Attention Bias Modification (ABM) for Major Depressive Disorder

Attention bias modification aims at targeting the attentional bias often found in depression (a difficulty to disengage attention from negative information), by training participants´ attention away from negative and towards positive stimuli. Studies provide preliminary evidence that ABM can modify cognitive biases in depressed samples (in mild and remitted depression) and may be of therapeutic value by reducing symptoms. In this double blind, randomized controlled trial, we primarily aim to investigate whether, in clinically depressed patients, (1) a positive attentional bias (i.e., relatively more attention for positive than for negative stimuli) can be induced and if the training attenuates (2) stress reactivity (3) and general levels of depression.

We expect that a positivity training based on attention bias modification (ABM), can induce (1) a positive attentional bias (i.e., relatively more attention for positive than for negative stimuli), (2) attenuates stress reactivity (3) and reduces general levels of depression in patients with Major Depressive Disorder (MDD).

Primary outcome measures:

• Attentional bias – Dot-probe task (pre to post)

• Depression level – IDS-SR (pre to post, 1 & 6 months follow-up)

• Emotional vulnerability in response to a speech task (post)

Secondary outcome measures:

• Classical & emotional Stroop task (pre to post)

• RRS-NL (pre to post, 1 & 6 months follow-up)

• PANAS (pre to post, 1 & 6 months follow-up)

• PIT (pre to post)

• RS (pre to post & 6 months follow-up)

• Number of sessions of out-patient therapy needed (follow-up)

• CEQ (after the first training session)

• EQ-5D (pre to post, 1, 6 & 12 months follow-up)

• TicP (pre & 12 months follow-up)

• Diagnostic status of depression according to the DSM-IV-TR as assessed by the MINI Neuropsychiatric Interview (pre & 12 months follow-up)

Attention Bias Modification (ABM)



A computerized, cognitive bias modification (CBM) training for attention (i.e., Attention Bias Modification) is offered eight times during a period of two weeks (i.e., 4 weekly sessions). As ABM paradigm, the dot-probe task is used. On each trial during this task, two pictures (always one positive and one negative picture) are displayed next to each other for 1000-1500 ms. Thereafter, a probe (i.e., an arrow pointing up versus down) appears behind one of the pictures. Participants have to identify the probe as quickly as possible. Each session contains 210 trials and takes about 20 minutes. Besides the first, all training sessions are completed via the internet, at participant’s home.



Positivity training:

In the positivity training the probe replaces the positive pictures in 90% of the cases and the negative pictures in 10 % of the cases. Hence, patients are trained to attend to positive pictures and to avoid negative pictures.

Control training:

In the control condition, patients receive a sham-training, during which the probe appears equally often behind positive and negative pictures, hence attentional bias is only assessed, but not modified.