Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: A randomized controlled trial

Amit Lazarov*, Sofi Marom, Naomi Yahalom, Daniel S. Pine, Haggai Hermesh, Yair Bar-Haim

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background Cognitive-behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT.Methods Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment.Results Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores.Conclusions This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive-behavioral therapy for adult SAD. Training patients' attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.

Original languageEnglish
Pages (from-to)2177-2185
Number of pages9
JournalPsychological Medicine
Issue number13
StatePublished - 1 Oct 2018


FundersFunder number
National Institute of Mental HealthZIAMH002781, MH020004
United States - Israel Binational Science Foundation2013349


    • attention bias
    • attention bias modification (ABM)
    • cognitive-behavioral group therapy (CBGT)
    • social anxiety disorder


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