehensive Meta-Analysis v2.002; Q-tests compared within-group effects and tested delivery context as a moderator; fail-safe numbers assessed the file-drawer problem.

Limitations

  • Stated: the small number of RCTs in clinical anxiety disorders; most RCTs are likely underpowered to detect the reported between-groups effect (d = 0.42), with power analysis indicating ≥142 participants (71 per group) needed; clinician-rated measures yielded stronger findings than self-reports, possibly reflecting the different distribution of delivery context across measure types; too few RCTs with follow-up to analyze long-lasting effects; and too few RCTs per specific disorder (e.g., GAD).
  • Stated: a formal meta-analytic moderation analysis of attention bias change as a mechanism was not viable because not all included studies reported pre/post attention bias scores.
  • Evident from the text: consideration of publication bias via the trim-and-fill method was not possible due to the small number of samples, so only fail-safe numbers were computed.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/da.22344

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 17 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The between-groups effect for self-reported anxiety at follow-up was nonsignificant, d = 0.23, P = .18, CI = -0.10-0.57.

    “as was the combined between-groups effect at follow-up (d = 0.23, P = .18,CI = -0.10-0.57).”
    Quote in the paperSubstantial claim
  • Findingown data

    ABMT produced significantly lower posttreatment attention bias scores than control training, between-groups d = 0.61, P < .05, CI = 0.09-1.12, k = 8.

    “The overall combined effect size for between-groups contrasts posttreatment reflects significantly lower attention bias score in the ABMT relative to the control condition, d = 0.61, P < .05,CI = 0.09-1.12,k = 8, suggesting that ABMT produces greater reductions in threat-related attention bias than control training.”
    Quote in the paperSubstantial claim
  • Findingown data

    The between-groups contrast for self-reported anxiety was nonsignificant, d = 0.08, P = .35, CI = -0.09-0.26, k = 10.

    “Analyses of patients' self-reported anxiety were nonsignificant for the between-groups contrast (P = .35)”
    • Also stated in: § Self-Reports. · plain
      “The overall combined between-groups effect at posttreatment was nonsignificant (d = 0.08, TABLE 2. Standard difference in means between groups for clinician-ratings and self-reported measures of anxiety P = .35,CI = -0.09-0.26,k = 10)”
    Quote in the paperSubstantial claim
  • Findingown data

    The between-groups effect for depression symptoms was nonsignificant, d = -0.02, P = .88, CI = -0.23-0.20, k = 9.

    “The combined between-groups effects were not significant (d = -0.02,P = .88,CI = -0.23-0.20,k = 9).”
    Quote in the paperSubstantial claim
  • Findingown data

    More patients in the ABMT group no longer met formal diagnostic criteria for their anxiety disorder posttreatment than in the control condition, d = 0.40, P < .05, CI = 0.02-0.78, k = 8.

    “More patients in the treatment group no longer met formal diagnostic criteria for their anxiety disorder posttreatment relative to patients in the control condition (P < .05).”
    • Also stated in: § ANXIETY SYMPTOMS · plain
      “Finally, the combined number of patients no longer meeting DSM criteria for an anxiety disorder following ABMT was significantly higher relative to the number of patients no longer meeting diagnostic criteria for their anxiety disorder in the control training condition, d = 0.40, P < .05,CI = 0.02-0.78,k = 8, fail-safe number = 14.”
    Quote in the paperSubstantial claim
  • May combine two claims. 13
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 3

  • May combine two claims.

    Findingown data

    The contrast between within-group effects for self-reported anxiety was at a trend level, Q = 3.49, P = .06, with greater reduction in ABMT than control training.

    “and were at a trend level of significance for the contrast between the within-group effects (P = .06).”
    • Also stated in: § Self-Reports. · plain
      “However, the difference between the two conditions was nonsignificant, Q = 3.49, P = 0.06, with a trend for greater reduction in ABMT relative to control training.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    ABMT produced significantly greater within-group reductions in attention bias (d = 0.85, P < .01, CI = 0.24-1.46, k = 7) than control training (d = 0.04, P = .76, CI = -0.20-0.27, k = 7), Q = 5.89, P < .05.

    “Combined within-group effects indicate that ABMT produces significant and greater reductions in attention bias (d = 0.85, P < .01,CI = 0.24-1.46,k = 7), relative to control training (d = 0.04, P = .76,CI = -0.20-0.27,k = 7), Q = 5.89, P < .05(Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    ABMT was associated with greater clinician-rated reductions in anxiety symptoms relative to control training, with a between-groups effect of d = 0.42 (P = .001, CI = 0.18-0.66) and a within-group contrast of Q = 7.25 (P < .01).

