Salutary Effects of an Attention Bias Modification Mobile Application on Biobehavioral Measures of Stress and Anxiety during Pregnancy

Abstract

Stress and anxiety during pregnancy are associated with a range of adverse health outcomes, thus there is an unmet need for low-barrier treatments that target stress and anxiety. One such treatment approach, attention bias modification training (ABMT), reduces the anxiety-related attentional threat bias, which is also associated with disrupted neural processing of threat. 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 19 ^th – 29 ^th week of pregnancy, randomized to four weeks of ABMT versus placebo training (PT) versions of the mobile app using a double-blind design. Self-report of anxiety, depression, and stress were obtained, and 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 threat bias (1-tailed) and 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.