Cognitive Bias Modification to Enhance Resilience to a Panic Challenge

Interventions targeting the development of resilience are lacking despite evidence that enhancing resilience may lead to decreased incidence of mental and physical illness (Kobasa, 1979), and consequently, less utilization of strained healthcare resources. While most research on resilience has focused on overcoming trauma, the current study targeted resilience among people with high anxiety sensitivity (fear of anxiety symptoms), which is a vulnerability marker for a broad range of anxiety disorders, especially panic disorder. Indeed, increasing resilience to panic-related stressors will likely have important implications for the development and maintenance of anxiety pathology, because those who find it difficult to recover from the relatively common experience of panic symptoms are thought to be most vulnerable to developing diagnosable panic disorder. While research on cognitive bias modification (CBM) interventions has shown they can be effective at reducing cognitive bias and emotional vulnerability in a variety of domains, including anxiety disorders (see Hallion & Ruscio, 2011), focusing on resilience enhancement is a novel application of CBM.
Participants (N = 50) high in anxiety sensitivity were randomly assigned to one of two conditions: four sessions of resilience-enhancing interpretation bias modification (CBM-I), or a control (Sham) condition in which participants completed four sessions of sham tasks similar in format to the CBM-I condition. Following the intervention, participants engaged in a 7.5% steady state carbon dioxide (CO2) breathing challenge, a reliable elicitor of panic symptoms (Bailey, Argyropoulos, Kendrick, & Nutt, 2005).
In line with hypotheses, those in the CBM-I condition reported a reduction in interpretation bias at post-training (this finding was significant for one measure and not another), and a trend for a greater reduction in anxiety sensitivity at 2-month follow-up compared to those in the Sham condition. Additionally, those in the CBM-I condition reported less intense cognitive symptoms of panic during the CO2 challenge, though not less intense physical symptoms or total sum of panic symptoms. Finally, model-predicted values suggested that those in the CBM-I condition experienced less anticipatory anxiety prior to the CO2 breathing period, and then less anxiety during the recovery period, compared to the Sham condition, but not differences in reactivity to breathing the CO2-enriched air (though this pattern needs to be interpreted with caution).
While the findings are somewhat mixed, the results of the current study are promising for CBM-I as an intervention to increase resilience to panic attacks for those vulnerable to developing panic disorder. It will be important to replicate this study with a larger sample size, given approximately half of the participants who were initially eligible for the study were excluded from analyses because their anxiety sensitivity score dropped before the start of the study. Additionally, replication with a community treatment-seeking sample will be important. Nonetheless, the current study adds to the CBM-I literature, showing that this training paradigm is able to reduce both maladaptive interpretations and some symptoms of anxiety, especially those tied to threat cognitions. It also contributes to the relatively sparse literature on interventions for adult resilience by showing that CBM-I has the potential to help enhance resilience to stressors, thus promoting prevention for those at risk of developing mental illness.