Neural changes with attention bias modification for anxiety: a randomized trial

Jennifer C Britton¹, Jenna G Suway², Michelle A Clementi², Nathan A Fox³, Daniel S Pine³, Yair Bar-Haim³

Affiliations

¹ Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel j.britton@miami.edu.
² Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel.
³ Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel.

PMID: 25344944
PMCID: PMC4483563
DOI: 10.1093/scan/nsu141

Randomized Controlled Trial

Neural changes with attention bias modification for anxiety: a randomized trial

Jennifer C Britton et al. Soc Cogn Affect Neurosci. 2015 Jul.

. 2015 Jul;10(7):913-20.

doi: 10.1093/scan/nsu141. Epub 2014 Oct 24.

Authors

Jennifer C Britton¹, Jenna G Suway², Michelle A Clementi², Nathan A Fox³, Daniel S Pine³, Yair Bar-Haim³

Affiliations

¹ Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel j.britton@miami.edu.
² Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel.
³ Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, 20892 USA, Department of Psychology, University of Miami, Coral Gables, FL, 33146 USA, Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742 USA, Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, 92120 USA, Department of Psychology, University of Houston, Houston, TX, 77204 USA, and School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, 69978 Israel.

PMID: 25344944
PMCID: PMC4483563
DOI: 10.1093/scan/nsu141

Abstract

Attention bias modification (ABM) procedures typically reduce anxiety symptoms, yet little is known about the neural changes associated with this behavioral treatment. Healthy adults with high social anxiety symptoms (n = 53) were randomized to receive either active or placebo ABM. Unlike placebo ABM, active ABM aimed to train individuals' attention away from threat. Using the dot-probe task, threat-related attention bias was measured during magnetic resonance imaging before and after acute and extended training over 4 weeks. A subset of participants completed all procedures (n = 30, 15 per group). Group differences in neural activation were identified using standard analyses. Linear regression tested predictive factors of symptom reduction (i.e., training group, baseline indices of threat bias). The active and placebo groups exhibited different patterns of right and left amygdala activation with training. Across all participants irrespective of group, individuals with greater left amygdala activation in the threat-bias contrast prior to training exhibited greater symptom reduction. After accounting for baseline amygdala activation, greater symptom reduction was associated with assignment to the active training group. Greater left amygdala activation at baseline predicted reductions in social anxiety symptoms following ABM. Further research is needed to clarify brain-behavior mechanisms associated with ABM training.

Trial registration: ClinicalTrials.gov NCT00018057.

Keywords: amygdala; anxiety; attention training; dot-probe; fMRI; treatment.

Published by Oxford University Press 2014. This work is written by US Government employees and is in the public domain in the US.

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Figures

**Fig. 2**
Neural changes associated with ABM training. Whole brain, random-effects analyses indicated three-way interactions (Group × Time × Condition) in the right and left amygdala: [right: (16, − 1, −9), 54 voxels (844 mm³), F(4,112) = 4.3, p < 0.05 corrected; left: (−19, 1, −11), 49 voxels (766 mm³), F(4,112) = 5.4, p < 0.05 corrected]. To decompose this three-way interaction, the percent signal-change values, relative to fixation, across significant voxels in each whole-brain cluster were averaged for each condition for each participant. *Post-hoc* analysis examined the threat bias contrast (i.e. threat incongruent > congruent).

**Fig. 3**
Predictors of symptom reduction. Panel A: Across both groups, left amygdala activation to threat bias contrast prior to training predicted symptom reduction (scores on LSAS from screening to post-extended training). Panel B: The active group showed greater symptom reduction than the placebo group.

See this image and copyright information in PMC

References

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Neural changes with attention bias modification for anxiety: a randomized trial

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Neural changes with attention bias modification for anxiety: a randomized trial

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