Attention Training for Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is characterized by excessive, uncontrollable worry
(Barlow, et al., 1986) leading to medical over-utilization, poor perceived health, low
ratings of quality of life, and impairment at work resulting in a significant economic and
public health impact (Wittchen et al., 2002; Ballenger et al., 2001). Lifetime prevalence of
GAD is high (5.7%, Kessler, et al, 2005), with even higher estimates in the primary care
setting (8.5%, Roy-Byrne & Wager, 2004). Researchers have established a relationship between
GAD and attention bias to threatening information (Mogg & Bradley 2005). This knowledge,
however, has not been translated into more effective treatments for this disorder. This
five-year, two site proposal aims to test a computerized treatment for GAD in a
double-blind, placebo-controlled study bridging basic attention bias research and treatment
outcome. We present the results from 7 studies demonstrating the efficacy of attention
modification programs (AMP) in ameliorating symptoms of anxiety. Specifically, we report
results from a pilot study of individuals with Generalized Anxiety Disorder (n=24, Dr Amir's
lab), and high worries (n=24, Dr. Schmidt's lab) demonstrating the effectiveness of the
procedures described in this proposal.

In brief, our intervention was effective in: a) changing biased attention, b) reducing
symptoms of GAD, and c) maintaining its effects in up to one year follow-up. This technique
for changing attention bias in GAD can provide a cost-effective and easy to administer
treatment grounded in basic cognitive science that may help reduce suffering in individuals
with anxiety. A larger study would allow us to test the treatment and examine the
generalizability of the intervention to patients with GAD along with comorbid conditions.
Moreover, we will examine the transportability of the intervention by examining the proposed
intervention at two sites. There are currently 10 participants enrolled in the newest phase
of pilot data collection (SDSU 6, FSU 4).

The goal of the current proposal is to extend these findings to a larger group of
individuals with GAD and to examine the generalizability of the results to individuals with
comorbid GAD. In the current proposal we will test two hypotheses:

1. Individuals with GAD completing the AMP will show a larger reduction in their attention
bias to threat compared to the clinical monitoring group

2. Individuals with GAD completing AMP will show a larger reduction in anxiety symptoms
compared to the clinical monitoring group.

3. Individuals with GAD completing AR will show a larger reduction in anxiety symptoms
compared to the clinical monitoring group.

Specifically, in the current proposal directly responds to the NIMH priorities for
evaluating user-friendly interventions and non-traditional delivery methods to increase
access to evidence-based interventions. We will evaluate the efficacy of a 12-week
computer-delivered home-based treatment program for GAD. Treatment will comprise a
combination of two interventions shown to be efficacious in the treatment of GAD. The
Attention Modification Program (AMP) is a computerized program designed to facilitate
attention disengagement from threatening stimuli (Amir et al., 2009). Applied Relaxation
(AR) is a behavioral, skills-based intervention where individuals learn ways to reduce the
physiological cues associated with anxiety and worry (Öst, 1987; Siev & Chambless, 2007).
Following the recommended guidelines of the NIMH Workgroup on Psychosocial Intervention
Development (Hollon et al., 2002), we review evidence suggesting that both treatments are
ideal candidates for the efficient, economical, and widespread transportation of
evidence-based treatments for GAD. This proposal has the potential for a significant public
health impact by evaluating a new method for delivering evidence-based interventions for
hard-to-reach populations through the use of innovative technologies.

Inclusion Criteria:

- Primary diagnosis of Generalized Anxiety Disorder

Exclusion Criteria:

- Evidence of suicidal intent

- Evidence of current substance abuse

- Evidence of current or past schizophrenia, bipolar disorder, or organic mental
disorder

- Current CBT

- Change in other psychosocial or pharmacological treatment during the 12 weeks prior
to study entry.