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: 8641727
• 负责人: JEREMY W PETTIT
• 金额: $ 20.85万
• 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/8641727
• 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）：本申请提出了在儿童和青少年中进行注意力偏差修正训练（ABMT）的试点测试，这些儿童和青少年已经完成了针对焦虑的认知行为治疗（CBT）的完整方案，并且在完成CBT一整年后仍然符合社交恐惧症（SOP）、分离焦虑症（SAD）或广泛性焦虑症（GAD）的初步诊断标准。目前，在青少年焦虑治疗文献中，还没有一项实证研究系统地研究了对整个CBT疗程没有反应的青少年的治疗增强。解决这一问题的经验性努力很重要，因为对CBT没有反应的青少年继续遭受与焦虑症相关的情绪困扰和损害，经历挫折和因感知“失败”而士气低落，并可能对医疗保健系统造成经济负担。 ABMT是一种基于实验和神经科学研究结果的新型焦虑转化治疗方法。研究表明，ABMT导致焦虑及其障碍的减少。基于最近的理论和研究表明，对威胁的注意力偏见预测了焦虑青年中的CBT无反应，研究人员假设ABMT可能有望作为CBT的补充，因为它特别关注针对额叶皮层和皮层下回路的注意力偏见。 这项研究将招募大约70名儿童和青少年，他们已经完成了12-14周的焦虑症CBT试验（Silverman，R 01 MH 079943），并且在一年的随访中继续符合SOP，SAD或GAD的初步诊断标准。这70名儿童和青少年（年龄8-16岁）将被随机分配完成8次ABMT或安慰剂对照（PC）任务，每两周一次。将收集临床医生对青少年焦虑严重程度的评分，并将其作为主要结局进行评价。将收集青少年对焦虑症状的自我评级和青少年焦虑症状的父母评级，并作为次要结局进行评估。将在条件分配（治疗前）、治疗后即刻和8周随访时收集所有测量值。 将处理以下具体目标。目的1：测试与安慰剂对照任务相比，ABMT是否导致治疗后焦虑水平显著降低。目标二：在治疗后8周的随访评估中，检查ABMT是否导致焦虑水平显著低于安慰剂对照任务。这表明在8周未治疗后，ABMT效应仍能维持。目标3：了解变量作为反弹道导弹条约潜在中介者和调节者的可行性，以便为决定是否在未来的R 01中继续研究这些变量提供信息。作为潜在的中介变量提出的注意偏向威胁和威胁相关的解释偏差。作为一个潜在的调节变量提出的是注意力控制。 总的来说，该项目将提供ABMT作为对CBT无反应的焦虑症青年治疗增强的急需数据。有了这些数据，该领域将能够更好地确定ABMT是否以及如何在可能需要更多CBT的焦虑青年中得到最佳使用。