Attention Bias Modification Research Articles

Visual search attentional bias modification reduced the attentional bias in socially anxious individuals.

Recent years have raised questions about the effectiveness of attentional bias modification (ABM) in individuals with social anxiety. In the current study, we employed a novel training method-ABM-positive-search training-to modify attentional bias in socially anxious individuals. The attentional bias was measured using the dot-probe task, and brain electrical activity was recorded. The ABM-positive-search group was instructed to search for a happy face in a 3 × 3 visual array. The placebo control group was asked to find out whether the only male from the female or the only female from the male. In terms of behavioral indicators, the results showed a significant reduction in the variability of trial level-bias score (TL-BS) in the ABM-positive-search group post-training. However, there was no significant change observed in the placebo control group. The electrophysiological results were consistent with the behavioral findings. To be specific, both groups displayed the N2pc effect in response to threatening faces before the training. After training, the N2pc effect disappeared in the ABM-positive search group, while it remained in the placebo control group. In conclusion, ABM-positive-search training can effectively modify the attentional bias of socially anxious individuals, and cognitive control plays an important role in this process.

Attention and nocebo hyperalgesia: Testing a novel virtual reality attention bias modification paradigm

Nocebo effects in pain (nocebo hyperalgesia) have received significant attention recently, with negative expectancies and anxiety proposed to be explanatory factors. While both expectancy and anxiety can bias attention, attention has been rarely explored as a potential mechanism involved in nocebo hyperalgesia. The present study aimed to explore whether attention bias modification (ABM) using an immersive, ecologically valid VR paradigm successfully induced attention biases (AB) and subsequently influenced nocebo hyperalgesia. One-hundred and two healthy participants were randomised in a 2 (AB training: towards vs. away from pain) x 2 (nocebo condition: nocebo vs. control) design. Pain-related AB was successfully changed by the VR paradigm as measured by reaction time and gaze, with moderate to large effects. Participants then completed either a nocebo instruction and conditioning procedure (nocebo paradigm) or a matched control procedure. The primary outcome was self-reported pain intensity. Secondary outcomes were attention bias and self-reports of expectancy, anticipatory anxiety, and state anxiety. The nocebo paradigm induced significantly greater pain expectancy, anticipatory anxiety and pain intensity during the test phase for the nocebo group compared to control. Pain expectancy also fully mediated the effect of the nocebo group on nocebo hyperalgesia and anticipatory anxiety in separate models. ABM did not, however, affect nocebo hyperalgesia or pain expectancy, casting doubt on the potential for ABM to inoculate against nocebo hyperalgesia. Unexpected effects of ABM were observed for state anxiety and anticipatory anxiety, whereby training away from pain exacerbated each, which necessitates further exploration. PerspectiveThis article tests the efficacy of a novel attention bias modification paradigm, designed in virtual reality, for inducing pain-related biases, and whether these biases exacerbate or inoculate against nocebo hyperalgesia. While pain-related biases were successfully induced, there was no relationship with the strength of induced nocebo hyperalgesia.

The effect of attentional bias modification on positive affect dynamics

Negative attentional bias and alterations in positive affect dynamics constitute emotional vulnerability to depression. Attentional bias modification (ABM) aims to reduce emotional vulnerability to depression by fostering attentional deployment towards positive stimuli. In this randomized controlled trial, we examined whether ABM leads to changes in positive affect dynamics in a sample with an emotional vulnerability to depression (N = 65). Affect dynamics were measured based on experience sampling data gathered 14 days before and after ABM. During ABM, participants paid attention to pairs of emotional faces and responded to dots that were appearing in their place. There was an 87% chance for the dots to appear in place of the relatively more positive face, with the purpose to implicitly foster attentional focus on positive stimuli. In the control condition, there was a 50% chance of the dots to appear in place of the positive stimuli. Results showed that the lag-1 autocorrelation of affect (“inertia”) increased within the ABM group and decreased in the control group, but the findings were not robust and it was unclear whether ABM was the cause. There were no changes in the other affect dynamics indices. Improvements in depression during ABM were not associated with changes in affect dynamics, and affect dynamics post ABM did not predict depression symptoms six months later. In conclusion, the study showed no clear effect of ABM on affect dynamics.

