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
Randomized Controlled Trial
. 2023 Jun;53(8):3601-3610.
doi: 10.1017/S003329172200023X. Epub 2022 Feb 8.

A randomized controlled trial of supervised remotely-delivered attention bias modification for posttraumatic stress disorder

Yaron Alon  1 , Omer Azriel  1 , Daniel S Pine  2 , Yair Bar-Haim  1   3
Affiliations
Randomized Controlled Trial

A randomized controlled trial of supervised remotely-delivered attention bias modification for posttraumatic stress disorder

Yaron Alon et al. Psychol Med. 2023 Jun.

Abstract

Background: Many individuals with posttraumatic stress disorder (PTSD) have limited access to first-line treatments, warranting the development of remotely-delivered treatments. Attention bias modification (ABM), targeting perturbed threat-related attentional patterns, shows promise when delivered in-person. However, previous studies found ABM to be ineffective when delivered remotely. Randomized clinical trials usually applied two variations of ABM: ABM away from threat or attention control training (ACT) balancing attention between threat-related and neutral stimuli. We tested remotely-delivered ACT/ABM with tighter supervision and video-based interactions that resemble in-clinic protocols. We expected to replicate the results of in-clinic trials, in which ACT outperformed ABM for PTSD.

Methods: In this double-blinded, parallel-group randomized controlled trial, 60 patients diagnosed with PTSD were randomized (ABM n = 30; ACT n = 30). Patients performed eight bi-weekly remotely-delivered supervised ABM/ACT sessions. Symptoms were assessed pre- and post-treatment with Clinician-Administered PTSD Scale 5 (CAPS-5) severity score and PTSD diagnosis as the primary outcomes. Current depressive episode, current anxiety-related comorbidity, and time elapsed since the trauma were examined as potential moderators of treatment outcome.

Results: Significant decrease in CAPS-5 severity scores and PTSD diagnosis was observed following both ACT and ABM with no between-group difference. Patients without depression or whose trauma occurred more recently had greater symptom reduction in the ACT than the ABM group.

Conclusions: Contrary to our expectation, symptoms decreased similarly following ACT and ABM. Moderator analyses suggest advantage for ACT in non-depressed patients and patients whose trauma occurred more recently. Further refinements in remotely-delivered ABM/ACT may be needed.

Keywords: Attention bias modification; posttraumatic stress disorder; randomized controlled trial; telemedicine.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
CONSORT flow diagram.
Fig. 2.
Fig. 2.
Clinician-rated PTSD symptom severity (CAPS-5) as a function of current severe depressive episode, condition, and time.
Fig. 3.
Fig. 3.
Illustration of change in clinician-rated PTSD symptom severity (CAPS-5) as a function of condition and PTSD chronicity. The graph illustrates decomposition of the interaction between time since trauma and treatment condition based on splitting the time since trauma variable into those below or above the average.
See this image and copyright information in PMC

References

    1. Alon, Y., Naim, R., Pine, D. S., Bliese, P. D., & Bar-Haim, Y. (2019). Validity of attention bias variability indices for posttraumatic stress disorder research: Evidence from patient data. Journal of Traumatic Stress, 32(5), 791–798. 10.1002/jts.22443. - DOI - PMC - PubMed
    1. American Psychiatric Association. (2013). Trauma- and Stressor-Related Disorders. In Diagnostic and statistical manual of mental disorders, fifth edition (pp. 265–290). Arlington, VA: American Psychiatric Association. 10.1176/appi.books.9780890425596.744053. - DOI
    1. Armstrong, T., & Olatunji, B. O. (2012). Eye tracking of attention in the affective disorders: A meta-analytic review and synthesis. Clinical Psychology Review, 32, 704–723. 10.1016/j.cpr.2012.09.004. - DOI - PMC - PubMed
    1. Badura-Brack, A. S., Naim, R., Ryan, T. J., Levy, O., Abend, R., Khanna, M. M., … Bar-Haim, Y. (2015). Effect of attention training on attention bias variability and PTSD symptoms: Randomized controlled trials in Israeli and U.S. Combat Veterans. American Journal of Psychiatry, 172(12), 1233–1241. 10.1176/appi.ajp.2015.14121578. - DOI - PMC - PubMed
    1. Bardeen, J. R., Tull, M. T., Daniel, T. A., Evenden, J., & Stevens, E. N. (2016). A preliminary investigation of the time course of attention bias variability in posttraumatic stress disorder: The moderating role of attentional control. Behaviour Change, 33(2), 94–111. 10.1017/bec.2016.5. - DOI

Publication types