Attentional Processes in Anxiety: Examining Threat-Related Attention Bias and Attentional Control in Anxious Youth

Abstract

Attention bias modification treatment (ABMT) is a computer-administered intervention informed by theoretical models implicating the role of attentional processes in the etiology and maintenance of anxiety. Attention bias modification treatment presents an innovative, cost-effective approach to meeting demand for treatment of anxiety disorders; however data are limited regarding long-term outcomes and related predictors of ABMT treatment outcomes in youth. Therefore, the present study examined long-term outcomes of ABMT as a standalone or adjunctive treatment in 74 youth referred to an anxiety disorders clinic. Three groups of youth (ages 9 to 22) were identified and assessed approximately one to six years (average four years) following their most recent in-clinic assessment: 1) youth who completed only a pre-treatment assessment (assessed only group; n = 12); 2) youth who completed ABMT only (ABMT group; n = 34); and 3) youth who completed ABMT followed by CBT (ABMT+CBT group; n = 28). Long-term follow-up (LTFU) consisted of parent- and child self-report questionnaires assessing anxiety symptoms and anxiety-related impairment; clinician-rated assessment of anxiety symptom severity; and structured diagnostic interview. Multiple pairwise binary logistic regressions indicated that at LTFU, the assessed only, ABMT, and ABMT+CBT groups were statistically indistinguishable with respect to diagnostic recovery status. Multiple pairwise analyses of covariance controlling for baseline variables and time elapsed since their most recent assessment yielded no significant between-groups differences regarding treatment targets. Finally, separate hierarchical regressions indicated that variables assessed at pre-treatment assessment, including attentional control, attention bias variability, minority status, anxiety symptoms, and anxiety symptom severity were not predictive of outcomes at post-assessment or LTFU in the ABMT group. Overall, parent, youth, and clinician ratings indicated levels of anxiety and related impairment at LTFU that fell below recommended clinical severity. These outcomes provide a promising outlook on the use of ABMT as a least-restrictive intervention for anxiety. Unfortunately, findings on predictors of outcomes are not as clear. Future research is encouraged to expand on these findings by further examining efficacy and predictors of outcomes within the context of a controlled trial to best identify which youth may benefit from ABMT as a standalone or adjunctive treatment.