RT-based attention bias modification helps prevent PTSD in soldiers

The use of response time (RT)-based attention bias modification (ABM) can protect soldiers against the development of post-traumatic stress disorder (PTSD) when implemented before exposure to combat, suggests a study. 

“From a clinical perspective, the demonstrated replicable efficacy of RT-based ABM highlights its potential for widespread implementation in military training programs as a preventive measure against PTSD in combat-bound troops,” the investigators said. 

The delivery of RT-based ABM prior to combat exposure resulted in lower symptom severity and lower prevalence of probable PTSD postcombat when compared with sham training (number needed to treat=22.7). [Am J Psychiatry 2026;183:204-213] 

In the RT-based ABM group, training-induced threat attention showed a significant association with postcombat PTSD symptom severity. Furthermore, eye-tracking-based ABM was found ineffective as a primary prevention protocol for PTSD symptoms. 

“The modest effect sizes and the number needed to treat values indicate that although potentially beneficial, RT-based ABM should probably be integrated as part of a comprehensive resilience-building framework rather than a stand-alone solution,” according to the investigators. 

Threat recognition 

In combat, attending to threats can prove advantageous, given that vigilance enables survival. [Curr Dir Psychol Sci 2016;25:431-437; Annu Rev Neurosci 2000;23:155-184] 

“In extreme situations such as combat, and possibly in less extreme dangerous scenarios, attending to threat may support adaptation,” the investigators said. “RT-based ABM may reduce risk for PTSD by instantiating such adaptive forms of vigilance.” 

In the present study, the approach differs from that used in ABM for anxiety disorders, in which attention is trained away from threats. 

The current findings are comparable to the expected effect sizes in other trials for PTSD primary prevention, which often yield small or null effects due to program inefficacy or low-risk populations. [J Consult Clin Psychol 2009;77:928-940] 

“Participants in our sample reported low symptom severity, with many reporting negligible symptoms,” the investigators said. “Nevertheless, the results demonstrated statistically significant effects, replicating and extending findings by Wald [and colleagues], who used a similar design and population.” [J Consult Clin Psychol 2009;77:928-940] 

Further independent verification could allow ABM to be implemented to at-risk populations and enhance public health outcomes, according to the investigators. 

Method 

A total of 501 male combat-bound soldiers were included in this study, which used a three-arm randomized controlled trial to assess the efficacy of two ABM protocols: RT-based ABM to train attention toward threat over neutral stimuli (dot-probe task) and eye-tracking-based ABM employing instrumental reward to improve sustained attention to threat over neutral stimuli. 

The investigators compared each intervention to a sham RT-based task presenting only neutral stimuli. Participants underwent four sessions of active or sham training, with threat-related attention measured pre- and post-training. Self-reported symptoms of PTSD (primary outcome) and ofdepression and anxiety (secondary outcomes) were examined at baseline and 1-year postcombat. 

“Future research, preferably in other militaries and by other researchers, could focus on refining cognitive training protocols, elucidating mechanisms of action, and exploring individual differences to maximize the clinical utility of these interventions,” the investigators said.