Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-08T16:29:27.916Z Has data issue: false hasContentIssue false
  • English
  • Français

Selective prevention of combat-related post-traumatic stress disorder using attention bias modification training: a randomized controlled trial

Published online by Cambridge University Press:  05 July 2016

I. Wald ,
E. Fruchter ,
K. Ginat ,
E. Stolin ,
D. Dagan ,
P. D. Bliese ,
P. J. Quartana ,
M. L. Sipos ,
D. S. Pine  and
Y. Bar-Haim
I. Wald*
Affiliation:
School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
E. Fruchter
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
K. Ginat
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
E. Stolin
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
D. Dagan
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
P. D. Bliese
Affiliation:
Darla Moore School of Business, University of South Carolina, SC, USA
P. J. Quartana
Affiliation:
Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, US Army Medical Research and Materiel Command, MD, USA
M. L. Sipos
Affiliation:
Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, US Army Medical Research and Materiel Command, MD, USA
D. S. Pine
Affiliation:
National Institutes of Mental Health, MD, USA
Y. Bar-Haim
Affiliation:
School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
*
*Address for correspondence: I. Wald, Ph.D., School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Efficacy of pre-trauma prevention for post-traumatic stress disorder (PTSD) has not yet been established in a randomized controlled trial. Attention bias modification training (ABMT), a computerized intervention, is thought to mitigate stress-related symptoms by targeting disruptions in threat monitoring. We examined the efficacy of ABMT delivered before combat in mitigating risk for PTSD following combat.

Method

We conducted a double-blind, four-arm randomized controlled trial of 719 infantry soldiers to compare the efficacy of eight sessions of ABMT (n = 179), four sessions of ABMT (n = 184), four sessions of attention control training (ACT; n = 180), or no-training control (n = 176). Outcome symptoms were measured at baseline, 6-month follow-up, 10 days following combat exposure, and 4 months following combat. Primary outcome was PTSD prevalence 4 months post-combat determined in a clinical interview using the Clinician-Administered PTSD Scale. Secondary outcomes were self-reported PTSD and depression symptoms, collected at all four assessments.

Results

PTSD prevalence 4 months post-combat was 7.8% in the no-training control group, 6.7% with eight-session ABMT, 2.6% with four-session ABMT, and 5% with ACT. Four sessions of ABMT reduced risk for PTSD relative to the no-training condition (odds ratio 3.13, 95% confidence interval 1.01–9.22, p < 0.05, number needed to treat = 19.2). No other between-group differences were found. The results were consistent across a variety of analytic techniques and data imputation approaches.

Conclusions

Four sessions of ABMT, delivered prior to combat deployment, mitigated PTSD risk following combat exposure. Given its low cost and high scalability potential, and observed number needed to treat, research into larger-scale applications is warranted. The ClinicalTrials.gov identifier is NCT01723215.

