The impact of ADHD on attentional bias modification outcomes: Evidence from gaze-contingent music reward therapy for social anxiety disorder.

BACKGROUND: Attention Bias Modification (ABM) for social anxiety disorder (SAD) aims to reduce anxiety by training attention away from social threats. ABM training involves various attentional processes, including on-task sustained attention, a faculty that is typically impaired in individuals with attention deficit/hyperactivity disorder (ADHD). Thus, ABM's efficacy for individuals with comorbid ADHD remains uncertain. This study examined whether comorbid ADHD moderates outcomes of Gaze-Contingent Music Reward Therapy (GC-MRT), an emerging eye-tracking-based ABM intervention for SAD. METHODS: 112 treatment-seeking adults with SAD were analyzed, 42 with comorbid ADHD and 70 without. Patients underwent eight sessions of GC-MRT over four weeks. Clinical outcomes included the clinician-rated Liebowitz Social Anxiety Scale (LSAS), the self-reported Social Phobia Inventory (SPIN), and the Patient Health Questionnaire-9 (PHQ-9). Attentional learning was indexed by reduction in dwell time on threat faces from pre-to post-treatment and throughout the training sessions. RESULTS: Both the ADHD and no-ADHD groups demonstrated significant and comparable reductions in social anxiety symptoms following treatment. Patients with ADHD exhibited a steeper reduction in dwell time on threat compared to the no-ADHD group. However, this advantage was not translated into greater SAD symptom reduction. Finally, baseline depression levels were comparable between the groups, and both groups demonstrated comparable significant reductions in depressive symptoms post-treatment. CONCLUSIONS: Comorbid ADHD does not appear to hinder the clinical effectiveness of GC-MRT for SAD. It is conceivable that the reward-based nature of GC-MRT engages the on-task behavior of individuals with ADHD, assisting to bypass potential attentional barriers associated with this disorder. GOV ID: NCT06732999, NCT02590770, NCT03346239, NCT05018260.