    “ABMT was associated with greater clinician-rated reductions in anxiety symptoms relative to control training: between-groups effect (d = 0.42, P = .001,confidence interval (CI) = 0.18-0.66),contrast of within-group effects (Q = 7.25, P < .01).”
    • Also stated in: § ANXIETY SYMPTOMS · plain
      “The overall between-groups combined effect size based on clinician-rated measures of anxiety was significant, d = 0.42, P = .001,CI = 0.18-0.66,k = 6, fail-safe number = 14.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Within-group effect sizes for studies reporting follow-up showed a similar pattern to posttreatment: ABMT d = 1.10, P < .001, CI = 0.54-1.66; control d = 0.54, P < .001, CI = 0.32-0.75; Q = 3.43, P = .06.

    “Within-group effect sizes for studies reporting a follow-up measurement (k = 8, mean time to follow-up =12.62, range = 2-16 weeks) revealed a similar pattern of results to that observed at posttreatment (ABMT: d = 1.10,P < .001,CI = 0.54-1.66;control training: d = 0.54, P < .001,CI = 0.32-0.75),Q = 3.43, P = .06.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    For self-reported anxiety, ABMT delivered in the clinic had a significant between-groups effect (d = 0.34, P = .01, CI = 0.07-0.62), while ABMT delivered at home had a nonsignificant effect (d = -0.10, P = .40, CI = -0.33-0.13); the difference between these effects was significant, Q = 5.85, P < .05.

    “Moderation analysis of the betweengroups effect revealed a significant effect for ABMT delivered in the clinic (d = 0.34, P = 0.01, CI = 0.07-0.62),and a nonsignificant effect for ABMT delivered at home (d = -0.10,P = 0.40, CI = -0.33-0.13).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Within-group reductions in depression symptoms were significant for ABMT (d = 0.41, P < .001, CI = 0.22-0.60) and control training (d = 0.32, P < .01, CI = 0.10-0.53), with no significant difference between them, Q = 0.37, P = .54.

    “The combined within-group effect sizes of change in depression symptoms from pre-to posttreatment were significant, both for the ABMT condition (d = 0.41, P < .001,CI = 0.22-0.60)and the control training condition (d = 0.32, P < .01,CI = 0.10-0.53).The difference between these effects was not significant, Q = 0.37, P = .54.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    A more direct evaluation of attention bias change as a moderator requires a formal meta-analytic moderation analysis, which cannot be performed due to insufficient published data.

    “A more direct evaluation requires a formal meta-analytic moderation analysis, which cannot be performed due to insufficient published data.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All ABMT effects across all samples were associated with some improvement in clinical status, with all samples aligned greater than zero.

    “Indeed, all ABMT effects, across all samples, were associated with some improvement in clinical status (see Table 1, all samples aligned greater than zero), highlighting the potential therapeutic effect of ABMT even in studies that failed to find a significant between-groups effect above and beyond placebo.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Control training conditions were still associated with significant reduction in anxiety symptoms, although therapeutic effects were significantly attenuated relative to ABMT.

    “Although therapeutic effects were significantly attenuated in control training conditions relative to ABMT, these control trainings were still associated with significant reduction in anxiety symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Twelve RCTs of ABMT in clinically diagnosed anxiety patients had been published, and eleven of these used variants of the dot-probe task.

    “Twelve RCTs of ABMT in clinically diagnosed anxiety patients were published to date.Eleven of these RCTs used variants of the dot-probe task as means of attention bias modification (cf.Waters et al. [7] ).[12][13][14][15][16][17][18][19][20][21][22]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [12] *Eldar, 2012, Attention bias modification treatment for pediatric anxiety disorders: a randomized controlled trial, Am J Psychiatry source

      Not checked in the free run.

    • cites [13] *Schoorl, 2013, Attentional bias modification in posttraumatic stress disorder: a randomized controlled trial, Psychother Psychosom source

      Not checked in the free run.

    • cites [14] *Schmidt, 2009, Attention training for generalized social anxiety disorder, J Abnorm Psychol source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Prior meta-analytic reviews do not focus specifically on results in clinically affected patients, and no review provides a direct meta-analytic test of ABMT as a stand-alone treatment for clinical anxiety disorders.

    “However, prior reviews do not focus specifically on results in clinically affected patients.As a result, no review provides a direct meta-analytic test of the utility of ABMT as a stand-alone treatment for clinical anxiety disorders.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [8] Hakamata, 2010, Attention bias modification treatment: a meta-analysis toward the establishment of novel treatment for anxiety, Biol Psychiatry source

      Not checked in the free run.

