title: Selective prevention of combat-related post-traumatic stress disorder using attention bias modification training: a randomized controlled trial.
abstract: Efficacy of pre-trauma prevention for post-traumatic stress disorder (PTSD) has not yet been established in a randomized controlled trial. Attention bias modification training (ABMT), a computerized intervention, is thought to mitigate stress-related symptoms by targeting disruptions in threat monitoring. We examined the efficacy of ABMT delivered before combat in mitigating risk for PTSD following combat.
  
  
  
  We conducted a double-blind, four-arm randomized controlled trial of 719 infantry soldiers to compare the efficacy of eight sessions of ABMT (n = 179), four sessions of ABMT (n = 184), four sessions of attention control training (ACT; n = 180), or no-training control (n = 176). Outcome symptoms were measured at baseline, 6-month follow-up, 10 days following combat exposure, and 4 months following combat. Primary outcome was PTSD prevalence 4 months post-combat determined in a clinical interview using the Clinician-Administered PTSD Scale. Secondary outcomes were self-reported PTSD and depression symptoms, collected at all four assessments.
  
  
  
  PTSD prevalence 4 months post-combat was 7.8% in the no-training control group, 6.7% with eight-session ABMT, 2.6% with four-session ABMT, and 5% with ACT. Four sessions of ABMT reduced risk for PTSD relative to the no-training condition (odds ratio 3.13, 95% confidence interval 1.01-9.22, p < 0.05, number needed to treat = 19.2). No other between-group differences were found. The results were consistent across a variety of analytic techniques and data imputation approaches.
  
  
  
  Four sessions of ABMT, delivered prior to combat deployment, mitigated PTSD risk following combat exposure. Given its low cost and high scalability potential, and observed number needed to treat, research into larger-scale applications is warranted. The ClinicalTrials.gov identifier is NCT01723215.
authors.affiliation: School of Psychological Sciences,Tel Aviv University,Tel Aviv,Israel.
authors.forename: I
authors.initials: I
authors.lastname: Wald
authors.affiliation: Division of Mental Health,Medical Corps,Israel Defense Forces,Israel.
authors.forename: E
authors.initials: E
authors.lastname: Fruchter
authors.affiliation: Division of Mental Health,Medical Corps,Israel Defense Forces,Israel.
authors.forename: K
authors.initials: K
authors.lastname: Ginat
authors.affiliation: Division of Mental Health,Medical Corps,Israel Defense Forces,Israel.
authors.forename: E
authors.initials: E
authors.lastname: Stolin
authors.affiliation: Division of Mental Health,Medical Corps,Israel Defense Forces,Israel.
authors.forename: D
authors.initials: D
authors.lastname: Dagan
authors.affiliation: Darla Moore School of Business,University of South Carolina,SC,USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Bliese
authors.affiliation: Center for Military Psychiatry and Neuroscience,Walter Reed Army Institute of Research,US Army Medical Research and Materiel Command,MD,USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Quartana
authors.affiliation: Center for Military Psychiatry and Neuroscience,Walter Reed Army Institute of Research,US Army Medical Research and Materiel Command,MD,USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Sipos
authors.affiliation: National Institutes of Mental Health,MD,USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Pine
authors.affiliation: School of Psychological Sciences,Tel Aviv University,Tel Aviv,Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Bar-Haim
mesh_terms: D000293:Adolescent; D000328:Adult; D000070379:Attentional Bias / Q000502:physiology*; D003130:Combat Disorders / Q000517:prevention & control*; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D011613:Psychotherapy / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Attention bias modification training; combat; post-traumatic stress disorder; prevention; stress