Biobehavioral Markers of Attention Bias Modification in Temperamental Risk for Anxiety: A Randomized Control Trial

Abstract

Objective: Children with behavioral inhibition, a temperament characterized by biologically based hypervigilance to novelty and social withdrawal, are at high risk for developing anxiety. This study examined the effect of a novel attention training protocol, attention bias modification (ABM), on symptomatic, behavioral, and neural risk markers in children with behavioral inhibition.

Method: Nine- to 12-year-old typically developing children identified as having behavioral inhibition (N = 84) were assigned to a 4-session active ABM training (n = 43) or placebo protocol (n = 41) using a double-blinded, randomized, controlled trial approach. Anxiety symptoms (Diagnostic Interview Schedule for Children-Fourth Edition), attention bias (AB; measured by a dot-probe task; AB = incongruent reaction time - congruent reaction time), and AB-related neural activation (measured by functional magnetic resonance imaging activation for the incongruent > congruent contrast in the dot-probe task) were assessed before and after the training sessions.

Results: Results showed that active ABM (n = 40) significantly alleviated participants' symptoms of separation anxiety, but not social anxiety, compared with the placebo task (n = 40); ABM did not modify behavioral AB scores in the dot-probe task; and at the neural level, active ABM (n = 15) significantly decreased amygdala and insula activation and increased activation in the ventrolateral prefrontal cortex compared with placebo (n = 19).

Conclusion: These findings provide important evidence for ABM as a potentially effective protective tool for temperamentally at-risk children in a developmental window before the emergence of clinical disorder and open to prevention and intervention. Clinical trial registration information-Attention and Social Behavior in Children (BRAINS); https://ichgcp.net/clinical-trials-registry/NCT02401282" title="See in ClinicalTrials.gov">NCT02401282.

Keywords: anxiety; attention bias modification; behavioral Inhibition; dot probe; fronto-limbic activation.

Conflict of interest statement

Disclosure: Drs. Liu, Taber-Thomas, Pérez-Edgar, and Ms. Fu report no biomedical financial interests or potential conflicts of interest.

Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

>FIGURE 1. Study flow.

Note: ABM = attention bias modification; BI = behavioral inhibition; BIQ = Behavioral Inhibition Questionnaire; BLN = baseline; fMRI = functional magnetic resonance imaging; OCM = outcome.

FIGURE 2. The dot-probe paradigm.

Note: The active attention bias modification (ABM) task includes only the incongruent angry-neutral condition (and the neutral-neutral condition); the placebo task includes incongruent and congruent conditions in an equal number of trials (and the neutral-neutral condition). fMRI = functional magnetic resonance imaging.

FIGURE 3. Separation anxiety scores for the attention bias modification (ABM; n = 40) and placebo (n = 40) groups at baseline (BLN) and outcome (OCM).

Note: The full-color figure is available online.

FIGURE 4. Three brain clusters showing a significant time × training interaction and the extracted percentage of signal change (%SC) values for attention bias modification (ABM; n = 15) and placebo (n = 19) at baseline (BLN) and outcome (OCM).

Note: The full-color figure is available online. vlPFC = ventrolateral prefrontal cortex.