Attention Bias Modification Treatment Effective for Treatment-Resistant Anxiety in Youth

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Both attention bias modification treatment and attention control training showed increased recovery rates in youth who did not respond to cognitive behavioral therapy.

Attention bias modification treatment (ABMT) and attention control training (ACT) reduced anxiety in youth who did not respond to cognitive behavioral therapy, according to trial data published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Investigators conducted a randomized controlled trial to assess the efficacy of ABMT and ACT in reducing anxiety symptoms. The cohort comprised 64 youths who had not achieved remission from anxiety despite completing cognitive behavioral therapy. The mean cohort age was 11.7 years; the majority (85.9%) of participants were Hispanic, and 53.1% were boys. Participants were randomly assigned to receive either ABMT (n=33) or ACT (n=31).

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ABMT and ACT each consisted of dot-probe attention tasks in which a pair of faces appeared side by side, followed immediately by a probe. In each ABMT trial, a pair of threatening and neutral faces appeared simultaneously, with the probe replacing neutral faces 100% of the time. In ACT trials, the probe appeared just 50% of the time in the location of the neutral stimulus. ABMT and ACT were administered to participants twice weekly for 4 weeks, for a total of 8 sessions. The Pediatric Anxiety Rating Scale was used to capture anxiety levels at baseline, post-treatment, and 2 months’ follow-up.

Of 64 youths randomly assigned at baseline, 61 completed the assigned treatment arm and 51 completed the 2-month follow-up assessment. Attrition did not differ significantly across study arms, nor were any statistically significant differences observed between study completers and non-completers. Both treatment arms produced significant reductions in anxiety severity. Collapsing across study arms, mean total scores were lower post-treatment than at baseline on the Pediatric Anxiety Rating Scale (P <.001) and on parent- and youth-rated measures of anxiety. Primary anxiety disorder diagnostic recovery was 50% at post-treatment and 58% at follow-up when combined across study arms. Attention control, but not attention bias to threat, was also significantly improved at post-treatment in both arms.

The study was limited by a sample consisting of predominantly Hispanic/Latino participants.

“These findings…raise intriguing questions about mechanisms of anxiety reduction in treatment-resistant youth with attention training that require further research,” the investigators concluded.


Pettit JW, Bechor M, Rey Y, et al. A randomized controlled trial of attention bias modification treatment in youth with treatment-resistant anxiety disorders [published online March 12, 2019]. J Am Acad Child Adolesc Psychiatry. doi:10.1016/j.jaac.2019.02.018