Attention Training for Generalized Anxiety Disorder
Condition: Generalized Anxiety Disorder
MeSH terms: Anxiety Disorders
Study type: Interventional

Summary: 
      Generalized Anxiety Disorder (GAD) has high prelevance (up to 8.5%; Roy-Byrne & Wagner, 2004)
      and leads to functional impairment (Wittchen et al., 2002; Ballenger et al., 2001).
      Researchers have demonstrated a relationship between attention bias to threatening
      information and GAD. However, this knowledge has not yet been translated into effective
      treatments. The goal of this project is develop and test a new computerized treatment for
      Generalized Anxiety Disorder.
    

Detailed description: 
      Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry
      (Barlow, et al., 1986) leading to medical over-utilization, poor perceived health, low
      ratings of quality of life, and impairment at work resulting in a significant economic and
      public health impact (Wittchen et al., 2002; Ballenger et al., 2001). Lifetime prevalence of
      GAD is high (5.7%, Kessler, et al, 2005), with even higher estimates in the primary care
      setting (8.5%, Roy-Byrne & Wager, 2004). Researchers have established a relationship between
      GAD and attention bias to threatening information (Mogg & Bradley 2005). This knowledge,
      however, has not been translated into more effective treatments for this disorder. This
      five-year, two site proposal aims to test a computerized treatment for GAD in a double-blind,
      placebo-controlled study bridging basic attention bias research and treatment outcome. We
      present the results from 7 studies demonstrating the efficacy of attention modification
      programs (AMP) in ameliorating symptoms of anxiety. Specifically, we report results from a
      pilot study of individuals with Generalized Anxiety Disorder (n=24, Dr Amir's lab), and high
      worries (n=24, Dr. Schmidt's lab) demonstrating the effectiveness of the procedures described
      in this proposal.

      In brief, our intervention was effective in: a) changing biased attention, b) reducing
      symptoms of GAD, and c) maintaining its effects in up to one year follow-up. This technique
      for changing attention bias in GAD can provide a cost-effective and easy to administer
      treatment grounded in basic cognitive science that may help reduce suffering in individuals
      with anxiety. A larger study would allow us to test the treatment and examine the
      generalizability of the intervention to patients with GAD along with comorbid conditions.
      Moreover, we will examine the transportability of the intervention by examining the proposed
      intervention at two sites. There are currently 10 participants enrolled in the newest phase
      of pilot data collection (SDSU 6, FSU 4).

      The goal of the current proposal is to extend these findings to a larger group of individuals
      with GAD and to examine the generalizability of the results to individuals with comorbid GAD.
      In the current proposal we will test two hypotheses:

        1. Individuals with GAD completing the AMP will show a larger reduction in their attention
           bias to threat compared to the clinical monitoring group

        2. Individuals with GAD completing AMP will show a larger reduction in anxiety symptoms
           compared to the clinical monitoring group.

        3. Individuals with GAD completing AR will show a larger reduction in anxiety symptoms
           compared to the clinical monitoring group.

      Specifically, in the current proposal directly responds to the NIMH priorities for evaluating
      user-friendly interventions and non-traditional delivery methods to increase access to
      evidence-based interventions. We will evaluate the efficacy of a 12-week computer-delivered
      home-based treatment program for GAD. Treatment will comprise a combination of two
      interventions shown to be efficacious in the treatment of GAD. The Attention Modification
      Program (AMP) is a computerized program designed to facilitate attention disengagement from
      threatening stimuli (Amir et al., 2009). Applied Relaxation (AR) is a behavioral,
      skills-based intervention where individuals learn ways to reduce the physiological cues
      associated with anxiety and worry (Öst, 1987; Siev & Chambless, 2007). Following the
      recommended guidelines of the NIMH Workgroup on Psychosocial Intervention Development (Hollon
      et al., 2002), we review evidence suggesting that both treatments are ideal candidates for
      the efficient, economical, and widespread transportation of evidence-based treatments for
      GAD. This proposal has the potential for a significant public health impact by evaluating a
      new method for delivering evidence-based interventions for hard-to-reach populations through
      the use of innovative technologies.
    

Intervention name(s): AMP; Applied Relaxation (AR); Clinical Monitoring (CM); Combining the AMP and AR
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): The AMP is a computer-delivered attention modification protocol designed to enhance attention disengagement from threatening stimuli. The AMP protocol includes twelve 20-min sessions delivered over a 6-week period. During each session, participants will see 240 trials consisting of the various combinations of probe type (E or F), probe position (top or bottom), and word type (Neutral or Threat). 192 trials include one neutral word and one threat word: 2 (probe type) X 2 (probe position) X 2 (repetitions) X 24 (word pairs). On trials where participants see one neutral word and one threat word (i.e., 80% of the trials), the probe always follows the neutral word.; Applied Relaxation (AR) is a behavioral, skills-based intervention where individuals learn ways to reduce the physiological cues associated with anxiety and worry (Öst, 1987; Siev & Chambless, 2007); participants assigned to the clinical monitoring (CM) condition will receive the same information about the nature of GAD provided to participants in the active conditions; The AMP is a computer-delivered attention modification protocol designed to enhance attention disengagement from threatening stimuli. The AMP protocol includes twelve 20-min sessions delivered over a 6-week period. During each session, participants will see 240 trials consisting of the various combinations of probe type (E or F), probe position (top or bottom), and word type (Neutral or Threat). 192 trials include one neutral word and one threat word: 2 (probe type) X 2 (probe position) X 2 (repetitions) X 24 (word pairs). On trials where participants see one neutral word and one threat word (i.e., 80% of the trials), the probe always follows the neutral word. Applied Relaxation (AR) is a behavioral, skills-based intervention where individuals learn ways
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Generalized Anxiety Disorder; Information Processing