Attention training to augment post traumatic stress disorder treatment for veterans: A pilot RCTAttention training to augment post traumatic stress disorder treatment for veterans: A pilot RCT

Abstract

Background: Posttraumatic stress disorder (PTSD) is a debilitating condition with high prevalence among veteran and military populations. Numerous guidelines support the use of evidence-based treatments for PTSD, yet research shows that treatment outcomes for veteran and military populations when using such evidence based treatments are modest. Accordingly, there is a mandate to continue to explore methods of augmentation of evidence based treatments in order to maximise therapeutic outcomes. One emerging augmentation approach is attention training, which is a brief, computed-based task aimed at reducing attentional bias towards threat. Attention bias to threat is a cognitive mechanism thought to be critical in the development and maintenance of PTSD, particularly the symptoms of hypervigilance and avoidance. ACTIVATE is a pilot randomised controlled trial (RCT) investigating two types of attention training and their ability to augment treatment outcomes in veterans with PTSD.

Method: A sample of 50 veterans will be recruited from the Toowong Private Hospital Trauma Recovery Program (TRP). Participants will be 18 years or older and have a DSM-5 diagnosis of PTSD as determined by the Clinician-Administered PTSD scale (CAPS). Participants will be randomised to receive four sessions of either attention bias modification (ABM) or attention control training (ACT) over a period of 2-4 weeks prior to commencing standard PTSD treatment. Both ABM and ACT utilise the well-studied dot-probe task, involving simultaneous presentation of neutral and threat-related cues. Both cues then disappear, with a response probe appearing at the location of either the neutral or threat-related cue. During ABM, the response probe always replaces the neutral cue with the aim of training attention away from threat (i.e. reducing hypervigilance). Conversely, during ACT, the response probe replaces the neutral and threat-related cues with equal frequency with the aim of training balanced attentional allocation. Participants’ threat bias will be assessed immediately before and after their attention training, and at 3 month follow-up. Mental health outcomes will also be assessed at these time points, and 3 and 9 month follow-up.

Results: Quantitative methods will be used to determine differences in treatment outcomes between participants assigned to each attention training condition at the various follow-up time points.

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