Attention Bias Modification Training for Child Anxiety CBT Nonresponders
Condition: Anxiety Disorders
MeSH terms: Anxiety Disorders
Study type: Interventional

Summary: 
      This project will test Attention Bias Modification Training (ABMT) among children and
      adolescents who have completed a full protocol of cognitive behavior therapy (CBT) for
      anxiety and still meet criteria for a primary diagnosis of an anxiety disorder. The purpose
      of this project is to determine whether ABMT leads to reductions in anxiety and related
      impairment, relative to a placebo task condition.
    

Detailed description: 
      This application proposes a pilot test of Attention Bias Modification Training (ABMT) among
      children and adolescents who have completed a full protocol of cognitive behavior therapy
      (CBT) for anxiety and still meet criteria for a primary diagnosis of an anxiety disorder a
      full year after completion of CBT. There is currently not a single empirical study in the
      youth anxiety treatment literature that has systematically examined a treatment augment for
      youth who fail to respond to a full course of CBT. Empirical efforts to address this issue
      are important because youths who do not respond to CBT continue to suffer emotional distress
      and impairment associated with anxiety disorders, experience frustration and demoralization
      by perceived "failure," and likely pose a financial burden on the health care system.

      ABMT is a novel translational treatment for anxiety based on experimental and neuroscience
      research findings on attention processes. Research demonstrates that ABMT leads to reductions
      in anxiety and its disorders. Based on recent theory and research demonstrating an attention
      bias toward threat predicts CBT nonresponse among anxious youth, researchers have postulated
      that ABMT may hold promise as an augment to CBT because of its specific focus on attention
      bias that targets both frontal-cortical and subcortical circuitry.

      This study will recruit an estimated 70 children and adolescents who have completed a 12-14
      week CBT trial for anxiety disorders and at the one year follow-up continue to meet criteria
      for a primary diagnosis of an anxiety disorders. These 70 children and adolescents (ages 8-16
      years) will be randomly assigned to complete eight biweekly sessions of either ABMT or a
      placebo control (PC) task. Clinician ratings on youth anxiety severity will be collected and
      evaluated as the primary outcome. Youth self ratings on anxiety symptoms and parent ratings
      on youth anxiety symptoms will be collected and evaluated as secondary outcomes. All measures
      will be collected before condition assignment (pretreatment), at immediate posttreatment, and
      at an eight week follow up. The following specific aims will be addressed.

      Aim 1: Test whether ABMT leads to significantly lower levels of anxiety at posttreatment as
      compared to a Placebo Control Task.

      Aim 2: Examine whether ABMT leads to significantly lower levels of anxiety as compared to a
      Placebo Control Task at a follow up evaluation eight weeks posttreatment. This would suggest
      the maintenance of ABMT effects after eight weeks of no treatment.

      Aim 3: Gain perspective on the viability of variables as potential mediators and moderator of
      ABMT so as to inform decisions about whether to pursue these variables in a future R01. The
      variables proposed as potential mediators are attention bias toward threat and threat-related
      interpretation bias. The variable proposed as a potential moderator is attention control.

      Overall, this project will provide critically needed data on ABMT as a treatment augment for
      youth with anxiety disorders who do not respond CBT. With these data in hand, the field will
      be in a better position to determine whether and how ABMT may be used optimally among anxious
      youth who are likely to need more than CBT.
    

Intervention name(s): Attention Bias Modification; Placebo Attention Task
Intervention type(s): Behavioral; Behavioral
Intervention description(s): At each of eight sessions, participants complete 160 computer administered trials wherein a pair of threatening stimuli and neutral stimuli is presented simultaneously and then followed immediately by a probe. The probe always replaces the neutral stimulus and never replaces the threatening stimulus. The intervention is based on the idea that attention can be shaped via repetitive computer based training methods, and training attention toward neutral stimuli will lead to a reduction in anxiety and its disorders.; At each of eight sessions, participants complete 160 computer administered trials wherein a pair of threatening stimuli and neutral stimuli is presented simultaneously and then followed immediately by a probe. The probe replaces the neutral stimulus and the threatening stimulus with equal probability.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment