Augmenting attention treatment therapies for difficult-to-treat anxiety in children and adolescents

"CBT is the leading evidence-based psychosocial treatment," said co-lead author Jeremy Pettit, PhD, a Professor in the Department of Psychology and Center for Children and Families at Florida International University. "So there is a critical need to have other treatment options available for this population given that persistent anxiety is associated with distress, impairment in functioning, and elevated risk for other psychiatric disorders and suicide."

The study is the first to provide a potentially effective augmentation strategy for children and adolescents with anxiety disorders who do not respond to CBT. The 64 participants, between the ages of 7 and 16 years old, in this study were selected after evaluations determined each still met the criteria for an anxiety disorder after receiving manualized cognitive behavior therapy. After four weeks of attention training, 50 percent of participants no longer met the criteria for their primary anxiety diagnosis, according to the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Participants received one of two forms of computer-based attention training. The first-attention bias modification treatment-trained attention toward neutral stimuli and away from threatening stimuli. The second-attention control training-trained attention to neutral and threatening stimuli equally. Both forms of attention training led to comparable reductions in anxiety.

"Attention training is a promising augment for children who do not respond to CBT," said the article's other co-lead author Wendy Silverman, PhD, the Alfred A. Messer Professor in the Child Study Center at Yale University School of Medicine. "Florida International University and Yale University currently are conducting a two-site treatment study to understand more clearly how attention training produces anxiety-reduction effects and the results of this article in JAACAP give us a promising start."