Internet-Based Attention Bias Modification for Social Anxiety: A Randomised Controlled Comparison of Training towards Negative and Training Towards Positive Cues

Boettcher, Johanna; Leek, Linda; Matson, Lisa; Holmes, Emily A.; Browning, Michael; MacLeod, Colin; Andersson, Gerhard; Carlbring, Per

doi:10.1371/journal.pone.0071760

Cited by 109Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health InterventionsPsychological Treatments and Assessments

Internet-Based Attention Bias Modification for Social Anxiety: A Randomised Controlled Comparison of Training towards Negative and Training Towards Positive Cues

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Boettcher, Johanna, Leek, Linda, Matson, Lisa, Holmes, Emily A., Browning, Michael, MacLeod, Colin, Andersson, Gerhard, Carlbring, Per·2013·PLoS ONE

DOI 10.1371/journal.pone.0071760PMC PMC3787061

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Abstract

UNLABELLED: Biases in attention processes are thought to play a crucial role in the aetiology and maintenance of Social Anxiety Disorder (SAD). The goal of the present study was to examine the efficacy of a programme intended to train attention towards positive cues and a programme intended to train attention towards negative cues. In a randomised, controlled, double-blind design, the impact of these two training conditions on both selective attention and social anxiety were compared to that of a control training condition. A modified dot probe task was used, and delivered via the internet. A total of 129 individuals, diagnosed with SAD, were randomly assigned to one of these three conditions and took part in a 14-day programme with daily training/control sessions. Participants in all three groups did not on average display an attentional bias prior to the training. Critically, results on change in attention bias implied that significantly differential change in selective attention to threat was not detected in the three conditions. However, symptoms of social anxiety reduced significantly from pre- to follow-up-assessment in all three conditions (dwithin = 0.63-1.24), with the procedure intended to train attention towards threat cues producing, relative to the control condition, a significantly greater reduction of social fears. There were no significant differences in social anxiety outcome between the training condition intended to induce attentional bias towards positive cues and the control condition. To our knowledge, this is the first RCT where a condition intended to induce attention bias to negative cues yielded greater emotional benefits than a control condition. Intriguingly, changes in symptoms are unlikely to be by the mechanism of change in attention processes since there was no change detected in bias per se. Implications of this finding for future research on attention bias modification in social anxiety are discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT01463137.

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The absence of social stress with online training at home compared to lab studies might explain recent null findings.
“The absence of (social) stress with online training at home compared to lab studies might explain recent null findings (Boettcher, Berger, & Renneberg, 2012;Boettcher et al., 2013;Kuckertz et al., 2014).”
From Online attentional bias modification training targeting anxiety and depression in unselected adolescents: short- and long-term effects of a randomized controlled trial (2016) · cites this paper as Boettcher et al., 2013
Previous research has shown that baseline attentional bias moderated training effects.
“As previous research has shown that baseline attentional bias moderated training effects (e.g., Boettcher et al., 2013;Kuckertz et al., 2014)”
From Online attentional bias modification training targeting anxiety and depression in unselected adolescents: short- and long-term effects of a randomized controlled trial (2016) · cites this paper as Boettcher et al., 2013
In some ABM studies, ABM-threat-avoidance training and control conditions with similar exposure to threat cues both reduced anxiety.
“In some ABM studies, ABM-threat-avoidance training and control conditions, which involved a similar level of exposure to threat cues, both reduced anxiety”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Boettcher et al., 2013
Studies comparing ABM-threat-avoidance, inverse-ABM, and control attention training showed reduction in anxiety symptoms from pre- to post-training, irrespective of the type of training task, and without reducing AB to threat on spatial-attention tasks.
“These showed reduction in anxiety symptoms from pre-to post-training, irrespective of the type of training task, and without reducing AB to threat on spatial-attention tasks.”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Boettcher et al., 2013
Many ABM studies find no evidence of AB in orienting to threat in anxious individuals before ABM training.
“First, many ABM studies find no evidence of AB in orienting to threat in anxious individuals before ABM training (e.g., Boettcher et al., 2013;Britton et al., 2013;Carleton et al., 2015;Eldar et al., 2012;Heeren, Mogoas ¸e, McNally, et al., 2015;McNally et al., 2013;Waters et al., 2015).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Boettcher et al., 2013

One study found that training attention towards threat reduced social anxiety more than a control training condition, possibly due to enhanced exposure to threat cues.
“One study unexpectedly found that training attention towards threat reduced social anxiety more than a control training condition; which may have been due to the attend-threat training condition enhancing exposure to threat cues (Boettcher et al., 2013).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Boettcher et al., 2013
Some findings indicate that attention-training methods, including ABM-threat-avoidance and ABM-positive-search training, can reduce anxiety without reducing AB in orienting to threat.
“Second, some findings indicate that attention-training methods, including ABM-threat-avoidance and ABM-positive-search training, can reduce anxiety without reducing AB in orienting to threat.”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Boettcher et al., 2013
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 Boettcher et al., 2013
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 Boettcher et al., 2013

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“Subsequent studies have yielded a bit more positive results (Boettcher et al., 2013), but overall this line of research has not been as efficient as the ICBT trials with minimal therapist support and mainly text-based interventions.”
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Authors: Boettcher, J., Leek, L., Matson, L., Holmes, E. A., Browning, M., MacLeod, C., Andersson, G., & Carlbring, P.
Affiliations: Stockholm University (SE)
Umeå University (SE)
MRC Cognition and Brain Sciences Unit (GB)
University of Oxford (GB)
The University of Western Australia (AU)
Linköping University (SE)
Corresponding author: Boettcher, Johanna
ORCID: Boettcher, Johanna
Holmes, Emily A.
Browning, Michael
MacLeod, Colin
Andersson, Gerhard
Carlbring, Per
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2013-09-30
Volume: 8
Issue: 9
Pages: e71760
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0071760
PMC: PMC3787061
OpenAlex: W1977127560
Cited by: 109
References: 81
Citations by year: 2025: 5 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 5 · 2019: 15 · 2018: 9 · 2017: 12 · 2016: 15 · 2015: 14 · 2014: 10 · 2013: 2
FWCI: 18.51
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS ONE (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
UWA Profiles and Research Repository (University of Western Australia) (publishedVersion, other-oa)
PubMed (publishedVersion)
ePrints Soton (University of Southampton) (acceptedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
DiVA (Linkoping University) (submittedVersion, other-oa)
DiVA (Stockholm University) (submittedVersion, other-oa)
DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Figshare (submittedVersion, cc-by)
Funders: Forskningsrådet för Arbetsliv och Socialvetenskap
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: attentional bias modification, social anxiety disorder, online intervention, attentional bias, selective attention, threat cues, dot-probe task, cognitive training, mechanisms of change
MeSH terms: Adult, Anxiety, Attention, Cues, Double-Blind Method, Female, Humans, Male, Middle Aged, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Treatment Outcome, Internet

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Internet-Based Attention Bias Modification for Social Anxiety: A Randomised Controlled Comparison of Training towards Negative and Training Towards Positive Cues

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