Depressive self-focus bias following failure: an eye-tracking study among individuals with clinical depression.

Depression is often characterized by a persistent sense of failure. Cognitive theories of depression suggest that depressed individuals may exhibit a maladaptive cognitive style, characterized by increased self-focus following personal failure. The validity of this proposition, however, is yet to be fully examined. This study aimed to identify the relation between symptoms in major depressive disorder and increased self-focus in failure situations. This clinical study involved a cohort of 30 patients diagnosed with and treated for depression. We used an eye-tracking paradigm to observe and analyze gaze direction - indicative of either self-focus or self-avoidance - after remembering a significant failure event. Contrary to the maladaptive cognitive style hypothesis, a majority of the depressed participants demonstrated an inclination towards self-avoidance following failure. Nevertheless, approximately 30% of the patient group - those with the highest scores of guilt, punishment, and self-blame - displayed a self-focused attentional bias post-failure. The presence of a maladaptive self-focusing style may be confined to severely depressed patients with high levels of guilt, punishment, and self-blame. These findings could have substantial clinical implications, as attention bias modification interventions could be particularly beneficial for this subgroup of patients.

Comparative Analysis of LORETA Z Score Neurofeedback and Cognitive Rehabilitation on Quality of Life and Response Inhibition in Individuals with Opioid Addiction.

Background. Previous studies has shown that conventional neurofeedback and cognitive rehabilitation can improve psychological outcomes in people with opioid use disorders. However, the effectiveness of LORETA Z-score neurofeedback (LZNFB) and attention bias modification training on quality of life and inhibitory control of these people has not been investigated yet. LZNFB targets deeper brain structures with higher precision, compared to conventional neurofeedback that typically focuses on surface EEG activity. The present study aims to compare the effect of these two methods on quality of life and response inhibition in men with opioid use disorders under methadone maintenance therapy (MMT). Methods. In this randomized controlled clinical trial with a pre-test, post-test, follow-up design, 30 men with opioid use disorders under MMT were randomly assigned into three groups of LZNFB, attention bias modification training, and control (MMT alone). The LZNFB and Cognitive Rehabilitation groups received 20 and 15 sessions of treatment, respectively. The Persian versions WHO Quality of Life-BREEF questionnaire and the Go/No-Go test were completed by the participants before, immediately after, and one month after interventions. The collected data were analyzed in SPSS v.22 software. Results. Both intervention groups showed a significant improvement in quality-of-life score and a significant reduction in response time at the post-test phase (P < .05), where LZNFB group showed more improvement in quality of life and more reduction in response inhibition. After one month, the increase in quality of life continued in both groups, while the decrease in response time continued only in the LZNFB group. Conclusion. Both LZNFB and attention bias modification training are effective in improving quality of life and response inhibition of men with OUD under MMT, however, LZNFB is more effective.

Smartphone-Delivered Attentional Bias Modification Training for Mental Health: Systematic Review and Meta-Analysis.

Smartphone-delivered attentional bias modification training (ABMT) intervention has gained popularity as a remote solution for alleviating symptoms of mental health problems. However, the existing literature presents mixed results indicating both significant and insignificant effects of smartphone-delivered interventions. This systematic review and meta-analysis aims to assess the impact of smartphone-delivered ABMT on attentional bias and symptoms of mental health problems. Specifically, we examined different design approaches and methods of administration, focusing on common mental health issues, such as anxiety and depression, and design elements, including gamification and stimulus types. Our search spanned from 2014 to 2023 and encompassed 4 major databases: MEDLINE, PsycINFO, PubMed, and Scopus. Study selection, data extraction, and critical appraisal were performed independently by 3 authors using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. When necessary, we pooled the standardized mean difference with a 95% CI. In addition, we conducted sensitivity, subgroup, and meta-regression analyses to explore moderator variables of active and placebo ABMT interventions on reducing symptoms of mental health problems and attentional bias. Our review included 12 papers, involving a total of 24,503 participants, and we were able to conduct a meta-analysis on 20 different study samples from 11 papers. Active ABMT exhibited an effect size (Hedges g) of -0.18 (P=.03) in reducing symptoms of mental health problems, while the overall effect remained significant. Similarly, placebo ABMT showed an effect size of -0.38 (P=.008) in reducing symptoms of mental health problems. In addition, active ABMT (Hedges g -0.17; P=.004) had significant effects on reducing attentional bias, while placebo ABMT did not significantly alter attentional bias (Hedges g -0.04; P=.66). Our understanding of smartphone-delivered ABMT's potential highlights the value of both active and placebo interventions in mental health care. The insights from the moderator analysis also showed that tailoring smartphone-delivered ABMT interventions to specific threat stimuli and considering exposure duration are crucial for optimizing their efficacy. This research underscores the need for personalized approaches in ABMT to effectively reduce attentional bias and symptoms of mental health problems. PROSPERO CRD42023460749; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=460749.

