Biobehavioral Markers of Attention Bias Modification in Temperamental Risk for Anxiety: A Randomized Control Trial

Abstract

Children with behavioral inhibition, a temperament characterized by biologically based hypervigilance to novelty and social withdrawal, are at high risk for developing anxiety. This study examined the effect of a novel attention training protocol, attention bias modification (ABM), on symptomatic, behavioral, and neural risk markers in children with behavioral inhibition. Nine- to 12-year-old typically developing children identified as having behavioral inhibition (N= 84) were assigned to a 4-session active ABM training (n= 43) or placebo protocol (n= 41) using a double-blinded, randomized, controlled trial approach. Anxiety symptoms (Diagnostic Interview Schedule for Children-Fourth Edition), attention bias (AB; measured by a dot-probe task; AB= incongruent reaction time- congruent reaction time), and AB-related neural activation (measured by functional magnetic resonance imaging activation for the incongruent > congruent contrast in the dot-probe task) were assessed before and after the training sessions. Results showed that active ABM (n= 40) significantly alleviated participants' symptoms of separation anxiety, but not social anxiety, compared with the placebo task (n= 40); ABM did not modify behavioral AB scores in the dot-probe task; and at the neural level, active ABM (n= 15) significantly decreased amygdala and insula activation and increased activation in the ventrolateral prefrontal cortex compared with placebo (n= 19). These findings provide important evidence for ABM as a potentially effective protective tool for temperamentally at-risk children in a developmental window before the emergence of clinical disorder and open to prevention and intervention. Clinical trial registration information-Attention and Social Behavior in Children (BRAINS); http://clinicaltrials.gov/; NCT02401282.