Attention Bias Modification Training Research Articles

Attentional bias modification is associated with fMRI response toward negative stimuli in individuals with residual depression: a randomized controlled trial

Attentional bias modification (ABM) may lead to more adaptive emotion perception and emotion regulation. Understanding the neural basis of these effects may lead to greater precision for the development of future treatments. Task-related functional MRI (fMRI) after ABM training has not been investigated in depression so far. The main aim of this randomized controlled trial was to explore differences in brain activity after ABM training, in response to emotional stimuli. A total of 134 people with previous depression, who had been treated for depression and had various degrees of residual symptoms, were randomized to 14 days of active ABM or a closely matched placebo training, followed by an fMRI emotion regulation task. The training procedure was a classical dot–probe task with emotional face stimuli. In the active ABM condition, the probes replaced the more positively valenced face of a given pair. As participants implicitly learned to predict the probe location, this would be likely to induce a more positive attentional bias. The placebo condition was identical, except for the contingency of the probe, which appeared equally behind positive and negative stimuli. We compared depression symptoms and subjective ratings of perceived negativity during fMRI between the training groups. We explored brain activation in predefined regions of interest and across the whole brain. We explored activation in areas associated with changes in attentional bias and degree of depression. Compared with the placebo group, the ABM group showed reduced activation in the amygdala and the anterior cingulate cortex when passively viewing negative images. We found no group differences in predefined regions of interest associated with emotion regulation strategies. Response in the temporal cortices was associated with the degree of change in attentional bias and the degree of depressive symptoms in ABM versus placebo. These findings should be replicated in other samples of patients with depression, and in studies using fMRI designs that allow analyses of within-group variability from baseline to follow-up. Attentional bias modification training has an effect on brain function in the circuitry associated with emotional appraisal and the generation of affective states. NCT02931487

Is It Possible to Train the Focus on Positive and Negative Parts of One's Own Body? A Pilot Randomized Controlled Study on Attentional Bias Modification Training.

Dysfunctional body- and shape-related attentional biases are involved in the etiology and maintenance of eating disorders (ED). Various studies suggest that women, particularly those with ED diagnoses, focus on negatively evaluated parts of their own body, which leads to an increase in body dissatisfaction. The present study aims to empirically test the hypothesis that non-ED women show an attentional bias toward negative body parts and that the focus on positive and negative parts of one’s own body can be modified by attentional bias modification training based on a dot-probe task. Although several studies have measured body-related attentional biases by using pictures of participants’ own bodies, the approach of investigating attentional bias via a dot-probe task while presenting pictures of the participants’ own body parts and modifying the biased attention using such pictures is novel. Women (n = 60) rank-ordered 10 parts of their own body regarding their attractiveness. To examine and modify the attentional focus, pictures of the self-defined positive and negative parts of one’s own body were presented by means of a dot-probe task. A paired-sample t-test revealed no difference between reaction times to negative compared to positive body parts, indicating no attentional bias toward negative parts of one’s own body. A two-way ANOVA revealed a main effect of time for pictures of positive and negative parts of one’s own body, with a decrease in reaction times from pre- to post-training. However, there was no significant interaction between time and training condition concerning reaction times to positive and negative body parts. Our findings replicate previous evidence of a balanced attentional pattern regarding one’s own body in women without ED diagnoses. However, the dot-probe task failed to modify the attentional focus. As the modifiability of state body image increases with more pronounced body dissatisfaction, the next step would be to test this approach in clinical samples of women with ED diagnoses.

Attentional Bias Modification in Virtual Reality – A VR-Based Dot-Probe Task With 2D and 3D Stimuli

BackgroundAttentional bias modification (ABM) aims to reduce anxiety by attenuating bias toward threatening information. The current study incorporated virtual reality (VR) technology and three-dimensional stimuli with a dot-probe task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.MethodsA total of 100 participants were randomized to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-months follow-up.ResultsChange in anxiety did not correlate with change in bias (p = 0.24). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM (p = 0.144), or between groups (p = 0.976). For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < 0.001). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 9% of participants were classified as ‘recovered’ at 3-months follow-up.ConclusionA single session of VR-based ABM did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.

Linear Ballistic Accumulator Modeling of Attentional Bias Modification Revealed Disturbed Evidence Accumulation of Negative Information by Explicit Instruction.

