Attention Bias Modification Training in Child Anxiety CBT Nonresponders

描述(由申请者提供)：本申请建议在已完成焦虑认知行为疗法(CBT)的完整方案，但在完成CBT一整年后仍符合社交恐惧症(SOP)、分离性焦虑障碍(SAD)或广泛性焦虑障碍(GAD)初步诊断标准的儿童和青少年中进行注意偏差修正训练(ABMT)的试点测试。目前，在青少年焦虑治疗文献中没有一项经验性研究系统地研究了对CBT全程无效的青少年的治疗增强剂。解决这一问题的经验努力很重要，因为没有对CBT做出反应的年轻人继续遭受与焦虑症相关的情绪困扰和损害，经历被认为是“失败”的挫折感和士气低落，并可能给医疗保健系统带来经济负担。ABMT是一种基于实验和神经科学对注意过程的研究结果的焦虑症的新型转化性疗法。研究表明，ABMT可以减少焦虑及其障碍。根据最近的理论和研究表明，焦虑的年轻人对威胁的注意偏差可以预测CBT的无反应，研究人员推测，ABMT可能有希望作为CBT的补充，因为它特别关注针对额叶皮质和皮质下回路的注意偏差。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，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(年龄8-16岁)将被随机分配到完成ABMT或安慰剂对照(PC)任务的每两周八次。临床医生对青少年焦虑严重程度的评分将被收集并作为主要结果进行评估。青少年焦虑症状的自我评分和家长对青少年焦虑症状的评分将被收集并作为次要结果进行评估。所有的测量将在条件分配(治疗前)、治疗后立即和8周的随访时收集。将实现以下具体目标。目的1：与安慰剂对照任务相比，测试ABMT是否能显著降低治疗后的焦虑水平。目的2：在治疗8周后的随访评估中，检查ABMT是否导致与安慰剂对照任务相比显著降低的焦虑水平。这将建议在八周不治疗后维持ABMT的效果。目的3：了解变量作为ABMT的潜在调节者和调节者的可行性，以便为是否在未来的R01中追求这些变量提供决策依据。被认为是潜在中介变量的变量是对威胁的注意偏差和与威胁相关的解释偏差。被认为是潜在调节变量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无效的患有焦虑症的青年的治疗补充。有了这些数据，该领域将更好地确定ABMT是否以及如何在焦虑的年轻人中以最佳方式使用，他们可能需要比CBT更多的东西。

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.