    • cites [9] Hallion, 2011, A meta-analysis of the effect of cognitive bias modification on anxiety and depression, Psychol Bull source

      Not checked in the free run.

    • cites [10] Beard, 2012, Efficacy of attention bias modification using threat and appetitive stimuli: a meta-analytic review, Behav Ther source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Four published meta-analyses have examined the effects of attention bias modification on symptoms and, as a group, reported small-to-medium effect sizes.

    “Four published meta-analyses have examined the effects of attention bias modification on symptoms, as a group reporting small-to-medium effect sizes.[8][9][10][11]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [8] Hakamata, 2010, Attention bias modification treatment: a meta-analysis toward the establishment of novel treatment for anxiety, Biol Psychiatry source

      Not checked in the free run.

    • cites [9] Hallion, 2011, A meta-analysis of the effect of cognitive bias modification on anxiety and depression, Psychol Bull source

      Not checked in the free run.

    • cites [10] Beard, 2012, Efficacy of attention bias modification using threat and appetitive stimuli: a meta-analytic review, Behav Ther source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Attention bias modification treatment for anxiety disorders grew out of data on threat-related attentional biases in anxiety.

    “Attention bias modification treatment (ABMT) for anxiety disorders grew out of data on threat-related attentional biases in anxiety.[1,2]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Armstrong, 2012, Eye tracking of attention in the affective disorders: a meta-analytic review and synthesis, Clin Psychol Rev source

      Not checked in the free run.

    • cites [2] Bar-Haim, 2007, Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study, Psychol Bull source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    ABMT effects are mainly evident when ABMT is delivered in the clinic and when clinical outcome is evaluated by a clinician.

    “Overall, ABMT effects are mainly evident when it is delivered in the clinic and when clinical outcome is evaluated by a clinician.”
    • Also stated in: § Depression and Anxiety · plain
      “The meta-analysis revealed that treatment effects of ABMT were more pronounced in clinician-reported than in self-reported measures.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The difference between clinician-rated and self-reported measures may be attributed to the different distribution of ABMT delivery context relative to each measure type.

    “This difference may be attributed to the different distribution of ABMT delivery context relative to each measure type.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    ABMT is based on the notion that reduction in attention bias toward threat via training drives the reduction in anxiety symptoms.

    “ABMT is based on the notion that reduction in attention bias toward threat via training drives the reduction in anxiety symptoms.[36]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] MacLeod, 2002

      Not checked in the free run.

16 of 16

  • The paper relies on this without support.

    The control training conditions in the included RCTs function as placebo training protocols that isolate the specific therapeutic effect of ABMT.

    “The between-groups effects found here directly reflect the added therapeutic value of ABMT relative to placebo training, and are notable in light of the control used in the RCTs included in the meta-analysis.”
1 of 1

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Each contradiction between two passages listed here was confirmed by an independent check.

  • Delivery-context moderator test is described inconsistently

    Minor

    The methods say delivery context was evaluated using within-group contrasts, but the results describe the reported moderator test as a comparison of between-groups effects.

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Authors
Linetzky, M., Pergamin-Hight, L., Pine, D. S., & Bar-Haim, Y.
Affiliations
  • Tel Aviv University (IL)
  • School of Psychological Sciences; Tel Aviv University; Tel Aviv Israel
  • National Institutes of Health (US)
Corresponding author
Linetzky, Marian
ORCID
Venue
Depression and Anxiety
Publisher
Wiley
Published
2015-02-24
Volume
32
Issue
6
Pages
383-391
ISSN
1091-4269 (ISSN-L)
DOI
10.1002/da.22344
OpenAlex
W3111406481
Semantic Scholar
3f232c9e7551607b08622801ead1f83df0efd0d4
Cited by
185
References
38
Citations by year
2026: 3 · 2025: 9 · 2024: 10 · 2023: 12 · 2022: 12 · 2021: 12 · 2020: 19 · 2019: 21 · 2018: 23 · 2017: 24 · 2016: 27 · 2015: 13
FWCI
3.75
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 189 d)
Locations
  • Depression and Anxiety (publishedVersion)
  • PubMed (publishedVersion)
Funders
United States-Israel Binational Science Foundation
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
attentional bias modification, anxiety disorders, dot-probe task, treatment efficacy, home-based intervention, clinic-based intervention, symptom relief, self-reported anxiety
MeSH terms
Anxiety Disorders, Attention, Behavior Therapy, Humans, Bias, Randomized Controlled Trials as Topic, Treatment Outcome, Self Report

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