title: Moderation and mediation of the effect of attention training in social anxiety disorder.
abstract: While attention modification programs (AMP) have shown promise as laboratory-based treatments for social anxiety disorder, trials of internet-delivered AMP have not yielded significant differences between active and control conditions. To address these inconsistencies, we examined the moderational and mediational role of attention bias in the efficacy of attention training. We compared data reported by Carlbring et al. (2012) to an identical AMP condition, with the exception that participants were instructed to activate social anxiety fears prior to each attention training session (AMP + FACT; n = 39). We also compared all attention training groups to an internet-delivered cognitive-behavioral therapy (iCBT) condition (n = 40). Participants in the AMP + FACT group experienced greater reductions in social anxiety symptoms than both active (n = 40) and control (n = 39) groups reported by Carlbring et al., and did not differ in symptom reductions from the iCBT group. Higher attention bias predicted greater symptom reductions for participants who completed AMP, but not for the control group. Moreover, change in attention bias mediated the relationship between AMP group (active condition reported by Carlbring et al. versus AMP + FACT) and change in social anxiety symptoms. These results suggest the importance of interpreting findings related to symptom change in attention training studies in the context of bias effects.
  
  
  BACKGROUND
  ISRCTN01715124.
authors.affiliation: Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.
authors.forename: Jennie M
authors.initials: JM
authors.lastname: Kuckertz
authors.affiliation: Department of Psychology, Umeå University, Umeå, Sweden.
authors.forename: Elena
authors.initials: E
authors.lastname: Gildebrant
authors.affiliation: Department of Psychology, Umeå University, Umeå, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Liliequist
authors.affiliation: Department of Psychology, Umeå University, Umeå, Sweden.
authors.forename: Petra
authors.initials: P
authors.lastname: Karlström
authors.affiliation: Department of Psychology, Umeå University, Umeå, Sweden.
authors.forename: Camilla
authors.initials: C
authors.lastname: Väppling
authors.affiliation: Department of Clinical Science, Umeå University, Umeå, Sweden.
authors.forename: Owe
authors.initials: O
authors.lastname: Bodlund
authors.affiliation: Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
authors.forename: Therése
authors.initials: T
authors.lastname: Stenlund
authors.affiliation: Department of Psychology, Boston University, Boston, MA, USA.
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Hofmann
authors.affiliation: Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA.
authors.forename: Nader
authors.initials: N
authors.lastname: Amir
authors.affiliation: Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden. Electronic address: Per@Carlbring.se.
authors.forename: Per
authors.initials: P
authors.lastname: Carlbring
mesh_terms: D000328:Adult; D001288:Attention; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010698:Phobic Disorders / Q000628:therapy*; D012919:Social Behavior; D016896:Treatment Outcome; D055815:Young Adult
keywords: Attention; Information processing; Social anxiety disorder; Social phobia; Treatment