Cognitive Bias Modification for Youth Anxiety

Research in the last fifteen years suggests that anxious individuals selectively attend
towards threatening information. Attention modification interventions for internalizing
adults have been developed to target cognition at this basic level; these programs have
demonstrated initial efficacy in attention bias and anxiety symptom reduction. To date, there
have been minimal published studies of attention modification in youths with clinical levels
of anxiety.

This study is a large randomized efficacy-effectiveness trial (N = 498) to test the benefit
of this low-cost, computerized attention modification intervention (Cognitive Bias
Modification (CBM) computer application) for anxiety disorders and symptomatology in youth
ages 12 to 17. This trial conducted will compare three intervention arms, all of which
include underlying treatment as usual (TAU). The investigators directly test the level of
clinical support ("scaffolding") needed to adequately deliver self-administered CBM to
anxious youth, a finding that will be key to preparing for future deployment-focused trials.
The investigators will compare an attention control version of the CBM program (Arm 1) to two
active versions of the CBM intervention that have varying levels of patient clinical support:
a self-administered CBM program that participants download and install on their home
computers (Self-Administered CBM-only; Arm 2), and the same CBM program paired with an
adherence promotion (AP) component delivered via brief telephone calls from study "coaches,"
including as needed, brief motivational enhancement and/or technical assistance
(Self-Administered CBM+AP; Arm 3).

The investigators expect that youth receiving CBM and CBM+AP will have improvement in anxiety
symptoms and functioning. The investigators will also complete a cost-effectiveness analysis
to examine potential costs offset by this intervention.