Training-associated changes and stability of attention bias in youth: Implications for Attention Bias Modification Treatment for pediatric anxiety

Abstract

Attention Bias Modification Treatment (ABMT), an emerging treatment for anxiety disorders, is thought to modify underlying, stable patterns of attention. Therefore, ABMT research should take into account the impact of attention bias stability on attention training response, especially in pediatric populations. ABMT research typically relies on the dot-probe task, where individuals detect a probe following an emotional-neutral stimulus pair. The current research presents two dot-probe experiments relevant to ABMT and attention-bias stability. In Experiment 1, anxious youth receiving 8-weeks of cognitive-behavioral therapy (CBT) were randomly assigned to ABMT that trains attention towards happy faces (n=18) or placebo (n=18). Two additional comparison groups, anxious youth receiving only CBT (n=17) and healthy comparison youth (n=16), were studied. Active attention training towards happy faces did not augment clinician-rated response to CBT; however, individuals receiving training exhibited reductions on self-report measures of anxiety earlier than individuals receiving CBT only. In Experiment 2, healthy youth (n=12) completed a dot-probe task twice while undergoing functional magnetic resonance imaging. Intra-class correlation demonstrated stability of neural activation in response to attention bias in the ventrolateral prefrontal cortex and amygdala. Together, these two studies investigate the ways in which attention-bias stability may impact future work on ABMT.

Copyright © 2012 Elsevier Ltd. All rights reserved.

Figures

Fig. 1

Attention Bias Modification Treatment (ABMT) study compliance profile (Experiment 1).

Fig. 2

Symptom changes in anxious youth receiving cognitive-behavioral therapy (CBT) with and without Attention Bias Modification Treatment (ABMT). Legend: Independent of training status, anxious youth receiving CBT improved over time [panels A–D, all p > 0.001]. However, based on the combined parent and child Screen for Child Anxiety-Related Emotional Disorders (panel C, SCARED), families of youth receiving active ABMT in addition to CBT reported reductions earlier than families receiving CBT only [p < 0.05]. Of note, across all anxious individuals, the parent and child SCARED scores positively correlated [r = 0.38, p < 0.008]. Mean and standard error bars of intent-to-treat variables displayed.

Fig. 3

Test–retest reliability of neural activation in healthy youth across visits. Legend: Activation in regions showing significant intra-class correlation (ICC) values include the ventrolateral prefrontal cortex and amygdala for unmasked threat (both angry [(−32, 29, 3), 64 voxels (1728 mm3), ICC = 0.73] and fear bias [(41, 20, −4), 77 voxels (2079 mm3), ICC = 0.75]) and masked fear bias [(−31, 5, −19), 24 voxels (648 mm3), ICC = 0.83], respectively. Images display ICC surviving p < 0.05 corrected threshold for these regions. Images are displayed in radiological convention (left = right). Percent signal change values from each functionally defined region are shown in the plots below each image. Grid lines indicate region of extracted data.