Background: Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias towards threatening information. The current study incorporated virtual reality (VR) technology and 3-dimensional stimuli with a person-identity-matching (PIM) task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.

Methods: One hundred participants with elevated social anxiety were randomised to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-month follow-up.

Results: Change in anxiety did not correlate with change in bias (r = −0.08). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM, or between groups. For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < .001, Nagelkerke's pseudo r2 = 0.65). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 4% of participants were classified as ‘recovered’ at 3-month follow-up.

Conclusions: A single session of VR-based PIM task did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.

Background: Considerable effort and funding have been spent on developing Attention Bias Modification (ABM) as a treatment for anxiety disorders, theorized to exert therapeutic effects through reduction of a tendency to orient attention towards threat. However, meta-analytical evidence that clinical anxiety is characterized by threat-related attention bias is thin. The largest meta-analysis to date included dot-probe data for n=337 clinically anxious individuals. Baseline measures of biased attention obtained in ABM RCTs form an additional body of data that has not previously been meta-analyzed.

Method: This paper presents a meta-analysis of threat-related dot-probe bias measured at baseline for 1005 clinically anxious individuals enrolled in 13 ABM RCTs.

Results: Random-effects meta-analysis indicated no evidence that the mean bias index (BI) differed from zero (k= 13, n= 1005, mean BI = 1.8 ms, SE = 1.26 ms, p = .144, 95% CI [-0.6 - 4.3]. Additional Bayes factor analyses also supported the point-zero hypothesis (BF10 = .23), whereas interval-based analysis indicated that mean bias in clinical anxiety is unlikely to extend beyond the 0 to 5 ms interval. 

Discussion: Findings are discussed with respect to strengths (relatively large samples, possible bypassing of publication bias), limitations (lack of control comparison, repurposing data, specificity to dot-probe data), and theoretical and practical context. We suggest that it should no longer be assumed that clinically anxious individuals are characterized by selective attention towards threat.

Conclusion: Clinically anxious individuals enrolled in RCTs for Attention Bias Modification are not characterized by threat-related attention bias at baseline.

Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias towards threatening information. The current study incorporated virtual reality (VR) technology and 3-dimensional stimuli with a dot-probe task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms. A total of 100 participants were randomised to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-months follow-up. Change in anxiety did not correlate with change in bias. No significant difference in bias was observed from pre- to post-ABM or between groups. For anxiety symptoms, participants showed significant reduction in anxiety scores over time. However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 9% of participants were classified as ‘recovered’ at 3-months follow-up.

Background: Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias toward threatening information. The current study incorporated virtual reality (VR) technology and three-dimensional stimuli with a dot-probe task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.

Methods: A total of 100 participants were randomized to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-months follow-up.

Results: Change in anxiety did not correlate with change in bias (p = 0.24). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM (p = 0.144), or between groups (p = 0.976). For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < 0.001). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 9% of participants were classified as ‘recovered’ at 3-months follow-up.

Conclusion: A single session of VR-based ABM did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.

Introduction: Cognitive Bias Modification (CBM) refers various computerized training protocols aimed at modifying individuals’ automatic information processing patterns (cognitive biases). CBM protocols are commonly regarded as potential new treatments, targeting cognitive biases believed to be involved in anxiety, depression, substance abuse, disordered eating, pain perception, insomnia, etc. Designed to reward response tendencies associated with more desired information processing patterns trough repeated practice, CBM tasks tend to rely on a (hidden) contingency between stimulus valence and response rewards. In CBM studies, active training conditions are typically contrasted with control conditions lacking the contingency, often called 50/50 placebo. This report focusses on the wide-spread, and intuitive, notion that pre-existing bias may affect the contingency experienced by an individual engaging in a 50/50 placebo control condition thereby inadvertently rendering the intended placebo condition more potent.

Method: We employed probabilistic reasoning, presenting formulae to compute the probability for each type of trial to modify or consolidate an individuals initial response tendency. In addition, an interactive online visualization app has been made available.

Results: Contrary to the often-forwarded notion, pre-existing bias cannot increase the potency of a 50/50 placebo condition. In contrast, we arrived at the unforeseen conclusion that lack of pre-existing bias may render an active training condition functionally similar to a placebo condition.

Discussion: Our probabilistic arguments invite discussion of CBM’s implicitness assumption, as well as the ever more clearly emerging problem of information processing biases not being reliably observed in clinical populations whereas our arguments suggest that pre-existing bias is necessary for CBM to function in the manner that it is devised to function.

