Skip to main content Accessibility help
×
×
Home

Online Attention Bias Modification in Combination With Cognitive-Behavioural Therapy for Children and Adolescents With Anxiety Disorders: A Randomised Controlled Trial

  • Jasmijn M. de Lijster (a1), Gwendolyn C. Dieleman (a1), Elisabeth M.W.J. Utens (a1) (a2) (a3), Jan van der Ende (a1), Tamsin M. Alexander (a4), Albert Boon (a4) (a5), Manon H.J. Hillegers (a1) and Jeroen S. Legerstee (a1)...

Abstract

Attention Bias Modification (ABM) targets attention bias (AB) towards threat, which is common in youth with anxiety disorders. Previous clinical trials showed inconsistent results regarding the efficacy of ABM, and few studies have examined the effect of online ABM and its augmented effect with cognitive behavioural therapy (CBT). The aim of the current study was to examine the efficacy of online ABM combined with CBT for children and adolescents with anxiety disorders in a randomised, double-blind, placebo-controlled trial. Children (aged 8–16 years) completed nine online sessions of ABM (n = 28) or online sessions of the Attention Control Condition (ACC; n = 27) over a period of 3 weeks (modified dot-probe task with anxiety disorder-congruent stimuli), followed by CBT. Primary outcomes were clinician-reported anxiety disorder status. Secondary outcomes were patient-reported anxiety and depression symptoms and AB. Results showed a continuous decrease across time in primary and secondary outcomes (ps < .001). However, no differences across time between the ABM and ACC group were found (ps > .50). Baseline AB and age did not moderate treatment effects. Online ABM combined with CBT does not show different efficacy compared with online ACC with CBT for children and adolescents with anxiety disorders.

Copyright

Corresponding author

*Corresponding author: Jeroen S. Legerstee, Erasmus Medical Center – Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, 3000 CB, Rotterdam, The Netherlands. Email: j.s.legerstee@erasmusmc.nl

