Combining Attention Bias Pretraining with Exposure Therapy for Individuals with a Fear of Spiders

Abstract

The exposure therapy literature supports the notion that facilitated attentional focus on threat is necessary for a reduction in fear symptoms. A newer, computer-based cognitive training program for anxiety conditions that manipulates patterns of attentional allocation called attention bias modification has also demonstrated efficacy in the reduction of anxiety symptoms. Interestingly, this form of treatment promotes the opposite pattern of attentional processing (i.e., disengagement from threat stimuli). Taken together, it appears that the optimal pattern of attentional allocation during exposure needed to facilitate the reduction of anxiety symptoms remains unclear. Furthermore, the effect of combining attention bias modification with exposure therapy has yet to be established in the literature. Research that directly examines the role of attention in the process of exposure therapy may have the benefit of increasing our understanding of this underlying mechanism and improving this form of treatment. To this end, participants of the current study were randomly assigned to receive a computer-based treatment program that either trained attention towards or away from spider-threat stimuli or a placebo program that was not expected to alter patterns of attentional processing. In addition, all participants completed a single session of exposure therapy. Group differences were examined in terms of subjective fear and anxiety symptoms, behavioral and physiological indices of fear and avoidance, and patterns of attentional processing. Results indicated that there is some evidence attention was trained in the expected directions, although that the adjunctive attention pre-training program did not yield differential impact on the exposure therapy procedure. There is also evidence that individuals in all groups increased in attentional engagement towards spider images suggesting the possibility that exposure may have overridden the effects of attention training. Explanations for the observed null findings will be discussed and suggestions for future research will be presented.