A meta-analysis of bias at baseline in RCTs of attention bias modification: no evidence for dot-probe bias towards threat in clinical anxiety and PTSD


Background: Considerable effort and funding have been spent on developing Attention Bias Modification (ABM) as a treatment for anxiety disorders, theorized to exert therapeutic effects through reduction of a tendency to orient attention towards threat. However, meta-analytical evidence that clinical anxiety is characterized by threat-related attention bias is thin. The largest meta-analysis to date included dot-probe data for n = 337 clinically anxious individuals. Baseline measures of biased attention obtained in ABM RCTs form an additional body of data that has not previously been meta-analyzed. Method: This paper presents a meta-analysis of threat-related dot-probe bias measured at baseline for 1005 clinically anxious individuals enrolled in 13 ABM RCTs. Results: Random-effects meta-analysis indicated no evidence that the mean bias index (BI) differed from zero (k= 13, n= 1005, mean BI = 1.8ms, SE = 1.26ms, p= .144, 95% CI [-0.6 -4.3]. Additional Bayes factor analysesalsosupported the point-zerohypothesis (BF10 = .23),whereas interval-based analysis indicated that mean bias in clinical anxiety is unlikely to extend beyond the 0 to 5ms interval. Discussion: Findings are discussed with respect to strengths (relatively large samples, possible bypassing of publication bias), limitations (lack of control comparison, repurposing data, specificity to dot-probe data), and theoretical and practical context. We suggest that it should no longer be assumed that clinically anxious individuals are characterized by selective attention towards threat. Conclusion: Clinically anxious individuals enrolled in RCTs for Attention Bias Modification are not characterized by threat-related attention bias at baseline. Preprint available: psyarxiv.com/rfjup

Journal of Abnormal Psychology