A Randomized Controlled Trial of Attention Bias Modification Treatment in Youth With Treatment-Resistant Anxiety Disorders.

OBJECTIVE: Randomized clinical trials of augmentation strategies for youth with treatment-resistant anxiety disorders do not exist. We present findings from an efficacy trial of attention bias modification treatment (ABMT) as an augment for this population, in comparison with attention control training (ACT).

METHOD: Sixty-four youths (34 boys; M age=11.7 years) who continued to meet for anxiety diagnoses after completing cognitive behavior therapy (CBT) were randomized to either ABMT or ACT. ABMT and ACT consisted of dot-probe attention training trials presenting angry and neutral faces; probes appeared in the location of neutral faces on 100% of trials in ABMT and 50% of trials in ACT. Independent evaluators, youths, and parents completed ratings of youth anxiety severity, and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and two-month follow-up.

RESULTS: Both arms produced significant reductions in anxiety severity, with no differences between arms. Specifically, across informants, anxiety severity was significantly reduced at posttreatment and reductions were maintained at follow-up. Primary anxiety disorder diagnostic recovery combined across arms was 50% at posttreatment and 58% at follow-up. Attention control, but not attention bias to threat, was significantly improved at posttreatment in both arms.

CONCLUSION: This is the first study to show anxiety can be reduced in youth who did not respond to CBT, and that anxiety-reducing effect is found using both attention training contingency schedules. These findings, along with increases in attention control in both arms, raise intriguing questions about mechanisms of anxiety reduction in treatment-resistant youth with attention training that require further research.