Attention Bias Modification Training for Child Anxiety CBT Nonresponders

This application proposes a pilot test of Attention Bias Modification Training (ABMT) among
children and adolescents who have completed a full protocol of cognitive behavior therapy
(CBT) for anxiety and still meet criteria for a primary diagnosis of an anxiety disorder a
full year after completion of CBT. There is currently not a single empirical study in the
youth anxiety treatment literature that has systematically examined a treatment augment for
youth who fail to respond to a full course of CBT. Empirical efforts to address this issue
are important because youths who do not respond to CBT continue to suffer emotional distress
and impairment associated with anxiety disorders, experience frustration and demoralization
by perceived "failure," and likely pose a financial burden on the health care system.

ABMT is a novel translational treatment for anxiety based on experimental and neuroscience
research findings on attention processes. Research demonstrates that ABMT leads to reductions
in anxiety and its disorders. Based on recent theory and research demonstrating an attention
bias toward threat predicts CBT nonresponse among anxious youth, researchers have postulated
that ABMT may hold promise as an augment to CBT because of its specific focus on attention
bias that targets both frontal-cortical and subcortical circuitry.

This study will recruit an estimated 70 children and adolescents who have completed a 12-14
week CBT trial for anxiety disorders and at the one year follow-up continue to meet criteria
for a primary diagnosis of an anxiety disorders. These 70 children and adolescents (ages 8-16
years) will be randomly assigned to complete eight biweekly sessions of either ABMT or a
placebo control (PC) task. Clinician ratings on youth anxiety severity will be collected and
evaluated as the primary outcome. Youth self ratings on anxiety symptoms and parent ratings
on youth anxiety symptoms will be collected and evaluated as secondary outcomes. All measures
will be collected before condition assignment (pretreatment), at immediate posttreatment, and
at an eight week follow up. The following specific aims will be addressed.

Aim 1: Test whether ABMT leads to significantly lower levels of anxiety at posttreatment as
compared to a Placebo Control Task.

Aim 2: Examine whether ABMT leads to significantly lower levels of anxiety as compared to a
Placebo Control Task at a follow up evaluation eight weeks posttreatment. This would suggest
the maintenance of ABMT effects after eight weeks of no treatment.

Aim 3: Gain perspective on the viability of variables as potential mediators and moderator of
ABMT so as to inform decisions about whether to pursue these variables in a future R01. The
variables proposed as potential mediators are attention bias toward threat and threat-related
interpretation bias. The variable proposed as a potential moderator is attention control.

Overall, this project will provide critically needed data on ABMT as a treatment augment for
youth with anxiety disorders who do not respond CBT. With these data in hand, the field will
be in a better position to determine whether and how ABMT may be used optimally among anxious
youth who are likely to need more than CBT.

Inclusion Criteria:

- 8-16 years old

- completed a 12-14 week cognitive behavioral therapy for anxiety

- a primary DSM-IV diagnosis of generalized anxiety disorder, social anxiety disorder,
or separation anxiety disorder

- if other psychiatric disorders are present, they must be treated with medication and
stable

Exclusion Criteria:

- meet diagnostic criteria for Organic Mental Disorders, Psychotic Disorders, Pervasive
Developmental Disorders, or Mental Retardation

- a high likelihood of harming self or others

- not been living with a primary caregiver for at least 6 months who is legally able to
give consent for the child's participation

- previously undisclosed abuse requiring investigation or ongoing supervision by the
Department of Social Services;

- involved currently in another psychosocial/behavioral treatment

- a serious vision problem that is not corrected with prescription lenses

- a physical disability that interferes with the ability to click a mouse button rapidly
and repeatedly