Attention-Control Training Reduces PTSD Symptoms

People have their own biases in what they pay attention to; it’s why one person might remember someone’s face while another will remember what they were wearing.

In patients with anxiety disorders, the attention paid to specific triggers, such as an enclosed space or a large social gathering, can reach undesirable levels. However, a technique known as attention-bias modification, which trains people to shift their attention from threatening stimuli to neutral ones, is emerging as a potential solution.

After the results of several clinical trials suggested that attention-bias modification can help to reduce symptoms of anxiety, researchers have started to examine whether the technique might also work for patients with posttraumatic stress disorder (PTSD).

“People with PTSD tend to alternate between moments of threat vigilance and threat avoidance, so bias training will address only part of the problem,” said Amy Badura Brack, Ph.D., a professor of psychology at Creighton University. A better approach might be to focus on the ability to control these fluctuations, she noted.

In a new study published in the American Journal of Psychiatry, Brack joined with colleagues in the United States, Canada, and Israel to demonstrate that attention-control training can reduce PTSD symptoms more effectively than attention-bias modification.

With attention-bias modification, patients try to locate a probe on a screen after seeing a series of images; the probe appears in a spot held by a neutral image so they spend more time looking at those images. Attention-control training uses visual cues to shift attention to a specific stimulus, but instead of shifting attention away from threat, attention-control training aims to balance attention between threatening and neutral stimuli by alternating where the probe appears.

“Basically we are trying to educate veterans to ignore irrelevant information and focus on the task at hand,” Brack told Psychiatric News.

Two separate groups of male veterans (52 U.S. military and 46 Israeli Defense Forces) with PTSD were randomized to receive four weeks of either attention-bias modification or attention-control training; both sets of trials employed similar testing protocols, though the Israeli team used neutral and aggressive words instead of faces, and performed sessions once a week instead of twice a week.

Both testing approaches did reduce PTSD symptoms in the veterans, as measured by both self-reporting and clinician assessment, but the attention-control training had greater benefits in both study groups. Among U.S. military, for example, clinician-rated PTSD scores dropped from 72 to 56 after attention-bias modification, and from 72 to 44 following attention-control training.

“We feel good about the validity of these findings, as we had similar benefits in two independent sets of veterans using two slightly different protocols,” Brack said.

“What’s also promising is that none of the participants was taking psychiatry medications or engaged in psychotherapy, which suggests attention-control training could be used as a standalone treatment.”

Brack and her team are currently engaged in converting the computer programs into a web deliverable format that patients could access more easily, though she does believe attention-control therapy should be a prescribed treatment and not completely open access.

She also noted that it is important to carry out further studies in other groups, particularly women, who may have PTSD as the result of other, non-combat traumatic events to see how well they respond to attention-bias modification and attention-control training.

This study was funded by Creighton University, Tel Aviv University, and AtEaseUSA. ■