Combining attention training with internet-based cognitive-behavioural self-help for social anxiety: a randomised controlled trial
Open accessAbstract
Guided Internet-based cognitive-behavioural self-help (ICBT) has been proven to be effective for social anxiety disorder (SAD) by several independent research groups. However, as the proportion of clinical significant change has room for improvement, new treatments should be developed and investigated. A novel treatment is attention bias modification (ABM). This study aimed at evaluating the combination of ABM and ICBT. We compared two groups, one group receiving ICBT and ABM targeting attentional avoidance and the other group receiving ICBT and control training. ABM and control training tasks were both based on the dot-probe paradigm. A total of 133 participants, diagnosed with SAD, were randomised to these two groups. The attention training group (N = 66) received 2 weeks of daily attention training followed by 9 weeks of ICBT. The control group (N = 67) received 2 weeks of daily control training, also followed by 9 weeks of ICBT. Social anxiety measures as well as the attention bias were assessed at pre-assessment, at week 2, and at post-treatment. Results showed no significant differences between the attention training group and the control group. Both groups improved substantially on social anxiety symptoms from pre- to post-assessment (dwithin = 1.39-1.41), but showed no change in attention processes (dwithin = 0.10-0.17). In this trial, the attention modification training failed to induce differential change in attention bias. Results demonstrate that the applied ABM procedure with its focus on the reduction of attentional avoidance was ineffective in the Internet-based setting. The results do not suggest that adding ABM targeting attentional avoidance to ICBT results in better outcomes than ICBT alone.
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The two forms of attention bias modification used in the SAD sample produced similar results and were considered equal.
“The two forms of attention bias modification used produced similar results (Boettcher et al., 2014), and were hence considered equal in the current study.”
From Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus? (2016) · cites this paper as Boettcher et al., 2014
The Results (Change in social anxiety and Change in attention bias; page unavailable) report similar outcomes and no significant difference between groups. But the study compared active attention bias modification with control training, not two forms of attention bias modification. The citing authors’ decision to treat them as equal in their own study is their inference, not a finding attributed to Boettcher et al. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPsychological treatment studies often describe an increased rate of clinical change within samples of increased baseline symptom severity.
“First, psychological treatment studies often describe an increased rate of clinical change within samples of increased baseline symptom severity [20,28].”
From Measurement of Symptom Change Following Web-Based Psychotherapy: Statistical Characteristics and Analytical Methods for Measuring and Interpreting Change (2018) · cites this paper as [28]
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- Authors
- Boettcher, J., Hasselrot, J., Sund, E., Andersson, G., & Carlbring, P.
- Affiliations
- Stockholm University (SE)
- Umeå University (SE)
- Linköping University (SE)
- Corresponding author
- Boettcher, Johanna
- Venue
- Cognitive Behaviour Therapy
- Publisher
- Informa UK Limited
- Published
- 2013-07-30
- Volume
- 43
- Issue
- 1
- Pages
- 34-48
- ISSN
- 1650-6073 (ISSN-L)
- 1651-2316
- PMC
- PMC3869050
- OpenAlex
- W2009571619
- Cited by
- 68
- References
- 88
- Citations by year
- 2026: 2 · 2024: 7 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 7 · 2018: 8 · 2017: 5 · 2016: 11 · 2015: 10 · 2014: 3 · 2013: 3
- FWCI
- 12.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Cognitive Behaviour Therapy (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Boettcher Foundation
- Forskningsrådet för Arbetsliv och Socialvetenskap
- Karolinska Institutet
- Uppsala Universitet
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- social anxiety disorder, attentional bias modification, attentional avoidance, dot-probe task, combination therapy, attention training, treatment efficacy
- MeSH terms
- Adult, Attention, Cognition, Combined Modality Therapy, Female, Humans, Male, Phobic Disorders, Self Care, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Young Adult
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