Florida International University.
Florida International University.
Behav Ther. 2023 Jan;54(1):77-90. doi: 10.1016/j.beth.2022.07.004. Epub 2022 Jul 16.
Although youth anxiety treatment research has focused largely on severe and impairing anxiety levels, even milder anxiety levels, including levels that do not meet full criteria for a diagnosis, can be impairing and cause for concern. There is a need to develop and test viable treatments for these concerning anxiety levels to improve functioning and reduce distress. We present findings from a randomized controlled efficacy trial of attention bias modification treatment (ABMT) and attention control training (ACT) for youths with concerning anxiety levels. Fifty-three clinic-referred youths (29 boys, M age = 9.3 years, SD age = 2.6) were randomized to either ABMT or ACT. ABMT and ACT consisted of attention-training trials in a dot-probe task presenting angry and neutral faces; probes appeared in the location of neutral faces in 100% of ABMT trials and 50% of ACT trials. Independent evaluators provided youth anxiety severity ratings; youths and parents provided youth anxiety severity and global impairment ratings; and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and 2-month follow-up. In both arms, anxiety severity and global impairment were significantly reduced at posttreatment and follow-up. At follow-up, anxiety severity and global impairment were significantly lower in ACT compared with ABMT. Attention control, but not attention bias to threat, was significantly improved at follow-up in both arms. Changes in attention control and attention focusing were significantly associated with changes in anxiety severity. Findings support the viability of attention training as a low-intensity treatment for youths with concerning anxiety levels, including levels that do not meet full criteria for a diagnosis. Superior anxiety reduction effects in ACT highlight the critical need for mechanistic research on attention training in this population.
虽然青少年焦虑治疗研究主要集中在严重和致残的焦虑水平上，但即使是更轻微的焦虑水平，包括未达到完整诊断标准的焦虑水平，也可能会造成损害，并引起关注。需要开发和测试可行的治疗方法来治疗这些令人担忧的焦虑水平，以改善功能并减轻痛苦。我们介绍了一项针对有焦虑症状的青少年的注意偏向修正治疗（ABMT）和注意控制训练（ACT）的随机对照疗效试验的结果。53 名来自诊所的青少年（29 名男孩，M 年龄=9.3 岁，SD 年龄=2.6 岁）被随机分配到 ABMT 或 ACT 组。ABMT 和 ACT 包括在呈现愤怒和中性面孔的点探测任务中进行注意力训练试验；在 ABMT 试验中，探针出现在 100%的中性面孔位置，在 ACT 试验中，探针出现在 50%的中性面孔位置。独立评估者提供了青少年焦虑严重程度的评分；青少年和家长提供了青少年焦虑严重程度和整体受损程度的评分；青少年在治疗前、治疗后和 2 个月随访时完成了对威胁的注意偏向和注意控制的测量。在两个治疗组中，治疗后和随访时焦虑严重程度和整体受损程度均显著降低。在随访时，ACT 组的焦虑严重程度和整体受损程度明显低于 ABMT 组。在两个治疗组中，治疗后注意控制而不是对威胁的注意偏向都有显著改善。注意控制和注意聚焦的变化与焦虑严重程度的变化显著相关。这些发现支持将注意力训练作为一种低强度治疗方法用于治疗有焦虑症状的青少年，包括那些未达到完整诊断标准的焦虑症状。在 ACT 中观察到的焦虑缓解效果更好，突显了在该人群中对注意力训练的机制研究的迫切需要。
