Can Remote Attention Training Help Reduce PTSD Symptoms?

What you need to know

• This study tested if remotely-delivered attention training could help reduce PTSD symptoms
• Two types of attention training were compared: attention bias modification and attention control training
• Both types of training led to reductions in PTSD symptoms, with no significant difference between them
• The treatments were well-tolerated, with low dropout rates compared to other PTSD therapies
• People without depression and those with more recent trauma may benefit more from attention control training

Background on PTSD and attention training

Posttraumatic stress disorder (PTSD) is a condition that can develop after experiencing or witnessing a traumatic event. People with PTSD often have intrusive memories of the trauma, avoid reminders of it, experience negative changes in their thoughts and mood, and have heightened reactivity and arousal.

Many individuals with PTSD have difficulty accessing or engaging in standard treatments like psychotherapy. This can be due to avoidance symptoms, living far from treatment centers, or high dropout rates from intensive therapies. Therefore, researchers are exploring alternative treatment options that can be delivered remotely to patients’ homes.

One potential approach is attention training. People with PTSD often show changes in how they pay attention to information in their environment, particularly threat-related information. Two patterns have been observed:

1. An attentional bias toward threat - automatically paying more attention to threatening stimuli
2. Attentional bias variability - rapid shifting between paying attention to and avoiding threat

Attention training aims to modify these attentional patterns. Two main types have been developed:

1. Attention bias modification (ABM) - designed to train attention away from threat
2. Attention control training (ACT) - designed to balance attention between threatening and neutral information

Previous studies testing these approaches in clinics found they could reduce PTSD symptoms, with some evidence that ACT may be more effective. However, attempts to deliver ABM remotely have generally not been successful. This study aimed to test a new supervised remote delivery method for both ACT and ABM.

How the study worked

The researchers recruited 60 adults diagnosed with PTSD to participate in the study. Participants were randomly assigned to receive either ACT or ABM training delivered remotely to their homes.

The training involved completing a computerized task where participants had to respond to arrows appearing on a screen after being shown pairs of faces - one with an angry expression and one neutral. In the ABM condition, the arrows always appeared in place of the neutral face to train attention away from threat. In the ACT condition, arrows appeared equally often in place of both angry and neutral faces.

Participants completed 8 training sessions over 4 weeks. Importantly, each session was supervised via video call by a research assistant who helped set up the proper environment and monitored the session.

Before and after the 4 weeks of training, participants completed assessments of their PTSD symptoms, depression symptoms, and measures of their attention patterns. The main outcomes the researchers looked at were changes in PTSD symptom severity and PTSD diagnosis rates.

Key findings

Both the ACT and ABM training led to significant reductions in PTSD symptoms over the 4-week period. On average, symptom severity decreased by a medium to large amount statistically. However, contrary to the researchers’ expectations, there was no significant difference between the two types of training - both seemed to be equally effective.

Some other important findings:

• The dropout rate was very low at only 6.7%, much lower than typical dropout rates for other PTSD treatments
• Participants found the treatment acceptable and were able to complete all the training trials with high accuracy
• Both types of training reduced variability in attention to threat, but neither changed the overall bias toward threat
• People without depression showed greater symptom improvement with ACT compared to ABM
• ACT also seemed more effective for people whose trauma was more recent

What this means for patients

This study provides early evidence that supervised remotely-delivered attention training could be a promising treatment option for some people with PTSD. The key advantages appear to be:

1. High acceptability and low dropout - patients were able to stick with the full course of treatment
2. Accessibility - can be delivered to patients’ homes
3. Symptom reduction - both types of training led to meaningful decreases in PTSD symptoms

However, it’s important to note this was an initial study and more research is needed before this could become a widely available treatment. Some limitations to keep in mind:

• The study did not compare the training to other established PTSD treatments or a placebo control group
• It’s not clear exactly how or why the training leads to symptom improvement
• The long-term effects beyond 4 weeks are unknown
• Some technical issues occurred with the remote delivery

Additionally, the findings suggest this approach may work better for certain patients - particularly those without depression and with more recent trauma onset. Patients with co-occurring depression may need additional or different treatment approaches.

Conclusions

• Supervised remotely-delivered attention training shows promise as an accessible treatment option for PTSD
• Both attention bias modification and attention control training led to symptom improvements
• The treatment was well-tolerated with very low dropout rates
• More research is needed to understand how it compares to other treatments and its long-term effects