Introduction: It has been theorised that attentional biases (sensitivity and hypervigilance towards threat-related information) may play a causal role in the aetiology and maintenance of dysfunctional anxiety. Attentional bias modification (ABM) aims to directly modify the underlying attentional biases implicated in anxiety disorders, and consequently reduce anxiety symptoms.

We conducted two studies that examined the effectiveness of ABM training programs in reducing attentional bias and anxiety. Both programs were delivered via virtual reality (VR) technology. Study 1 utilised a traditional dot-probe ABM, and Study 2 utilised a Person Identity Match (PIM) ABM. In addition to the comparison of two different ABM programs, the studies also investigated whether the use of 3 dimensional stimuli has an impact on the outcome of the ABM training.

Methods:

Study 1

One hundred participants with elevated anxiety scores (LSAS > 30) were randomly assigned to 4 groups:

1. ABM with 2D stimuli (n = 25)2. Mock-ABM with 2D stimuli (n = 25)3. ABM with 3D stimuli (n = 25)4. Mock-ABM with 3D stimuli (n = 25)

The participants first completed questionnaires that measured their anxiety and other factors of interest. After which the participants completed 100 trials of a dot-probe task to measure their pre-training attentional bias. The participants then completed 360 trials of ABM training. Following ABM, the participants carried out post-training bias measurement and anxiety measurement. Finally, the participants answered follow-up questionnaires 1 week and 3months after the ABM training.

Study 2

Study 2 shares the exact same design as Study 1, but utilised a different version of ABMtraining.

Results: Data analysis is currently ongoing and results are pending. The change in attentional bias and anxiety are the primary outcome measures. Both within-group comparisons (pre-training vs. post-training) and between-group comparisons (ABM vs. mock; 2D vs 3D; Dot-probe vs. PIM) will be carried out. Some preliminary results will be presented at the conference.

Conclusions: Pending

Background: Considerable effort and funding are spent on developing and assessing clinical efficacy of dot probe task (DPT) based Attention Bias Modification (ABM). ABM is regarded as a potential new (online) treatment for anxiety disorders especially. Anxiety disorders are commonly asserted to be characterised by ABM’s treatment target: preferential processing of threatening information. Yet the available meta-analytical evidence for this specific threat- bias in clinically anxious individuals is thin: the largest meta-analysis to date included DPT data for only n = 337 clinically anxious individuals. We reasoned that the baseline bias measures obtained in RCTs for ABM constitute a considerable, hitherto not assessed, body of data on the existence of DPT threat bias in clinically anxious samples.

Method: Baseline ‘threat vs neutral’ DPT summary data for n=860 clinically anxious individuals enrolled in k=11 ABM RCTs were meta-analysed using REML. Additional Bayesian analysis was used to assess support for a series of 1 ms wide bias size intervals.

Results: REML analysis indicated no evidence that mean observed Bias Index (BI) differs from point zero (k= 11, n= 860, mean BI = 1.8, SE = 1.53, p = .229, 95% CI [-1.2 - 4.8]). Bayesian analyses indicated moderate support for the traditional ‘point-zero’ over the ‘not point-zero’ hypothesis (BF01 = 6.7). Interval-based Bayesian analysis suggest that BI most likely falls in the 0-1 ms interval (BFinterval/notinterval = 231) and is almost certainly not larger than +2 ms (towards threat), or -1 ms (away from threat).

Conclusion: Clinically anxious individuals enrolled in RCTs for Attention Bias Modification do not display attention bias towards threat at the start of their trials. This meta-analytical finding casts strong doubt on the common assumption that clinical anxiety is characterized by preferential attention allocation towards threatening information.

Cognitive Bias Modification (CBM) is an overarching term for various computerized training protocols developed to change automatic information processing patterns (cognitive biases). CBM tasks are designed to reward response tendencies associated with more desired information processing patterns trough repeated practice. Target cognitive biases include those believed to be involved in anxiety, depression, addiction, and eating disorders, and CBM protocols are commonly regarded as potential new treatments. Most CBM forms rely on a (hidden) contingency between stimulus valence and response rewards. In CBM studies, active training conditions are typically contrasted with control conditions lacking the contingency, often called 50/50 placebo. This report focusses on the wide-spread, and intuitive, notion that pre-existing bias may affect the contingency experienced by an individual engaging in a 50/50 placebo control condition, and that this may inadvertently render the intended placebo condition more potent. Employing probabilistic reasoning, we conclude that, contrary to the often-forwarded notion, pre-existing bias cannot increase the potency of a 50/50 placebo condition. In contrast, we arrived at the unforeseen conclusion that lack of pre-existing bias may render an active training condition functionally similar to a placebo condition. In this paper we develop these arguments, review literature with respect to our assumptions, and discuss implications.