Neural activation changes following attention bias modification treatment or a selective serotonin reuptake inhibitor for social anxiety disorder.

Delineation of changes in neural function associated with novel and established treatments for social anxiety disorder (SAD) can advance treatment development. We examined such changes following selective serotonin reuptake inhibitor (SSRI) and attention bias modification (ABM) variant - gaze-contingent music reward therapy (GC-MRT), a first-line and an emerging treatments for SAD. Eighty-one patients with SAD were allocated to 12-week treatments of either SSRI or GC-MRT, or waitlist (ns = 22, 29, and 30, respectively). Baseline and post-treatment functional magnetic resonance imaging (fMRI) data were collected during a social-threat processing task, in which attention was directed toward and away from threat/neutral faces. Patients who received GC-MRT or SSRI showed greater clinical improvement relative to patients in waitlist. Compared to waitlist patients, treated patients showed greater activation increase in the right inferior frontal gyrus and anterior cingulate cortex when instructed to attend toward social threats and away from neutral stimuli. An additional anterior cingulate cortex cluster differentiated between the two active groups. Activation in this region increased in ABM and decreased in SSRI. In the ABM group, symptom change was positively correlated with neural activation change in the dorsolateral prefrontal cortex. Brain function measures show both shared and treatment-specific changes following ABM and SSRI treatments for SAD, highlighting the multiple pathways through which the two treatments might work. Treatment-specific neural responses suggest that patients with SAD who do not fully benefit from SSRI or ABM may potentially benefit from the alternative treatment, or from a combination of the two. ClinicalTrials.gov, Identifier: NCT03346239. https://clinicaltrials.gov/ct2/show/NCT03346239.

The effect of ABM on attentional networks and stress-induced emotional reactivity in a mixed clinical sample with depression: A randomized sham-controlled trial

Research on the efficacy of Attention Bias Modification for depressive symptoms has predominantly yielded unfavorable outcomes. Despite adhering to rigorous conventions in randomized controlled trials, findings from these studies have indicated minimal effect sizes, thereby raising concerns about their limited clinical significance. This may be attributed to the overlapping mechanisms in ABM and the sham comparator, both affecting attentional processes. Participants with a diagnosis of major depressive disorder, with and without comorbid anxiety (N = 101) were randomized to a two-week preregistered randomized trial of ABM compared to sham. Attentional networks were assessed prior to and after the intervention by the Attention Network Task (ANT), and emotional reactivity was assessed in response to a lab-stressor. Irrespective of condition, participants improved their performance on the alerting and executive attentional networks, but not orienting, and stress-induced emotional reactivity was marginally decreased. Changes in attentional networks predicted post-intervention depression scores. It is imperative to reconsider the employment of a sham comparator in the exploration of the clinical efficacy of ABM.

Inhibition moderates the effect of attentional bias modification for reducing residual depressive symptoms: A randomized sham-controlled clinical trial

