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ViewAttendees 5

Individual Oral Paper

Treatment - Other

Youth Treatment: Intervention Development and Implementation

5 - (IOP 30) Gamified Attention Bias Modification Training to Augment CBT for Youth Anxiety Disorders: Clinical Insights from a Randomized Controlled Trial

Sunday, November 23, 2025
11:00 AM - 11:15 AM CST
Location: Celestin A, Level 3
Keywords: Randomized Controlled Trial, Treatment, Anxiety
Recommended Readings: Linke, J. O., Jones, E., Pagliaccio, D., Swetlitz, C., Lewis, K. M., Silverman, W. K., ... & Brotman, M. A. (2019). Efficacy and mechanisms underlying a gamified attention bias modification training in anxious youth: protocol for a randomized controlled trial. BMC psychiatry, 19, 1-12.,   White, L. K., Sequeira, S., Britton, J. C., Brotman, M. A., Gold, A. L., Berman, E., ... & Pine, D. S. (2017). Complementary features of attention bias modification therapy and cognitive-behavioral therapy in pediatric anxiety disorders. American Journal of Psychiatry, 174(8), 775-784.,   Lazarov, A., Marom, S., Yahalom, N., Pine, D. S., Hermesh, H., & Bar-Haim, Y. (2018). Attention bias modification augments cognitive–behavioral group therapy for social anxiety disorder: a randomized controlled trial. Psychological medicine, 48(13), 2177-2185.,   ,  
Background: Attention bias modification training (ABMT) was designed to engage implicit mechanistic components of threat processing that are less targeted by cognitive behavioral therapy (CBT) alone. Thus, augmenting CBT with ABMT may maximize therapeutic benefit for anxiety. However, studies investigating the efficacy of ABMT in the context of CBT for youth have yielded mixed results. The current preregistered, double-blind, randomized controlled trial utilized a novel, gamified ABMT to target attentional bias towards threat, in addition to classic CBT for anxiety disorders in youth, to evaluate the potential for added clinical efficacy. We hypothesized that youth receiving active ABMT+CBT would show greater improvement in clinical symptoms compared to youth receiving placebo+CBT.

Method: Medication-free pediatric patients (N=121; 8-17 years old) with anxiety disorders were randomized to either active (n=59) or placebo (n=62) gamified ABMT alongside 12-weeks of manualized CBT. The computer-based attention retraining, delivered in a double-blind randomized-controlled design, was designed to implicitly direct attention away from threat stimuli. Symptom improvement across treatment was compared between the active and placebo conditions for primary (clinician-rated) and secondary (self- and parent-reported) outcomes using mixed-effects models.

Results: Over the course of treatment, clinician-rated anxiety decreased significantly in both ABMT groups (F(2, 215)=82.88; p<.001, partial eta squared=0.44). Contrary to hypotheses, active ABMT did not enhance these symptom reductions (F(2, 215)=0.62; p=.54, partial eta squared < 0.01). A similar pattern of findings emerged for secondary clinical outcomes. There were no significant ABMT condition differences in the number of treatment responders compared to non-responders post-CBT (chi-square=.76, p=.38).

Discussion: Hypotheses that youth receiving active gamified ABMT+CBT would show greater anxiety symptom improvement were not supported. Robust clinical effects of CBT on symptom outcomes may have reduced sensitivity to any additional small effect size of treatment augmentation between the active and placebo ABMT groups. The lack of between-group differences could also reflect expectancy effects, given there was no third-arm comparison group receiving CBT alone in the current study. The efficacy of this novel therapeutic intervention designed to modify attentional biases towards threat to reduce anxiety symptoms among youth remains unclear. This work highlights the need to explore alternate, reliable attention-bias modification tasks for augmenting the clinical response to CBT for anxiety.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Gain clinical insights from a transparent, pre-registered randomized controlled trial to better advance future research on psychopathology-related attention biases.