Complementary Features of Attention Bias Modification Therapy and Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders
Open accessAbstract
OBJECTIVE: In the treatment of anxiety disorders, attention bias modification therapy (ABMT) and cognitive-behavioral therapy (CBT) may have complementary effects by targeting different aspects of perturbed threat responses and behaviors. ABMT may target rapid, implicit threat reactions, whereas CBT may target slowly deployed threat responses. The authors used amygdala-based connectivity during a threat-attention task and a randomized controlled trial design to evaluate potential complementary features of these treatments in pediatric anxiety disorders. METHOD: Prior to treatment, youths (8-17 years old) with anxiety disorders (N=54), as well as healthy comparison youths (N=51), performed a threat-attention task during functional MRI acquisition. Task-related amygdala-based functional connectivity was assessed. Patients with and without imaging data (N=85) were then randomly assigned to receive CBT paired with either active or placebo ABMT. Clinical response was evaluated, and pretreatment amygdala-based connectivity profiles were compared among patients with varying levels of clinical response. RESULTS: Compared with the CBT plus placebo ABMT group, the CBT plus active ABMT group exhibited less severe anxiety after treatment. The patient and healthy comparison groups differed in amygdala-insula connectivity during the threat-attention task. Patients whose connectivity profiles were most different from those of the healthy comparison group exhibited the poorest response to treatment, particularly those who received CBT plus placebo ABMT. CONCLUSIONS: The study provides evidence of enhanced clinical effects for patients receiving active ABMT. Moreover, ABMT appears to be most effective for patients with abnormal amygdala-insula connectivity. ABMT may target specific threat processes associated with dysfunctional amygdala-insula connectivity that are not targeted by CBT alone. This may explain the observation of enhanced clinical response to CBT plus active ABMT.
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Negative biases in attention and self-representations have been directly linked to reduced functional connectivity in prefrontal-limbic circuitry, suggesting these neural and behavioral features of depression could reflect a unitary plasticity impairment, expressed across levels of analysis.
“Negative biases in attention 42,43,104,105 and self-representations 44 have been directly linked to reduced functional connectivity in prefrontal-limbic circuitry, suggesting these neural and behavioral features of depression could reflect a unitary plasticity impairment, expressed across levels of analysis.”
From Neuroplasticity in cognitive and psychological mechanisms of depression: an integrative model (2020) · cites this paper as [105]
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Experimental — accuracy not yet measuredDecreased PFC-limbic intrinsic and task-based connectivity is linked to increased negative attentional bias.
“↓ PFC-limbic intrinsic 83 and task- based 42,43,105 connectivity linked to ↑ negative attentional bias”
From Neuroplasticity in cognitive and psychological mechanisms of depression: an integrative model (2020) · cites this paper as [105]
The Methods (Attention Bias Assessment; page unavailable) define the dot-probe contrast as a measure of attention bias, and the Results (Pretreatment Amygdala Connectivity; page unavailable) report different task-based amygdala–insula connectivity patterns in anxious youths and healthy subjects on that contrast. The cited paper does not establish that decreased PFC–limbic connectivity is linked to increased negative attentional bias; its reported group difference concerns the amygdala and insula, with direction varying by trial condition. The intrinsic-connectivity portion is attached to a different citation in the citing sentence. (LLM, conf=0.78)
Experimental — accuracy not yet measuredCBM has been proposed as a complementary treatment approach that can effectively work side-by-side with CBT and other psychotherapies by targeting different aspects of negative thinking and responding.
“CBM has been proposed as a complementary treatment approach that can effectively work side-by-side with cognitive behavioral therapy (CBT) and other psychotherapies, by targeting different aspects of negative thinking and responding.”
From Acceptability and Co-Development of an Online Cognitive Bias Modification Intervention for Emerging Adults With Hazardous Alcohol Use and Social Anxiety: A Mixed Methods Study (2020) · cites this paper as White et al., 2017
The Objective and Limitations and Conclusions sections propose that attention bias modification therapy (ABMT) complements CBT by targeting threat reactions that CBT targets less directly; the Discussion reports an enhanced clinical response when the two were combined in youths with anxiety disorders. The paper does not establish that cognitive bias modification broadly works alongside other psychotherapies, or that it targets negative thinking generally rather than the specific threat-attention processes studied. (LLM, conf=0.85)
Experimental — accuracy not yet measuredCBM can help reduce negative thinking styles and behavioral responses at a subconscious, habitual, and implicit level via repeated practice on a cognitive task, which may further aid treatment effectiveness.
“Alongside working to reduce negative thinking styles and behavioral responses in a conscious, deliberate, and explicit way during CBT, CBM can help reduce these processes at a subconscious, habitual, and implicit level (via repeated practice on a cognitive task), which may further aid the effectiveness of treatment (Baert et al., 2011; Bowler et al., 2012; White et al., 2017).”
From Acceptability and Co-Development of an Online Cognitive Bias Modification Intervention for Emerging Adults With Hazardous Alcohol Use and Social Anxiety: A Mixed Methods Study (2020) · cites this paper as White et al., 2017
The opening discussion describes ABMT as repetitive, implicit training on a modified dot-probe task and says it could augment CBT by changing attention biases that CBT does not fully address. The Discussion reports improved clinician-rated anxiety when active ABMT was added to CBT in youths with anxiety disorders. The source does not establish that CBM generally reduces negative thinking styles or habitual behavioral responses; it specifically studies attention bias modification in pediatric anxiety. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDysfunctional connections between these regions may influence treatment outcome.
“Dysfunctional connections between these regions may influence treatment outcome [109,110].”
From Anxiety and Threat-Related Attention: Cognitive-Motivational Framework and Treatment (2018) · cites this paper as [109]
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References 31 · Cited by 96
- Authors
- White, L. K., Sequeira, S., Britton, J. C., Brotman, M. A., Gold, A. L., Berman, E., Towbin, K., Abend, R., Fox, N. A., Bar-Haim, Y., Leibenluft, E., & Pine, D. S.
- Affiliations
- National Institutes of Health (US)
- From NIMH, Bethesda, Md.; Children’s Hospital of Philadelphia, Philadelphia; the Department of Psychology, University of Miami, Coral Gables, Fla.; the Child Development Laboratory, University of Maryland, College Park; and the Department of Psychology, Tel Aviv University, Tel Aviv.
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2017-08-01
- Volume
- 174
- Issue
- 8
- Pages
- 775-784
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC6343478
- OpenAlex
- W2606438535
- Cited by
- 96
- References
- 31
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 4 · 2023: 10 · 2022: 5 · 2021: 14 · 2020: 14 · 2019: 19 · 2018: 15 · 2017: 7
- FWCI
- 19.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 MH999999)
- 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
- cognitive behavioral therapy, childhood anxiety disorders, treatment response prediction, combined psychotherapy
- MeSH terms
- Attentional Bias, Adolescent, Amygdala, Anxiety Disorders, Arousal, Behavior Therapy, Cerebral Cortex, Child, Combined Modality Therapy, Female, Humans, Magnetic Resonance Imaging, Male, Nerve Net, Prognosis, Reference Values, Cognitive Behavioral Therapy
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