Attentional bias modification in anxiety disorders and depression: A synthetic review of literature

Introduction.- According to the theoretical models in cognitive psychopathology, the susceptibility to develop an emotional disorder is causally related to the presence of cognitive biases in the information treatment process such as attention, memory and interpretation biases. Researchers are collecting data supporting the idea that it is possible to modify the cognitive biases and the clinical symptoms as well. The present paper focuses on the modification of attentional bias and symptoms in both anxiety disorders and depression. Method. - After a brief recall about the nature of attentional biaes in anxiety and depression disorders, the article offers a synthetic review of the recent literature on attentional bias modification (ABM) in these mental disorders. First, it explains and debates the methodology mostly employed in this domain. Secondly, it presents the main results with a critical viewpoint especially on the therapeutic interests of these findings by answering a series of questions relevant for the clinical practice. Results.- In anxiety disorders, the attentional bias selectively favors information that is the most threatening for the trouble. The attentional bias in depression is characterized by a preference toward negative information and is also likely to have an absence of bias for positive information compared to healthy subjects. The attentional bias is most often modified using the so-called dot probe task. However, poor psychometric properties have been now repetitively reported. What are the effects of attentional bias modification on anxiety disorders? The research showed that only one session of ABM is sufficient to modify the bias toward threat and to reduce the emotional vulnerability when people are exposed to stressful situations. These findings have been reported for different anxiety disorders and in adults, adolescents and children. Can the attentional bias modification be envisaged as a therapeutic intervention of anxiety disorders? To answer to this question, patients have been exposed to several ABM sessions. Furthermore, a variety of outcomes measures (subjective, behavioural and physiological) have been taken. The researchers reported a modification of the attentional bias and an improvement of a variety of clinical symptoms. The results of one meta-analysis revealed that more ABM sessions lead to a more extended bias modification. However, another meta-analysis failed to show that a more extended bias modification leads to a greater improvement of the clinical symptoms. This report puts forward the need to enhance our knowledge on the causal relationship between the attentional bias and clinical symptoms. More recently, researchers have developed ABM training at home or via smartphone but the results are mitigated. Is it useful to combine the modification of attentional bias to another clinical intervention to treat anxiety disorders? A few studies have been conducted and even if some of them reported positive findings, overall, the results are reserved. Further, given the number of dropout reported, the effectiveness of the current ABM paradigm in a real-world setting is questionable. What are the effects of attentional bias modification on depression? A few small studies on ABM for depression have been published. Researchers found that ABM sessions lead to a reduced bias for negative stimuli but it is likely that this is only for individuals suffering from a low level of depression. The research on ABM in depression seems to be more successful in the use of ABM as a means to prevent the depressive relapse. Conclusion. - The ABM paradigm seems to be efficient to treat anxiety disorders even if its capacity to improve the clinical symptoms remains small. In depression, its efficiency remains to be established. So, researchers are now trying to alleviate the use of the current ABM paradigm or to innovate new paradigms to make ABM more exploitable in the context of a therapeutic treatment. (C) 2016 Elsevier Masson SAS. All rights reserved.