ObjectivesResidual symptoms represent risk factor for relapse. Attention bias modification (ABM) may reduce clinical and sub-clinical depressive symptoms, indicating that is may be of relevance when preventing relapse. Current evidence suggests that executive functions may moderate the outcome of interventions targeting depressive symptoms. MethodsWe assessed inhibition and shifting as indicators of executive functioning by means of the Color-Word Interference Test (i.e., “Stroop task”). These baseline characteristics were investigated as moderator of the effect of ABM on depression symptoms in a double-blinded randomized sham-controlled trial of ABM including patients with a history of recurrent depression (N = 301). Inclusion and follow-ups took place from January 2015 to October 2016. The trial was retrospectively registered #NCT02658682 January 2016. ResultsThe moderation analysis was based on the interaction term ABM x Stroop. Scaled inhibition scores ≤10.8, but not shifting ability, moderated the effect of ABM compared to sham on clinician-rated depression (HDRS). The difference from the 15th to the 85th percentile of the inhibition score was about 1 HDRS-point, indicating a small effect size. No moderation was found when self-reported depression and AB were the outcome. Post-hoc power calculation indicates risk of Type-II error. ConclusionWhen targeting depressive symptoms, ABM seems to be somewhat more effective in patients with weak inhibitory control. This suggests that evaluating the level of inhibition in individual patients could provide some information when making decisions about prescribing ABM to reduce residual symptoms, but the clinical implications of this is uncertain due to an overall small effect size attributable to ABM. Future studies should examine whether inhibitory control still is a relevant moderator when comparing ABM to treatment options other than the sham control condition.

Social anxiety and attentional bias to negative emotional information: the relationship and intervention

BackgroundAccording to the cognitive behavioral model of social anxiety, attentional bias to negative emotional information causes and maintains anxiety. The goal of attentional bias modification (ABM) is to reduce anxiety by reducing attention bias to negative emotional information.MethodWe used questionnaires and experiments to explore the improvement effect of ABM training on social anxiety in college students. In Study 1, we used dot-probe tasks to investigate the attentional bias to negative emotional information and the relationship with social anxiety severity in college students. In Study 2, college students with high social anxiety were divided into two groups: attentional bias modification training task group (ABM) and attention control condition task group (ACC). The ABM group received a continuous intervention for 10 days to observe changes in social anxiety levels and attentional bias scores in the pretest and posttest stages.ResultsThe results showed that the correlation of attentional bias to negative emotional information and social anxiety severity was significant. Meanwhile, the high social anxiety participants responded more quickly to negative emotional information. After the intervention, social anxiety levels and attentional bias scores of the training group were significantly reduced.ConclusionsThe results showed that attentional bias modification training can reduce attentional bias to negative emotional information in college students with social anxiety and effectively improve their social anxiety.

Prenatal affective cognitive training to reduce the risk of postpartum depression (PACT): study protocol for a randomized controlled trial

BackgroundPostpartum depression (PPD) affects 30–50% of women with a history of previous depression or bipolar disorder and 8% of women with no history of depression. Negative cognitive biases in the perception of infant cues and difficulties with emotion regulation are replicated risk factors. Current interventions focus on detecting and treating rather than preventing PPD. The aim of this randomized controlled intervention trial is therefore to investigate the potential prophylactic effects of prenatal affective cognitive training for pregnant women at heightened risk of PPD.MethodsThe study will enrol a total of 292 pregnant women: 146 at high risk and 146 at low risk of PPD. Participants undergo comprehensive assessments of affective cognitive processing, clinical depressive symptoms, and complete questionnaires at baseline. Based on the responses, pregnant women will be categorized as either at high or low risk of PPD. High-risk participants will be randomized to either prenatal affective cognitive training (PACT) or care as usual (CAU) immediately after the baseline testing. The PACT intervention is based on emerging evidence for efficacy of affective cognitive training approaches in depression, including cognitive bias modification, attention bias modification, mindfulness-inspired emotion regulation exercises, and working memory training. Participants randomised to PACT will complete five individual computerised and virtual reality-based training sessions over 5 weeks. The primary outcome is the difference between intervention arms in the incidence of PPD, assessed with an interview 6 months after birth. We will also assess the severity of depressive symptoms, rated weekly online during the first 6 weeks postpartum.DiscussionThe results will have implications for future early prophylactic interventions for pregnant women at heightened risk of PPD. If the PACT intervention reduces the incidence of PPD, it can become a feasible, non-invasive prophylactic strategy during pregnancy, with positive mental health implications for these women and their children.Trial registrationClinicalTrials.gov NCT06046456 registered 21-09-2023, updated 08-07-2024.

Does rumination moderate the effect of attention bias modification for depressive symptoms?

