Behavioral measurement of attention bias for emotional stimuli has traditionally ignored whether trial-level task data have a strong enough general factor to justify a unidimensional measurement model. This is surprising, as unidimensionality across trials is an important assumption for computing bias scores. In the present study, we assess the psychometric properties of a free-viewing, eye-tracking task measuring attention for emotional stimuli. We applied a bifactor measurement model across ten attention bias metrics derived from the data of N = 130 participants, assessing whether trial-level data load on to a single, general factor. Unidimensionality was evaluated using omega hierarchical, explained common variance, and percentage of uncontaminated correlations. Total dwell time had excellent internal consistency for sad (ɑ = .95, ɷ = .96) and neutral stimuli (ɑ = .95, ɷ = .95), and met criteria for unidimensionality, suggesting the trial-level data within each task reflect a single underlying construct. However, the remaining bias metrics fell short of the unidimensionality thresholds, suggesting not all metrics are good candidates for creating bias scores. This study demonstrates the importance of assessing whether trial-level data load onto a general factor, as not all metrics are equivalent, even when derived from the same task data.

Background: This study examined the efficacy Attention Bias Modification Training (ABMT) for the treatment of depression. Methods: In this randomized clinical trial, 145 adults (77% female, 62% white) with at least moderate depression severity (i.e., self-reported Quick Inventory of Depressive Symptomatology (QIDS-SR) ≥ 13) and a negative attention bias were randomized to active ABMT, sham ABMT, or assessments only. Training consisted of two in-clinic and three (brief) at-home ABMT sessions per week for four weeks (2,224 training trials total). The pre-registered primary outcome was change in QIDS-SR. Secondary outcomes were the 17-item Hamilton Depression Rating Scale (HRSD) and anhedonic depression and anxious arousal from the Mood and Anxiety Symptom Questionnaire (MASQ). Primary and secondary outcomes were administered at baseline and four weekly assessments during ABMT. Results: Intent-to-treat analyses indicated that, relative to assessment only, active ABMT significantly reduced QIDS-SR and HRSD scores by an additional 0.62 ± 0.23 (p = .008, d = -0.57) and 0.74 ± 0.31 (p = .021, d = -0.49) points per week. Similar results were observed for active vs sham ABMT: a greater symptom reduction of 0.44 ± 0.24 QIDS-SR (p = .067, d = -0.41) and 0.69 ± 0.32 HRSD (p = .033, d = -0.42) points per week. Sham ABMT did not significantly differ from the assessment-only condition. No significant differences were observed for the MASQ scales.Conclusion: Depressed individuals with at least modest negative attentional bias benefitted from active ABMT.

Theoretical models and empirical research point to negatively biased attention as a maintaining factor in depression. Although preliminary studies suggest experimentally modifying attentional biases (i.e., attentional bias modification; ABM) reduces depression symptoms and depression risk, relatively few rigorous studies with clinical samples have been completed. This clinical trial examines the impact of ABM on a sample of adults (N = 123) with elevated depression severity who also exhibit at least modest levels of negatively biased attention prior to treatment. Participants will be randomly assigned to either active ABM, placebo ABM, or an assessment-only control condition. Individuals assigned to ABM will complete 5 trainings per week (2 in-clinic, 3 brief trainings at-home) during a four-week period. Throughout this four-week period, participants will complete weekly assessments of symptom severity and putative treatment mediators measured across different levels of analysis (e.g., eye tracking, behavioral measures, and functional Magnetic Resonance Imaging). This article details the rationale and design of the clinical trial, including methodological issues that required more extensive consideration. Our findings may not only point to an easily-accessible, efficacious treatment for depression but may also provide a meaningful test of whether a theoretically important construct, negatively biased attention, maintains depression.