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

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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.