Efficacy of traditional and gamified attention bias modification for depression: Study protocol for a randomized controlled trial

Cognitive models posit that negatively biased attention toward dysphoric information has a causal role in the maintenance of depression-related psychopathology. Attention bias modification (ABM) tests this idea by altering an attentional bias and examining subsequent effects on depression. Prior work finds that ABM alters negatively biased attention for dysphoric information and reduces depression; however, a number of studies have failed to show these effects. Other research suggests that adding game-like elements (i.e.game play, achievements, levels, challenges, and points) to cognitive training can enhance participant engagement. No prior work has examined the efficacy of gamified ABM for depression. The goal of this study is to conduct a large (N = 600) efficacy trial comparing gamified, mobile ABM and traditional, web-based ABM to traditional, web-based sham ABM among adults with elevated symptoms of depression. Participants in all conditions are asked to complete 16 ABM sessions across a four week period (i.e., 4 training sessions per week). We hypothesize that gamified and traditional ABM will lead to significantly greater reductions in self-reported and interviewer-rated depression symptoms than traditional sham ABM. We further hypothesize that gamified ABM will be non-inferior to traditional ABM. Our third hypothesis is that people with a strong attentional bias will experience greater reductions in depression in response to either gamified or traditional ABM compared to sham ABM. Secondary analyses will examine putative mediators of ABM. Finally, we will estimate the durability of ABM by collecting post-treatment symptom data 2-, 3-, and 6-months after the acute ABM period. ClinicalTrials.gov ID: NCT06361095.