By Avigayil Kadesh
New research from Israel suggests that it may not be necessary to medicate highly anxious children. Instead, their anxiety can be relieved with a computer-based technique called attention bias modification (ABM) that’s already seen success in adult patients.
The relatively new treatment was developed at several labs around the world, including that of Prof. Yair Bar-Haim of Tel Aviv University's School of Psychological Sciences. The treatment draws people away from their tendency to dwell on potential threats, ultimately changing their thought patterns.
Early intervention is critical because most adult anxiety disorders begin during childhood. According to Bar-Haim, anywhere from five percent to 20 percent of children suffer from an anxiety disorder. But drugs come with side effects, and both drugs and cognitive behavioral therapy are effective in only about 70% of pediatric cases. Professionals are eager to find alternatives.
An initial clinical trial in Israel showed that the ABM program was as effective as medication and cognitive therapy for children and offered several distinct advantages, as reported
by Bar-Haim’s team from the Adler Center for Research in Child Development and Psychopathology at Tel Aviv University in cooperation with the Feinberg Child Study Center at Schneider Children's Medical Center in Petah Tikvah.
Bar-Haim outlined three major advantages of ABM for younger patients: Children generally feel comfortable using computers; this method does not pose any of the physical risks associated with medications; and it doesn’t require a highly trained professional as does cognitive behavioral therapy. The program can be accessed via the Internet.
"This could be a game-changer for providing treatment," he said.
Neutralizing anxiety producers
ABM therapy is based on a “dot-probe” test, which measures a patient's threat-related attention patterns. Anxious individuals have a heightened sensitivity (an “attention bias”) toward threats that the average person simply ignores, explained Bar-Haim.
In the 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. 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 an “attention bias” toward the threat.
To turn this test into a mode of 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 the non-threatening stimulus instead, predicting that this is where the dot will appear. This exercise helps to normalize the attention bias pattern and reduce anxiety.
Bar-Haim and his colleagues performed their clinical trial with 40 eight- to 14-year-old patients at the Child Anxiety Clinic at Schneider Children’s Medical Center. Of these children, 55% had a primary diagnosis of separation anxiety disorder, 22.5% had generalized anxiety disorder, 20% had specific phobia, and 2.5% had social phobia. Seventy-five percent were also diagnosed with a second anxiety disorder.
The children were divided into three groups. The first received 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 images. Patients participated in one session a week for four weeks, completing 480 dot-probe tests 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, there were marked differences in the ABM group. By the end of the trial, approximately one-third of the patients in this group no longer met the diagnostic criteria for anxiety disorder.
Additional pediatric trials are now under way at more than 20 sites across five continents, in collaboration with the US National Institute of Mental Health.
ABM is likely to offer a welcome treatment alternative for children, Bar-Haim predicted. "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."