BackgroundCurrent treatment of major depressive disorders still leave many patients with modest improvement. Attention Bias Modification (ABM) is an approach that may serve as an adjuvant therapy for subgroups of patients. We examined whether rumination, often found to be associated with a negative attentional bias, acts as a moderating variable in a computerized ABM procedure in participants with recurrent depression. MethodsA total of 301 patients were randomized to receive either active - or sham ABM twice daily for 14 days. A regression-based moderator analysis was applied to evaluate whether baseline brooding, from the Rumination Response Scale (RRS-B), moderated the effect of ABM on Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory II (BDI-II). ResultsThere was no significant interaction effect of ABM and RRS-B on HDRS or BDI-II at post-intervention or at 1 month follow-up. In addition, no correlation was found for pre-training attention bias and RRS-B. Limitations: Generalizability is limited to individuals with non-clinical symptom scores. ConclusionsThere was no moderator effect of brooding rumination on clinical depression scales in the largest clinical study on ABM to date.

Supplemental Material for Using Eye Tracking to Evaluate the Impact of Smartphone-Delivered Attentional Bias Modification Training for Smokers

Supplemental Material for Using Eye Tracking to Evaluate the Impact of Smartphone-Delivered Attentional Bias Modification Training for Smokers

Concurrent self-administered transcranial direct current stimulation and attention bias modification training in binge eating disorder: feasibility randomised sham-controlled trial.

Binge eating disorder (BED) is a common and disabling condition, typically presenting with multiple psychiatric and obesity-related comorbidities. Evidence-based treatments are either resource-intensive (psychotherapies) or have side-effects (medications): these achieve remission in around 50% of cases. Novel treatments are needed. This randomised sham-controlled trial aimed to assess feasibility, acceptability and preliminary efficacy of at-home, self-administered transcranial direct current stimulation (tDCS) and attention bias modification training (ABMT) in adults with binge eating disorder. Eighty-two participants with binge eating disorder were randomly allocated to real tDCS with ABMT, sham tDCS with ABMT, ABMT only or waitlist control. Intervention groups received ten sessions of their allocated treatment over 2-3 weeks. tDCS (2 mA, 20 min) was self-administered using a bilateral (anode right/cathode left) montage targeting the dorsolateral prefrontal cortex. Outcomes were assessed at baseline, post-treatment and 6-week follow-up. Prespecified feasibility criteria (recruitment ≥80 participants and retention rate ≥75%) were exceeded, and treatment completion rates were high (98.7%). All interventions reduced binge eating episodes, eating disorder symptoms and related psychopathology between baseline and follow-up, relative to waitlist control (medium-to-large between-group effect sizes for change scores). Small-to-medium effect sizes for change scores favoured real tDCS with ABMT versus comparators, suggesting the verum intervention produces superior outcomes. At-home, self-administered tDCS with ABMT is feasible and acceptable, and preliminary data on efficacy are promising. This approach could be a useful and scalable alternative or adjunct to established treatments for binge eating disorder. Confirmatory trials can, and should, be pursued.

Training Gains and Losses: Their Link with Treatment Effects of Attention Bias Modification for Anxiety

Training Gains and Losses: Their Link with Treatment Effects of Attention Bias Modification for Anxiety

Improving Anorexia Nervosa Treatment with Virtual Reality Body Exposure and Attentional Bias Modification: A Single Case Study

This case study explores the potential of integrating attentional bias modification training (ABMT) with mirror exposure therapy (MET), utilizing virtual reality and eye-tracking, for a 14-year-old girl diagnosed with anorexia nervosa (AN). The ABMT-MET intervention was used alongside a standard treatment program called Home Treatment (HoT), which combines cognitive behavioral therapy with family-based therapy. Though the patient began HoT with a 3-week inpatient phase, the ABMT-MET intervention specifically took place during the subsequent Home Treatment sessions. The experimental treatment, comprising five consecutive weekly sessions, was bookended by pre- and post-assessment sessions and included a six-month follow-up. During the sessions, the patient engaged in systematic and hierarchical exposure to a virtual representation of her silhouette, with gradual adjustments made to the avatar’s body mass index (BMI) toward a healthier range. ABMT sessions, conducted before each MET session, aimed to redistribute the patient’s focus evenly across her body, successfully neutralizing her initial attentional bias toward non-weight-related body parts. The patient demonstrated consistent decreases in anxiety and fear of weight gain, effectively progressing through the BMI hierarchy in the virtual setting. Post-treatment assessments indicated significant enhancements in body dissatisfaction, drive for thinness, body-checking behaviors, and body appreciation, with these gains preserved at the six-month follow-up, although the attentional bias returned to pre-treatment levels. Though the single-case design limits definitive conclusions, these findings suggest ABMT-MET may be a promising adjunct therapy for AN, requiring further research for confirmation.

