Attention Bias Modification Training in Youth With Subthreshold Impairing Anxiety

This study will collect preliminary data on Attention Bias Modification Training (ABMT) among
clinic referred children and adolescents who display subthreshold impairing anxiety
(SubImpAnx; anxiety & related impairment that fails to meet diagnostic criteria for an
anxiety disorder). Traditional approaches to mental health service delivery cannot meet
current demand. The inadequacies of traditional service delivery are magnified when viewed
through the lens of impaired but undiagnosed youth. It is an unaddressed empirical question
whether a least restrictive treatment can effectively reduce SubImpAnx in youth. Empirical
efforts to address this issue are important because youths with SubImpAnx experience
substantial impairment, are at high risk of escalation to full syndrome anxiety disorder, and
pose a burden on the health care system.

This study will enroll 66 clinic referred children and adolescents (ages 8-16 years) who meet
criteria for SubImpAnx. Participants will be randomly assigned to complete 8 sessions of
either ABMT or a placebo control (PC) task over 4 weeks. Clinician ratings on youth anxiety
severity and impairment will be evaluated as the primary outcome. Youth self ratings and
parent ratings on youth anxiety symptoms and impairment will be evaluated as secondary
outcomes. All measures will be collected before condition assignment (pretreatment), at
immediate posttreatment, and at an 8 week follow up. In addition, initial data will be
collected to shed light on whether it would be useful to pursue (a) attention bias to threat
as a mediator of ABMT's anxiety reduction effects and (b) dose-response issues related to
ABMT's anxiety reduction effects in a subsequent, larger study.

The specific aims are: Collect pilot data on the effects of ABMT and a PC task on levels of
anxiety and impairment at a post evaluation (Aim 1) and at a follow up (FU) evaluation 8
weeks after the post evaluation (Aim 2); Preliminarily examine whether ABMT leads to lower
levels of attention bias toward threatening stimuli as compared to a PC Task at post and 8
week FU (Aim 3); Describe the course of anxiety symptoms and impairment during treatment
among youth in the ABMT condition (Aim 4).

This project will provide critically needed pilot data on ABMT for youth with SubImpAnx. With
these data in hand, the field will be in a better position to determine whether ABMT may be
used as a least restrictive intervention among anxious youth who are 'impaired but
undiagnosed.'

Inclusion Criteria:

- 8-16 years old

- meet criteria for subthreshold impairing anxiety

Exclusion Criteria:

- meet diagnostic criteria for Anxiety Disorder, 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