Attention bias modification treatment for pediatric anxiety disorders: a randomized controlled trial

Abstract

Objective: While attention bias modification (ABM) is a promising novel treatment for anxiety disorders, clinical trial data remain restricted to adults. The authors examined whether ABM induces greater reductions in pediatric anxiety symptoms and symptom severity than multiple control training interventions.

Method: From a target sample of 186 treatment-seeking children at a hospital-based child anxiety clinic, 40 patients with an ongoing anxiety disorder who met all inclusion criteria were enrolled in the study. Children were randomly assigned to one of three conditions: ABM designed to shift attention away from threat; placebo attention training using stimuli identical to those in the ABM condition; and placebo attention training using only neutral stimuli. All participants completed four weekly 480-trial sessions (1,920 total trials). Before and after the attention training sessions, children's clinical status was determined via semistructured interviews and questionnaires. Reduction in the number of anxiety symptoms and their severity was compared across the three groups.

Results: Change in the number of anxiety symptoms and their severity differed across the three conditions. This reflected significant reductions in the number of anxiety symptoms and symptom severity in the ABM condition but not in the placebo attention training or placebo-neutral condition.

Conclusions: ABM, compared with two control conditions, reduces pediatric anxiety symptoms and severity. Further study of efficacy and underlying mechanisms is warranted.

Trial registration: ClinicalTrials.gov NCT00482820.

Figures

FIGURE 1

CONSORT Diagram Illustrating the Flow of Children Through the Studya a Children were seeking treatment for symptoms of anxiety at the Child Anxiety Clinic at Schneider Children’s Medical Center of Israel (Petach-Tikva, Israel). b Posttreatment data for the Anxiety Disorders Interview Schedule for DSM-IV–Child and Parent versions were not provided for one child. c One child was excluded from reaction time analysis (posttreatment bias >3 standard deviations from group mean).

FIGURE 2

Anxiety Symptom Counts and Severity Among Children Randomly Assigned to Attention Bias Modification, Placebo, and Neutral-Neutral Training Conditions a Per the Anxiety Disorders Interview Schedule for DSM-IV–Child and Parent versions.