Abstract
Individuals with clinical anxiety demonstrate an attention bias toward threatening information, which is thought to be partially driven by heightened amygdala activity to perceived threat. Attention Bias Modification (ABM) is a computer-based treatment that trains attention toward neutral stimuli and away from threatening stimuli. Alterations in initial processing of threat have been linked to ABM responses, but the impact of protracted processing in the aftermath of neutral and threatening information on ABM outcomes has not been well studied. Our study tested whether sustained activity in the amygdala, which occurred after neutral and threatening stimuli had been removed, could predict which individuals would respond well to ABM. Unmedicated anxious individuals underwent a baseline fMRI assessment during performance of a task sensitive to protracted emotional processing. Afterward, they were randomized to complete eight sessions of ABM (n = 38) or a sham training (n = 19). ABM patients who displayed greater sustained bilateral amygdalar response in the aftermath of neutral stimuli displayed the least improvement in self-reported (but not clinician-rated) vigilance symptoms. In contrast, amygdalar response did not predict improvement in sham patients. Results suggest that in certain anxious individuals, the amygdala may have a robust protracted response even to subjectively neutral cues, which could make these individuals a poor fit for ABM because of its focus on repeatedly retraining attention toward neutral cues. Findings may help elucidate neural mechanisms of ABM and promote the identification of a subset of anxious patients who would be good candidates for this intervention.
Highlights
Clinical and subclinical forms of anxiety represent a significant public health burden[1,2], but response rates for current first-line treatments for anxiety stand at only 50–70% with high rates of relapse and low rates of remission[3,4,5,6]
The primary aim of the current study was to determine whether individual differences in protracted amygdalar response in the aftermath of threatening and neutral stimuli could predict Attention Bias Modification (ABM) response
Consistent with our hypotheses, results indicated that sustained bilateral amygdala activity during neutral trials predicted poorer outcomes following ABM treatment in anxious patients, as defined by pre- to post-treatment changes in patient-reported symptoms of vigilance
Summary
Clinical and subclinical forms of anxiety represent a significant public health burden[1,2], but response rates for current first-line treatments for anxiety stand at only 50–70% with high rates of relapse and low rates of remission[3,4,5,6]. Some of the most deleterious transdiagnostic symptoms of anxiety involve involuntary orientation toward and perseveration about potential threats (i.e., vigilance)[7]. The development of novel mechanistic approaches to reduce vigilance may be an essential step in advancing the treatment of anxiety disorders. Among anxious individuals (as a transdiagnostic group), vigilance often manifests at the behavioral level in the form of an attentional preference for threatening information, or an attentional bias (AB)[8]. Anxious individuals orient attention more quickly toward threatening stimuli than neutral stimuli, indicating an AB toward threat[9]. This observation invited speculation that AB may be a mechanism underlying the development and maintenance of anxiety disorders.
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