Recent efforts to improve existing treatments for anxiety have emerged from the established experimental literature on threat-related attention bias in anxiety. Attention Bias Modification (ABM) is a novel theory-driven treatment that utilizes computer-based attention training methods to directly but implicitly modify biased attention patterns in anxious individuals in service of symptom relief. The rapidly accumulating evidence base for ABM suggests it may be a promising new intervention for anxiety with an identified mechanism of action - attention bias change. While multiple reviews and meta-analyses are in general support of ABM efficacy, effectiveness studies are sparse particularly with underserved groups such as low income Latino and rural youth. Given data suggesting that anxiety may be more prevalent among Latinos, and that Latinos and rural youth underutilize mental health services, effectiveness studies are necessary to examine culturally informed and innovative evidence-based interventions in these communities. Indeed, ABM may prove to be an ideal intervention for underserved groups by addressing frequently cited barriers to treatment such as access, time, transportation, literacy, and clinician shortages. ABM is also a highly transportable, brief, computerized treatment requiring minimal training, which makes it accessible to a paraprofessional workforce, in this case, community health workers (CHW), who have been reported to have greater success in health outreach, recruitment, and education efforts in hard to reach communities. Efforts to understand the feasibility, acceptability, and effectiveness of a service delivery model which uses CHWs to administer evidence based treatments such as ABM are essential in order to improve access, quality of care, and cost-effectiveness of services for underserved and hard-to-reach communities. Moreover, we aim to develop an ABM paradigm that can be administered via a handheld electronic tablet device with a game-like format, which may increase youth engagement and thereby optimize attention bias change. The overarching goal of this study is to refine and test a developmentally sensitive and ecologically valid ABM paradigm for low-income and rural Latino youth as an initial step towards demonstrating its feasibility, acceptability and effectiveness. The proposed study will be conducted in two phases: 1) an open case series study that will provide initial feasibility data on multiple domains, including the neurocognitive protocol, face stimuli selection, CHW (i.e., promotora) training, and attention training procedures and: 2) a pilot RCT of ABM versus a control condition in 52 anxious Latino youth (26 per group) that will focus on the feasibility of ABM implementation and provide preliminary effectiveness data. This study will also explore the relationship between ABM and changes in neurocognitive correlates of cognitive control in samples of youth not typically recruited in efficacy studies. Our expectation is that feasibility and preliminary effectiveness findings from this project will inform the development of a future large-scale comparative effectiveness trial in rural and hard-to-reach communities, which will further advance the development of innovative, personalized interventions consistent with NIMH Strategic Plan's Objectives (3.1).
The overarching goal of this R34 is to refine and test a developmentally sensitive Attention Bias Modification (ABM) intervention for low-income and rural Latino youth with anxiety as an initial step towards demonstrating its feasibility, acceptability and effectiveness for underserved communities. ABM is a highly transportable, brief, computerized treatment with an identified mechanism of action requiring minimal training and provider time, thus lending itself to community based service delivery models that rely on paraprofessionals such as community healthcare workers. We will also explore whether cognitive control may serve as a potential biomarker for pediatric anxiety as well as a moderator of treatment response in this group of underserved youth.
| Muñoz, Ricardo F; Chavira, Denise A; Himle, Joseph A et al. (2018) Digital apothecaries: a vision for making health care interventions accessible worldwide. Mhealth 4:18 |
