Abstract
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. 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. 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. 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.
Highlights
Posttraumatic stress disorder (PTSD) is associated with major functional impairments (American Psychiatric Association, 2013)
Even when patients do reach to clinics, first-line treatments for posttraumatic stress disorder (PTSD) exhibit high attrition rates (Imel, Laska, Jakupcak, & Simpson, 2013; Maguen et al, 2019; Straud, Siev, Messer, & Zalta, 2019)
Recent reports suggest an advantage for attention control training (ACT) over Attention bias modification (ABM) in PTSD symptom reduction (Badura-Brack et al, 2015; Lazarov et al, 2019a)
Summary
Posttraumatic stress disorder (PTSD) is associated with major functional impairments (American Psychiatric Association, 2013). In-clinic randomized controlled trials (RCTs) for PTSD typically contrasted ABM designed to shift attention away from threats and attention control training (ACT) designed to reduce ABV (Badura-Brack et al, 2015; Lazarov et al, 2019a). Results suggest that both induce symptom reduction (Badura-Brack et al, 2015; Lazarov et al, 2019a; Schoorl, Putman, & van der Does, 2013). Further refinements in remotely-delivered ABM/ACT may be needed
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