Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
Brain Behav. 2020 Aug;10(8):e01664. doi: 10.1002/brb3.1664. Epub 2020 Jul 7.
Altered attention to threatening stimuli at initial and sustained stages of processing may be dissociable dimensions that influence the development and maintenance of transdiagnostic symptoms of anxiety, such as vigilance, and possibly require distinct intervention. Attention bias modification (ABM) interventions were created to implicitly train attention away from threatening stimuli and have shown efficacy in treating anxiety. ABM alters neurocognitive functioning during initial stages of threat processing, but less is known regarding effects of ABM on neural indices of threat processing at sustained (i.e., intermediate and late) stages, or if ABM-related neural changes relate to symptom response. The current study utilized pupillary response as a temporally sensitive and cost-effective peripheral marker of neurocognitive response to ABM.
In a randomized controlled trial, 79 patients with transdiagnostic anxiety provided baseline data, 70 were randomized to receive eight sessions of twice-weekly ABM (n = 49) or sham training (n = 21), and 65 completed their assigned treatment condition and returned for post-training assessment.
Among ABM, but not sham, patients, pupillary response to threat words during initial and intermediate stages decreased from pre- to post-training. Pre- to post-training reductions in intermediate and late pupillary response to threat were positively correlated with reductions in patient-reported vigilance among ABM, but not sham, patients.
All measured stages of threat processing had relevance in understanding the neural mechanisms of ABM, with overlapping yet dissociable roles exhibited within a single neurophysiological marker across an initial-intermediate-late time continuum. Pupillometry may be well suited to measure both target engagement and treatment outcome following ABM.
在处理威胁刺激的初始和持续阶段，注意力的改变可能是影响焦虑症共病症状（如警觉）发展和维持的可分离维度，可能需要不同的干预措施。注意偏向修正（ABM）干预措施旨在通过暗示训练将注意力从威胁刺激上转移开，并已显示出对治疗焦虑症的有效性。ABM 改变了威胁处理初始阶段的神经认知功能，但对于 ABM 对威胁处理持续（即中间和晚期）阶段的神经指标的影响知之甚少，或者 ABM 相关的神经变化是否与症状反应有关。本研究利用瞳孔反应作为一种对 ABM 神经反应具有时间敏感性和成本效益的外周标记。
在一项随机对照试验中，79 名具有跨诊断焦虑症的患者提供了基线数据，70 名患者被随机分配接受八次每周两次的 ABM（n=49）或假训练（n=21），65 名患者完成了他们的指定治疗条件并返回进行治疗后评估。
在 ABM 组，但不是在假训练组中，瞳孔对威胁词的反应在初始和中间阶段从治疗前到治疗后减少。在 ABM 组中，中间和晚期瞳孔对威胁的反应从治疗前到治疗后的减少与患者报告的警觉性减少呈正相关，而在假训练组中则没有。
所有威胁处理阶段都与理解 ABM 的神经机制有关，在单一神经生理标记物中，在初始-中间-晚期的时间连续体上表现出重叠但可分离的作用。瞳孔测量可能非常适合测量 ABM 后的目标参与和治疗结果。
