A major international research effort led by the U.S. National Institute of Mental Health is looking at a new computer program that so far has proven as effective as medications or psychotherapy for childhood anxiety disorders.
Yair Bar-Haim, Ph.D., of Tel Aviv University in Israel, and his fellow researchers are using a treatment technique called Attention Bias Modification (ABM) to reduce anxiety by drawing children away from their tendency to dwell on potential threats — ultimately changing their thought patterns.
In its initial clinical trial, the program worked as well as medication and cognitive therapy for children — with several distinct advantages.
Children are digital natives and comfortable with computers, said Bar-Haim. He believes the computer-assisted program can provide an option when parents want to avoid the potential side effects of medications or have difficulty in finding a therapist to administer cognitive behavioral therapy.
Attention Bias Modification (ABM) treatments can be provided over the Internet or administered by personnel who don’t have to be Ph.D.s.
“This could be a game-changer for providing treatment,” Bar-Haim said.
In the U.S., one in eight children suffers from an anxiety disorder, a condition that untreated, often turns into severe anxiety by adulthood. Early intervention is recommended, but current methods to relieve a child’s anxiety often involve the use of psychiatric medications, an option many parents seek to avoid.
Anxious individuals have a heightened sensitivity towards threats that the average person would ignore, a sensitivity which creates and maintains anxiety, said Bar-Haim.
One of the ways to measure a patient’s threat-related attention patterns is called the dot-probe test.
The patient is presented with two pictures or words, one threatening and one neutral. These words then disappear and a dot appears where one of the pictures or words had been, and the patient is asked to press a button to indicate the dot’s location.
A fast response time to a dot that appears in the place of the threatening picture or word indicates a bias towards threat.
To turn this test into a therapy, the location of the dot target is manipulated to appear more frequently beneath the neutral word or picture. Gradually, the patient begins to focus on that stimulus instead, predicting that this is where the dot will appear — helping to normalize the attention bias pattern and reduce anxiety.
In a study, researchers examined 40 pediatric patients with ongoing anxiety disorders and divided them into three groups. The first received the new ABM treatment; the second served as a placebo group where the dot appeared equally behind threatening and neutral images; and the third group was shown only neutral stimuli. Patients participated in one session a week for four weeks, completing 480 dot probe trials each session.
The children’s anxiety levels were measured before and after the training sessions using interviews and questionnaires. In both the placebo group and neutral images group, researchers found no significant change in the patients’ bias towards threatening stimuli.
However, in the ABM group, there were marked differences in the participants’ threat bias. By the end of the trial, approximately 33 percent of the patients in this group no longer met the diagnostic criteria for anxiety disorder.
The success of this preliminary research has led to the large international trial spearheaded by the NIMH. The computer program is being used in trial investigations at more than 20 sites across five continents.
The more options that exist for patients, the better that clinicians can tailor treatment for their patient’s individual needs, Bar-Haim said. There are always patients for whom medication or cognitive therapy is not a viable option, he said.
“Psychological disorders are complex, and not every patient will respond well to every treatment. It’s great to have new methods that have a basis in neuroscience and clinical evidence,” he said.
The results of the trial are found in the American Journal of Psychiatry.