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Attention Bias Modification Training Via Smartphone to Reduce Social Anxiety: A Randomized, Controlled Multi-Session Experiment

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Abstract

Testing feasibility and efficacy of psychological treatment via mobile devices is important, given its potential benefits for high-dosage treatment delivery, widespread and inexpensive dissemination, and efficient research methods. We conducted the first randomized controlled trial of attention bias modification training delivered via smartphones, comparing this training to control training in a double-blind design, also including a waitlist condition. All participants performed a variant of dot-probe training involving faces with neutral and disgust (representative of social threat) expressions in brief sessions three times daily over 4 weeks on their own smartphones, at home or anywhere they chose. Attention bias modification, also known as cognitive bias modification of attention, training included a contingency to induce attentional deployment away from disgust faces, whereas the control training included no contingency. Participants completed weekly Internet-based self-report symptom assessments as well as smartphone-delivered dot-probe attention bias assessments, whose reliability findings supported the viability of using smartphones for reaction-time based assessments. The between-groups training effect on attention bias scores was small, showing statistical significance in some analyses and not in others. On measures of social anxiety, intention-to-treat analyses (n = 326) revealed significant pre–post treatment declines with medium to large effect sizes in both training groups, whereas small declines in a waitlist group were nonsignificant. Both training groups showed greater reductions in social anxiety than did waitlist; however, the benefits under these two training conditions were statistically indistinguishable. Improvements in the two training conditions beyond those of waitlist could be attributable to any factors common to them, but not to the contingency training specific to active attention bias modification training.

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Notes

  1. Data from study signup was missing for one participant, and the answer on handheld device type was missing for 1.4 % of participants.

  2. Due to a programming error, in two of the eight pairs, the face of one model (ID YY2) was paired with the face of another model (ID ES2) who shared similar features. Because many participants had already completed training when we discovered this problem, we maintained the same stimuli throughout the study without mentioning it to participants. Two participants reported noticing the mismatch. However, the error did not violate the requirement for attention bias modification that each pair consist of a neutral and a threat stimulus.

  3. All p values are two-tailed. T tests employ Welch’s method (equal variances are not assumed). Those appearing in the second paragraph under each symptom heading (e.g., under LSAS above) apply to comparisons of change scores, whereas those in the third paragraph apply to scores at one time, either postassessment or two-month follow-up. For pre–post Cohen’s d effect sizes within each group, we used the formula (M post − M pre)/SDpre. For between-groups Cohen’s d effect sizes, we employed the standard Cohen’s d formula using pooled standard deviation, (M Group1 − M Group2)/SDpooled.

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Acknowledgments

The authors thank Imke Vonk, Linh Vu, and Jennifer Yu for their assistance, primarily in data collection.

Conflict of Interest

Philip M. Enock, Stefan G. Hofmann and Richard J. McNally declare that they have no conflict of interest.

Informed Consent

All participants signed up through the website, which described the study in an easy-to-read format (Online Supplement 1). They electronically provided consent after going through these pages and a detailed consent form. All procedures were approved by Harvard’s Committee on the Use of Human Subjects in Research.

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No animal studies were carried out by the authors for this article.

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  1. Department of Psychology, Harvard University, Cambridge, MA, USA

    Philip M. Enock & Richard J. McNally

  2. Department of Psychology, Boston University, Boston, MA, USA

    Stefan G. Hofmann

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  1. Philip M. Enock
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Correspondence to Philip M. Enock.

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Enock, P.M., Hofmann, S.G. & McNally, R.J. Attention Bias Modification Training Via Smartphone to Reduce Social Anxiety: A Randomized, Controlled Multi-Session Experiment. Cogn Ther Res 38, 200–216 (2014). https://doi.org/10.1007/s10608-014-9606-z

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