Combining Unguided Web-Based Attentional Bias Modification and Affective Working Memory Training to Decrease Anxiety: A Randomized Controlled Trial

Abstract

Purpose: Cognitive vulnerability to anxiety can partly be explained by an interplay of attentional biases and control processes. This suggests that when aiming to reduce anxiety, simultaneously reducing an attentional bias for threat and strengthening control processes would be the optimal approach. We investigated whether a combined web-based Attentional Bias Modification (ABM) with affective Working Memory Training (WMT) was effective in reducing trait anxiety relative to control conditions and whether state anxiety moderated ABM effects. Methods: In this pre-registered randomized controlled trial, adults with heightened trait anxiety (n = 433) received either an active or control visual search ABM combined with an active or control emotional chessboard WMT training (2 × 2 design). Trait anxiety (primary outcome) was assessed at pre- (T1), mid- (T2), and post-training (T3), and at 1, 2, and 3-months follow-up. Attentional Bias (AB) and Working Memory (WM) capacity were assessed at T1, T2, T3, and FU3. State anxiety was measured prior to each training session. Results: Irrespective of the training conditions, participants showed a decrease in trait anxiety over time. The ABM training was associated with stronger reductions in AB. The WMT training was not associated with more improvements in WM capacity relative to the control condition. No moderating effects of state anxiety, baseline AB or WM capacity were observed. Conclusions: The findings suggested that the current type of ABM combined with WMT in a web-based format, without therapist support, was not effective in reducing trait anxiety beyond control conditions. The study was registered in the Netherlands Trial Register (NTR-NL4525, https://www.onderzoekmetmensen.nl/en/trial/23135).