Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 8;10(1):1625690.
doi: 10.1080/20008198.2019.1625690. eCollection 2019.

Appraisal-based cognitive bias modification in patients with posttraumatic stress disorder: a randomised clinical trial

Rianne A de Kleine  1   2   3 , Marcella L Woud  3   4 , Hannah Ferentzi  2   3   5 , Gert-Jan Hendriks  2   3   6 , Theo G Broekman  7 , Eni S Becker  3 , Agnes Van Minnen  2   3   8
Affiliations

Appraisal-based cognitive bias modification in patients with posttraumatic stress disorder: a randomised clinical trial

Rianne A de Kleine et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: Negative appraisals of the trauma and its sequelae play a crucial role in the development and maintenance of Posttraumatic Stress Disorder (PTSD). Experimental studies have shown promise in reducing negative appraisal through Cognitive Bias Modification (CBM) training. Objective: To determine whether an online CBM training designed to modify dysfunctional appraisals is successful in reducing appraisal bias in PTSD patients. Method: In this double-blinded 2-arm randomised clinical trial, 107 patients with PTSD were randomly allocated to active (n = 49) or control online CBM training (n = 57). Training comprised the completion of four sessions of online CBM training within one week. Change in bias, as measured by a scenario task and questionnaire (i.e. PostTraumatic Cognition Inventory), was the primary outcome. Secondary outcome included change in PTSD symptoms. Assessments took place prior to training, during training sessions, post-training and at 1- and 6-month follow-up. Results: Intent-to-treat analysis indicated that there was no interaction effect of condition by time. Regardless of training condition, participants showed a small to moderate decline in appraisal bias and PTSD symptoms from pre- to post-training. In both conditions, bias change during training sessions was related to decline in PTSD symptomatology following training. No moderators of outcome were found. Conclusions: There was no evidence that active training was more effective than control training in reducing dysfunctional appraisals. In both conditions, participants showed a decline in dysfunctional appraisals and PTSD symptoms following training. Importantly, bias reduction during training was related to PTSD symptom decline following training. Explanations and future research directions are discussed.

Antecedentes: Las valoraciones negativas del trauma y sus secuelas juegan un rol crucial en el desarrollo y mantención del Trastorno de Estrés Postraumático (TEPT). Estudios experimentales han mostrado promesa en reducir las valoraciones negativas a través de un entrenamiento de modificación de sesgo cognitivo (MSC).Objetivo: Determinar si un entrenamiento MSC en línea diseñado para modificar valoraciones disfuncionales es exitoso en reducir sesgos de valoración en pacientes con TEPT.Método: En este ensayo clínico randomizado doble ciego de 2 ramas, 107 pacientes con TEPT fueron asignados a entrenamiento MSC en línea activo (n=49) o control (n=57). El entrenamiento incluyó la realización de cuatro sesiones de entrenamiento MSC en línea dentro de una semana. El cambio en el sesgo, medido por un escenario de tareas y cuestionario (por ej. Inventario de Cogniciones Postraumáticas), fue el resultado primario. El resultado secundario incluyó cambios en los síntomas de TEPT. Las evaluaciones fueron realizadas antes del entrenamiento, durante las sesiones de entrenamiento, y posterior al tratamiento al mes y a los 6 meses de seguimiento.Resultados: El análisis del tipo intención de tratar indicó que no hubo efecto en la interacción de la condición según el tiempo. Pese a la condición de entrenamiento, los participantes mostraron una disminución leve a moderada en el sesgo de valoración y síntomas de TEPT desde el periodo anterior y posterior al entrenamiento. En ambas condiciones el cambio en el sesgo durante las sesiones de entrenamiento se relacionó con la disminución de la sintomatología de TEPT tras el entrenamiento. No se encontraron moderadores de resultados.Conclusiones: No hubo evidencia de que el entrenamiento activo fuera más efectivo que el entrenamiento control en reducir las valoraciones disfuncionales. En ambas condiciones, los participantes mostraron una disminución en las valoraciones disfuncionales y síntomas de TEPT tras el entrenamiento. De forma importante, la reducción del sesgo se relacionó con la disminución de sintomatología de TEPT tras el entrenamiento. Explicaciones y orientaciones sobre futura investigación fueron discutidas.

背景：对创伤及其后遗症的负面评价在创伤后应激障碍（PTSD）的发展和维持中起着至关重要的作用。实验研究显示，通过认知偏差校正（CBM）培训减少负面评价具有前景。目的：确定用于校正功能失调评估的在线CBM培训是否能成功降低创伤后应激障碍患者的评估偏差。方法：在这项双盲双臂随机临床试验中，107名创伤后应激障碍患者被随机分配到积极在线CBM训练（n = 49）或对照组（n = 57）中。培训包括在一周内完成四次在线CBM培训。通过情景任务和问卷（即创伤后认知清单）测量的认知偏差变化是主要结果。次要结果包括PTSD症状的改变。测量在培训之前，培训期间，培训后以及1个月和6个月的随访期间进行。结果：治疗意向分析表明，组别与时间没有交互作用。无论训练条件如何，参与者表现出从训练前到训练后评估偏差和创伤后应激障碍症状的轻到中度下降。在两种组别下，训练期间的偏差变化与训练后PTSD症状的下降有相关。但没有找到结果的中介变量。结论：没有证据表明积极训练比控制训练更有效减少功能失调的评估。在这两种情况下，参与者表现出训练后的功能失调评估和创伤后应激障碍症状的下降。重要的是，训练期间的偏倚减少与训练后PTSD症状下降有关。文章讨论了可能的解释和未来的研究方向。.

Keywords: CBM training aimed at reducing negative appraisals yielded promising findings in clinical analogue samples• In this RCT, active CBM training did not lead to a greater decline in dysfunctional appraisals than control training.• This study highlights the impact of appraisal on PTSD symptoms: irrespective of training condition, bias reduction during training was related to lower PTSD symptoms following training. • Follow-up studies are needed to further explore the possible clinical efficacy of CBM interventions in PTSD.; Cognitive bias modification; appraisals; bias posttraumatic stress disorder; randomised clinical trial; trauma-related cognitions.

PubMed Disclaimer

Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Progress of participants in the study.
See this image and copyright information in PMC

References

    1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Press.
    1. Amir N., Coles M. E., & Foa E. B. (2002). Automatic and strategic activation and inhibition of threat-relevant information in posttraumatic stress disorder. Cognitive Therapy and Research, 26(5), 645–12.
    1. Beck A. T., Steer R. A., & Garbin M. G. (1988). Psychometric properties of the beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.
    1. Beck A. T., Ward C. H., Mendelson M., Mock J., & Erbaugh J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. - PubMed
    1. Blackwell S. E., Woud M. L., & MacLeod C. (2017). A question of control? Examining the role of control conditions in experimental psychopathology using the example of cognitive bias modification research. Spanish Journal of Psychology, 20, E54. - PubMed