Integrating cognitive bias modification into a standard cognitive behavioural treatment package for social phobia: A randomized controlled trial

• Published in: Behaviour research and therapy 2013-05, Vol.51 (4-5), p.207-215
• Main Authors: Rapee, Ronald M., MacLeod, Colin, Carpenter, Leigh, Gaston, Jonathan E., Frei, Jacqueline, Peters, Lorna, Baillie, Andrew J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Aged; Anxiety; Anxiety disorders. Neuroses; Anxiety-Depression; Attention training; Attentional bias; Behavior therapy. Cognitive therapy; Behaviour therapy; Bias; Biological and medical sciences; Clinical trials; Cognition - physiology; Cognitive bias modification; Cognitive Therapy - methods; Fear & phobias; Female; Follow-Up Studies; Humans; Information processing; Male; Medical sciences; Middle Aged; Modification; Phobia; Phobic Disorders - psychology; Phobic Disorders - therapy; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Randomized controlled trial; Resource allocation; Social anxiety disorder; Social phobia; Surveys and Questionnaires; Symptoms; Therapy, Computer-Assisted - methods; Treatment Outcome; Treatments; Young Adult
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2013.01.005

The aim of the current study was to integrate recent developments in the retraining of attentional biases towards threat into a standard cognitive behavioural treatment package for social phobia. 134 participants (M age – 32.4: 53% female) meeting DSM-IV criteria for social phobia received a 12-week cognitive behavioural treatment program. They were randomly allocated to receive on a daily basis using home practice, either an additional computerised probe procedure designed to train attentional resource allocation away from threat, or a placebo variant of this procedure. Measures included diagnostic severity, social anxiety symptoms, life interference, and depression as well as state anxiety in response to a laboratory social threat. At the end of treatment there were no significant differences between groups in attentional bias towards threat or in treatment response (all p's > 0.05). Both groups showed similar and highly significant reductions in diagnostic severity, social anxiety symptoms, depression symptoms, and life interference at post-treatment that was maintained and in most cases increased at 6 month follow-up (uncontrolled effect sizes ranged from d = 0.34 to d = 1.90). The current results do not indicate that integration of information processing-derived attentional bias modification procedures into standard treatment packages as conducted in this study augments attentional change or enhances treatment efficacy. Further refinement of bias modification techniques, and better methods of integrating them with conventional approaches, may be needed to produce better effects. ► Treatment for social phobia was successful through a comprehensive cognitive behavioural package of 12 sessions. ► Attentional bias modification integrated into the homework component of treatment failed to change attentional biases. ► Attentional bias modification conducted in this way also failed to increase the efficacy of the basic treatment package.