References

Hide All
Abend, R, de Voogd, L, Salemink, E, Wiers, RW, Pérez-Edgar, K, Fitzgerald, ABar-Haim, Y (2018). Association between attention bias to threat and anxiety symptoms in children and adolescents. Depression and Anxiety, 35, 229238.
Abend, R, Naim, R, Pergamin-Hight, L, Fox, NA, Pine, DS and Bar-Haim, Y (2018). Age moderates link between training effects and treatment response to attention bias modfication treatment for social anxiety disorder. Journal of Abnormal Child Psychology, Advance online publication. doi:10.1007/s10802-018-0494-7
Arrindell, WA (2001). Changes in waiting-list patients over time: Data on some commonly-used measures. Beware! Behaviour Research Therapy, 39, 12271247.
Bar-Haim, Y (2010). Research review: Attention bias modification (ABM): A novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry, 51, 859870.
Barrett, PM (2014). Friends for life: Group leader's manual for children. Brisbane, Australia: Pathways Health and Research Centre.
Biehl, M, Matsumoto, D, Ekman, P, Hearn, V, Heider, K, Kudoh, T and Ton, V (1997). Matsumoto and Ekman's Japanese and Caucasian Facial Expressions of Emotion (JACFEE): Reliability data and cross-national differences. Journal of Nonverbal Behavior, 21, 321.
Birmaher, B, Brent, DA, Chiappetta, L, Bridge, J, Monga, S and Baugher, M (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child Adolescent Psychiatry, 38, 12301236.
Birmaher, B, Khetarpal, S, Brent, D, Cully, M, Balach, L, Kaufman, J and Neer, SM (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child Adolescent Psychiatry, 36, 545553.
Boettcher, J, Leek, L, Matson, L, Holmes, EA, Browning, M, MacLeod, C, Andersson, G and Carlbring, P (2013). Internet-based attention bias modification for social anxiety: A randomised controlled comparison of training towards negative and training towards positive cues. PLoS One, 8, e71760.
Britton, JC, Bar-Haim, Y, Clementi, MA, Sankin, LS, Chen, G, Shechner, TPine, DS (2013). Training-associated changes and stability of attention bias in youth: Implications for Attention Bias Modification Treatment for pediatric anxiety. Developmental Cognitive Neuroscience, 4, 5264.
Chang, SW, Kuckertz, JM, Bose, D, Carmona, AR, Piacentini, J and Amir, N (2018). Efficacy of attention bias training for child anxiety disorders: A randomized controlled trial. Child Psychiatry and Human Development, Advance online publication. Retrieved from https://link.springer.com/article/10.1007%2Fs10578-018-0832-6
Chavira, DA, Stein, MB, Bailey, K and Stein, MT (2004). Child anxiety in primary care: Prevalent but untreated. Depression and Anxiety, 20, 155164.
Cisler, JM, Bacon, AK and Williams, NL (2009). Phenomenological characteristics of attentional biases towards threat: A critical review. Cognitive Therapy and Research, 33, 221234.
Cisler, JM and Koster, EH (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30, 203216.
Cristea, IA, Kok, RN and Cuijpers, P (2015). Efficacy of cognitive bias modification interventions in anxiety and depression: Meta-analysis. The British Journal of Psychiatry, 206, 716.
Cristea, IA, Mogoase, C, David, D and Cuijpers, P (2015). Practitioner review: Cognitive bias modification for mental health problems in children and adolescents: A meta-analysis. Journal of Child Psychology and Psychiatry, 56, 723734.
de Lijster, JM, Dieleman, GC, Utens, E, Dierckx, B, Wierenga, M, Verhulst, FC and Legerstee, JS (2018). Social and academic functioning in adolescents with anxiety disorders: A systematic review. Journal of Affective Disorders, 230, 108117.
de Voogd, EL, Wiers, RW, Prins, PJM, de Jong, PJ, Boendermaker, WJ, Zwitser, RJ and Salemink, E (2016). Online attentional bias modification training targeting anxiety and depression in unselected adolescents: Short- and long-term effects of a randomized controlled trial. Behaviour Research and Therapy, 87, 1122.
Derryberry, D and Reed, MA (2002). Anxiety-related attentional biases and their regulation by attentional control. Journal of Abnormal Child Psychology, 111, 225236.
Dudeney, J, Sharpe, L and Hunt, C (2015). Attentional bias towards threatening stimuli in children with anxiety: A meta-analysis. Clinical Psychology Review, 40, 6675.
Eldar, S, Apter, A, Lotan, D, Edgar, KP, Naim, R, Fox, NA, … Bar-Haim, Y (2012). Attention bias modification treatment for pediatric anxiety disorders: A randomized controlled trial. American Journal of Psychiatry, 169, 213220.
Enock, PM, Hofmann, SG and McNally, RJ (2014). Attention Bias Modification Training via smartphone to reduce social anxiety: A randomized, controlled multi-session experiment. Cognitive Therapy and Research, 38, 200216.
Finch, AJ Jr, Saylor, CF, Edwards, GL and McIntosh, JA (1987). Children's Depression Inventory: Reliability over repeated administrations. Journal of Clinical Child Psychology, 16, 339341.