The impact of transcranial direct current stimulation on attention bias modification in children with ADHD.

Individuals with attention deficit-hyperactivity disorder (ADHD) struggle with the interaction of attention and emotion. The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are assumed to be involved in this interaction. In the present study, we aimed to explore the effect of stimulation applied over the dlPFC and vmPFC on attention bias in individuals with ADHD.Twenty-three children with ADHD performed the emotional Stroop and dot probe tasks during transcranial direct current stimulation (tDCS) in 3 conditions: anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), and sham stimulation.Findings suggest reduction of attention bias in both real conditions based on emotional Stroop task and not dot probe task. These results were independent of emotional states.The dlPFC and vmPFC are involved in attention bias in ADHD. tDCS can be used for attention bias modification in children with ADHD.

Attention and Interpretation Bias Modification Transfers to Memory Bias: Testing the Combined Cognitive Bias Hypothesis

PurposeThis study delves into the combined cognitive bias hypothesis in depression, exploring the interaction between negative attention, interpretation and memory biases. We aimed to assess whether modifying attention and interpretation bias would lead to congruent changes in memory bias, and to what extend and depth this causal effect can be.MethodNinety-nine undergraduates underwent either a positive (PT) or negative (NT) four-day attention and interpretation bias training. A set of well-established post-training assessments including free recall, recognition, autobiographic memory, and self-reference encoding tasks were used to evaluate memory bias. Affective states were measured pre- and post-training.ResultsCompared to PT, participants in NT correctly retrieved more negative trained stimuli, and falsely recognized more negative synonyms of trained terms. NT also exhibited an enhanced retrieval of negative autobiographical memory. No significant differences were found between NT and PT in self-referential encoding and retrieval bias, or affective states.DiscussionThe results suggested an extensive and strong transfer effect from attention and interpretation bias modification to different facets of memory bias, being found in retrieving trained emotional stimuli, in memory intrusion of negative synonyms, and in autobiographic memory recall. The findings underscored the causality between three biases, supporting the combined cognitive bias hypothesis. It might also suggest an effective new approach to modify memory bias via attention and interpretation bias training.

Software-based Attention Bias Modification Intervention for Adult EFL Learners’ Foreign Language Anxiety

Software-based Attention Bias Modification Intervention for Adult EFL Learners’ Foreign Language Anxiety

Testing a brief attention training protocol to prevent emotional distress from a fear induction procedure

Background and objectivesAttentional hypervigilance to threat in posttraumatic stress disorder (PTSD) is an important topic to investigate. Efforts to leverage attention training to prevent PTSD have been promising but underlying mechanisms have not been fully elucidated. The current study tested whether Attention Bias Modification (ABM) prior to an emotion induction of fear could reduce self-reported fear and arousal compared to two control conditions. MethodsParticipants (N = 86) were recruited from Amazon Mechanical Turk and randomized to receive either (1) ABM where they were directed towards fear related words on every trial; (2) Attention Control Training (ACT) where they were directed towards fear related words on 50% of trials; or (3) Neutral training where all words were neutral. Participants then completed a fear emotion induction (a 2-min video), reporting fear, arousal, and mood before and after the emotion induction. ResultsParticipants in the ABM condition had lower fear compared to the Neutral condition b = 11.43, 95% CI (1.20, 21.65), d = 0.48. Participants in the ABM condition did not have lower fear compared to the ACT condition b = 9.75, 95% CI (−0.64, 19.96), d = 0.41. Importantly, attentional avoidance at baseline moderated the effect of condition for both fear and arousal; higher avoidance at baseline for the ABM condition was associated with lower fear and arousal after the emotion induction compared to the Neutral condition. LimitationsThe sample size was relatively small and limited in diversity. ConclusionsThese findings are the first experimental evidence showing that the benefit of ABM prior to a fearful experience may be in its reduction of the target emotion. Additionally, ABM may work best for those that demonstrate the most avoidance at baseline in their attention towards fearful stimuli.