Salutary effects of an attention bias modification mobile application on biobehavioral measures of stress and anxiety during pregnancy
Salutary effects of an attention bias modification mobile application on biobehavioral measures of stress and anxiety during pregnancy
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DOI：
10.1016/j.biopsycho.2017.05.003
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发表时间：
2017-07-01
影响因子：
2.6
通讯作者：
Gelber, Shari
中科院分区：
文献类型：
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作者：
Dennis-Tiwary, Tracy A.;Denefrio, Samantha;Gelber, Shari
怀孕期间的压力和焦虑与一系列不良健康结果相关，但针对压力和焦虑的低屏障治疗需求尚未得到满足。其中一种治疗方法是注意偏差修正训练（ABMT），其目标是焦虑相关的威胁偏差，即对威胁相关信息的注意和神经处理的中断。然而，目前尚不清楚通过移动输送ABMT是否有效减少治疗障碍，以及ABMT的疗效是否取决于威胁神经处理的个体差异。本研究测试了移动、游戏化的ABMT是否减少了产前威胁偏差、焦虑和压力，以及ABMT的效果是否随个体对威胁的神经反应差异而变化。参与者是29名怀孕19 -29周的女性，采用双盲设计，随机分为四周的ABMT或安慰剂训练（PT）版本的移动应用程序。获得焦虑、抑郁和压力的自我报告；在家庭和实验室中收集唾液皮质醇对应激源的反应，以指示生物应激反应。威胁偏倚采用计算机化的注意分析来测量，在此过程中，脑电图被记录以产生事件相关电位（erp）来处理威胁线索。结果显示，与PT相比，ABMT后的实验室皮质醇水平较低。尽管ABMT对主观焦虑的主要影响不显著，但皮质醇降低的幅度与主观焦虑和威胁偏见的降低水平相关。那些接受ABMT的人在训练前对威胁表现出较小的erp时（P1, P2）也报告了较少的焦虑，但相反，当对威胁表现出较大的erp时，报告了更多的焦虑。使用游戏化的移动ABMT降低了产前压力和焦虑的生物行为指标，但对焦虑的影响因皮质醇反应和早期威胁注意的神经认知指标的个体差异而异。
Stress and anxiety during pregnancy are associated with a range of adverse health outcomes, but there is an unmet need for low-barrier treatments that target stress and anxiety. One such treatment approach, attention bias modification training (ABMT), targets the anxiety-related threat bias, a disruption in attention to and neural processing of threat-related information. It remains unclear, however, whether reducing treatment barriers via mobile delivery of ABMT is effective and whether ABMT efficacy varies depending on individual differences in neural processing of threat. The present study tested whether mobile, gamified ABMT reduced prenatal threat bias, anxiety and stress, and whether ABMT efficacy varied with individual differences in neural responses to threat. Participants were 29 women in their 19th-29th week of pregnancy, randomized to four weeks of an ABMT or placebo training (PT) version of the mobile app using a double-blind design. Self-report of anxiety, depression, and stress were obtained; salivary cortisol was collected at home and in lab in response to stressors to index biological stress reactivity. Threat bias was measured using a computerized attention assay during which EEG was recorded to generate event-related potentials (ERPs) to threat cues. Results showed lower levels of lab cortisol following ABMT versus PT. Although the main effect of ABMT on subjective anxiety was not significant, the magnitude of cortisol reduction was correlated with lower levels of subjective anxiety and threat bias. Those receiving ABMT also reported less anxiety when showing smaller ERPs to threat (P1, P2) prior to training, but, conversely reported more anxiety when showing larger ERPs to threat. Use of gamified, mobile ABMT reduced biobehavioral indices of prenatal stress and anxiety, but effects on anxiety varied with individual differences in cortisol response and neurocognitive indices of early attention to threat.