Hakamata, Y, Lissek, S, Bar-Haim, Y, Britton, JC, Fox, NA, Leibenluft, E, Ernst, M and Pine, DS (2010). Attention bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982990.
In-Albon, T, Dubi, K, Rapee, RM and Schneider, S (2009). Forced choice reaction time paradigm in children with separation anxiety disorder, social phobia, and nonanxious controls. Behaviour Research Therapy, 47, 10581065.
In-Albon, T, Kossowsky, J and Schneider, S (2010). Vigilance and avoidance of threat in the eye movements of children with separation anxiety disorder. Journal of Abnormal Child Psychology, 38, 225235.
Itti, L and Koch, C (2001). Computational modelling of visual attention. Nature Reviews Neurosience, 2, 194203.
James, AC, James, G, Cowdrey, FA, Soler, A and Choke, A (2015). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Systematic Reviews, CD004690.
Jennison, C and Turnbull, BW (1999). Group sequential methods with applications to clinical trials. Londen: Chapman and Hall.
Knol, F, Boelhouwer, J and Veldheer, V (2012). Summary: Neighbourhood status development in the Netherlands 1998–2010. Den Haag, the Netherlands: Sociaal en Cultureel Planbureau.
Kovacs, M (1992). The Children's Depression Inventory (CDI) manual. North Tonawanda, NY: Multi-Health Systems.
Lang, PJ, Bradley, MM and Cuthbert, BN (1997). International Affective Picture System (IAPS): Technical manual and affective ratings. Gainesville, SF: NIMH Center for the Study of Emotion and Attention.
Linetzky, M, Pergamin-Hight, L, Pine, DS and Bar-Haim, Y (2015). Quantitative evaluation of the clinical efficacy of attention bias modification treatment for anxiety disorders. Depression and Anxiety, 32, 383391.
Lowther, H and Newman, E (2014). Attention bias modification (ABM) as a treatment for child and adolescent anxiety: A systematic review. Journal of Affective Disorders, 168, 125135.
Macleod, C and Grafton, B (2016). Anxiety-linked attentional bias and its modification: Illustrating the importance of distinguishing processes and procedures in experimental psychopathology research. Behaviour Research and Therapy, 86, 6886.
Matsumoto, D and Ekman, P (1988). Japanese and Caucasian Facial Expressions of Emotion (JACFEE). San Francisco, CA: Intercultural and Emotion Research Laboratory, Department of Psychology, San Francisco State University.
Mogg, K and Bradley, BP (2018). Anxiety and threat-related attention: Cognitive-motivational framework and treatment. Trends in Cognitive Sciences, 22, 225240.
Mogg, K, Waters, AM and Bradley, BP (2017). Attention Bias Modification (ABM): Review of effects of multisession ABM training on anxiety and threat-related attention in high-anxious individuals. Clinical Psychological Science, 5, 698717.
Moors, A, De Houwer, J, Hermans, D, Wanmaker, S, van Schie, K, Van Harmelen, ALBrysbaert, M (2013). Norms of valence, arousal, dominance, and age of acquisition for 4,300 Dutch words. Behaviour Research Methods, 45, 169177.
Muris, P, Merckelbach, H, Mayer, B, van Brakel, A, Thissen, S, Moulaert, V and Gadet, B (1998). The Screen for Child Anxiety Related Emotional Disorders (SCARED) and traditional childhood anxiety measures. Journal of Behavior Therapy and Experimental Psychiatry, 29, 327339.
Muris, P, Steerneman, P and Brinkman, D (2000). De Nederlandse versie van de SCARED (SCARED-NL): Een nieuwe angstvragenlijst voor kinderen. Gedragstherapie, 33, 6372.
Neubauer, K, von Auer, M, Murray, E, Petermann, F, Helbig-Lang, S and Gerlach, AL (2013). Internet-delivered attention modification training as a treatment for social phobia: A randomized controlled trial. Behaviour Research and Therapy, 51, 8797.
Ollendick, TH, White, SW, Richey, J, Kim-Spoon, J, Ryan, SM, Wieckowski, ATSmith, M (2019). Attention bias modification treatment for adolescents with social anxiety disorder. Behavior Therapy, 50, 126139.
Pennant, ME, Loucas, CE, Whittington, C, Creswell, C, Fonagy, P, Fuggle, P, … Kendall, T (2015). Computerised therapies for anxiety and depression in children and young people: A systematic review and meta-analysis. Behaviour Research and Therapy, 67, 118.
Pergamin-Hight, L, Naim, R, Bakermans-Kranenburg, MJ, van, IMH and Bar-Haim, Y (2015). Content specificity of attention bias to threat in anxiety disorders: A meta-analysis. Clinical Psychology Review, 35, 1018.
Pergamin-Hight, L, Pine, DS, Fox, NA and Bar-Haim, Y (2016). Attention bias modification for youth with social anxiety disorder. Journal of Child Psychology and Psychiatry, 57, 13171325.
Price, RB, Wallace, M, Kuckertz, JM, Amir, N, Graur, S, Cummings, LBar-Haim, Y (2016). Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias. Clinical Psychology Review, 50, 3749.
Roy, AK, Vasa, RA, Bruck, M, Mogg, K, Bardley, BP, Sweeney, M, … Child/Adolescent Anxiety Multimodal Study Team. (2008). Attention bias towards threat in pediatric anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 11891196.
