Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: A randomized controlled trial

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Abstract

Objective

The aim of the current study was to integrate recent developments in the retraining of attentional biases towards threat into a standard cognitive behavioural treatment package for social phobia.

Method

134 participants (M age – 32.4: 53% female) meeting DSM-IV criteria for social phobia received a 12-week cognitive behavioural treatment program. They were randomly allocated to receive on a daily basis using home practice, either an additional computerised probe procedure designed to train attentional resource allocation away from threat, or a placebo variant of this procedure. Measures included diagnostic severity, social anxiety symptoms, life interference, and depression as well as state anxiety in response to a laboratory social threat.

Results

At the end of treatment there were no significant differences between groups in attentional bias towards threat or in treatment response (all p's > 0.05). Both groups showed similar and highly significant reductions in diagnostic severity, social anxiety symptoms, depression symptoms, and life interference at post-treatment that was maintained and in most cases increased at 6 month follow-up (uncontrolled effect sizes ranged from d = 0.34 to d = 1.90).

Conclusions

The current results do not indicate that integration of information processing-derived attentional bias modification procedures into standard treatment packages as conducted in this study augments attentional change or enhances treatment efficacy. Further refinement of bias modification techniques, and better methods of integrating them with conventional approaches, may be needed to produce better effects.

Highlights

► Treatment for social phobia was successful through a comprehensive cognitive behavioural package of 12 sessions. ► Attentional bias modification integrated into the homework component of treatment failed to change attentional biases. ► Attentional bias modification conducted in this way also failed to increase the efficacy of the basic treatment package.

Section snippets

Participants

Participants for the study were 134 individuals meeting Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV: American Psychiatric Association, 2000) criteria for social anxiety disorder who were randomly allocated to either an attention bias modification procedure (ABMP) or placebo training (PT). A planned sample size (N = 128) was determined to allow a minimum difference of 0.5 standard deviation units to be detected at an alpha of 0.05 with 80% power (Faul, Erdfelder,

Descriptive data

Descriptive data on the sample across the two groups are presented in Table 1. As can be seen from the table, the groups differed significantly on two demographic features: the ABMP group contained more males and more participants with avoidant personality disorder.

Training sessions completed and impact on attentional bias

The number of attention training task sessions completed at home across the entire sample over the 12 weeks ranged from 0 to 79, with a median of 39. The two groups did not differ significantly in their mean number of attention

Discussion

Cognitive bias modification procedures have begun to show some promising effects in reducing symptomatology across a range of anxiety disorders, including social anxiety disorder (Hallion & Ruscio, 2011). To date, these experimental techniques have not been combined with standard cognitive behavioural treatment programs for anxiety. The current study represents the first attempt at such integration. According to the current results the incorporation of a home-based probe task attention bias

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