Effect of attention training on attention bias variability and PTSD symptoms: Randomized controlled trials in Israeli and U.S. Combat Veterans

Abstract

Objective: Attention allocation to threat is perturbed in patients with posttraumatic stress disorder (PTSD), with some studies indicatingexcessattentiontothreatandothersindicatingfluctuations between threat vigilance and threat avoidance. The authors tested the efficacy of two alternative computerized protocols, attention biasmodification and attention control training, for rectifying threat attendance patterns and reducing PTSD symptoms. Method:Tworandomizedcontrolled trialscomparedtheefficacy of attention bias modification and attention control training for PTSD:onein IsraelDefenseForcesveteransandoneinU.S.military veterans.Bothutilizedvariantsof thedot-probetask,withattention bias modification designed to shift attention away fromthreat and attention control training balancing attention allocation between threat and neutral stimuli. PTSD symptoms, attention bias, and attentionbiasvariabilityweremeasuredbeforeandaftertreatment. Results: Both studies indicated significant symptom improvement after treatment, favoring attention control training. Additionally, both studies found that attention control training, but not attention bias modification, significantly reduced attention bias variability. Finally, a combined analysis of the two samples suggested that reductions in attention bias variability partially mediated improvement in PTSD symptoms. Conclusions: Attention control training may address aberrant fluctuations in attention allocation in PTSD, thereby reducing PTSD symptoms. Further study of treatment efficacy and its underlying neurocognitive mechanisms is warranted.