Roy, AK, Dennis, TA and Warner, CM (2015). A critical review of attentional bias and its role in the treatment of pediatric anxiety disorders. Journal of Cognitive Psychotherapy: An International Quaterly, 29, 171184.
Seligman, LD and Ollendick, TH (2011). Cognitive behavioral therapy for anxiety disorders in youth. Child and Adolescent Psychiatry Clinics of North America, 20, 217238.
Shechner, T, Rimon-Chakir, A, Britton, JC, Lotan, D, Apter, A, Bliese, PD, Pine, DS and Bar-Haim, Y (2014). Attention bias modification treatment augmenting effects on cognitive behavioral therapy in children with anxiety: Randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 6171.
Siebelink, BM and Treffers, DA (2001). ADIS-C Anxiety disorders Interview Schedule. Amsterdam: Pearson.
Silverman, WK and Albano, AM (1996). The Anxiety Disorders Interview Schedule for DSM-IV – Child and Parent Versions. San Antonio, TX: Physiological Corporation.
Silverman, WK, Saavedra, LM and Pina, AA (2001). Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 937944.
Sportel, BE, de Hullu, E, de Jong, PJ and Nauta, MH (2013). Cognitive bias modification versus CBT in reducing adolescent social anxiety: A randomized controlled trial. PLoS One, 8, e64355.
Timbremont, B and Braet, C (2002). Children's Depression Inventory: Nederlandstalige versie. Lisse, the Netherlands: Swets and Zeitlinger.
Timbremont, B, Braet, C and Dreessen, L (2004). Assessing depression in youth: Relation between the Children's Depression Inventory and a structured interview. Journal of Clinical Child and Adolescent Psychology, 33, 149157.
Utens, EMWJ, de Nijs, P and Ferdinand, RF (2001). Friends for children - manual for group leaders (Dutch translation). Rotterdam, the Netherlands: Department of Child and Adolescent Psychiatry Erasmus Medical Centre /Sophia Children's Hospital Rotterdam.
Van Bockstaele, B, Verschuere, B, Tibboel, H, De Houwer, J, Crombez, G and Koster, EH (2014). A review of current evidence for the causal impact of attentional bias on fear and anxiety. Psychological Bulletin, 140, 682721.
Waters, AM and Craske, MG (2016). Towards a cognitive-learning formulation of youth anxiety: A narrative review of theory and evidence and implications for treatment. Clinical Psychology Review, 50, 5066.
Waters, AM, Lipp, OV and Spence, SH (2004). Attentional bias toward fear-related stimuli: An investigation with nonselected children and adults and children with anxiety disorders. Journal of Experimental Child Psychology, 89, 320337.
Waters, AM, Pittaway, M, Mogg, K, Bradley, BP and Pine, DS (2013). Attention training towards positive stimuli in clinically anxious children. Developmental Cognitive Neuroscience, 4, 7784.
Waters, AM, Zimmer-Gembeck, MJ, Craske, MG, Pine, DS, Bradley, BP and Mogg, K (2015). Look for good and never give up: A novel attention training treatment for childhood anxiety disorders. Behavior Research and Therapy, 73, 111123.
Waters, AM, Zimmer-Gembeck, MJ, Craske, MG, Pine, DS, Bradley, BP and Mogg, K (2016). A preliminary evaluation of a home-based, computer-delivered attention training treatments for anxious children living in regional communities. Journal of Experimental Psychopathology, 3, 511527.
Wechsler, D (1991). The Wechsler Intelligence Scale for Children (3rd ed.). San Antonio, TX: The Psychological Corporation.
Weisz, JR, Kuppens, S, Ng, MY, Eckshtain, D, Ugueto, AM, Vaugh-Coaxum, RFordwood, SR (2017). What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist, 72, 79117.
White, LK, Sequeira, S, Britton, JC, Brotman, MA, Gold, AL, Berman, EPine, DS (2017). Complementary features of attention bias modification therapy and cognitive-behavioral therapy in pediatric anxiety disorders. American Journal of Psychiatry, 174, 775784.
Wittchen, HU, Lecrubier, Y, Beesdo, K and Nocon, A (2007). Relationships among anxiety disorders: Patterns and Implications. In Nutt, D and Ballenger, J (Eds.), Anxiety Disorders (pp. 2337). Hoboken, NJ: Blackwell Science.
Wood, JJ, Piacentini, JC, Bergman, RL, McCracken, J and Barrios, V (2002). Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of Clinical Child and Adolescent Psychology, 31, 335342.
Woodward, LJ and Fergusson, DM (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 10861093.
Zeger, SL and Liang, KY (1986). Longitudinal data analysis for discrete and continuous outcomes. Biometrics, 42, 121130.
Zeger, SL, Liang, KY and Albert, PS (1988). Models for longitudinal data: Q generalized estimating equation approach. Biometrics, 44, 10491060.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behaviour Change
  • ISSN: 0813-4839
  • EISSN: 2049-7768
  • URL: /core/journals/behaviour-change
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed