Department of Healthcare Policy, Harvard Medical School, Boston, MA, USA.
Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Scand J Psychol. 2023 Aug;64(4):390-400. doi: 10.1111/sjop.12902. Epub 2023 Jan 27.
BACKGROUND: Cognitive bias theories propose that reducing threat hypervigilance in mental disorders can augment cognitive behavioral therapy (CBT) outcomes. However, no studies have tested whether adding attention bias modification (ABM) can effectively enhance CBT's effects on anxiety sensitivity (AS), electromyography (EMG), and skin conductance (SC) for panic disorder (PD). This pilot randomized controlled trial (RCT) thus aimed to evaluate the efficacy of CBT + ABM (vs. CBT plus attention training placebo; PBO) on those outcomes. METHOD: This study is a secondary analysis (Baker et al., 2020). Adults with PD were randomized to receive CBT + ABM (n = 11) or CBT + PBO (n = 12). Before each of the first five CBT sessions, CBT + ABM and CBT + PBO participants completed a 15-min ABM task or attention training PBO, respectively. AS and depression severity as well as SC and EMG during habituation to a loud-tone startle paradigm were assessed. Hierarchical Bayesian analyses were conducted. RESULTS: During pre-post-treatment and pre-follow-up, CBM + ABM (vs. CBT + PBO) led to a notably greater reduction in ASI-Physical (between-group d = -1.26 to -1.25), ASI-Cognitive (d = -1.16 to -1.10), and depression severity (d = -1.23 to -0.99). However, no between-group difference was observed for ASI-Social, EMG, or SC indices. DISCUSSION: Adding a brief computerized ABM intervention to CBT for PD protocols may enhance therapeutic change.
背景:认知偏差理论提出,减少精神障碍中的威胁过度警觉可以增强认知行为疗法(CBT)的效果。然而,尚无研究测试过在惊恐障碍(PD)中,增加注意偏向修正(ABM)是否可以有效地增强 CBT 对焦虑敏感(AS)、肌电图(EMG)和皮肤电导(SC)的影响。因此,这项先导随机对照试验(RCT)旨在评估 CBT+ABM(与 CBT+注意训练安慰剂;PBO)对这些结果的疗效。
方法:这是一项次级分析(Baker 等人,2020 年)。将 PD 成人随机分为接受 CBT+ABM(n=11)或 CBT+PBO(n=12)治疗。在五次 CBT 治疗的前五次治疗前,CBT+ABM 和 CBT+PBO 参与者分别完成了 15 分钟的 ABM 任务或注意训练 PBO。评估了适应大声起始惊跳范式时的 AS 和抑郁严重程度以及 SC 和 EMG。进行了分层贝叶斯分析。
结果:在治疗前-后和随访前,CBM+ABM(与 CBT+PBO 相比)导致 ASI-身体(组间 d=-1.26 至-1.25)、ASI-认知(d=-1.16 至-1.10)和抑郁严重程度(d=-1.23 至-0.99)显著降低。然而,ASI-社会、EMG 或 SC 指数在两组之间没有差异。
讨论:将简短的计算机化 ABM 干预添加到 PD 协议的 CBT 中可能会增强治疗效果。
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