Keywords

Attention bias modification trainingcombatpost-traumatic stress disorderpreventionstress
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 12 , September 2016 , pp. 2627 - 2636
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abend, R, Pine, DS, Fox, NA, Bar-Haim, Y (2014). Learning and memory consolidation processes of attention bias modification in anxious and non-anxious individuals. Clinical Psychological Science 2, 620–627.Google Scholar
Adler, AB, Bliese, PD, McGurk, D, Hoge, CW, Castro, CA (2009). Battlemind debriefing and battlemind training as early interventions with soldiers returning from Iraq: randomization by platoon. Journal of Consulting and Clinical Psychology 77, 928–940.Google Scholar
Agorastos, A, Marmar, CR, Otte, C (2011). Immediate and early behavioral interventions for the prevention of acute and posttraumatic stress disorder. Current Opinion in Psychiatry 24, 526–532.Google Scholar
Badura-Brack, AS, Naim, R, Ryan, TJ, Levy, O, Abend, R, Khanna, MM, McDermott, TJ, Pine, DS, Bar-Haim, Y (2015). Effect of attention training on attention bias variability and PTSD symptoms: randomized controlled trials in Israeli and US combat veterans. American Journal of Psychiatry 172, 1233–1241.CrossRefGoogle ScholarPubMed
Beevers, CG, Lee, HJ, Wells, TT, Ellis, AJ, Telch, MJ (2011). Eye gaze bias for emotion stimuli prospectively predicts PTSD and depression symptoms among soldiers deployed in Iraq. American Journal of Psychiatry 168, 735–741.Google Scholar
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS, Keane, TM (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress 8, 75–90.Google ScholarPubMed
Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy 34, 669–673.Google Scholar
Bradley, R, Greene, J, Russ, E, Dutra, L, Westen, D (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry 162, 214–227.Google Scholar
Britton, JC, Suway, JG, Clementi, MA, Fox, NA, Pine, DS, Bar-Haim, Y (2015). Neural changes associated with attention bias modification (ABM): implications for anxiety disorders. Social Cognitive and Affective Neuroscience 10, 913–920.Google Scholar
Browning, M, Holmes, EA, Murphy, SE, Goodwin, GM, Harmer, CJ (2010). Lateral prefrontal cortex mediates the cognitive modification of attentional bias. Biological Psychiatry 67, 919–925.CrossRefGoogle ScholarPubMed
Eldar, S, Bar-Haim, Y (2010). Neural plasticity in response to attention training in anxiety. Psychological Medicine 40, 667–677.Google Scholar
Feldner, MT, Monson, CM, Friedman, MJ (2007). A critical analysis of approaches to targeted PTSD prevention – current status and theoretically derived future directions. Behavior Modification 31, 80–116.Google Scholar
Forneris, CA, Gartlehner, G, Brownley, KA, Gaynes, BN, Sonis, J, Coker-Schwimmer, E, Jonas, DE, Greenblatt, A, Wilkins, TM, Woodell, CL, Lohr, KN (2013). Interventions to prevent post-traumatic stress disorder: a systematic review. American Journal of Preventive Medicine 44, 635–650.CrossRefGoogle ScholarPubMed
Hoge, CW, Castro, CA, Messer, SC, McGurk, D, Cotting, DI, Koffman, RL (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351, 13–22.Google Scholar
Iacoviello, BM, Wu, G, Abend, R, Murrough, JW, Feder, A, Fruchter, E, Levinstein, Y, Wald, I, Bailey, CR, Pine, DS, Neumeister, A, Bar-Haim, Y, Charney, DS (2014). Attention bias variability and symptoms of posttraumatic stress disorder. Journal of Traumatic Stress 27, 232–239.Google Scholar
Kliem, S, Kroger, C (2013). Prevention of chronic PTSD with early cognitive behavioral therapy. A meta-analysis using mixed-effects modeling. Behaviour Research and Therapy 51, 753–761.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.Google Scholar
Kuckertz, JM, Amir, N, Boffa, JW, Warren, CK, Rindt, SE, Norman, S, Ram, V, Ziajko, L, Webb-Murphy, J, McLay, R (2014). The effectiveness of an attention bias modification program as an adjunctive treatment for post-traumatic stress disorder. Behaviour Research and Therapy 63, 25–35.Google Scholar
Ledoux, JE (2000). Emotion circuits in the brain. Annual Review of Neuroscience 23, 155–184.CrossRefGoogle ScholarPubMed
Linetzky, M, Pergamin-Hight, L, Pine, DS, Bar-Haim, Y (2015). Quantitative evaluation of the clinical efficacy of attention bias modification treatment for anxiety disorders. Depression and Anxiety 32, 383–391.Google Scholar
MacLeod, C, Clarke, PJF (2015). The attentional bias modification approach to anxiety intervention. Clinical Psychological Science 3, 58–78.Google Scholar
MacLeod, C, Grafton, B (2014). Regulation of emotion through modification of attention. In Handbook of Emotion Regulation, 2nd edn (ed. Gross, JJ), pp. 508–528. Guilford Press: New York.Google Scholar
Monk, CS, Telzer, EH, Mogg, K, Bradley, BP, Mai, X, Louro, HM, Chen, G, McClure-Tone, EB, Ernst, M, Pine, DS (2008). Amygdala and ventrolateral prefrontal cortext activation to masked angry faces in children and adolescents with generalized anxiety disorder. Archives of General Psychiatry 65, 568–576.Google Scholar
Naim, R, Abend, R, Wald, I, Eldar, S, Levi, O, Fruchter, E, Ginat, K, Halpern, P, Sipos, ML, Adler, AB (2015). Threat-related attention bias variability and posttraumatic stress. American Journal of Psychiatry 172, 1242–1250.Google Scholar
Pine, DS, Helfinstein, SM, Bar-Haim, Y, Nelson, E, Fox, NA (2009). Challenges in developing novel treatments for childhood disorders: lessons from research on anxiety. Neuropsychopharmacology 34, 213–228.CrossRefGoogle ScholarPubMed
Sipos, ML, Bar-HAIM, Y, Abend, R, Adler, AB, Bliese, PD (2014). Postdeployment threat-related attention bias interacts with combat exposure to account for PTSD and anxiety symptoms in soldiers. Depression and Anxiety 31, 124–129.Google Scholar
Skeffington, PM, Rees, CS, Kane, R (2013). The primary prevention of PTSD: a systematic review. Journal of Trauma and Dissociation 14, 404–422.CrossRefGoogle ScholarPubMed
Steenkamp, MM, Litz, BT (2013). Psychotherapy for military-related posttraumatic stress disorder: review of the evidence. Clinical Psychology Review 33, 45–53.Google Scholar
Thomas, JL, Wilk, JE, Riviere, LA, Mcgurk, D, Castro, CA, Hoge, CW (2010). Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry 67, 614–623.Google Scholar
Urbaniak, GC, Plous, S (2013). Research Randomizer (version 4.0) (http://www.randomizer.org/). Accessed June 2013.Google Scholar
Wald, I, Bitton, S, Levi, O, Zusmanovich, S, Fruchter, E, Ginat, K, Charney, DS, Pine, DS, Bar-Haim, Y (2016). Acute delivery of attention bias modification training (ABMT) moderates the association between combat exposure and posttraumatic symptoms: a feasibility study. Biological Psychology. Published online 15 January 2016. doi:10.1016/j.biopsycho.2016.01.005.Google Scholar
Wald, I, Degnan, KA, Gorodetsky, E, Charney, DS, Fox, NA, Fruchter, E, Goldman, D, Lubin, G, Pine, DS, Bar-Haim, Y (2013). Attention to threats and combat-related posttraumatic stress symptoms: prospective associations and moderation by the serotonin transporter gene. JAMA Psychiatry 70, 401–408.Google Scholar
Wald, I, Lubin, G, Holoshitz, Y, Muller, D, Fruchter, E, Pine, D, Charney, D, Bar-Haim, Y (2011). Battlefield-like stress following simulated combat and suppression of attention bias to threat. Psychological Medicine 41, 699–707.Google Scholar
Weathers, FW, Ruscio, AM, Keane, TM (1999). Psychometric properties of nine scoring rules for the clinician-administered posttraumatic stress disorder scale. Psychological Assessment 11, 124–133.Google Scholar
Zeger, SL, Liang, KY, Albert, PS (1988). Models for longitudinal data – a generalized estimating equation approach. Biometrics 44, 1049–1060.Google Scholar
Supplementary material: File

Wald supplementary material

Tables S1-S2 and Figures S1-S3

Download Wald supplementary material(File)
File 320.5 KB