A Clinical Trial of a Gamified Attention Bias Modification Training in Anxious Youth

Overview

Background: Attention bias modification training (ABMT) and cognitive behavioral therapy (CBT) likely target different aspects of aberrant threat responses in anxiety disorders and may be combined to maximize therapeutic benefit. However, studies investigating the effect of ABMT in the context of CBT have yielded mixed results. Objective: The primary goal of this project is to utilize an enhanced ABMT to target attentional bias towards threat, in addition to classic CBT for anxiety disorders in youth, to determine the efficacy of ABMT in the context of CBT. Study Population: 121 youth (8-17 years old) with a primary anxiety disorder diagnosis Methods: In this sub-study, * Participants will receive open CBT treatment. * Open CBT treatment will be augmented with computer-based attention retraining, delivered in a randomized-controlled design, with random assignment to either active or placebo attention-training regimens. * This enhanced ABMT integrates a modified dot-probe task used in previous studies, where a target is always presented at the previous location of the neutral and not the simultaneously presented threatening stimulus, with a visual search, where the targets are always presented distally of threatening distractors. * These two training elements (modified dot-probe and visual search) will be embedded in an engaging game to foster motivation and adherence. Outcome: Symptom improvement will be compared between the two study arms.

Background: Attention bias modification training (ABMT) and cognitive behavioral therapy (CBT) likely target different aspects of aberrant threat responses in anxiety disorders and may be combined to maximize therapeutic benefit. However, studies investigating the effect of ABMT in the context of CBT have yielded mixed results. Objective: The primary goal of this project is to utilize an enhanced ABMT to target attentional bias towards threat, in addition to classic CBT for anxiety disorders in youth, to determine the efficacy of ABMT in the context of CBT. Study Population: 121 youth (8-17 years old) with a primary anxiety disorder diagnosis who are originally consented on 01-M-0192 will be recruited and randomized to each arm in the sub-study Methods: In this sub-study, * Participants will receive open CBT treatment. * Open CBT treatment will be augmented with computer-based attention retraining, delivered in a randomized-controlled design, with random assignment to either active or placebo attention-training regimens. * This enhanced ABMT integrates a modified dot-probe task used in previous studies, where a target is always presented at the previous location of the neutral and not the simultaneously presented threatening stimulus, with a visual search, where the targets are always presented distally of threatening distractors. * These two training elements (modified dot-probe and visual search) will be embedded in an engaging game to foster motivation and adherence. Outcome: Symptom improvement will be compared between the two study arms at different times using * The Pediatric Anxiety Rating Scale (PARS) * The Clinical Global Impression of Improvement Scale (CGI-I) * The Children's Global Assessment Scale (CGAS) * The Screen for Child Anxiety Related Disorders (SCARED) * The State-Trait Anxiety Inventory for Children (STAI-C) * The Self-Efficacy Questionnaire (SEQ-C)