Attentional retraining

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Attentional retraining is the retraining of automatic attentional processes. The method of retraining varies but has typically employed computerized training programs ^[1]. The term originally indicated retraining of attention to rehabilitate individuals after a brain injury who suffered from neurological disorders of attention including hemineglect, perseveration, limited attention span, and even ADHD. However, in more recent research and clinical applications attentional retraining has also been applied as a type of cognitive bias modification. In this application, attentional retraining refers to the retraining of automatic attentional biases that have been observed in psychopathologies.

Neuropsychological rehabilitation applications

Computerized approaches to cognitive rehabilitation rose out of the recreational use of video games in the 1970s and the rise of the personal computer in the 1980s. The increased availability of personal computers and accessible programming languages allowed for researchers and clinicians to begin experimenting with computerized cognitive training ^[2]. Most tasks consisted of simple and repetitive training tasks that would increase in difficulty over time. In one such task participants must sit and observe on screen randomly presented numbers and push a buzzer when they see a specific digit - say, 3 ^[3]. Similar tasks were developed and administered to individuals demonstrating neuropsychological impairment in areas of attentional processing. The theorized mechanism of action in this approach to cognitive retraining rests on the ability of the generally trained task (recognizing and responding to numbers presented on screen) can generalize to attentional processes employed in every-day life.

Effectiveness in brain injury

In a 2001 meta-analysis of outcomes in attention rehabilitation after brain injury found the authors surveyed 30 studies with 359 patients. In this most recent meta-analysis of outcomes the authors found that there were significant and large effect sizes (d statistic) from pre-training to post-training. However, this large effect size was only found for studies without a control group. When the authors analyzed those pre/post studies with a control group the authors found much smaller effect sizes ^[4]. This finding may reflect the natural improvement seen over time after brain injury.

Cognitive bias modification applications

The attentional bias is one of several different cognitive biases. The attentional bias is the tendency of certain salient cues in a person's environment to preferentially draw and/or hold the person's attention. For example, individuals with anxiety disorders demonstrate an automatic attentional bias towards threatening cues in their environment and drug users and addicts demonstrate an automatic attentional bias towards drug related cues in their environment ^[5][6].

Diagram of sequence of events in a single VP trial. 1) The fixation cross is presented for 500ms, 2) the two pictures – one smoking and one neutral- are displayed, and 3) the probe to which the participant must respond is presented.

The rise of research in cognitive bias modification has led to the recent publication of a special issue of the Journal of Abnormal Psychology focusing on the methods and technologies used for cognitive bias modification in psychopathology ^[7]. Attentional retraining as cognitive bias modification is predicated on the observed attentional bias evident in psychopathology. The most common task used to retrain attention in psychopathologies is the dot-probe task developed originally by Macleod et al. (1986). In this task two stimuli are briefly presented on screen. One of the stimuli is emotionally salient (a drug cue or threat cue) and the other is neutral. Stimuli (usually words or images) are presented for about 500 milliseconds and then one of the stimuli is replaced by a probe to which the participant must respond. Required responses are usually to indicate what side of the screen the probe is on or to indicate which direction the probe (an arrow in this case) is pointing. The attentional bias is indicated by the difference in reaction time to the probe after it replaces a salient cue versus the reaction time to respond to a cue that replaces the neutral cue. Usually, the anxious participant will be faster in responding to probes replacing salient stimuli than those replacing neutral stimuli. This suggests their attention was drawn preferentially by the previously presented salient stimuli.

Attentional retraining attempts to retrain this automatic attentional process by using the dot-probe task and having the probe replace the neutral stimuli 100% of the time. Thus, the participant learns an implicit if-then rule: if both salient and neutral stimuli are present, then attend preferentially to the neutral stimuli^[8]. Therefore, if attentional biases have a causal role on the maintenance of anxiety or drug addictions then lowering the attentional biases should therefore lower feelings of anxiety amongst the anxious and craving and promote abstinence amongst the drug addicted.

Effectiveness

Effectiveness of attentional retraining has varied in both the anxiety and addictions literature. In an earlier study of attentional retraining in alcohol drinking attentional retraining altered attentional biases and altered the amount of alcohol subsequently consumed after training compared to a control group^[9]. However, in a later study by the same group of researchers attentional retraining did not appear to alter drinking behavior and the reductions on attentional bias was not seen on other attentional bias tasks such as the emotional Stroop task^[10]. In anxiety the results have been a little more promising and clear with several studies showing reductions in anxiety amongst the experimental group compared to control.^[11][12][13]

References

1. ^ Gray, J., Robertson, I., Pentland, B., & Anderson, S. (1992). Microcomputer-based attentional retraining after brain damage: A randomised group controlled trial. Neuropsychological Rehabilitation, 2(2), 97-115. DOI: http://dx.doi.org.lrc1.usuhs.edu/10.1080/09602019208401399
2. ^ Lynch, B. (2002). Historical review of computer-assisted cognitive retraining. The Journal of head trauma rehabilitation, 17(5), 446.
3. ^ Sohlberg, M., & Mateer, C. (1987). Effectiveness of an attention-training program. Journal of Clinical and Experimental Neuropsychology, 9(2), 117-130.
4. ^ Park, N., & Ingles, J. (2001). Effectiveness of attention rehabilitation after an acquired brain injury: A meta-analysis. NEUROPSYCHOLOGY-NEW YORK-, 15(2), 199-210.
5. ^ MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95(1), 15-20.
6. ^ Waters, A. J., Shiffman, S., Bradley, B. P., & Mogg, K. (2003a). Attentional shifts to smoking cues in smokers. Addiction, 98(10), 1409-1417.
7. ^ Journal of Abnormal Psychology (2009), 118(1)
8. ^ Mathews, A., & MacLeod, C. (2002). Induced processing biases have causal effects on anxiety. Cognition & Emotion, 16(3), 331-354.
9. ^ Field, M., & Eastwood, B. (2005). Experimental manipulation of attentional bias increases the motivation to drink alcohol. Psychopharmacology, 183(3), 350-357.
10. ^ Schoenmakers, T., Wiers, R. W., Jones, B. T., Bruce, G., & Jansen, A. T. M. (2007). Attentional re-training decreases attentional bias in heavy drinkers without generalization. Addiction, 102(3), 399-405.
11. ^ MacLeod, C., Rutherford, E., Campbell, L., Ebsworthy, G., & Holker, L. (2002). Selective attention and emotional vulnerability: Assessing the causal basis of their association through the experimental manipulation of attentional bias. Journal of Abnormal Psychology, 111(1), 107-123.
12. ^ See, J., MacLeod, C., & Bridle, R. (2009). The reduction of vulnerability through the modification of attentional bias: A real world study using a home-based cognitive bias modification procedure. Journal of Abnormal Psychology, 118(1), 65 - 75
13. ^ Amir, N., Beard, C., Burns, M., & Bomyea, J. (2009). Attention modification program in individuals with generalized anxiety disorder. Journal of abnormal psychology, 118(1), 28-33.