Category: Cognitive Science / Cognitive Processes

Symposium

Augmenting CBT for Panic Disorder With Attentional Bias Modification Improves Clinical Outcomes

Saturday, November 18
1:45 PM - 3:15 PM
Location: Sapphire Ballroom A, Level 4, Sapphire Level

Keywords: Cognitive Biases / Distortions | Panic | Psychophysiology
Presentation Type: Symposium

Background: CBT has good tolerability and cost-effectiveness for panic disorder (PD; Barlow et al., 2000). However, many patients with PD fail to respond, discontinue early, or return to treatment within two years (Gloster et al., 2013). There is a need to develop and evaluate novel treatment augmentation strategies to improve outcomes. Selective and automatic biases towards threat-related stimuli may contribute to the development and maintenance of PD (Bar-Haim, et al., 2007; Reinecke et al., 2012). Attention bias modification (ABM) is designed to modify this bias by shifting attention away from threatening stimuli (Amir et al., 2009). We compared the effect of CBT+ABM to CBT+placebo training (PBO) on PD symptom severity and psychophysiological response (electromyography, skin conductance, and heart rate) to a loud tone paradigm (LTP). We hypothesized that CBT+ABM would lead to greater reduction in PD severity and psychophysiological reactivity than CBT+PBO. 


Method: Participants (n=23, mean(SD) age = 32.40(10.32) years, 53% women) with PD were randomized to ABM or PBO augmentation of 7 sessions of CBT for PD (Otto et al., 2012). The ABM/PBO paradigm consisted of 5 sessions of 120 trials each, during which pairs of neutral words or a neutral and threat word were presented. ABM data were cleaned and analyzed according to established protocols (Price et al., 2015). The LTP was administered at baseline and post-treatment.


Results: ABM augmentation of CBT was associated with lower endpoint clinician related Panic Disorder Severity Scale scores when controlling for baseline levels of PD severity (R2 =.37, F(2, 19)=5.68, β =0.42, p =0.03) and greater improvement on the Clinical Global Impression Improvement Scale (R2 =.19, F(1, 21)=4.94, β =0.44, p =0.04) compared to CBT+PBO. There were no significant differences in psychophysiological responses to the LTP by ABM/PBO condition (all t’s < 1.95, p’s > 0.05).


Conclusion: ABM training prior to exposure sessions may enhance clinical panic outcomes when used as augmentation to a 7 session CBT, even without impacting psychophysiological reactivity. Additional considerations, limitations and future directions will be discussed.  

Amanda W. Baker

Clinical Psychologist, Instructor in Psychology
Massachusetts General Hospital/Harvard Medical School

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