Attentional Bias Modification: Development and testing of a school-based "Cognitive Vaccine" for the reduction and prevention of child anxiety

儿童焦虑问题是如此严重和普遍，以至于早期干预和促进儿童情绪健康的必要性一直是英国政府几份报告的重点。儿童期焦虑通常持续到青春期和成年期，并与学校困难、社会功能受损和同伴问题有关。它也是经历其他心理和身体健康问题的一个主要风险因素。针对有发展焦虑风险的儿童，可能会导致旨在帮助弱势儿童的预防项目，特别是在高压力时期。在这一早期阶段进行预防性干预可以使个人回到健康的道路上，避免日后出现相当大的痛苦，并使个人和社会付出代价。通过识别和理解使一些孩子更容易患上焦虑的因素，我们应该能够治疗他们并防止他们经历焦虑。通过这种方式，我们可以开发出像疫苗一样的治疗方法——增加孩子们面对压力时的免疫力，使他们不会感到非常焦虑。一个已知的对产生焦虑很重要的因素是人们的大脑处理情绪信息的方式，比如面部表情的图片或情感词汇。有证据表明，焦虑程度高的孩子会更注意威胁性信息，比如一张愤怒或厌恶的脸。以儿童如何注意情绪信息为目标，可能是预防和治疗儿童焦虑的一种有希望的方法。已经有一种简单的方法可以改变孩子对情感信息的关注方式；注意偏差修正任务（ABM）。ABM是一项简单的计算机化任务，训练孩子养成不注意威胁信息的习惯。在这个项目中，我们想要评估ABM是否可以作为抗焦虑的疫苗，以应对压力经历，如必须在观众面前做演讲，或参加年终考试。我们将对一组9到11岁的孩子进行三项研究他们的焦虑程度高于正常水平。这三项研究都将比较ABM与非活动控制条件的效果，而非旨在改变儿童对情绪信息的关注方式。研究1将确定情感信息的类型，它是最有用的，以引导儿童的注意力。具体来说，我们感兴趣的是让孩子更多地关注积极的信息还是中性的信息是最有效的。研究2将提供提供治疗的最佳方式的信息；这就是孩子们应该定期完成治疗的时间。研究3将测试ABM在预防焦虑方面的有效性，通过测量它是否影响儿童对情绪信息的关注，以及儿童通常报告的焦虑程度。我们将测量ABM对儿童对实验性压力任务（演讲和做一道困难的数学题）的焦虑反应的影响。我们还将探讨ABM对儿童年终全国课程考试（sat）焦虑的影响，我们知道许多孩子都觉得压力很大。这些措施将告诉我们ABM是否有可能防止儿童感到焦虑，以及我们是否准备好在大规模的临床试验中对非常焦虑的儿童进行ABM测试。

Childhood anxiety problems are so serious and common that the need for early intervention and the promotion of emotional well-being in children has been the focus of several UK government reports. Childhood anxiety often continues into adolescence and adulthood, and is associated with difficulties at school and with impaired social functioning and peer problems. It is also a major risk factor for experiencing other psychological and physical health problems. Targeting children at risk of developing anxiety, could lead to prevention programs aimed at helping vulnerable children, especially during periods of high stress. Preventative interventions at this early stage can set the individual back onto a healthy path avoiding considerable later distress and cost to both the individual and society. By identifying and understanding the factors that make some children more vulnerable to developing anxiety, we should be able to treat them and prevent them from experiencing anxiety. In this way, we can develop treatments that act like a vaccine - increasing children's immunity against feeling very anxious when faced with stress. One factor that is known to be important for developing anxiety is the way people's brains process emotional information, such as pictures of facial expressions or emotional words. There is evidence that children who have elevated anxiety pay greater attention to threatening information, for example an angry or disgusted face. Targeting how children pay attention to emotional information may be a promising way of preventing and treating childhood anxiety. A simple method for changing how children pay attention to emotional information already exists; the attentional bias modification task (ABM). ABM is a simple computerised task that trains children to get into the habit of not paying attention to threatening information. In this project, we want to assess whether ABM may act as a vaccine against feeling anxious, in response to a stressful experience such as having to do a presentation in front of an audience, or taking end of year exams. We are going to perform three studies with a group of children aged 9 to 11 years who are experiencing higher than normal levels of anxiety. All three studies will compare the effect of ABM with an inactive control condition not designed to change how children pay attention to emotional information. Study 1 will establish the type of emotional information it is most useful to direct children's attention to. Specifically, we are interested in whether it is most effective to make children pay greater attention to positive or neutral information. Study 2 will provide information on the best way to deliver the treatment; that is how regularly the children should complete the treatment. Study 3 will test how effective ABM is in preventing anxiety, by measuring whether it affects how children pay attention to emotional information, and how much anxiety, children report generally. We will measure the effects of ABM on children's anxiety response to an experimental stress task (performing a talk and doing a difficult maths problem). We will also explore the effects of ABM on children's anxiety surrounding the end of year national curriculum exams (SATs), which we know that many children find stressful. These measures will tell us whether ABM is likely to prevent children from feeling anxious and whether we are ready to test ABM with children who are very anxious in large scale clinical trials.