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

儿童焦虑问题如此严重和普遍，以至于早期干预的必要性和促进儿童的情绪健康一直是几份英国政府报告的重点。童年焦虑通常持续到青春期和成年期，并与学习困难、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主要风险因素。针对有患焦虑症风险的儿童，可能会导致旨在帮助弱势儿童的预防计划，特别是在高度紧张的时期。在早期阶段进行预防性干预可以使个人回到健康的道路上，避免以后给个人和社会带来相当大的痛苦和代价。通过识别和了解使一些儿童更容易患上焦虑症的因素，我们应该能够治疗他们，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--提高儿童在面临压力时感到非常焦虑的免疫力。众所周知，导致焦虑的一个重要因素是人们大脑处理情绪信息的方式，比如面部表情的图片或情绪化的词语。有证据表明，焦虑程度升高的儿童更关注威胁信息，例如愤怒或厌恶的面孔。针对儿童如何注意情绪信息可能是预防和治疗儿童焦虑的一种有前途的方法。一种改变儿童注意情绪信息方式的简单方法已经存在；注意偏差修正任务(ABM)。ABM是一个简单的计算机化任务，它训练孩子们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是否可以作为对抗焦虑的疫苗，以应对压力体验，如不得不在观众面前做演讲，或参加年终考试。我们将对一组9至11岁的儿童进行三项研究，他们的焦虑程度高于正常水平。所有这三项研究都将比较ABM和非主动控制条件的效果，这些条件并不是为了改变儿童对情绪信息的注意方式。研究1将确定它最有助于引导孩子注意的情感信息类型。具体地说，我们感兴趣的是，让孩子更多地关注积极信息还是中性信息是最有效的。研究2将提供关于提供治疗的最佳方式的信息；即儿童应以多长时间完成治疗。研究3将通过测量ABM是否影响儿童对情绪信息的注意以及焦虑程度来测试ABM在预防焦虑方面的有效性，儿童一般报告说。我们将测量ABM对儿童对实验性压力任务(进行谈话和做一道困难的数学题)的焦虑反应的影响。我们还将探索ABM对儿童在年终国家课程考试(SAT)前后的焦虑的影响，我们知道许多儿童感到压力很大。这些措施将告诉我们，ABM是否可能防止儿童感到焦虑，以及我们是否准备好在大规模临床试验中用非常焦虑的儿童测试ABM。

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.