Threat-Related Selective Attention Predicts Treatment Success in Childhood Anxiety Disorders

Abstract

Objective: The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. Method: Participants consisted of 131 children with anxiety disorders (aged 8Y16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dotprobe task was administered to assess selective attention. Both at pretreatment and posttreatment, diagnostic status of the children was evaluated with a semistructured clinical interview (the Anxiety Disorders Interview Schedule for Children).Results: Selective attention for severely threatening pictures at pretreatment assessment was predictive of treatment success. Examination of the specific components of selective attention revealed that nonresponders showed difficulties to disengage their attention away from severe threat. Treatment responders showed a tendency not to engage their attention toward severe threat. Age was not associated with selective attention and treatment success. Conclusions: Threatrelated selective attention is a significant predictor of treatment success in children with anxiety disorders. Clinically anxious children with difficulties disengaging their attention away from severe threat profit less from cognitive-behavioral

Threat perception predicts cognitive behavioral therapy outcomes in anxious children

“…Consistent with previous studies, attention to threat on this visual, implicit task seemed to predict limited benefits of CBT [16,18]. As learning is adversely affected by heightened arousal [30], threat perception (and attendant increased arousal) may interfere with learning coping strategies in CBT.…”

“…However, included studies used a variety of more or less explicit experimental paradigms. In anxious children, Legerstee and colleagues [16] found that difficulty disengaging from threatening pictures on a dot probe (implicit) task was associated with treatment nonresponse to CBT. Subsequently, they linked normalization of this bias to child response to "stepped care CBT" (an unusually intensive child-and parentfocused intervention) [17].…”

Evaluating differences in Pavlovian fear acquisition and extinction as predictors of outcome from cognitive behavioural therapy for anxious children

“…Treatment responders (N = 26) versus nonresponders (N = 18) were defined as being free from all anxiety disorders diagnosed with the ADIS-C/P-IV at posttreatment assessment (i.e., CSR < 4), consistent with prior studies (e.g., Legerstee et al, 2009;Waters et al, 2012Waters et al, , 2015. Pre-to posttreatment change in SCAS-C and SCAS-P scores were correlated with each dependent variable for anxious children to provide a continuous measure of treatment change.…”

An Introduction to the Study of Information Processing Biases in Childhood Anxiety: Theoretical and Methodological Issues

“…Increasingly, researchers and clinicians working with children who experience clinical levels of anxiety recognize that a focus on changing attentional processing can form an effective component of treatment (e.g. Legerstee et al, 2009). This approach to treatment is summarized in Chapter 13.…”