Complementary Features of Attention Bias Modification Therapy and Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders

White, Lauren K.; Sequeira, Stefanie; Britton, Jennifer C.; Brotman, Melissa A.; Gold, Andrea L.; Berman, Erin; Towbin, Kenneth E.; Abend, Rany; Fox, Nathan A.; Bar‐Haim, Yair; Leibenluft, Ellen; Pine, Daniel S.

doi:10.1176/appi.ajp.2017.16070847

Cited by 89 publications

(95 citation statements)

References 31 publications

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“…Specific inclusion/exclusion criteria for each site, as well as additional information, are detailed in the supplementary material. Some of the sites have previously published the attention bias and anxiety severity data for some of their respective participants as pre-treatment mean threat bias and anxiety scores, and as correlations between these two measures (de Voogd et al, 2016; Fitzgerald, Rawdon, & Dooley, 2016; Morales, Taber-Thomas, & Pérez-Edgar, 2017; White, Britton et al, 2016; White, Sequeira et al, 2017). …”

Section: Methodsmentioning

confidence: 99%

Association between attention bias to threat and anxiety symptoms in children and adolescents

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These findings indicate associations between threat bias and pediatric anxiety symptoms, and suggest that vigilance to external threats manifests more prominently in symptoms of social anxiety and school phobia, regardless of age and gender. These findings point to the role of attention bias to threat in anxiety, with implications for translational clinical research. The significance of applying standardized methods in multi-site collaborations for overcoming challenges inherent to clinical research is discussed.

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Section: Methodsmentioning

confidence: 99%

Association between attention bias to threat and anxiety symptoms in children and adolescents

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“…Attempts to demonstrate mediation of symptom changes by attention bias changes using reaction time (RT) measures yielded mixed results, possibly due to low reliability of RT‐based bias scores (Price et al., ; Schmukle, ; White et al., ) or lack of statistical power (but see Price et al., ). Data on change in neural activity pre‐to‐post ABM may provide more sensitive markers of mediation as these markers relate to mechanisms of symptom changes (Britton et al., ; Browning, Holmes, Murphy, Goodwin, & Harmer, ; Eldar & Bar‐Haim, ; Nelson, Jackson, Amir, & Hajcak, ; White et al., , ). Nevertheless, while informative, such designs do not quantify online changes in cognitive processes, which could be highly relevant to these mechanisms.…”

Section: Introductionmentioning

confidence: 99%

“…in neural activity pre-to-post ABM may provide more sensitive markers of mediation as these markers relate to mechanisms of symptom changes (Britton et al, 2015;Browning, Holmes, Murphy, Goodwin, & Harmer, 2010;Eldar & Bar-Haim, 2010;Nelson, Jackson, Amir, & Hajcak, 2017;White et al, 2016White et al, , 2017. Nevertheless, while informative, such designs do not quantify online changes in cognitive processes, which could be highly relevant to these mechanisms.…”

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A neuromarker of clinical outcome in attention bias modification therapy for social anxiety disorder

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Background Attention bias modification (ABM) therapy aims to modify threat‐related attention patterns via computerized tasks. Despite showing medium clinical effect sizes for anxiety disorders, underlying neural‐cognitive mechanisms of change remain unclear. We used visual mismatch negativity (vMMN), an event‐related potential sensitive to violations of learned statistical contingencies, to assess therapy‐related contingency extraction processes in healthy participants and in patients with social anxiety disorder (SAD). We then assessed whether vMMN amplitude predicts ABM treatment outcome. Methods A modified version of the dot‐probe task was used to elicit vMMN, in which 80% of trials were standard and 20% were deviant. In study 1, 30 healthy adults were randomly assigned to one of two ABM conditions: one in which threat‐congruent targets were deviant trials and threat‐incongruent targets were standard trials, and another in which the contingency was reversed. Electroencephalography (EEG) was continuously measured and vMMN analyzed. In study 2, 38 patients with SAD underwent six sessions of ABM therapy. We tested whether rule extraction in the ABM task, indicated by vMMN amplitude, predicts treatment outcome. Results vMMN clearly emerged over prespecified scalp locations indicating contingency extraction during ABM (study 1). vMMN amplitude predicted clinical improvement after ABM therapy, uniquely accounting for 7% and 14.4% of the variance in clinician‐rated and self‐reported posttreatment SAD symptoms, respectively. Conclusions vMMN emerges as a neural marker for contingency learning in ABM, suggesting a significant role for contingency extraction processes in the clinical efficacy of this therapy.

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“…By contrast, CBGT explicitly teaches patients to change their attention and behavior through instruction and practice. Based on these differences, prior work suggests that CBGT and ABM could complement each other by targeting different aspects of anxiety (Barry et al 2015; White et al 2017). …”

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“…This design could have potentially offset attentional training effects that may have been achieved with active ABM practiced at home. Finally, Rapee et al (2013) applied social threat words as ABM stimuli, whereas the more common ABM stimuli used for SAD are threat-related faces (Riemann et al 2013; Shechner et al 2014; Heeren et al 2015; White et al 2017). …”

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Attention bias modification augments cognitive–behavioral group therapy for social anxiety disorder: a randomized controlled trial

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Background Cognitive–behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT. Methods Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment. Results Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores. Conclusions This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive–behavioral therapy for adult SAD. Training patients’ attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.

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Complementary Features of Attention Bias Modification Therapy and Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders

Cited by 89 publications

References 31 publications

Association between attention bias to threat and anxiety symptoms in children and adolescents

Association between attention bias to threat and anxiety symptoms in children and adolescents

A neuromarker of clinical outcome in attention bias modification therapy for social anxiety disorder

Attention bias modification augments cognitive–behavioral group therapy for social anxiety disorder: a randomized controlled trial

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