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Attention bias modification augments cognitive–behavioral group therapy for social anxiety disorder: a randomized controlled trial

Published online by Cambridge University Press:  20 December 2017

Amit Lazarov ,
Sofi Marom ,
Naomi Yahalom ,
Daniel S. Pine ,
Haggai Hermesh  and
Yair Bar-Haim
Amit Lazarov*
Affiliation:
Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
Sofi Marom
Affiliation:
Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel
Naomi Yahalom
Affiliation:
Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center, Tel-Aviv University, Tel-Aviv, Israel
Daniel S. Pine
Affiliation:
Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland, USA
Haggai Hermesh
Affiliation:
Anxiety Disorders and Behavior Therapy Unit, Outpatient Department, Geha Mental Health Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
Yair Bar-Haim
Affiliation:
School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel
*
Author for correspondence: Amit Lazarov, E-mail: amitlaza@post.tau.ac.il
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Abstract

Background

Cognitive–behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT.

Methods

Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment.

Results

Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores.

Conclusions

This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive–behavioral therapy for adult SAD. Training patients’ attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.

Keywords

social anxiety disorderattention biasattention bias modification (ABM)cognitive-behavioral group therapy (CBGT)
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 13 , October 2018 , pp. 2177 - 2185
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

*

This work reflects equal contribution of these authors.

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