Attention training towards positive stimuli in clinically anxious children
Open accessAbstract
Objective Attention bias modification training (ABMT) is a promising treatment. Nevertheless, few studies examine its effectiveness in anxious children. This study examined the efficacy of such an ABMT protocol in pediatric anxiety.Method 37 anxious children were randomly assigned to one of two ABMT conditions. In the attention-towards-positive (ATP) condition, children searched 3×3 matrices for a happy face amongst angry faces. In the attention-training-control (ATC) condition, they searched for a bird amongst flowers. Children completed 160 trials in each of four training sessions per week for three weeks at home (1920 total trials). Clinical and attention bias measures were assessed before and after ABMT.Results Children randomized to ATP showed greater post-training attention bias towards happy faces than children randomized to ATC. ATP also produced significantly greater reductions in clinician-rated diagnostic severity and number of diagnoses, compared to ATC. In the ATP group, 50% of children who completed training did not meet criteria for their principal diagnosis, compared to 8% in the ATC group.Conclusion Training anxious children to focus attention on positive features of their environment may be a promising treatment.
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Clinical studies report anxiety reduction following adaptive ABM, gaze-contingent music-reward therapy combined with CBT, emotional face visual search training, and enhanced positive search training.
“Clinical studies which evaluate multi-session ABM training in individuals with anxiety disorders report anxiety reduction following adaptive ABM (uncontrolled pilot study), gaze-contingent music-reward therapy (combined with CBT), emotional face visual search training, and enhanced positive search training [21,69,72,75,76].”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [72]
Evidence for therapeutic efficacy of alternative ABM training methods is limited.
“Evidence for the therapeutic efficacy of alternative ABM training methods is limited.”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [72]
Lack of consensus about why conventional ABM has inconsistent effects has encouraged development of alternative methods with preliminary efficacy data.
“Lack of consensus regarding why conventional ABM threat-avoidance training has inconsistent effects (discussed earlier) has encouraged the development of various alternative methods which have preliminary data suggesting efficacy”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [72]
In most ABM training methods, nonthreat targets are more likely to appear in different locations from threat cues, encouraging attention-orienting away from threat.
“In most ABM training methods, nonthreat targets are more likely to appear in different locations [ 5 0 8 _ T D $ D I F F ] from threat cues, which encourages attention-orienting away from threat.”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [72]
Stronger training effects might be obtained in subclinical samples of adolescents, as research in clinically anxious children with variants of VS training also suggests.
“Stronger training effects might be obtained in (sub)clinical samples of adolescents, as research in clinically anxious children with variants of VS training also suggests (Waters et al., 2013;2015).”
From Online attentional bias modification training targeting anxiety and depression in unselected adolescents: short- and long-term effects of a randomized controlled trial (2016) · cites this paper as Waters et al., 2013
Only one study in the meta-analysis used ABM-positive-search training with a clinically anxious sample, and that showed significant improvement in anxiety symptoms.
“Only one study in the metaanalysis used ABM-positive-search training with a clinically anxious sample, and that showed significant improvement in anxiety symptoms (Waters et al., 2013).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Waters et al., 2013
In the Mogoas et al. (2014) meta-analysis, symptom-improvement effect sizes of several comparisons using ABM-positive-search training were larger than the average effect size of the whole dataset.
“This meta-analysis indicated that symptom-improvement effect sizes of several comparisons which used ABM-positive-search training were larger than the average effect size of the whole dataset (Dandeneau et al., 2007; Study 3a and 3b; Waters et al., 2013).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Waters et al., 2013
Most studies of ABM-positive-search training found changes in AB measures for threat and positive stimuli, although these changes varied across studies.
“Regarding effects of ABM-positive-search training on AB, most studies found changes in AB measures for threat and positive stimuli, although these changes varied across studies.”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Waters et al., 2013
Findings from these studies indicate that ABM-positive-search training reduces self-reported stress and cortisol measures of stress reactivity in adults, social anxiety symptoms in youth and clinician-rated symptom severity of anxiety disorders in children.
“Findings from these studies indicate that ABM-positive-search training reduces self-reported stress and cortisol measures of stress reactivity in adults (Dandeneau et al., 2007), social anxiety symptoms in youth (De Voogd et al., 2014) and clinician-rated symptom severity of anxiety disorders in children (Waters et al., 2013(Waters et al., , 2015(Waters et al., , 2016)).”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Waters et al., 2013
Clinically anxious children did not show AB towards threat (angry relative to neutral faces) before or after ABM-positive-search training, as assessed at 500 ms on the visual-probe task.
“In two studies assessing AB at 500 ms on the visual-probe task, clinically anxious children did not show AB towards threat (angry relative to neutral faces) before or after training”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Waters et al., 2013
Clinically anxious children did not show change in AB to threat during ABM-positive-search training, as assessed at 500 ms on the visual-probe task.
“or change in AB to threat during ABM-positive-search training”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Waters et al., 2013
ABM-positive-search training increased AB for positive relative to neutral faces on the visual-probe task in children with anxiety disorders.
“increased AB for positive relative to neutral faces on the visual-probe task in children with anxiety disorders (Waters et al., 2013)”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Waters et al., 2013
Some findings indicate that attention-training methods, including ABM-threat-avoidance and ABM-positive-search training, can reduce anxiety without reducing AB in orienting to threat.
“Second, some findings indicate that attention-training methods, including ABM-threat-avoidance and ABM-positive-search training, can reduce anxiety without reducing AB in orienting to threat.”
From Anxiety and attention to threat: cognitive mechanisms and treatment with attention bias modification (2016) · cites this paper as Waters et al., 2013
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- Authors
- Waters, A. M., Pittaway, M., Mogg, K., Bradley, B. P., & Pine, D. S.
- Affiliations
- Griffith University (AU)
- University of Southampton (GB)
- National Institutes of Health (US)
- Corresponding author
- Waters, Allison M.
- Venue
- Developmental Cognitive Neuroscience
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 4
- Pages
- 77-84
- ISSN
- 1878-9293 (ISSN-L)
- PMC
- PMC3947762
- OpenAlex
- W1976003493
- Cited by
- 135
- References
- 33
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 9 · 2021: 9 · 2020: 8 · 2019: 15 · 2018: 14 · 2017: 12 · 2016: 14 · 2015: 20 · 2014: 11 · 2013: 7 · 2012: 1
- FWCI
- 16.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Developmental Cognitive Neuroscience (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Funders
- Australian Research Council (DP1095536)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- attentional bias modification, childhood anxiety, attentional bias, children, anxiety levels, face recognition (cognition), home-based exercise, cognitive training
- MeSH terms
- Adolescent, Anger, Anxiety Disorders, Attention, Child, Facial Expression, Female, Happiness, Humans, Male, Cognitive Behavioral Therapy, Treatment Outcome
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