Reduces fluctuations in attention toward and away from threat.
A computerized attention-control training program significantly reduced combat veterans’ tendency either to fixate on threat or to avoid it, along with associated PTSD symptoms. In parallel trials conducted with U.S. and Israeli combat veterans, researchers found that attention-control training decreased the instability in attention allocation—called attention bias variability—whereas attention bias modification, a technique that has helped in some anxiety disorders by shifting attention consistently away from threat, did not produce the same PTSD symptom reductions.
The two computerized approaches differ in how they guide attention. Attention bias modification typically trains participants to orient away from threatening stimuli, reinforcing a unidirectional shift. Attention control training, by contrast, implicitly teaches that threat-related stimuli are not relevant to the task at hand and encourages equal attention to threatening and neutral cues. This balancing of attention reduces extreme swings between hypervigilance and avoidance, targeting the variability in attention that appears to be a core cognitive feature of PTSD.
Key findings: Across randomized controlled trials in Israeli and U.S. combat veterans, attention control training produced greater symptom improvement than attention bias modification. Attention control training also significantly reduced attention bias variability, and reductions in this variability partially mediated improvements in PTSD symptoms.
Funding: The studies were funded by the NIH / National Institute of Mental Health and At Ease USA.
Source: Jules Asher – NIH
Image Credit: The image is in the public domain
Original Research: Abstracts for the two related papers published in the American Journal of Psychiatry—“Effect of Attention Training on Attention Bias Variability and PTSD Symptoms: Randomized Controlled Trials in Israeli and U.S. Combat Veterans” and “Threat-Related Attention Bias Variability and Posttraumatic Stress”—report the trial results and analyses in detail.
Abstract summary
Effect of Attention Training on Attention Bias Variability and PTSD Symptoms: Randomized Controlled Trials in Israeli and U.S. Combat Veterans
Objective:
Attention allocation to threat is disrupted in posttraumatic stress disorder. Some studies report excessive attention to threat, while others report unstable patterns that alternate between vigilance and avoidance. The investigators tested whether two computerized interventions—attention bias modification and attention control training—could normalize threat-related attention and reduce PTSD symptoms.
Method:
Two randomized controlled trials were conducted: one with Israel Defense Forces veterans and one with U.S. military veterans. Both used variants of the dot-probe task. Attention bias modification aimed to redirect attention away from threat, while attention control training aimed to equalize attention between threatening and neutral stimuli. PTSD symptoms, attention bias, and attention bias variability were measured before and after treatment.
Results:
Both trials showed symptom improvement, with attention control training producing significantly greater benefits. Attention control training—unlike attention bias modification—also significantly reduced attention bias variability. A combined analysis suggested that reductions in attention bias variability partially explained the improvement in PTSD symptoms.
Conclusions:
Attention control training may reduce PTSD symptoms by stabilizing attention allocation and correcting aberrant fluctuations between vigilance and avoidance. These results support further investigation of attention-control approaches and their neurocognitive mechanisms in PTSD treatment.
Threat-Related Attention Bias Variability and Posttraumatic Stress
Abstract summary
Objective:
Threat monitoring is an adaptive process that allows rapid detection of danger, but traumatic exposure can disrupt healthy threat monitoring and produce biased or unstable threat-related attention. Recent evidence indicates greater attention bias variability—frequent alternation between attention toward and away from threat—in individuals with PTSD compared with healthy controls and participants with other anxiety disorders. The study aimed to refine measurement of attention bias variability and confirm its association with PTSD across multiple datasets.
Method:
Researchers refined attention bias variability measurement using a moving average technique and analyzed seven independent datasets collected with dot-probe task variants. Trauma exposure and symptom severity were assessed using structured interviews and validated self-report measures appropriate to each sample.
Results:
Across datasets, individuals with PTSD showed consistently greater attention bias variability than healthy participants, as well as participants with social anxiety disorder and acute stress disorder. Importantly, variability tied specifically to threat-related cues was correlated with PTSD severity, whereas variability related to positive cues was not.
Conclusions:
Threat-related attention bias variability appears to be a replicable cognitive marker of PTSD. These findings suggest that treatments designed to stabilize attention allocation—such as attention control training—may be particularly relevant for PTSD and that protocols for attention bias modification should consider variability in threat-related attention when applied to this disorder.