Attention Bias Modification Treatment Augmenting Effects on Cognitive Behavioral Therapy in Children With Anxiety: Randomized Controlled Trial

Abstract

Objective Attention bias modification treatment (ABMT) is a promising novel treatment for anxiety disorders, but clinical trials have focused largely on stand-alone formats among adults. This randomized controlled trial examined the augmenting effects of threat-based ABMT on cognitive behavioral therapy (CBT) in clinically anxious youth. Method Sixty-three treatment-seeking children with anxiety disorder were randomly assigned to 1 of the following 3 treatment groups: ABMT + CBT; ABMT placebo + CBT; and CBT-alone. Participants in the 2 ABMT conditions received repeated training on dot–probe tasks either designed to shift attention away from threats (active) or designed to induce no changes in attention patterns (placebo). Primary outcome measures were frequency and severity of anxiety symptoms as determined by a clinician using a semi-structured interview. Self- and parent-rated anxiety measures and threat-related attention bias scores were also measured before and after treatment. Results Both the active and placebo ABMT groups showed greater reductions in clinician-rated anxiety symptoms than the CBT-alone group. Furthermore, only the active ABMT group showed significant reduction in self- or parentrated anxiety symptoms. Finally, all groups showed a shift in attention patterns across the study, starting with a bias toward threat at baseline and shifting attention away from threat after treatment. Conclusions Active and placebo ABMT might augment the clinical response to CBT for anxiety. This effect could arise from benefits associated with performing computer-based paradigms such as the dot–probe task. Given the absence of group differences in attention-bias changes during treatment, possible mechanisms and methodological issues underlying the observed findings are discussed. Clinical trial registration information—Augmenting Effects of ABMT on CBT in Anxious Children: A Randomized Clinical Trial; http://clinicaltrials.gov/; NCT01730625.

Look for good and never give up: A novel attention training treatment for childhood anxiety disorders

“…While this might minimize deleterious effects, it limits applicability to subsets of anxious children. Other studies that have not pre-selected on the basis of pre-treatment bias direction have found mixed results regarding bias modification and anxiety reductions (e.g., Bechor et al, 2014;Cowart & Ollendick, 2011;Rozenman et al, 2011;Shechner et al, 2014).…”

Modificación de Sesgos Cognitivos (MSC) en depresión: Una revisión crítica de nuevos procedimientos para el cambio de sesgos cognitivos

“…Por ejemplo, Boettcher, Hasselrot, Sund, Andersson y Carlbring (2014) han hallado que en el tratamiento de la ansiedad social, un procedimiento de MSC-A no añade ninguna mejoría a los participantes en un programa de terapia conductual están-dar a través de Internet. En otro caso, la combinación de TCC y MSC-A frente a la TCC combinada con relajación no arrojó resultados superiores en una muestra con fobia social (Shechner et al, 2014). Sin embargo, como se ha indicado previamente, la combinación de MSC-I con TCC sí ha mostrado ser superior al entrenamiento MSC-I aislado y a la no intervención en población con depresión (Williams et al, 2013).…”

Improving the Efficacy of Cognitive Training for Digital Mental Health Interventions Through Avatar Customization: Crowdsourced Quasi-Experimental Study (Preprint)

“…We chose ABMT as a task for attentional retraining in the context of mental health because it has been studied extensively [32,37,87], has been deployed in the context of mobile digital interventions [88], has been successfully modified to include game-based elements, showing that its efficacy is resilient to modifications to its core format [88], and because of the ease of integrating customized stimuli -in our case, in the form of faces. While early work on ABMT (2010) highlighted it as a promising new treatment with medium to large effect sizes [32], a 2015 follow-up meta-analysis showed smaller effect sizes that fell below clinical relevance [89]; however, a 2017 meta-analysis [37] suggests that the discrepancy might be due to methodological differences in how the meta analyses were conducted.…”

“…However, limitations of Internet-based CBT programs, such as the reading and language requirements, financial and time costs of localization, and the required time investment that is difficult for users to achieve suggest that other approaches might need to be deployed in tandem. Further, Computerized Cognitive Training (CCT), such as ABMT, has been applied adjacent [87] to Internetbased CBTs, showing potential in blending approaches.…”