This application proposes to collect preliminary data on Attention Bias Modification Training (ABMT) among clinic referred children and adolescents who display subthreshold impairing anxiety (SubImpAnx; anxiety & related impairment that fails to meet DSM criteria for an anxiety disorder). Traditional approaches to mental health service delivery cannot meet current demand. The inadequacies of traditional service delivery are magnified when viewed through the lens of impaired but undiagnosed youth. It is an unaddressed empirical question whether a least restrictive treatment can effectively reduce SubImpAnx in youth. Empirical efforts to address this issue are important because youths with SubImpAnx experience substantial impairment, are at high risk of escalation to full syndrome anxiety disorder, and pose a burden on the health care system. ABMT is a novel translational treatment for anxiety based on experimental and neuroscience research findings on attention processes. Research demonstrates that ABMT leads to reductions in anxiety and its disorders. ABMT holds promise as a potential least restrictive treatment for SubImpAnx because (a) youth with SubImpAnx display an attention bias toward threatening stimuli, (b) ABMT is brief, inexpensive, and highly portable, and (c) ABMT does not require skilled clinicians. This study will enroll 66 clinic referred children and adolescents (ages 8-16 years) who meet criteria for SubImpAnx. Participants will be randomly assigned to complete 8 sessions of either ABMT or a placebo control (PC) task over 4 weeks. Clinician ratings on youth anxiety severity and impairment will be evaluated as the primary outcome. Youth self ratings and parent ratings on youth anxiety symptoms and impairment will be evaluated as secondary outcomes. All measures will be collected before condition assignment (pretreatment), at immediate posttreatment, and at an 8 week follow up. In addition, initial data will be collected to shed ligh on whether it would be useful to pursue (a) attention bias to threat as a mediator of ABMT's anxiety reduction effects and (b) dose-response issues related to ABMT's anxiety reduction effects in a subsequent, larger study.
The specific aims are: Collect pilot data on the effects of ABMT and a PC task on levels of anxiety and impairment at a post evaluation (Aim 1) and at a follow up (FU) evaluation 8 weeks after the post evaluation (Aim 2); Preliminarily examine whether ABMT leads to lower levels of attention bias toward threatening stimuli as compared to a PC Task at post and 8 week FU (Aim 3); Describe the course of anxiety symptoms and impairment during treatment among youth in the ABMT condition (Aim 4). This project will provide critically needed pilot data on ABMT for youth with SubImpAnx. With these data in hand, the field will be in a better position to determine whether ABMT may be used as a least restrictive intervention among anxious youth who are 'impaired but undiagnosed.'

Public Health Relevance

This R21 application proposes a pilot test of Attention Bias Modification Training (ABMT) among clinic referred children and adolescents with subthreshold impairing anxiety (i.e., anxiety and related impairment that fails to meet DSM-IV criteria for an anxiety disorder diagnosis). Findings of the proposed research are expected to place the field in a better position to determine whether ABMT may be tested as a preventive intervention for youth with subthreshold anxiety and whether ABMT may be evaluated as an initial, least restrictive treatment in a stepped care approach for youth with subthreshold anxiety.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Cooperative Agreement Phase I (UH2)
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Interventions Committee for Disorders Involving Children and Their Families (ITVC)
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Avenevoli, Shelli A
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Florida International University
Schools of Arts and Sciences
United States
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Abend, Rany; de Voogd, Leone; Salemink, Elske et al. (2018) Association between attention bias to threat and anxiety symptoms in children and adolescents. Depress Anxiety 35:229-238
Pettit, Jeremy W; Rey, Yasmin; Bechor, Michele et al. (2017) Can less be more? Open trial of a stepped care approach for child and adolescent anxiety disorders. J Anxiety Disord 51:7-13
Melendez, Raquel; Bechor, Michele; Rey, Yasmin et al. (2017) Attentional Control Scale for Children: Factor Structure and Concurrent Validity Among Children and Adolescents Referred for Anxiety Disorders. J Clin Psychol 73:489-499
Silverman, Wendy K; Pettit, Jeremy W; Lebowitz, Eli R (2016) Stepping Toward Making Less More for Concerning Anxiety in Children and Adolescents. Clin Psychol (New York) 23:234-238