Attention Bias Modification Training in Child Anxiety CBT Nonresponders

针对儿童焦虑 CBT 无反应者的注意力偏差修正培训

• 批准号: 8520791
• 负责人: JEREMY W PETTIT
• 金额: $ 20.86万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2016-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8520791
• 关键词: Address; Adolescent; Adult; Affect; Aftercare; Age; Amygdaloid structure; Anxiety; Anxiety Disorders; Attention; Awareness; Behavioral; Child; Clinical Trials; Cognition; Cognitive Therapy; Cognitive remediation; Computers; Data; Development; Diagnosis; Diagnostic; Disease; Double-Blind Method; Enrollment; Evaluation; Failure; Family; Financial compensation; Frustration; Future; Generalized Anxiety Disorder; Hand; Healthcare; Healthcare Systems; Impairment; Intervention; Literature; Maintenance; Measures; Mediator of activation protein; Modification; Neurobiology; Neurosciences; Neurosciences Research; Parents; Patients; Placebo Control; Plant Roots; Positioning Attribute; Process; Protocols documentation; Randomized; Randomized Clinical Trials; Recruitment Activity; Research; Research Personnel; Sampling; Separation Anxiety Disorder; Severities; Social Phobia; Specific Phobia; Stimulus; Structure; Symptoms; Techniques; Testing; Training; Treatment Efficacy; Work; Youth; base; behavior change; blind; emotional distress; evidence base; experience; follow-up; interest; meetings; novel; primary outcome; psychosocial; public health relevance; research study; response; secondary outcome; theories

DESCRIPTION (provided by applicant): This application proposes a pilot test of Attention Bias Modification Training (ABMT) among children and adolescents who have completed a full protocol of cognitive behavior therapy (CBT) for anxiety and still meet criteria for a primary diagnosis of Social Phobia (SOP), Separation Anxiety Disorder (SAD), or Generalized Anxiety Disorder (GAD) a full year after completion of CBT. There is currently not a single empirical study in the youth anxiety treatment literature that has systematically examined a treatment augment for youth who fail to respond to a full course of CBT. Empirical efforts to address this issue are important because youths who do not respond to CBT continue to suffer emotional distress and impairment associated with anxiety disorders, experience frustration and demoralization by perceived "failure," and likely pose a financial 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. Based on recent theory and research demonstrating an attention bias toward threat predicts CBT nonresponse among anxious youth, researchers have postulated that ABMT may hold promise as an augment to CBT because of its specific focus on attention bias that targets both frontal-cortical and subcortical circuitry. Thi study will recruit an estimated 70 children and adolescents who have completed a 12-14 week CBT trial for anxiety disorders (Silverman, R01 MH079943) and at the one year follow-up continue to meet criteria for a primary diagnosis of SOP, SAD, or GAD. These 70 children and adolescents (ages 8-16 years) will be randomly assigned to complete eight biweekly sessions of either ABMT or a placebo control (PC) task. Clinician ratings on youth anxiety severity will be collected and evaluated as the primary outcome. Youth self ratings on anxiety symptoms and parent ratings on youth anxiety symptoms will be collected and evaluated as secondary outcomes. All measures will be collected before condition assignment (pretreatment), at immediate posttreatment, and at an eight week follow up. The following specific aims will be addressed. Aim 1: Test whether ABMT leads to significantly lower levels of anxiety at posttreatment as compared to a Placebo Control Task. Aim 2: Examine whether ABMT leads to significantly lower levels of anxiety as compared to a Placebo Control Task at a follow up evaluation eight weeks posttreatment. This would suggest the maintenance of ABMT effects after eight weeks of no treatment. Aim 3: Gain perspective on the viability of variables as potential mediators and moderator of ABMT so as to inform decisions about whether to pursue these variables in a future R01. The variables proposed as potential mediators are attention bias toward threat and threat-related interpretation bias. The variable proposed as a potential moderator is attention control. Overall, this project will provide critically needed data on ABMT as a treatment augment for youth with anxiety disorders who do not respond CBT. With these data in hand, the field will be in a better position to determine whether and how ABMT may be used optimally among anxious youth who are likely to need more than CBT.

描述（由申请人提供）：本申请提出了一个注意偏差修正训练（ABMT）在儿童和青少年中进行的试点测试，这些儿童和青少年已经完成了焦虑的认知行为治疗（CBT）的完整协议，并且在完成CBT一年后仍然符合社交恐惧症（SOP），分离焦虑障碍（SAD）或广泛性焦虑障碍（GAD）的初步诊断标准。目前，在青少年焦虑治疗文献中，没有一项实证研究系统地检查了对CBT全疗程无效的青少年的治疗增加。解决这个问题的经验努力是很重要的，因为对CBT没有反应的年轻人继续遭受与焦虑症相关的情绪困扰和损害，体验到“失败”的挫败感和士气低落，并可能给卫生保健系统带来经济负担。ABMT是一种基于注意力过程的实验和神经科学研究成果的新型焦虑转化治疗方法。研究表明，ABMT可以减少焦虑及其紊乱。基于最近的理论和研究表明，对威胁的注意偏倚可以预测焦虑青少年对CBT的无反应，研究人员假设ABMT可能有希望作为CBT的补充，因为它特别关注注意偏倚，针对额叶皮层和皮层下回路。这项研究将招募大约70名儿童和青少年，他们已经完成了针对焦虑症的12-14周CBT试验（Silverman, R01 MH079943），并在一年的随访中继续满足SOP、SAD或GAD的初步诊断标准。这70名儿童和青少年（8-16岁）将被随机分配完成8个双周的ABMT或安慰剂对照（PC）任务。临床医生对青少年焦虑严重程度的评分将被收集和评估作为主要结果。青少年焦虑症状的自我评分和父母对青少年焦虑症状的评分将被收集和评估为次要结果。在条件分配前（预处理）、治疗后立即和8周随访时收集所有测量数据。将讨论以下具体目标。目的1：测试与安慰剂控制任务相比，ABMT是否显著降低了治疗后的焦虑水平。目的2：在治疗后8周的随访评估中，检查与安慰剂控制任务相比，ABMT是否显著降低了焦虑水平。这表明在8周未治疗后，ABMT的效果仍能维持。目标3：了解变量作为ABMT的潜在中介和调节因子的可行性，以便为是否在未来的R01中追求这些变量的决策提供信息。威胁的注意偏倚和威胁相关的解释偏倚是潜在的中介变量。建议作为潜在调节因素的变量是注意控制。总的来说，这个项目将提供ABMT作为对CBT无效的青少年焦虑症的治疗补充的关键数据。有了这些数据在手，该领域将处于更好的位置，以确定ABMT是否以及如何在可能需要比CBT更多的焦虑青少年中得到最佳应用。