Untangling attention bias modification from emotion: A double-blind randomized experiment among individuals with social anxiety disorder

Background: Uncertainty abounds regarding the putative mechanisms of attention bias modification (ABM). Although early studies showed that ABM reduced anxiety proneness more than control procedures lacking a contingency between cues and probes, recent work suggests that the later just performed as well as the former did. In this experiment, we investigated a non-emotional mechanism that may play a role in ABM. Methods: We randomly assigned 62 individuals with a DSM-IV diagnosis of social anxiety disorder to a single-session of either a non-emotional contingency training, non-emotional no-contingency training, or control condition controlling for potential practice effects. Working memory capacity and anxiety reactivity to a speech challenge were assessed before and after training. Results: Consistent with the hypothesis of a practice effect, the three groups likewise reported indistinguishably significant improvement in self-report and behavioural measures of speech anxiety as well as in working memory. Repeating the speech task twice may have had anxioltyic benefits. Limitations: The temporal separation between baseline and post-training assessment as well as the scope of the training sessions could be extended. Conclusions: The current findings are at odds with the hypothesis that ABM is effective because of the presence of a contingency between cues and probes. They also show the importance of including a credible additional condition controlling for practice effects