Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias.
Computer-based approaches, such as Attention Bias Modification (ABM), could help improve access to care for anxiety. Study-level meta-analyses of ABM have produced conflicting findings and leave critical questions unresolved regarding ABM's mechanisms of action and clinical potential. We pooled patient-level datasets from randomized controlled trials of children and adults with high-anxiety. Attentional bias (AB) towards threat, the target mechanism of ABM, was tested as an outcome and a mechanistic mediator and moderator of anxiety reduction. Diagnostic remission and Liebowitz Social Anxiety Scale (LSAS) were clinical outcomes available in enough studies to enable pooling. Per-patient data were obtained on at least one outcome from 13/16 eligible studies [86% of eligible participants; n=778]. Significant main effects of ABM on diagnostic remission (ABM-22.6%, control-10.8%; OR=2.57; p=0.006) and AB (β* (95%CI)=-0.63 (-0.83, -0.42); p<0.00005) were observed. There was no main effect of ABM on LSAS. However, moderator analyses suggested ABM was effective for patients who were younger (≤37y), trained in the lab, and/or assessed by clinicians. Under the same conditions where ABM was effective, mechanistic links between AB and anxiety reduction were supported. Under these specific circumstances, ABM reduces anxiety and acts through its target mechanism, supporting ABM's theoretical basis while simultaneously suggesting clinical indications and refinements to improve its currently limited clinical potential.
University of Pittsburgh, United States. Electronic address: rebecca.price@stanfordalumni.org.
Rebecca B
RB
Price
University of Pittsburgh, United States.
Meredith
M
Wallace
San Diego State University, United States.
Jennie M
JM
Kuckertz
San Diego State University, United States.
Nader
N
Amir
University of Pittsburgh, United States.
Simona
S
Graur
University of Pittsburgh, United States.
Logan
L
Cummings
University of Pittsburgh, United States.
Paul
P
Popa
Stockholm University, Sweden.
Per
P
Carlbring
Tel Aviv University, Israel.
Yair
Y
Bar-Haim
D000328:Adult; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D000070379:Attentional Bias; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D006801:Humans; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome
Anxiety; Attention Bias Modification; Attention training; Attentional bias; Patient-level meta-analysis
Stat Med. 2008 May 20;27(11):1870-93
18069721
Emotion. 2016 Feb;16(1):110-6
26389646
Arch Gen Psychiatry. 2005 Jun;62(6):629-40
15939840
J Abnorm Psychol. 1986 Feb;95(1):15-20
3700842
J Child Psychol Psychiatry. 2016 Nov;57(11):1317-1325
27435286
Front Psychiatry. 2015 Oct 28;6:154
26578986
J Consult Clin Psychol. 2011 Aug;79(4):533-41
21707134
J Abnorm Psychol. 2009 Feb;118(1):65-75
19222315
J Clin Psychol. 2014 Dec;70(12):1133-57
24652823
Behav Res Ther. 2014 Feb;53:30-40
24373984
J Consult Clin Psychol. 2009 Oct;77(5):961-73
19803575
JAMA. 2000 May 17;283(19):2529-36
10815116
PLoS One. 2015 Apr 24;10(4):e0124182
25909846
Behav Res Ther. 2007 Dec;45(12):3030-40
17826734
Clin Psychol Rev. 2010 Aug;30(6):768-78
20619943
Arch Gen Psychiatry. 2005 Jun;62(6):617-27
15939839
Behav Res Ther. 2016 Nov;86:68-86
27461003
Depress Anxiety. 2015 Jun;32(6):383-91
25708991
Soc Cogn Affect Neurosci. 2015 Jul;10(7):913-20
25344944
Behav Res Ther. 2013 Dec;51(12):882-8
24211339
Biol Psychiatry. 2014 Dec 15;76(12):946-52
24690113
BMC Psychiatry. 2014 Jan 15;14:8
24423043
BMJ. 2010 Feb 05;340:c221
20139215
Gen Hosp Psychiatry. 2013 Jul-Aug;35(4):332-8
23664503
Behav Res Ther. 1992 Mar;30(2):151-61
1567344
BMC Psychiatry. 2012 Jun 25;12:66
22731889
Psychol Assess. 2015 Jun;27(2):365-76
25419646
Biol Psychiatry. 2010 Dec 1;68(11):982-90
20887977
J Anxiety Disord. 2013 Oct;27(7):684-91
24121100
Front Hum Neurosci. 2013 Jul 23;7:389
23888138
J Abnorm Psychol. 2002 Feb;111(1):107-23
11866165
Behav Res Ther. 2012 Jan;50(1):30-9
22055280
Behav Ther. 2013 Dec;44(4):662-73
24094791
J Abnorm Psychol. 2009 Feb;118(1):28-33
19222311
Cogn Behav Ther. 2014;43(1):34-48
23898817
Psychol Med. 2001 Aug;31(6):1025-35
11513370
Behav Res Ther. 2015 Oct;73:111-23
26310362
Psychol Med. 2013 May;43(5):897-910
22781489
Psychol Aging. 2002 Jun;17(2):299-320
12061414
J Clin Psychiatry. 2008 Apr;69(4):621-32
18363421
Behav Ther. 2012 Dec;43(4):724-40
23046776
Psychol Bull. 2007 Jan;133(1):1-24
17201568
Clin Psychol Sci. 2014 Sep 1;2(5):576-590
26029490
Br J Psychiatry. 2015 Jan;206(1):7-16
25561486
Behav Res Ther. 2015 Feb;65:93-100
25594940
Am J Psychiatry. 2012 Feb;169(2):213-20
22423353
J Abnorm Psychol. 2009 Feb;118(1):5-14
19222309
Psychol Bull. 2011 Nov;137(6):940-58
21728399
Am J Psychiatry. 2010 Jul;167(7):748-51
20595427
Dev Cogn Neurosci. 2013 Apr;4:77-84
23063461
Clin Psychol Rev. 2015 Aug;40:76-90
26080314
Depress Anxiety. 2011 Nov;28(11):981-8
21898705
Am J Psychiatry. 2015 Dec;172(12):1233-41
26206075
J Clin Psychiatry. 2004 Dec;65(12):1696-707
15641876
J Clin Psychiatry. 2007;68 Suppl 2:10-9
17288502
J Clin Psychiatry. 1999 Jul;60(7):427-35
10453795
PLoS One. 2013 Sep 30;8(9):e71760
24098630