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）：本申请建议对已完成焦虑认知行为治疗 (CBT) 完整方案且在完成 CBT 一年后仍符合社交恐惧症 (SOP)、分离焦虑症 (SAD) 或广泛性焦虑症 (GAD) 初步诊断标准的儿童和青少年进行注意偏差修正训练 (ABMT) 试点测试。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检验了对整个 CBT 疗程没有反应的青少年的治疗增强方法。解决这一问题的实证研究非常重要，因为对 CBT 没有反应的青少年会继续遭受与焦虑症相关的情绪困扰和损害，因感知到“失败”而感到沮丧和士气低落，并可能给医疗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结果的新型焦虑转化疗法。研究表明 ABMT 可以减少焦虑及其疾病。根据最近的理论和研究表明，对威胁的注意偏差可以预测焦虑青少年对 CBT 的无反应，研究人员推测 ABMT 可能有望作为 CBT 的增强，因为它特别关注针对额叶皮层和皮层下回路的注意偏差。 这项研究将招募约 70 名儿童和青少年，他们已完成为期 12-14 周的焦虑症 CBT 试验（Silverman，R01 MH079943），并在一年的随访中继续满足 SOP、SAD 或 GAD 初步诊断的标准。这 70 名儿童和青少年（8-16 岁）将被随机分配完成八次每两周一次的 ABMT 或安慰剂对照 (PC) 任务。将收集临床医生对青少年焦虑严重程度的评级并将其作为主要结果进行评估。将收集青少年对焦虑症状的自我评分和家长对青少年焦虑症状的评分，并将其作为次要结果进行评估。所有测量值将在病情分配（治疗前）之前、治疗后立即以及八周随访时收集。 将解决以下具体目标。目标 1：测试与安慰剂对照任务相比，ABMT 是否会导致治疗后的焦虑水平显着降低。目标 2：在治疗后八周的随访评估中，检查 ABMT 是否比安慰剂控制任务显着降低焦虑水平。这表明在八周不治疗后 ABMT 效果仍能维持。目标 3：了解变量作为 ABMT 的潜在中介者和调节者的可行性，以便为是否在未来的 R01 中追求这些变量的决策提供信息。提议作为潜在调解因素的变量是对威胁的注意偏差和与威胁相关的解释偏差。提议作为潜在调节因素的变量是注意力控制。 总体而言，该项目将提供急需的 ABMT 数据，作为对 CBT 没有反应的焦虑症青少年的治疗辅助手段。有了这些数据，该领域将能够更好地确定是否以及如何在可能需要 CBT 以外的焦虑青少年中最佳地使用 ABMT。