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Selective prevention of combat-related post-traumatic stress disorder using attention bias modification training: a randomized controlled trial

Published online by Cambridge University Press:  05 July 2016

I. Wald ,
E. Fruchter ,
K. Ginat ,
E. Stolin ,
D. Dagan ,
P. D. Bliese ,
P. J. Quartana ,
M. L. Sipos ,
D. S. Pine  and
Y. Bar-Haim
I. Wald*
Affiliation:
School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
E. Fruchter
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
K. Ginat
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
E. Stolin
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
D. Dagan
Affiliation:
Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
P. D. Bliese
Affiliation:
Darla Moore School of Business, University of South Carolina, SC, USA
P. J. Quartana
Affiliation:
Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, US Army Medical Research and Materiel Command, MD, USA
M. L. Sipos
Affiliation:
Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, US Army Medical Research and Materiel Command, MD, USA
D. S. Pine
Affiliation:
National Institutes of Mental Health, MD, USA
Y. Bar-Haim
Affiliation:
School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
*
*Address for correspondence: I. Wald, Ph.D., School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel. (Email: ilanwald@013net.net)
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Abstract

Background

Efficacy of pre-trauma prevention for post-traumatic stress disorder (PTSD) has not yet been established in a randomized controlled trial. Attention bias modification training (ABMT), a computerized intervention, is thought to mitigate stress-related symptoms by targeting disruptions in threat monitoring. We examined the efficacy of ABMT delivered before combat in mitigating risk for PTSD following combat.

Method

We conducted a double-blind, four-arm randomized controlled trial of 719 infantry soldiers to compare the efficacy of eight sessions of ABMT (n = 179), four sessions of ABMT (n = 184), four sessions of attention control training (ACT; n = 180), or no-training control (n = 176). Outcome symptoms were measured at baseline, 6-month follow-up, 10 days following combat exposure, and 4 months following combat. Primary outcome was PTSD prevalence 4 months post-combat determined in a clinical interview using the Clinician-Administered PTSD Scale. Secondary outcomes were self-reported PTSD and depression symptoms, collected at all four assessments.

Results

PTSD prevalence 4 months post-combat was 7.8% in the no-training control group, 6.7% with eight-session ABMT, 2.6% with four-session ABMT, and 5% with ACT. Four sessions of ABMT reduced risk for PTSD relative to the no-training condition (odds ratio 3.13, 95% confidence interval 1.01–9.22, p < 0.05, number needed to treat = 19.2). No other between-group differences were found. The results were consistent across a variety of analytic techniques and data imputation approaches.

Conclusions

Four sessions of ABMT, delivered prior to combat deployment, mitigated PTSD risk following combat exposure. Given its low cost and high scalability potential, and observed number needed to treat, research into larger-scale applications is warranted. The ClinicalTrials.gov identifier is NCT01723215.

Keywords

Attention bias modification trainingcombatpost-traumatic stress disorderpreventionstress
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 12 , September 2016 , pp. 2627 - 2636
Copyright
Copyright © Cambridge University Press 2016 

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