Augmenting attention treatment therapies for difficult-to-treat anxiety in children and adolescents shows promise in first randomized controlled trial

First study to show that anxiety could be decreased in youth who did not respond to earlier cognitive-behavior therapy

First study to show that anxiety could be decreased in youth who did not respond to earlier cognitive-behavior therapy



Washington, DC, December 19, 2019

Between 30 to 50 percent of youth in the United States diagnosed with an anxiety disorder fail to respond to cognitive-behavior therapy (CBT). A new study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that computer-based attention training could reduce 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.”

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Notes for editors

The article is "A Randomized Controlled Trial of Attention Bias Modification Treatment in Youth With Treatment-Resistant Anxiety Disorders," by Jeremy W. Pettit, PhD, Michele Bechor, PhD, Yasmin Rey, PhD, Michael W. Vasey, PhD, Rany Abend, PhD, Daniel S. Pine, MD, Yair Bar-Haim, PhD, James Jaccard, PhD, Wendy K. Silverman, PhD (https://doi.org/10.1016/j.jaac.2019.02.018). It currently appears on the JAACAP Articles In Press page and will appear in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 59, issue 1 (January 2020), published by Elsevier.

Dr. Pettit is Professor and Chair of Psychology at Florida International University and affiliate of the Center for Children and Families. Dr. Silverman is the Alfred A. Messer Professor of Child Psychiatry in the Yale University School of Medicine and Director of the Anxiety and Mood Disorders Program in the Child Study Center.

This study was funded with a grant from the National Institute of Mental Health.

Copies of this paper are available to credentialed journalists upon request; please contact Mary Billingsley at mbillingsley@aacap.org or +1 202 587 9672. Journalists wishing to interview the authors may contact Jeremy Pettit, PhD at jpettit@fiu.edu.

About JAACAP

Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families. www.jaacap.org