In recent years, several attentional bias modification (ABM) studies have been conducted. Previous studies have suggested that explicit instruction (i.e., informing participants of the contingency of stimuli) enhances the effect of ABM. However, the specific working mechanism has not been identified. This is partly because reaction time (RT) data are typically reduced to an attention bias score, which is a mere difference of RT between experimental and control conditions. This data reduction causes a loss of information, as RT reflects various cognitive processes at play while making a response or decision. To overcome this issue, the present study applied linear ballistic accumulator (LBA) modeling to the outcomes (RT measures) of explicitly guided (compared to standard) ABM. This computational modeling approach allowed us to dissociate RTs into distinct components that can be relevant for attentional bias, such as efficiency of information processing or prior knowledge of the task; this provides an understanding of the mechanism of action underlying explicitly guided ABM. The analyzed data were RT-observed in the dot-probe task, which was administered before and after 3-days of ABM training. Our main focus was on the changes in LBA components that would be induced by the training. Additionally, we analyzed in-session performances over the 3 days of training. The LBA analysis revealed a significant reduction in processing efficiency (i.e., drift rate) in the congruent condition, where the target probe is presented in the same location as a negative stimulus. This explains the reduction in the overall attentional bias score, suggesting that explicit ABM suppresses processing of negative stimuli. Moreover, the results suggest that explicitly guided ABM may influence prior knowledge of the target location in the training task and make participants prepared to respond to the task. These findings highlight the usefulness of LBA-based analysis to explore the underlying cognitive mechanisms in ABM, and indeed our analyses revealed the differences between the explicit and the standard ABM that could not be identified by traditional RT analysis or attentional bias scores.

Efficacy and mechanisms underlying a gamified attention bias modification training in anxious youth: protocol for a randomized controlled trial

BackgroundAttention bias modification training (ABMT) and cognitive behavioral therapy (CBT) likely target different aspects of aberrant threat responses in anxiety disorders and may be combined to maximize therapeutic benefit. However, studies investigating the effect of ABMT in the context of CBT have yielded mixed results. Here, we propose an enhanced ABMT to target the attentional bias towards threat, in addition to classic CBT for anxiety disorders in youth. This enhanced ABMT integrates the modified dot-probe task used in previous studies, where a target is always presented at the previous location of the neutral and not the simultaneously presented threatening stimulus, with a visual search, where the targets are always presented distally of threatening distractors. These two training elements (modified dot-probe and visual search) are embedded in an engaging game to foster motivation and adherence. Our goal is to determine the efficacy of the enhanced ABMT in the context of CBT. Further, we aim to replicate two previous findings: (a) aberrant amygdala connectivity being the neurobiological correlate of the attentional bias towards threat at baseline; and (b) amygdala connectivity being a mediator of the ABMT effect. We will also explore moderators of treatment response (age, sex, depressive symptoms and irritability) on a behavioral and neuronal level.MethodsOne hundred and twenty youth (8–17 years old) with a primary anxiety disorder diagnosis all receive CBT and are randomized to nine weeks of either active or control ABMT and symptom improvement will be compared between the two study arms. We will also recruit 60 healthy comparison youth, who along with eligible anxious youth, will be assessed with the dot-probe task during fMRI (anxious youth: before and after training; healthy volunteers: second measurement twelve weeks after initial assessment).DiscussionThe present study will contribute to the literature by (1) potentially replicating that aberrant amygdala connectivity mediates the attentional bias towards threat in anxious youth; (2) determining the efficacy of enhanced ABMT; and (3) advancing our understanding of the mechanisms underlying ABMT.Trial registrationClinicaltrials.gov: NCT03283930 Trial registration date: September 14th 2017. The trial registration took place retrospectively. Data acquisition started February 1st 2017.

Cognitive training on eating behaviour and weight loss: A meta-analysis and systematic review.

Cognitive deficits play a role in the development and maintenance of overeating and obesity, and cognitive training in obesity refers to a family of interventions aimed at reducing overeating and obesity by improving these cognitive deficits. In this review, we synthesize the current literature on these issues by conducting a meta-analysis of studies investigating the effects of cognitive trainings on eating behaviour and presenting a systematic review of studies investigating the effects of cognitive trainings on weight loss. We examined 66 independent experiments that examined the effects of cognitive training aimed at reducing cognitive bias or improving executive control on eating behaviour and weight loss. Overall, inhibition training, attention bias modification training, and episodic future thinking training significantly influenced eating behaviour; however, approach/avoidance training did not significantly influence eating behaviour. Moderator analyses indicated that the effect of inhibition training on eating behaviour was moderated by training task and food novelty, the effect of approach/avoidance training was moderated by food type, and the effect of episodic future thinking training was moderated by type of episodic future thinking. Literature reviewed on cognitive training and weight loss provided preliminary support for the effects of food-specific inhibition training on weight loss from pre-intervention to post intervention. However, because most of the included studies focused on short-term outcomes in normal-weight samples, longer duration studies in clinical populations (eg, individuals with obesity) are needed to examine the generalizability of these results.

Brain structure changes induced by attention bias modification training

Attention bias modification (ABM) therapy aims to reduce anxiety by changing threat-related attention patterns using computerized training tasks. We examined changes in brain microstructure following ABM training. Thirty-two participants were randomly assigned to one of two training conditions: active ABM training shifting attention away from threat or attention control training involving no attention modification. Participants completed six lab visits, including five training sessions and three diffusion tensor imaging scans: immediately before and after the first training session, and at the end of the training series. Indices of local and global changes in microstructure and connectivity were measured. Significant longitudinal differences in fractional anisotropy (FA) between the active and control training regimens occurred in inferior temporal cortex. Changes in FA occurred across groups within ventromedial prefrontal cortex and middle occipital gyrus. These results indicate specific effects of active ABM on brain structure. Such changes could relate to clinical effects of ABM.

Learning to Look at the Bright Side of Life: Attention Bias Modification Training Enhances Optimism Bias.

Identifying neurocognitive mechanisms underlying optimism bias is essential to understand its benefits for well-being and mental health. The combined cognitive biases hypothesis suggests that biases (e.g., in expectancies and attention) interact and mutually enforce each other. Whereas, in line with this hypothesis, optimistic expectancies have been shown to guide attention to positive information, reverse causal effects have not been investigated yet. Revealing such bidirectional optimism-attention interactions both on a behavioral and neural level could explain how cognitive biases contribute to a self-sustaining upward spiral of positivity. In this behavioral study, we hypothesized that extensive training to direct attention to positive information enhances optimism bias. To test this hypothesis, for 2 weeks, 149 participants underwent either daily online 80-trial attention bias modification training (ABMT) toward accepting faces and away from rejecting faces or neutral control training. Participants in the ABMT group were instructed to click as quickly as possible on the accepting face among 15 rejecting faces randomly displayed on a 4-by-4 matrix; participants in the control group were instructed to click on the five-petaled flower depicted among 15 seven-petaled flowers. Comparative optimism bias and state optimism were measured via questionnaires before training, after one training week, and after two training weeks. ABMT enhanced comparative optimism bias, whereas control training did not. Our findings reveal that ABMT toward positive social information causally influences comparative optimism bias and may, thereby trigger the biases’ benefits for well-being and mental health. These results can (a) stimulate future neurophysiological research in the area of positive psychology; and (b) reveal an innovative low-cost and easy-to-access intervention that may support psychotherapy in times of rising numbers of patients with psychological disorders.

The Effect of Attentional Bias Modification Training on Attentional Bias for High-calorie Food Cues in the Obese with Binge Eating

The obese with binge eating has more biased attention to food than the obese without binge eating, which causes a risk of food cravings and binge eating problems. A direct treatment of the automatic attentional bias on high-calorie food cues is expected to reduce the attentional bias and binge eating. The goal of this study is to examine the effect of attentional bias modification (ABM) training, which is a method of training that disengage attentional bias for high-calorie food cues. 346 participants were divided into 25 obese female with binge eating and 25 obese female without binge eating, respectively, based on BMI, body fat percentage and binge eating scale. Each group completed self-report questionnaires, free viewing task, gap-overlap task before and after ABM training. And also food intake was measured before and after training. The results showed that only obese without binge eating showed a significant decrease in attentional bias for high-calorie food cues after ABM training. In addition, the obese with binge eating consumed more high-calorie foods than low-calorie foods after ABM training. These results suggest that the obese with binge eating have to conduct repeated ABM training because their attentional bias and binge eating problems are more serious than the obese without binge eating.

Neutral and Positive Attention Bias Modification Training for Young Adults With Depressive Symptoms

Neutral and Positive Attention Bias Modification Training for Young Adults With Depressive Symptoms

Neurocognitive mechanisms of prefrontal stimulation

The difficulty in treating mood and anxiety disorders has sparked clinical interest in novel treatments, such as transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC). However, underlying mechanisms of action are unclear. It is established that people with mood and anxiety disorders have negative cognitive biases, such as increased vigilance to threat. Psychiatric treatments have acute effects on these cognitive biases, which predict later therapeutic action. Such effects are proposed as cognitive biomarkers of response. A healthy volunteer investigation revealed an anxiolytic-like effect (reduced threat vigilance) of single-session tDCS on a behavioural test of proven clinical relevance (Ironside et al., 2016, Biological Psychiatry). Complementing this, we used functional imaging to reveal that, in a sample of trait anxious females, tDCS of the DLPFC increased activation in an attentional control network and reduced amygdala response to fearful face distractors (Ironside et al., under revision, JAMA Psychiatry). This provides causal evidence that modulating activity in the DLPFC inhibits amygdala response to threat, providing a potential neural mechanism for the previous reduction in vigilance to threat. Collectively, these results propose an emerging neurocognitive model of the mechanisms of action of tDCS. We also examined pairing tDCS with attentional bias modification training and found no effect of stimulation. However, DLPFC tDCS has been successfully paired with other paradigms such as cognitive control training. As highlighted in the next talks, we suggest that computationally specified learning tasks may be more sensitive. Together, findings point to an anxiolytic-like effect of DLPFC tDCS on cognitive and neural biomarkers relevant to mood and anxiety disorders, indicating potential neurocognitive mechanisms that may mediate the reported clinical efficacy of DLPFC tDCS. This has implications as the identification of treatment response markers that could aid patient selection for future trials and ultimately guide treatment selection for patients.

Effects of Attentional Bias Modification on residual symptoms in depression: a randomized controlled trial

BackgroundFollowing treatment, many depressed patients have significant residual symptoms. However, large randomised controlled trials (RCT) in this population are lacking. When Attention bias modification training (ABM) leads to more positive emotional biases, associated changes in clinical symptoms have been reported. A broader and more transparent picture of the true advantage of ABM based on larger and more stringent clinical trials have been requested. The current study evaluates the early effect of two weeks ABM training on blinded clinician-rated and self-reported residual symptoms, and whether changes towards more positive attentional biases (AB) would be associated with symptom reduction.MethodA total of 321 patients with a history of depression were included in a preregistered randomized controlled double-blinded trial. Patients were randomised to an emotional ABM paradigm over fourteen days or a closely matched control condition. Symptoms based on the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory II (BDI-II) were obtained at baseline and after ABM training.ResultsABM training led to significantly greater decrease in clinician-rated symptoms of depression as compared to the control condition. No differences between ABM and placebo were found for self-reported symptoms. ABM induced a change of AB towards relatively more positive stimuli for participants that also showed greater symptom reduction.ConclusionThe current study demonstrates that ABM produces early changes in blinded clinician-rated depressive symptoms and that changes in AB is linked to changes in symptoms. ABM may have practical potential in the treatment of residual depression.Trial registrationClinicalTrials.gov ID: NCT02658682 (retrospectively registered in January 2016).

A Randomized Controlled Trial of Attention Bias Modification Treatment in Youth With Treatment-Resistant Anxiety Disorders.

Randomized clinical trials of augmentation strategies for youth with treatment-resistant anxiety disorders do not exist. This report presents findings from an efficacy trial of attention bias modification treatment (ABMT) as an augment for this population compared with attention control training (ACT). Sixty-four youths (34 boys; mean age 11.7 years) who continued to meet for anxiety diagnoses after completing cognitive-behavioral therapy were randomized to ABMT or ACT. ABMT and ACT consisted of dot-probe attention training trials presenting angry and neutral faces; probes appeared in the location of neutral faces on 100% of trials in ABMT and 50% of trials in ACT. Independent evaluators, youths, and parents completed ratings of youth anxiety severity, and youths completed measures of attention bias to threat and attention control at pretreatment, post-treatment, and 2-month follow-up. The 2 arms showed significant decreases in anxiety severity, with no differences between arms. Specifically, across informants, anxiety severity was significantly decreased at post-treatment and decreases were maintained at follow-up. Primary anxiety disorder diagnostic recovery combined across arms was 50% at post-treatment and 58% at follow-up. Attention control, but not attention bias to threat, was significantly improved at post-treatment in the 2 arms. This is the first study to show anxiety can be decreased in youth who did not respond to cognitive-behaviorial therapy, and that the anxiety-decreasing effect is found using these 2 attention training contingency schedules. These findings and increases in attention control in the 2 arms raise intriguing questions about mechanisms of decreasing anxiety in treatment-resistant youth with attention training that require further research. Attention Bias Modification Training for Child Anxiety CBT Nonresponders; https://clinicaltrials.gov/; NCT01819311.

Attentional Bias Modification Training for Patients with Generalised Anxiety Disorder: a Randomised Controlled Study

Hypervigilance to threat is a mechanism contributing to generalised anxiety disorder (GAD). Although attentional bias modification training (ABMT) is designed to reduce attention to threat, its use as a mechanistically focused psychological intervention for GAD has not been examined. We aimed to investigate the effect of a brief ABMT on reducing anxiety, worry, and attentional bias in outpatients with GAD, and to determine the association between change in attentional bias and changes in anxiety and worry. This was a parallel-group, double-blind, randomised controlled trial. Patients with GAD who had no changes after medication treatment for the past 8 weeks were randomly allocated to either the treatment or control group to receive 4 weekly sessions of ABMT or sham ABMT, respectively, in addition to standard care. Anxiety was measured using the Hamilton Anxiety Rating Scale and the State-Trait Anxiety Inventory - trait anxiety subscale. Pathological worry was measured using the Penn State Worry Questionnaire. Attentional bias was measured using the bias score. A total of 33 participants were allocated to the treatment (n = 17) or control (n = 16) groups. Both groups reported a significant reduction in levels of anxiety and worry after intervention, but the reduction was not greater after ABMT than sham ABMT. There was no significant change in attentional bias after ABMT; change in attentional bias was not correlated to changes in anxiety and worry. The efficacy of the brief ABMT as a mechanistically focused treatment for GAD was not supported. The small sample size and short duration of treatment may have rendered the results inconclusive.

The Effect of Pictorial Health Warnings on Attention Bias and Attention Bias Modification Training in University Student Smokers

The Effect of Pictorial Health Warnings on Attention Bias and Attention Bias Modification Training in University Student Smokers

Gaze-contingent Attention Bias Modification Training and its Effect on Attention, Interpretations, Mood, and Aggressive Behavior

Cognitive theories propose that aggression is associated with specific patterns of attention to social cues, and suggest that cognitive biases in attention and interpretation are interrelated, The current study tested whether these attention patterns can be altered using a single session of a novel gaze-contingent cognitive bias modification paradigm (CBM-A) and assessed the impact of this on interpretation bias, aggressive behavior and mood. University students (18–31 years) were randomly assigned to either a single session of positive training (n = 40) aimed at increasing attention to pro-social cues, or negative training (n = 40) aimed at increasing attention to negative cues. Results showed that the positive training indeed resulted in an increase in pro-social attention bias, while the negative training seemed not to have an effect on attention to negative cues. Both groups did not differ on their interpretations, mood levels, self-reported aggression and behavioral aggression. Findings suggest that this novel gaze-contingent CBM-A paradigm can indeed alter biased gaze processes, but may not impact interpretations, aggression and mood. The current study was conducted in a non-clinical sample, further research with a clinical aggressive sample, such as forensic patients is necessary to further explore these issues.

Combining attentional bias modification with dorsolateral prefrontal rTMS does not attenuate maladaptive attentional processing

High frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to reduce depressive symptoms and improve cognitive biases such as attentional bias. One promising technique that may complement rTMS treatment is attentional bias modification (ABM) training, given the similarity in modulating attentional bias and affecting neuronal activity. We tested whether the combination of rTMS treatment and ABM training in a single session would attenuate maladaptive attentional processing and improve mood in participants with subclinical depressive symptoms. To this end, 122 healthy participants were randomly assigned to one of four groups, receiving either a single rTMS treatment, a single ABM treatment, a combination of rTMS and ABM or a sham treatment. Of these 122 participants, 72 showed a heightened BDI-II score (between 9 and 25) and were included in our main analyses. In our subclinical (≥9 and ≤25 BDI-II) sample, a single combination treatment of rTMS and ABM training induced no significant changes in attentional bias, attentional control or mood, nor did rTMS alone affect attentional bias systematically. We discuss these null findings in light of the task specifics and relate them to the ongoing discussion on ABM training in depression.

Investigating the Effects of Inhibition Training on Attentional Bias Change: A Simple Bayesian Approach.

Attention bias modification (ABM), in which participants are trained to direct attention away from negative information, has been shown to reduce anxiety. However, such findings have been inconsistent. Changes in attentional bias are often absent, suggesting need for further investigation of the underlying mechanisms of ABM, as well as better statistical methods to analyze ABM data in order to reduce inferential error. In this study, we (a) compared inhibition control training to standard ABM training conditions, and (b) demonstrated the benefits of using simple Bayesian analyses to analyze ABM data. We recruited 116 participants and assessed their attentional bias prior to and after training, which involved practice avoiding negative stimuli, attending to negative stimuli, or avoiding a non-emotional, exogenous attentional cue (inhibitory control training). Our results suggested no impact of any of the training conditions on attentional bias. We further demonstrate Bayesian analyses may help control for both Type I and Type II error relative to a frequentist approach.

Improving the Efficacy of Cognitive Training for Digital Mental Health Interventions Through Avatar Customization: Crowdsourced Quasi-Experimental Study.

BackgroundThe success of internet-based mental health interventions in practice—that is, in the wild—depends on the uptake and retention of the application and the user’s focused attention in the moment of use. Incorporating game-based motivational design into digital interventions delivered in the wild has been shown to increase uptake and retention in internet-based training; however, there are outstanding questions about the potential of game-based motivational strategies to increase engagement with a task in the moment of use and the effect on intervention efficacy.ObjectiveDesigners of internet-based interventions need to know whether game-based motivational design strategies can increase in-the-moment engagement and thus improve digital interventions. The aim of this study was to investigate the effects of 1 motivational design strategy (avatar customization) in an example mental health intervention (computerized cognitive training for attention bias modification).MethodsWe assigned 317 participants to either a customized avatar or an assigned avatar condition. After measuring state anxiety (State-Trait Anxiety Inventory), we randomly assigned half of the participants in each condition to either an attentional retraining condition (Attention Bias Modification Training) or a control condition. After training, participants were exposed to a negative mood induction using images with strong negative valance (International Affective Picture System), after which we measured state anxiety again.ResultsAvatar customization decreased posttraining state anxiety when controlling for baseline state anxiety for those in the attentional retraining condition; however, those who did not train experienced decreased resilience to the negative mood induction (F1,252=6.86, P=.009, ηp2=.027). This interaction effect suggests that customization increased task engagement with the intervention in the moment of use. Avatar customization also increased avatar identification (F5,252=12.46, P<.001, R2=.23), regardless of condition (F1,252=.79, P=.38). Avatar identification reduced anxiety after the negative mood induction for participants who underwent training but increased poststimulus anxiety for participants who did not undergo training, further suggesting that customization increases engagement in the task (F1,252=6.19, P=.01). The beneficial effect of avatar customization on training was driven by participants who were low in their basic satisfaction of relatedness (F10,248=18.5, P<.001, R2=.43), which is important because these are the participants who are most likely in need of digital interventions for mental health.ConclusionsOur results suggest that applying motivational design—specifically avatar customization—is a viable strategy to increase engagement and subsequently training efficacy in a computerized cognitive task.

Home-delivered attention bias modification training via smartphone to improve attention control in sub-clinical generalized anxiety disorder: A randomized, controlled multi-session experiment.

Mogg and Bradley (2016) proposed that attentional bias (to threat stimuli) among patients with generalized anxiety disorder (GAD) may be associated with the top-down attention control process. Additionally, some scholars (e.g., Enock & McNally, 2013) have designed mobile applications to enable patients to engage in home-delivered attentional bias modification (HD-ABM); however, many problems related to these training systems have not yet been addressed. A total of 82 participants (61 women, mean age = 21.47 y) who received GAD diagnoses were randomly assigned to an HD-ABM (n = 30), placebo training (n = 30), or waiting list (n = 22) group. Both the HD-ABM and placebo groups were trained with the attention training application (through Android phones three times a day for four weeks). (1) All measures of participants' self-reported symptoms (except for trait anxiety) were significantly lower in Week 4 and in the follow-up. (2) Attentional network test (ANT) results demonstrated that all participants' alerting scores significantly increased by Week 4. (3) Participants in the HD-ABM and placebo groups demonstrated significant increases in their self-reported attention control scores, decreases in their attention bias index (ABI) scores, and progress in their executive control abilities. Self-report scales may have been insufficient for measuring effectiveness in the present study. This study helps to elucidate the mechanism underlying changes in attention processes after HD-ABM training implemented through a mobile application in GAD.