Attention bias modification for depression: A systematic review and meta-analysis
Depression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of AB...
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| Published in | Frontiers in psychiatry Vol. 14; p. 1098610 |
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| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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Frontiers Media S.A
10.03.2023
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| Abstract | Depression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM.
Seven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
A total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = -0.48, 95% CI -0.80 to -0.17,
= 82%) and rumination (MD = -3.46, 95% CI -6.06 to -0.87,
= 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI -0.52 to 6.65,
= 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left-right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist.
Due to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression.
[PROSPERO], identifier [No. CRD42021279163]. |
|---|---|
| AbstractList | Background
Depression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM.
Methods
Seven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
Results
A total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = −0.48, 95% CI −0.80 to −0.17,
I
2
= 82%) and rumination (MD = −3.46, 95% CI −6.06 to −0.87,
I
2
= 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI −0.52 to 6.65,
I
2
= 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left–right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist.
Conclusion
Due to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression.
Systematic Review Registration:
[PROSPERO], identifier [No. CRD42021279163]. BackgroundDepression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM.MethodsSeven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).ResultsA total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = −0.48, 95% CI −0.80 to −0.17, I2 = 82%) and rumination (MD = −3.46, 95% CI −6.06 to −0.87, I2 = 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI −0.52 to 6.65, I2 = 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left–right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist.ConclusionDue to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression.Systematic Review Registration: [PROSPERO], identifier [No. CRD42021279163]. BackgroundDepression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM. MethodsSeven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). ResultsA total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = -0.48, 95% CI -0.80 to -0.17, I2 = 82%) and rumination (MD = -3.46, 95% CI -6.06 to -0.87, I2 = 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI -0.52 to 6.65, I 2 = 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left-right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist. ConclusionDue to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression.Systematic Review Registration: [PROSPERO], identifier [No. CRD42021279163]. Depression is a mental health disorder characterized by affective, somatic, and cognitive symptoms. Attention bias modification (ABM) has been widely used to treat depression. However, the results seem inconsistent. We conducted a systematic review and meta-analysis to investigate the efficacy of ABM for depression and to explore the optimal protocol of ABM. Seven databases were systematically searched from their inceptions to 5 October 2022 to include randomized controlled trials (RCTs) of ABM for depression. Two independent reviewers selected the eligible articles, extracted data, and evaluated the risk of bias using version 2 of the Cochrane risk-of-bias tool (ROB 2.0) for randomized trials. The primary outcome was the evaluation of depressive symptoms using widely accepted and validated scales. The secondary outcomes included rumination and attentional control. Meta-analysis was conducted by using RevMan (version 5.4) and Stata (version 12.0). Subgroup analyses and meta-regressions were performed to identify the source of heterogeneity. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). A total of 19 trials involving 20 datasets (1,262 participants) were included. The overall risk of bias in one study was rated as low risk of bias, three studies were considered as high, and the remaining studies were some concerns. Compared with attention control training (ACT), ABM had a greater effect in the improvement of depression (SMD = -0.48, 95% CI -0.80 to -0.17, = 82%) and rumination (MD = -3.46, 95% CI -6.06 to -0.87, = 0%). No significant differences were observed in the attentional control outcome between ABM and ACT (MD = 3.07, 95% CI -0.52 to 6.65, = 0%). Subgroup analysis demonstrated that adults exhibited a greater decrease in depression scores than adolescents. ABM using the dot-probe task, training target stimulus presented by face, and training directions by left-right were associated with better antidepressant effects. ABM training delivered in the laboratory tended to yield a better effect than those conducted at home. Sensitivity analysis indicated that the results were robust. The certainty of the evidence for all outcomes was low or very low, and publication bias may exist. Due to high heterogeneity and limited studies, not enough current evidence supported that ABM could be an effective intervention to relieve depressive symptoms. More rigorous RCTs are required to verify the benefits and to explore the optimal protocol of ABM training for depression. [PROSPERO], identifier [No. CRD42021279163]. |
| Author | Huang, Jia-Xi Li, Yu-Xi Zhong, Dong-Ling Li, Juan Liu, Xiao-Bo Ai, Shuang-Chun Zhang, Yue Jin, Rong-Jiang Xia, Hai-Sha Fan, Jin Zhao, Jing Zhang, Qing-Yun Gou, Xin-Yun |
| AuthorAffiliation | 4 Mental Health Center, West China Hospital, West China School of Medicine , Sichuan University , Chengdu , China 2 Department of Rehabilitation, The Third Hospital of Mianyang, Sichuan Mental Health Center , Mianyang , China 1 School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine , Chengdu , China 3 Department of rehabilitation, Mianyang Hospital of Traditional Chinese Medicine , Mianyang , China |
| AuthorAffiliation_xml | – name: 1 School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine , Chengdu , China – name: 3 Department of rehabilitation, Mianyang Hospital of Traditional Chinese Medicine , Mianyang , China – name: 2 Department of Rehabilitation, The Third Hospital of Mianyang, Sichuan Mental Health Center , Mianyang , China – name: 4 Mental Health Center, West China Hospital, West China School of Medicine , Sichuan University , Chengdu , China |
| Author_xml | – sequence: 1 givenname: Hai-Sha surname: Xia fullname: Xia, Hai-Sha organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 2 givenname: Yu-Xi surname: Li fullname: Li, Yu-Xi organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 3 givenname: Qing-Yun surname: Zhang fullname: Zhang, Qing-Yun organization: Department of Rehabilitation, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China – sequence: 4 givenname: Dong-Ling surname: Zhong fullname: Zhong, Dong-Ling organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 5 givenname: Xiao-Bo surname: Liu fullname: Liu, Xiao-Bo organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 6 givenname: Xin-Yun surname: Gou fullname: Gou, Xin-Yun organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 7 givenname: Jin surname: Fan fullname: Fan, Jin organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 8 givenname: Jing surname: Zhao fullname: Zhao, Jing organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 9 givenname: Yue surname: Zhang fullname: Zhang, Yue organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 10 givenname: Shuang-Chun surname: Ai fullname: Ai, Shuang-Chun organization: Department of rehabilitation, Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China – sequence: 11 givenname: Jia-Xi surname: Huang fullname: Huang, Jia-Xi organization: Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China – sequence: 12 givenname: Juan surname: Li fullname: Li, Juan organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China – sequence: 13 givenname: Rong-Jiang surname: Jin fullname: Jin, Rong-Jiang organization: School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36970284$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1016_j_brat_2024_104557 crossref_primary_10_1038_s44220_023_00185_y crossref_primary_10_3389_fnhum_2024_1360218 crossref_primary_10_1016_j_jbtep_2024_101956 crossref_primary_10_1152_physrev_00042_2023 crossref_primary_10_1177_20451253241243260 crossref_primary_10_2196_56326 crossref_primary_10_2147_PRBM_S459220 |
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| Keywords | meta-analysis cognitive deficits depression systematic review attention bias modification |
| Language | English |
| License | Copyright © 2023 Xia, Li, Zhang, Zhong, Liu, Gou, Fan, Zhao, Zhang, Ai, Huang, Li and Jin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 This article was submitted to Aging Psychiatry, a section of the journal Frontiers in Psychiatry Edited by: Maritta Välimäki, Central South University, China Reviewed by: Akira Monji, Saga University, Japan; Jie Yang, Central South University, China These authors have contributed equally to this work and share first authorship |
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| Title | Attention bias modification for depression: A systematic review and meta-analysis |
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