Effect of attention training on attention bias variability and PTSD symptoms: Randomized controlled trials in Israeli and U.S. Combat veterans
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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.
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In two ABM studies of patients with PTSD, control attention training reduced PTSD symptoms and AB variability, but did not affect the standard AB index at 500 ms.
“In two ABM studies of patients with PTSD, control attention training (visualprobe-training task with probes equally likely to replace threat and nonthreat cues) reduced PTSD symptoms and AB variability, but did not affect the standard AB index at 500 ms (which showed no overall bias to threat across both studies in PTSD patients).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Badura-Brack et al., 2015
Training direction of AB away from threat may convey little or no additional benefit.
“Also, training direction of AB away from threat may convey little or no additional benefit (see also Badura-Brack et al. 2015).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Badura-Brack et al., 2015
Some findings suggest that ABM and control attention training may reduce anxiety without reducing AB in orienting to threat, perhaps by improving cognitive control.
“as some findings suggest that ABM and control attention training may reduce anxiety, without reducing AB in orienting to threat, perhaps by improving cognitive control (e.g., Badura-Brack et al. 2015;Heeren, Mogoas ¸e, McNally et al., 2015;Boettcher et al., 2013;McNally et al., 2013).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Badura-Brack et al., 2015
Evidence of relationships between pre-existing AB to threat, AB reduction, and anxiety reduction is mixed.
“Also, evidence of relationships between pre-existing AB to threat, AB reduction, and anxiety reduction is mixed”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Badura-Brack et al., 2015
The computerized attentional-bias prevention program has been found to reduce PTSD symptoms in treatment-seeking combat veterans.
“and has been found to reduce PTSD symptoms in treatment seeking combat veterans 117 .”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [117]
The computerized attentional-bias prevention program appears to be a promising preventive strategy, at least in military personnel.
“This program appears to be a promising preventive strategy, at least in military personnel”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [117]
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References 57 · Cited by 185
- Authors
- Badura-Brack, A. S., Naim, R., Ryan, T. J., Levy, O., Abend, R., Khanna, M. M., McDermott, T. J., Pine, D. S., & Bar-Haim, Y.
- Affiliations
- Creighton University (US)
- From the Department of Psychology, Creighton University, Omaha, Neb.; the School of Psychological Sciences and the Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; the Department of Psychology, Simon Fraser University, Burnaby, B.C., Canada; the Division of Mental Health, Medical Corps, Israel Defense Forces, Israel; and the Intramural Research Program, NIMH, Bethesda, Md.
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2015-12-01
- Volume
- 172
- Issue
- 12
- Pages
- 1233-1241
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC6343502
- OpenAlex
- W1883359874
- Cited by
- 185
- References
- 57
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 8 · 2023: 12 · 2022: 24 · 2021: 37 · 2020: 15 · 2019: 23 · 2018: 13 · 2017: 16 · 2016: 19 · 2015: 4
- FWCI
- 21.52
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Creighton Digital Repository (CDR) (submittedVersion)
- Funders
- National Institutes of Health (Z99 MH999999)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, attentional bias modification, threat vigilance, threat avoidance, combat veterans, military veterans, dot-probe task, computerized cognitive training
- MeSH terms
- Adult, Aged, Attention, Behavior Therapy, Humans, Male, Middle Aged, Stress Disorders, Post-Traumatic, Veterans, Treatment Outcome, Young Adult
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